Being a Medical Resident: What nobody tells you

During my time in Medical School, I already knew I wanted to pursue Internal Medicine. Unfortunately for me, it took a lot of detours until I could find a place to start my dream job as a medical Resident. I did work in other departments, always knowing that this would not be the work I will do for the rest of my life. It was fun to work and learn and gain experiences, all the while knowing this was a relationship, not the marriage. It also made me a little arrogant, “hello! it is possible to be jack of all trades”… man! do I wish I knew how residency is really like. When you do make the final commitment and it dawns on you, that this is what you are going to do for the rest of your life… that one, yeah, that one is a whole different beast.

So, the ones which I was already warned about were: grueling hours, lots of paperwork, feeling stupid for the first few weeks, just the pressure of everyone looking at you for answers, here are a few which took me by surprise:

Your empathy will not always be a constant:
Its always played up in all the medical dramas on TV, how the doctor is suffering because his or her patient is going to die. Yes, I hold each and every person’s face in my head for a long time after I have told them bad news. I think about them even when I am at home. And although that part is hard to balance, it is easier to accept. What I did not expect was, how sometimes you don’t feel that warmth or worry for some patients. That patient who is yelling at you, the one who lie about their substance-abuse histories, the ones who just would not stop complaining… I know theoretically, what to remember in these cases, they are in pain, they are unhappy about something else, addiction is as much of a disease as anything else… but sometimes, its hard to feel sorry for the man who refuses treatment, when you have patients who would do anything for a cure. And you see this in everyone around you, the longer they have worked in the medical field, the thicker the skin gets. The talent, however lies, in maintaining the same level of care. You might not be the friend or confidant for every patient, and you just need to accept that at some point… but you do always need to be their doctors.

That book which you are clutching is not a parachute:
This one was tough to learn. I thought, hey if I have a doubt, I have my Harrison in my Phone, can always quickly check it up. Only after trying that, I realized, how our books never give a direct answer… which dose do I start with, which of the hundred possible medicines should I pick. A consultant once told me, don’t be shy in writing the medicines… It took a while to understand what he meant, you can’t always start with mini doses, you can’t always titrate things up… time is also a resource which cannot be overused in an acute care hospital. You have to trust your gut, trust your nurses and everyone in your team to monitor your patient. More importantly, you have to trust human body itself, there will be enough time to react and improve therapy, if the need arises. Your books don’t always have the answers, ask your seniors, ask your consultants, ask the nurses about their experiences with one medicine or the other; its as much an art as a science.

Forgive yourself, forgive others:
Like I said, I started off with a hint of arrogance, “how could he forget to do this”, “how did they not notice this”… yeah each and everything you cluck your tongues about, will eventually happen to you, unless you learn from other people’s mistake rather than judging them for making them. You will also forget something or the other at some point in your residency… it happens, its not always possible to keep each and every minute detail in your head about all your patients. You will forget to check the lab someday, there will be someone else who will roll your eyes on your mistakes as they correct them. Move on, forgive yourself and forgive others…

Sometimes treatment is not what a person needs:
Until I started internal Medicine, I didn’t realize, how important it is to learn when to stop the treatment. This is that part of the science which the patient teaches you. Initially, an old person telling me, they are done with everything and want to be left alone, used to bring a wave of frustration. I know, what is treatable and what is not, I know we can pull you through this one… why won’t you just listen. You become an unwilling observer, not the doctor. It is easier for the nurses to deal with this, cause they are still helping the patient, they are still taking an active part in making him feel better. But you are just there, not being allowed to do anything. There was one such case, where the 82 year old told me, he was ok about death and didn’t wish any treatments to prolong his life. He died before we could organize a nursing care team for him, so that he could live in his house. A few days ago, I was trying to convince him to try chemotherapy and he was smiling and shaking his head, basically saying no, thank you… I could not wrap my head around how fast it all went, and how maybe we could have won a few more months, if he had let us help him. His son though, opened my eyes at the end… he thanked me, which I myself found almost painful, but he went on to describe how, his father basically met and talked to everyone he needed to, how dying in his sleep peacefully, was probably exactly what his father wanted. We all did help his father, just not in the way we wanted to. It is about the patient in the end… let them teach you this.

You are never going to be exactly ready:
You can do all possible drills, read all possible protocols… but when it comes to it, you will never be ready to start this journey. You will not handle your first emergency with calm nerves, you will look around and try to find anyone else who can takeover for you. Nobody is ever ready to lead the team. Ask for help, fake that confidence, and maybe you will make it eventually.