Barely Cogent, Broadly Applicable

I made it!

Well, I made it six months ago. But the hours still be long for this doc.

This is how I got through it all. Kitty and Tea.

I’m now a PGY-2 (Post Graduate Year 2) resident, which means that I’ve successfully survived the dreaded first year of residency. Like every new MD, I got to spend a year rotating through largely off-service specialties, and not sleeping a whole lot. Now, I’m all psychiatry, all the time.

The nice thing about Canada is that we’ve gotten rid of the internship year-that is, the first season of Scrubs. Instead of rotating through various departments attached to a hospital, and then matching to a residency, we go through CaRMS, match, and start with our programs immediately.

It creates a little light a the end of the tunnel, for those wee hours of the morning on a specialty that bores the heck out of you. You rise early, work hard, stay late, stay up, and fix it as you go. Also, you learn what you can, because it’s going to be the last pass through specialties not your own and if you’re planning to be a physician, then you’d better know the basics of patient care. (Also you have to take the LMCC exam part 2 sometime after your first year but before your royal college.)

And for some reason, the higher years seem to have forgotten what it was like when they started. I remember being post-call on medicine and being asked by a junior attending to perform a specialized examination. I blinked at the patient (whom I had excellent rapport with), she blinked back at me, and I turned to that attending and said: “you know, I’m not certain I’ve ever done that examination in my life.” This was untrue, but I have the mental capacity of a cabbage after being awake for more than 24 hours.

Everyone in medicine is familiar with this feeling. Being on the awkward end of a retractor and having the surgeon poke at a little thingy and say “Which branch is this?” or the ubiquitous 3:30 AM medicine senior resident providing detailed teaching–those ones all seem like a bad dream, likely because I was actually asleep at the time.

This cycle is propagated from year to year. The more dour analyses suggest that it is like the cycle of abuse, but there’s another possibility–people might remember that they did learn something crucial at a few of these moments, and I think we’re all keen to pass that on. I also think that when we get a little cabbagy that we default into the “See one, do one, teach one” mode.

I suspect that we get into this particular rhythm of teaching just out of the sheer habit of it. I found myself grilling a nursing student the other day, and I didn’t realize what I was doing until one of my colleagues raised an eyebrow at me. Fortunately, I still seem to be a nice person, and the nurse wasn’t upset. I hope.

This only highlights the difficulty of changing a culture– even the best-intentioned people (and I’m very well intentioned!) are guilty when a particular view is so prevalent. I think that was the point I was driving at from the beginning; I felt that is was important to say, given the interesting times we are living in. Just like PGY-2, I got to it in the end.




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