Wednesday, July 13, 2011

July 13

His name was Girard. He had back pain. That's all I remember about him.

On July 13, many years ago, he was the very first patient I ever saw on my own.

Working without a net for the first time is terrifying. I'd survived 4 years of medical school, 4 years of residency, and 1 year of fellowship to get there. This is the goal I wanted. And when it finally came it scared the crap out of me.

There was fear in medical school, starting classes and later starting clinicals, and even more in residency. But in both those cases there was always a back-up system- more senior people who actually knew what they were doing. There was also a herd-based support system: You were with plenty of other people, all sharing the same challenges.

But here, after 9 years of training, it was just me and Girard. Even though his case was simple, it's pretty damn scary to realize that YOU are the attending, and if you screw up there's no one else to blame.

I remember another patient that day started the visit by saying "I came to Humungous Neurology because I heard you guys are the most experienced." My inner voice said "you probably don't want to know this is my first day."

Throughout medical school you saw the attending physicians as omniscient giants. Suddenly you're one of them, and realize that they don't know everything. And you aren't a giant.

Like everything else, after a while it becomes routine. But trying to remember that first day still helps to keep you on your toes.

I don't remember how many patients I saw that first day. A handful compared to what I see now. One of them is still with me. I think I told her a few years later she was on my first day. I even got a hospital consult, a lady who'd obviously had a stroke. I got lost in the hospital trying to find her room, then sat in the MRI control room to see images, terrified at the thought that if they were normal I'd have no idea what was going on.

I've now spent an estimated 4,420 days of seeing patients in one place or another, with a lot more to go. But the first one was the scariest. And hopefully always will be.

To all who are starting this July, good luck.

I'd like to thank ER's Mom, who's recent post got me thinking about this.


Packer said...

Human. Nice. Thanks for Sharing.

jenniferarb said...

yes, thanks for the reminder to have compassion on those baby docs

sexy KM said...

wow. thanks for sharing. my husband will soon finish residency and start his practice. i will share this to him :)

RehabRN said...

Nice article.

I wasn't there on the first day (because I wasn't born yet) but one of my docs had a relative as his attending.

This same doc (who's nearing retirement, but probably never will) told me one day, "You know we've been together over 20 years."
He read the chart and realized he had seen me that long.

He also saw me occasionally in peds, but that was not noted.

Time flies when you're having fun I guess.

Hope you keep all those long-timers even longer!

Anonymous said...

Last week a resident returned my page on a consult. When I asked him his name he said, "John Doe, ummm, uh, I mean DOCTOR John Doe." I had to laugh to myself as he just remembered that he is now a doctor!


erin said...

i'm starting nursing school this winter and i'm already terrified of that day, a couple years from now, when i'm on my own with a patient.

John Woolman said...

1974, there I am scrubbed for an elective Caesar, and the consultant says "what are standing that side for, you're doing this one..." I still have dreams about it.

Not House said...

As my attending today told me, "the terror doesn't go away as you get more senior, it's just less acceptable to go running in terror".

Thanks for sharing that.

Anonymous said...

Well, my first child was born at a teaching hospital in New England July 3.
My college's 5-year reunion was a few weeks before, I was at my due date and I told the baby, "look at all these new MDs who JUST finished internship. NOW would be a good time." Now, I KNEW some of these Skeeziks, and would not let any of them MD or no within a half-mile of me and the baby. Still won't. I also knew that new interns started on July 1.
Of course my daughter decided to be stubborn. VBG. Just preparing me for what was to come.
So On July 2, I started labor. (Wrong end, Dr. Ibee) Knowing there were brand-new interns (the lowest form of life known to hospitals besides med students)I waited as long as I could.
Anyway, my doc asked me just before I delivered if "Dr. Noexperience" could help.
To you males out there, you will agree to ANYTHING just before delivery. They could have marched the 5th Army through the L&D room and lynched my then-husband and I would not have cared.
So, I said yes.
And the look in Dr. Noexperience's eyes as my daughter landed in her hands was priceless. Daughter was fine and that was all that mattered.

Anonymous said...

Heh, I remember doing a Caesar on a lady dog at 2 a.m. Sunday morning with the owner, who was fortunatelya theatre nurse at the local hospital, assisting. As I was closing, she said "You're a better surgeon than most of our surgeons. How many dog Caesareans have you done?"
"Counting this one? One." I answered, truthfully.

Girard with back pain said...

Hi, Dr. G. Glad you remember me. I'm reporting you now for a HIPAA violation.

Anonymous said...

My first case as an attending by myself is lost to history, but I remember the sinking feeling the first time I got sign out and was left completely on my own.

Anonymous said...

July is rough for those of us nurses who work in teaching hospitals too! I'll try to remember this post.

Anonymous said...

I'd find you any day that I needed neurological treatment.

Bendy_Clutz said...

On my first night working solo as a Nurse.. things were fine and dandy till about 0600, only an hr and 1/2 till shift change. Just when I was just about the call the doc about my two increasingly wheezey patients.. when one of them suddenly had a seizure. (Nope, no hx of ever having a seizure before).

I wish I could say I gracefully handled the situation...but not so much. thankfully one of the nurses was nearby and kinda coached me along. I remembered the need to get her on her side, but didn't think about getting the suction stuff going. I also managed to call the wrong doctor at first and knocked over a glass of water during it but a call to the right doc, and a little ativan later and she was fine.. - Was a rather memorable first day!

Anonymous said...

What is your fellowship in?

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