tomorrow will be interesting

I start my life as a attending tomorrow.

I feel pretty much as anxious as I did  that sleepless night before I started my residency. It is a different type of anxiety. It’s different for sure, but it is so obnoxiously there.

I am not as nervous about the doctor part as I was the night before I was an intern. To be clear, I am very nervous about being a doctor (as I am sure, in my chosen specialty, I will always be), but the night before I was an intern, I didn’t even know what it meant to be a doctor.  At least now I’ve been a doctor for more than a minute.

Graduating from residency is emotional, something I will write about at another point.  But one thing is for sure, you make good friends.  One of my closest started his attending gig on July 1.

I asked him how it went, and he told me that for the first 6 hours of his shift he completely forgot how to be a doctor.

I can see that happening to me.

It’s a new place, new people, and for the first time ever, you are on your own. There were many times in residency when we were probably actually on our own, but it didn’t feel that way. At the point where we had been given enough responsibility and trust to be somewhat on our own, we had been there for 2, 3, or even 4 years and, for better or worse, we knew our team. If our attending wasn’t available, we still had seasoned nurses, pharmacists, and even techs who had good clinical judgment, who knew our strengths and weakness in a crisis, who could do good cpr….

So he told me, a 70 F came in after a mechanical fall… no head strike, no LOC, otherwise healthy, currently feeling great.  If she made it past the trauma bay and into the general department, that generally means the mechanism was insignificant and her primary survey was intact. In other words– her airway was patent, breathing/lungs/O2 sats were fine, circulation was functional, her vitals signs were beautiful, GCS pristine. SO, easy peasy, right? Complete a secondary survey.  If she’s over 65, depending on mechanism and other factors more than likely she’ll be getting a head and neck CT, you know this off the bat.  You keep this in mind as you prepare for the secondary survey where you’ll figure out the rest. And as always, you’ll be thorough. Xray an elbow? Arm? Great. Belly tender? CT a/p.

This is our bread and butter.  We trained at the busiest level 1 trauma center in our region.  And on this bread and butter case, my friend could not think. He literally could not decide what xrays to get. If we were back at our home shop, this would have been second nature. This would have been the patient the senior picked up because it would be uncomplicated, allowing him/her to supervise the junior residents as they picked up the more complicated, time-consuming, teachable cases.

But this wasn’t his home.  He didn’t know anyone that worked there.  No one knew him, no one yet trusted him.  This was an entirely new experience.Screen Shot 2015-07-12 at 10.57.10 PM

And with that, I get it.  He is one of our best, and I know without a doubt this woman got the best care possible, but I know better than most– when you are nervous and anxious, and on top of that, OUT OF YOUR ELEMENT, as I have mentioned a million times in the past, your brain just_ stops_ working.

Sigh.

I won’t sleep well tonight.

And tomorrow will be interesting.

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