Wednesday, April 07, 2004

don't worry, i'm a doctor

The weather's turning warm, the sun is out, I'm post-call, and I have an Egg McMuffin. It's the little things.

So I had a surprising thought at around 2am last night as I was watching over the dozen or so kids on my service, mostly children with congenital heart malformation in various stages of surgical and non-invasive repair. You're not going to like this, especially those of you who have kids or who have ever been in the hospital yourself. The thought I had was this:

I don't know what I'm doing.

In the most general, outward sense, yes, I kind of know what I'm doing. I know for the most part the important questions to ask, some of the things to look out for, what I problems I can pretty much handle overnight and what problems will send me running to the phone to page the senior or fellow "911." I even feel like I have pretty good clinical judgement a lot of the time. Maybe. Hopefully. But when you really dig beneath the surface, I feel like deep down, I really don't know what I'm doing at all.

Probably because so much of being an intern is pretending that you're in control and moderately abreast of the situation even if you're completely clueless and terrified. You walk into a patient's room and they think, with relief, "oh, the doctor is here." How many times have I come in while a parent is talking on the phone, only to have them cut their conversations short because of me? "Look, I can't talk right now, the doctor just walked in. I'll call you right back." They don't know that I have less than a year of training under my belt. They don't know that I have no good answers for many of the questions that they're asking. They don't know that when I say, "well, that's a discussion we'll have to have with the team," what I'm really saying is, "I have no idea, I have to ask the attending what to do." And honestly, I'd rather the parents not know that unless I tell them. Most people have some sense of the heirarchy, residents below the attendings and fellows, but rarely do they know just how inexperienced your typical intern is.

Often times when you're on a subspecialty service like cardiology or oncology, the intern on overnight is the only doctor on the floor. The first few times this happened, I was like, "Is this a joke? You know these kids have cancer, right? Shouldn't there be someone supervising me?" But you're the doctor. And no matter how little you know, I guess you always know a little something. Or you pretend until you find some backup. And even outside of inexperience-related cluelessness, there is a whole different categoy of cluelessness that interns face when taking care of so many new patients night after night.

Oh, I was looking for you. Patient Donnelly? Just spiked to 105 and is having EKG changes on telemetry.

Oh. Hmm. That sounds concerning. I'll be right there.

Who the hell is Patient Donnelly?

I'm feeling less and less like this every day. In three more months, I'll be a second year resident. A senior. I feel less panicked, and less often overwhelmed. I'm getting the hang of things, I guess. But there are still moments where I wonder how in the world I got this job. And I guess it's better to know that you don't know rather than to think you know it all.

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