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Nobody wears a white coat any more...
...a tribute to becoming a doctor.
What a long, strange trip it's been...
I find myself getting more and more paranoid, O Best Beloved.  Recently, a colleague of mine who's graduated sent us all an e-mail.  "Our family blog is now invitation only, because one of T's crazy patients Googled him and found it." 
Do you remember, O Best Beloved, when all of this started and I was a medical student who didn't know how it all worked, and I was so excited to find out?  It's been quite a while since then, and the Internet has evolved, and we've evolved.  And I find myself thinking about Next Year, when I'm a Real Doctor.

And I know I don't post much any more, but when I do I'm glad I did.  Things still happen to me that remind me how much I have to learn, and people still surprise me on a regular basis - both with the good and the bad.  And I'd like to keep it up, but I'm going to be in a small town, and you know how things are in a small town.
So I'm still thinking about how it'll happen, then.  How do you keep your anonymity in this world where everything's linked?  Your name becomes increasingly only one of the thousand ways to identify you - as evidenced by my secret excursion into Facebook, which became an explosion of connections; a veritable spiderweb of people I never knew I still remembered.
And I don't always know where to post my secrets any more, that cold dark callous bit of me that gloats when people get what they deserve, because I'm afraid someone will find me - and know I'm talking about them.

So I'm going to take you with me this year, and I'm going to write about things and save my posts and skew their times and obfuscate numbers and names and I'm going to never again post from work, because they made me login to the Internet, so they can track who goes where, and somewhere Big Brother is watching, and that's the scariest part of all for me.
Because some lawyer somewhere can decide that it's not important for you to know what it's like to watch a baby die or treat a crack addict or to see what's inside my mind in the witching hour.  Someone can decide that I wrote too much of a story and made it too real and they can track me down and take away my license if they like to.  Someone can decide that just because I don't like everyone all the time means I don't treat them right.  And all the Someones in the world these days, I just don't know.

This sounds like a paranoid fantasy.  I wish I hadn't started thinking about that email from T.

So at the moment I'm at $local_er, a long way from home, doing a couple of 12-hour shifts and I don't have anyone looking over my shoulder, not a single attending here.  It's just me and my ATLS certification and all of a sudden I have to decide what to do, and call people I don't know and tell them about their patients.
I'm a Real Doctor, down here, nobody's resident or fellow.  I write orders and people follow them.  I tell them to send people home or keep them or X-ray this or scan that and that's it.  That's all there is, out here.
18-month-old with croup, had me worried for a bit before he perked up.  Chest pain I can't explain.  A fall.  A wrestling match gone wrong.  Please do not put a needle in your gum for any reason unless you are a medical professional, and even then do think twice.  Coughs and colds and vomiting.  Bee stings.  All the usual stuff that I would see anywhere else, except now...
Now I don't have that tiny safe feeling in the back of my mind that says "You can always just have someone else look at them."  It's funny, because I see patients and I decide what I'm going to do and I make it happen, every day in clinic.  I adjust medications.  I call for admissions.  I tell them it's going to be okay and they don't need anything.  And I do it every day without needing someone to hold my hand.  But now that there isn't anyone there...

It's terrifying and exhilarating all at once.  And I know I'm going to make mistakes.  It had better not be a surprise to any of you, O Best Beloved, that we make mistakes.  I just hope I don't make any of the wrong ones.  And I keep watching my steps, trying to be my own attending, replaying conversations with ER doctors in my mind.  I want to do it right.

This year, I'm the obstetrics fellow.  I operate on people, and they tell me I'm pretty good at it already.  But I find myself looking up at my attendings still, for the unconscious movements they make when they know what comes next in the surgery.  Double-checking myself. 
The best surgery yet was the second one with Dr. J, when she smiled at the scrub tech and said so sweetly, "Don't hand her a single instrument until she asks for it by name."  And then folded her hands and smiled at me.  "I know you know how to do this.  Show me."

Independence is scary, O Best Beloved.  I've been a student for twenty-four years now, and it's finally coming down to the moments of truth.  There will be plenty.  I hope I have the courage to tell you about them.

7 whispers echo . o O ( ... ) O o . whisper a word
clipdude From: clipdude Date: September 13th, 2008 09:49 pm (UTC) (etched in stone)
One of the main reasons I friends-locked my entire journal is because I was afraid that my students might Google me.
surgeonufo From: surgeonufo Date: September 14th, 2008 01:54 am (UTC) (etched in stone)
I've said it before and I'll say it again -- it's posts like these that keep me going...
attickah From: attickah Date: September 14th, 2008 03:47 am (UTC) (etched in stone)
So, I'm sort-of a dunce....what does a needle in your gums do, exactly? Other than (presumably) hurt like a sonofabitch?
ayradyss From: ayradyss Date: September 14th, 2008 03:49 am (UTC) (etched in stone)
It provides a portal for infection, and ensures that your banal little abscess is now a raging periodontitis, so you can't hardly open your mouth. :)
attickah From: attickah Date: September 14th, 2008 03:57 am (UTC) (etched in stone)
One thing my youth has taught me: "abscess = bad"

I would have assumed the answer was "infection" much like sticking a needle through your skin can often cause/help along. But part of me was wondering if it was some sort of "your limbs go numb and a finger falls off" weird reaction or something. :-)
omarius From: omarius Date: September 15th, 2008 03:01 pm (UTC) (etched in stone)
I love this journal. I don't know you from Eve, and I don't even remember how I got here, but times when I wonder why I bother with Livejournal at all, and come upon one of your posts, I'm reminded that there is signal in the noise, that there are thoughtful, soulful people out there, and one of them is a doctor. And I appreciate it very much.
pwwka From: pwwka Date: September 16th, 2008 10:25 am (UTC) (etched in stone)
Google yourself every so often. It's a frightening thing. I had a few scares as a game administrator -- you can't tell if these are kids who are trying to upset you, or genuine stalkers who *will* carry out their threats. I have attempted to narrow my Internet footprint, though it is a shame that I cannot interact with the world at large in LiveJournal anymore. (Even that narrowing caused one person to gloat about how she made me do it.)

This is why I belong to no network on Facebook, why I stopped using the same net name on every forum, and why all of my blogs are private. There is an increasing awareness that the 'net is no longer our private playground -- it has become a face of professionalism, easily tainted by past choices which may or may not be removable.
7 whispers echo . o O ( ... ) O o . whisper a word