Wednesday, December 1, 2010

Clichés and the End of R1 Year

It has become a cliché to say that something you've been waiting for seemed to have arrived sooner than expected. "As if it was only yesterday that we were starting our residency training" is a statement I will not agree with. This year seemed to have passed too slowly and the end could not have come sooner.

I am happy to report that I learned a lot this year, not only about Internal Medicine but also about the more important thing in my profession: interpersonal relationships. I learned that people handle stress in many different ways and sometimes, one needs to let things slide to attain some form of peace. I also learned the value of being quick to apologize and admit error. I quickly averted several potential disasters just by immediately admitting my mistake and promising to do better next time. It's a work in progress but I'm slowly getting a handle on my temper and my impatience with incompetence, as I realize that I am incompetent more times than I care to admit, and in worse ways. Something Dr. Bengzon once said struck me and I think about it every time a patient (or family member) poses a "challenge": our patients remind us of our humanity. We are all impatient, difficult, cranky, and demanding at one point or another. We are all apprehensive about death and disease, albeit in variable degrees. These thoughts help me to maintain my composure, take a quick breath, and move on with my work.

This year, I also learned some good Medicine, mostly from the people who took the time to teach. We all had virtually no time to read Harrinson's so we were mostly learning by leeching: "leeching rounds," as one pre-resident put it. At one point, I was reading ECG tracings from a treadmill stress test and I remembered the time when I was a clerk and I was so impressed by the cardiology fellows who seemed to have read these same tracings as if it were a book, almost efortlessly. My clerkship self would be proud of my resident self, I think.

The learning was there. But the learning came with a huge price tag. Late nights, sleepless nights, missed time with family and friends ... the list is substantial. The way I coped, however, was to always have my long term goals in mind. As another cliché goes, I "kept my eye on the prize." I knew that sooner or later, R1 year would be over and I'd be moving on to more challenging stuff. But I'd be MOVING on and that means, pretty soon, the entire ordeal of residency would soon be over.

The Lord has shown me grace upon grace this year and my friend Angel, just tonight, reminded me of how undeserving I am of the favor I received from Him. He has been my source of strength, my source of peace, and the One who stretched my limits even more when I thought I had nothing else to give. He has given me an excellent set of duty mates (and now great friends) the past few months. He has sustained me through the most toxic of duty nights and has given me wisdom enough that I don't have screw-ups that endangered any of my patients' lives. As an added bonus, I get to do something I love more than medicine: teach. It might well be my only drive to read and study up on my cases.

I may be looking back and seeing things through rose-colored lenses because I am at a high right now: it is my last day as an R1 (and all its accompanying baggage, like DS!) and I had a pretty good dinner (more like excellent, really). But as I remember the year that has passed, it strikes me as being an over-all very positive year. And this makes me extremely happy. If you will notice the description I post about myself in my blog: "An occasional writer whose current preoccupation is getting through medical training unscathed and unjaded." I may have been scathed and stung the past year but I am as unjaded and enthusiastic about my work as the day I first started last year, considering everything that has happened. The ER and hemodialysis (and many more R2 issues) may quite possibly kill the buzz. But I say, bring it on.

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