I am sitting on the couch in the staffing room in the library, all dressed nice and melting inside. Residents come and sit next to me, ask me questions. I talk a little loudly - as if to a partly-deaf aunt - so that the actual staff can hear me and maybe provide some input. I think maybe I don't know anything at all.
Sometimes it is like this. Sometimes, I submit and resubmit my charts to my faculty attending in between providing what I hope is sound and evidence-based medical advice - and he sends them back to me with notes that remind me of how little I know. Sometimes, I think everyone knows more than I do.
I am in the adolescence of medical training.
Went into the OR with a new OB on my own patient - fourth baby, now with contractions at 37 weeks and a placenta previa on ultrasound suggestive of a possible vasa previa. What's the difference? Placenta previa means mom is bleeding when the cervix dilates. Vasa previa means baby is. When you consider the blood volume of a newborn baby, you don't have much spare to lose. So off we went to a C-section, with one anxious patient, one anxious fellow, and one attending obstetrician who was cool as a cucumber. Tell me what you want me to do. I want you to assist. Then I'll assist.
And then he smiled, and he assisted while I operated, and as I was scrabbling around inside an open uterus, shearing off the placenta trying to find a baby hidden somewhere under it, he leaned in. Let me know if you want help. "Now would be great." And he did what I wasn't brave enough to do - reached through the placenta and pulled out a baby's head, and then he looked at me. Go ahead. This isn't an easy surgery.
The rest of it went smoothly, tidily. As he looked across the table at me, stitching up the skin with slow careful movements (I love closing skin; it's artistry. Soothing. I love the look of a newly-closed incision, when I've done it well - smooth and well-approximated, as if I hadn't had my hands buried in the warm depths of humanity. A C-section is brutal, O Best Beloved - there is tugging and cutting and sometimes I come out of them with my deltoids aching from the effort - but closing is beautiful. And I close well, and I am proud of that beautiful approximation in the end) - he looked at me and said So what do you need, for paperwork? Nothing, just tell me I did a good job and have a good night.
You did great. Any time.
Saw a patient of my own postoperatively. I assisted on her initial section; I performed her repeat, from the decision to section to the phone call to the attending obstetrician. "Come in around five AM, we'll do it then." And I wrote orders, did everything but sign the consent. Halfway through, the attending looks up at me. Did you give antibiotics? I did, ma'am. Preoperatively. Oh, good. I guess I just assumed you'd done it all. And that was that - and I knew I had. And I closed, gently, smoothly - with the tiny needle that takes longer but makes it pretty, and we were still out in about an hour.
She came in for her 2 week check, showing off her flat belly. Showing off her scar. You did great. Can't hardly see it. And you couldn't, and it felt good.
I can operate.
Yesterday, I took over a case while the OB, scrubbed and with his arms folded, watched me operate and the resident whose patient it was assist. Between him and the anesthesiologist giving me a hard time through the entire case, it was a fair trial. And it went well - at least, we got the baby out without a problem and the uterus closed back up. Afterward, he nodded. "Your second layer on the uterus was worthless. But otherwise, nice job." And he was right, and we both knew it.
We are looking for housing in $new_city. We have found nothing, and I am resigned to renting until we do - perhaps, until we build something. My Angel is agitated about this. He wants to be settled - and so do I, really, but I want to be settled right. And we're talking about committing a positively ridiculous amount of money for a home, really, and we haven't even gotten our old one on the market. We've gotten acres of boxes moved and piles of trash reorganized, but it still looks just awful inside, and I don't think it will ever be ready.
I want this to be over with.
It's mid-March. At the end of May we're going to get on a plane - several sequential planes - and head to Papua New Guinea for a month of missions work. [ Incidentally, there is currently a 5-10 day layover in Brisbane, Australia planned. Can anyone give some advice on what MUST be done on the first trip to Australia, starting from Brisbane, with a 2 and a half year old? ] And when I come back, I'm going to be a real doctor - with no residency director and no work hours restrictions and nobody to look over my charts and ask me probing questions.
And I'm scared. I want to be a good doctor, and more than just compassion is required for that. And as I move through this awkward adolescence I am reminded of how much I don't know yet. It's definitely going to be an adventure.