Tuesday, April 04, 2006

"The Doctors We Become"

Here's something I recently read that really reminded me of the crossroads I am currently facing. The reality hasn't completely sunk in yet. I don't think I fully realize what it means for those two capital letters to be attached after my name. Maybe it's all a big fuss for nothing. But something tells me it's not, that there really is something to those two letters, M.D. I'm excited to find out.

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In Focus
The Doctors We Become

Daniel Egan, MD

One of the very interesting parts of my residency is that each month I have the opportunity to do something a little different. Unlike most other fields (maybe with the exception of family practice), as emergency medicine residents we spend a great deal of time in the earlier part of our residency on other services. For the past month I have rotated as a surgical intern. For my particular residency, this is our most challenging rotation of the year. My alarm has been sounding each morning at about 3:30 which, up until this point, had always been the middle of the night for me. Typically I am in the hospital at 4:30 am and I leave well into the evening hours. This is a drastic change from anything I have done up until this point.

The early-morning alarm clock is routine for my surgical colleagues. I watch some of the other services come into the hospital as we have already been rounding for 2 hours and think of how inhumane the whole system is. Beyond the basic differences in work hours between some of the specialties, what struck me recently is how much we (the new -- soon to be old -- interns) have all changed. Just about a year ago, as fourth-year medical students, we were sitting in medical school approaching graduation. Essentially, most of us had similar experiences up until that point. None of us was a specialist and few of us even had areas of expertise. Little by little our lives are taking such different paths to create the amazing world of medicine. Now we turn to each other and learn from each other on a daily basis.

Tonight I was speaking with a medical school classmate of mine. As an obstetrics and gynecology intern, she told me about the excitement she gets from going into the operating room for a challenging case. She told me a story about a 14-year-old girl whom she diagnosed with a malformation of her internal reproductive organs. The patient required corrective surgery by a urogynecologist. The diagnosis probably changed the girl's life. My friend told me she could only imagine how wonderful it would be -- what satisfaction it would bring -- to be the surgeon to fix that. This interaction gave her such a "high," as it affirmed her career choice.

It struck us how suddenly each of us was turning into a different type of physician. My friend has not had to deal with the acute resuscitation of a patient in months. Meanwhile, I cringe at yet another case in the OR on this rotation and the thought of standing in the same position for 4 hours. We are all even more excited as we transition out of the intern role and into the junior resident role. Meanwhile, the match lists were recently put out and a whole new group of you will be joining us and turning into your own type of physician.

It is easy to get caught up in the hours, the lack of sleep, or the frustration with the amount of "scut" work that needs to be done. By every once in a while I am struck by how frail human life is. Just a week ago, I took care of a patient who was initially an "unknown white female." Later she became, for me, the mother of a little 2-year-old who was killed in the same car accident that injured her. One of my patients right now is dying of cancer. Every day, I have a tearful session with her husband. Despite my lack of expertise as a surgeon, I have adopted the doctor role, and this man and his family turn to me for support.

Medicine becomes so much more than the next exciting case or opportunity to assist in a procedure. The human interaction, and incredible complexity that it carries with it, make it the amazing field that it is. As you all begin to adjust to the new role that you will have as doctors, clinical students, or subinterns, keep in mind what you heard at your white coat ceremonies years ago: Humanism in medicine is real and extremely powerful.

Daniel Egan, MD, 2002 graduate of Mount Sinai School of Medicine, New York, NY; first-year emergency medicine resident, Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts

Medscape Med Students 5(1), 2003. © 2003 Medscape

Posted 06/03/2003

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