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Deep dilemmas - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
Deep dilemmas
It's 1:45 in the morning, here at $hospital.  I'm on OB call, so I handle OB triage.  Somewhere on this floor is a woman who's walking.  Sometime in the next hour she'll return to the triage room and I'll get paged to go check her cervix.
If I never see another vagina it will be too soon.
I have been doing this almost nonstop since 7:30 PM or so, when the first wave of "I think I'm in Labor" washed over this city like a full moon (is it? It isn't, I don't think).  The day was stunningly, excruciatingly quiet after a hectic start - seven deliveries including a c-section and a vaginal breech (I love you, Dr. C, and your magic hands, but tell me when you're going to go deliver the single-footling breech, so I can watch) before noon - all ten labor rooms devoid of patients from 2 pm on. 

I was sociable and chatted with people and played around on the Internet instead of sleeping today; I am afraid these bipolar tendencies are on the downswing and I find that being a hermit is not helpful to keeping my sanity or my Angel's.  I also am on call with one of the few obstetricians who still intimidates me: his father started the practice that delivered my baby; he is blunt and doesn't sugarcoat his opinions; and he is a born surgeon. 
As I have told our maternal-fetal medicine specialist before, I am not a born surgeon.  I am a born family medicine physician - a generalist, an eclectic - who is trying to become a surgeon, because that's what I have to be to serve my patients the way I want to.  It's a learning process. 
"I wasn't sure about you," he said the other day.  "I had my doubts about how you'd do.  But you've really improved your skills.  I'm impressed.  You're doing well."  I didn't know he didn't think I was going to be able to do it. If I'd known, I would've been too terrified to try.

I walk into the operating room terrified - every time - but sometimes I am more terrified than others.  And with him, I know I am being evaluated.  His standards are high - he expects I'll be able to perform well, not just perform.  But to my amazement, I seem to be reaching - slowly - that level.
Dr. F stopped me in the hall outside a section the other day.  I'd resigned myself to just assisting him forever, as nice as he is, so my heart went into my throat when he spoke.  Think you're comfortable running the show?  "Yes, sir."  And I did, but I must have nearly collapsed from anxiety before even setting foot in the theater.
I want to do well.  This is vitally important to me - like it never has been before.  As I make this awkward transition into becoming an independent physician (I'll be taking boards in December!) I'm coming to realize just how important it is, and just how afraid I am that I'll come up short.

Sometimes I wish I'd taken some other route, where I went home at night and slept well and didn't worry about people dying because I missed something.  Where I'm not sitting up at oh-dark-hundred philosophizing about the importance of learning to tie a knot with my left hand (he asked me.  I was so glad I could say yes, I can, and prove it) or how straight my incision is.

There's no day and no night on OB call.  The windows are all UV-treated and tinted so the outside can't look in and we don't have to close any drapes in labor.  Dawn looks like dusk looks like noon; midnight is dark.  It can be 3 AM or 5 PM and the only way I know the difference is by how fatigued I am.  I sleep when I'm tired, eat peanut butter and cheese sticks when I'm hungry.  I hide in my room and wait for the intolerably cheerful warble of my pager to go off to tell me that I have to go make sociable with someone else, try to ignore the surreality of my job.

And in between - do I sleep?  She might be fifteen minutes, might be an hour.  I might have another triage patient soon - or there might be no-one until morning.  It's a gamble.  Uncertain.  How long does it take from four centimeters to seven? From six to complete?  There's no baby clock, no pop-up timer to warn me when I shouldn't plan on doing something else.
Went down to do a D&C today on a patient with a septic missed abortion (that's a miscarriage where not all of the tissue passed, which has now gotten infected) and was handed the suction curette, carefully walked through the procedure.  Came back upstairs and they'd kindly filled triage with patients who thought they were in labor.

It's late now, or early.  I can't tell in the constant fluorescent light, but in the mirror I look older by a factor of years.  By now I could have had almost an hour and a half of sleep, and just as I am thinking that I'll try and catch up to it the pager goes off again.
3 whispers echo . o O ( ... ) O o . whisper a word
Comments
From: broken_onewon1 Date: October 6th, 2008 12:47 am (UTC) (etched in stone)
Sounds rough, hang in there,

I hope this finds you well
aliasmisskat From: aliasmisskat Date: October 6th, 2008 03:36 pm (UTC) (etched in stone)
ayradyss~

i'm a friend of indurate, or more accurately, winktwice, and have read your journal for at least a couple years. i appreciate your willingness to share your story of becoming a doctor by leaving these posts open to the public.

i read this synopsis of a study on women's & men's confidence levels in medical school, and felt compelled to share.
http://jezebel.com/5059409/

thank you again for your beautiful and heartbreaking tales.
ayradyss From: ayradyss Date: October 6th, 2008 08:57 pm (UTC) (etched in stone)
And thank -you - for the link.
Interesting, isn't it?
3 whispers echo . o O ( ... ) O o . whisper a word