My first patient...as a doctor this time.

After reading about my first "patient" as a med student, my first fake patient, and my first patient as a Med 3, you may have been waiting for me to write about my first patient as a real doctor.  So here it is:

There was nothing striking about my first patient.  I already don't even really remember his name.  It was an uneventful quick office visit for a simple follow up.  The fact that it was unremarkable though, is what made it remarkable.

It doesn't take long being exposed to pediatrics to realize that a lot of kids have a tough life.  Parents don't always look out for their kids.  Some parents try really hard and have good intentions but live in a really negative environment.  Sometimes, parents just don't know anything else.  And occasionally, parents deliberately harm their children.  It's easy to get jaded and start to wonder if there are functional family units with loving parents.  And that is exactly what made my first patient memorable.  The parents were fantastic.

Their child had special needs and they had been working tirelessly to provide for his needs to see him excel.  They supported each other, were surrounded by a great support system, and lived out love.

What impressed me the most was their approach to medical care for their child.  They had an amazing balance of respecting the role of the medical providers while advocating for their child and also recognizing where limitations existed.

They truly respected the physicians and nurses around them (It's shocking how many families don't).  But they also respectfully advocated for the needs of their child.  They weren't afraid to stand up for what they knew their child needed even if it meant having to fight for it.  Through that advocating, they were also aware of limitations.  Their own limitations and those of the health care team.  They had realistic expectations, but respectfully fought for them.  It's a tough balance, but this family had mastered it.

As the days continue in residency, I appreciate more and more the families who understand this balance.  Every time a parent cusses me out, signs their child out of the hospital AMA, or has intentionally harmed their child - I try to remind myself of the great families. 

Most pediatricians will tell you that parents are the hardest part of the job.  While I don't deny I often feel that way, there are a lot of great parents out there too.  

But I didn't go into pediatrics for the parents...

First Days Are Hard

This is a bit late, but this just about sums up my first day:

 

 

The show "Scrubs" has a whole new meaning for me now.

What It's Like To Be a Doctor

If you're interested in reading a phenomenally written article about what being a physician is really like, I highly recommend reading this article from KevinMD.com.

It articulates some of the strains on medical professionals and answers the questions of "But you're a doctor now, aren't you making a lot of money?"

Although I will add, I am not complaining - I would do it all over again in a second.  The rewards are undoubtedly worth it to me.

Expectations for a New Physician

As I walk into orientation, I am handed a bag full of items.  As I pull things out one by one I find:

A long white coat with my name embroidered on the right side and the hospital logo on the left.  As I try it on I realize that people expect different things now that my coat has grown longer by a foot.  I am expected to know the answers.  I am expected to know enough to help my patients get better or keep them well.  I am expected to advise parents despite the fact that I have no children of my own.  I am expected to stop looking over my shoulder when someone calls out "Doctor."  I am expected to uphold the values of the profession.  I am to be a physician.

A pager with a number already publicized for all hospital staff to access at will.  I am to be reachable at all times now.  I am expected to return any page within five minutes and will never know until I pick up the phone if my patient needs a simple dose of Tylenol or is struggling to breathe.  I am expected to know what to do when that pager beeps and a patient or a nurse needs something from me.  I am to be accessible.

Business cards already printed with my name, M.D.  Below that is listed my office hours and appointment line phone number.  I am expected to convince patients and their parents that they want to request that I be their physician every time they come for a visit.  That they want me, a first year resident, to be their pediatrician.  That I will take care of them.  That I know what I'm doing enough to be a helpful resource for them.  I am to be likeable.

A pass-code security device that allows me to access patient charts from anywhere with an internet connection.  I am expected to be trustworthy and respect patient privacy.  I am expected to understand the laws regarding patient privacy and security of information.  I am expected to be willing to be audited at any time and have my every mouse click scrutinized and analyzed for intent.  I am expected to have integrity.  I am to be trusted.

Hospital-issued, baby blue scrubs immaculately pressed for the first and last time.  I am expected to look professional even when called into a patient's room at 4:00am.  I am expected to willingly spend as many nights at the hospital as teamwork demands.  I am expected to respond with a smile even if my pager beeps every 5 seconds from 1:00am on with requests that need not be handled in the middle of the night.  I am expected to tend to my patients needs even if I have not slept because they need me more than I need sleep.  I am to be selfless.

An ID badge featuring my smiling, well-rested face that will likely look less like how I do as the year goes on.  The hospital logo, "my name, M.D.", and "pediatrics" printed in bold across the front.  I belong to an organization nationally recognized for excellence.  I belong to a profession recognized for selflessness, sacrifice and empathy when done well.  I belong to a field of medicine known for being the "nicest physicians".  I am to belong and be worthy of belonging.

As I look down at my new belongings spread across the table, I cannot help but be filled with immense pride, awe and excitement.  I am proud to be where I am.  I am in awe of where I am blessed to be.  And I am beyond excited to begin this chapter of my journey.  I pledge to fight burnout, negativity, callousness and bitterness.  I am going to strive to be an accessible, likeable, trustworthy, selfless and worthy pediatrician.  And I'm going to try to never lose this sense of awe at a dream becoming reality.

What am I?

Patient (talking to the attending while pointing at me): Is she a student?
Attending: Nope, she's a doctor too.

...later in the conversation, while the attending is explaining something to me...

Patient: I thought she was a doctor?
Attending: She is, but she's also learning.
Patient: So she is a student?
Attending: No, she's a doctor.

Don't worry kid, I don't really know what I am either.

Forward Progress on my Journey Forward

So much has happened in the last three months since I last wrote about Match Day.   I officially graduated from med school and celebrated with our families.  We went on an incredible vacation for two weeks in South Carolina.  We also bought, moved into, painted, and unpacked a new home.  It's been a hectic, amazing, and busy break between med school and residency.

While I certainly enjoyed having some time off, it will feel good to get back to work and jump full speed into the world I love.  I start work tomorrow with a week of orientation then head straight into month-long rotations.

My intern year will be made up of 13 4-week blocks/rotations.  My schedule is:

• 7/1 - 7/28: Behavior and Development (Autism, ADHD, etc)
• 7/29 - 8/25: Neurology (Seizures, nerve problems, etc)
• 8/26 - 9/22: Infectious Diseases (Skin infections, meningitis, bronchitis, etc)
• 9/23 - 10/20: Emergency Medicine and Community Outreach (Emergency Room shifts and child advocacy experiences)
• 10/21 - 11/17: Hematology & Oncology (Blood disorders and childhood cancers)
• 11/18 - 12/15: Pulmonology (Lung and breathing difficulties, pneumonia, etc)
• 12/16 - 1/12: Rheumatology, Renal, and Endocrine (Autoimmune disorders, kidney problems, diabetes)
• 1/13 - 2/9: Neonatology (Premature babies)
• 2/10 - 3/9: Primary Care Clinics (Community pediatrics)
• 3/10 - 4/6: Infectious Diseases (same as above ID)
• 4/7 - 5/4: Well-baby Nursery (Healthy, normal newborns)
• 5/5 - 6/1: Gastroenterology ("GI", digestive problems)
• 6/2 - 6/30: Cardiology (Heart defects and problems)

My schedule most rotations will be roughly 7am-6pm with 4-6 days off per month.  I will also have around 4 days of night shift (5:30pm-7:30am) per month.   Most weeks I will also spend an afternoon working in a primary care clinic seeing patients on my own and developing my office skills.

They work us hard, but I'm going to learn a lot!  I can't wait to get started and hope to have time to continue updating!

Residency...here I come!

Match Day!

I found out on March 15th that I officially have matched at my first choice: Nationwide Children's Hospital!

It was so exciting opening that envelope to see exactly what I had hoped to see!

So what does that mean?

I'll be spending the next three years of my life:

• Working about 80 hrs/week
• Working 6 days a week, about 12hrs/day
• Hanging out with kids nonstop
• Learning more than I even know there is to learn about pediatrics
• Figuring out what style of pediatrician I'm going to be
• Building relationships with fellow future pediatricians
• Learning a whole new level of what "exhausted" means
• Trying to comfort parents as they go through some of the hardest things
• Making children laugh as often as possible
• Passing out a ridiculous number of stickers
• Fulfilling my dreams

The craziest part of all of it?  I can't wait!  (But I'm definitely going to enjoy some time off first...)