Showing posts with label residency. Show all posts
Showing posts with label residency. Show all posts

Tuesday, June 12, 2018

Intern Year Recap

Intern Year Recap

As my kids end school and I start power- reading to get ready to be a 2nd year resident, I want to take a chance to recap this crazy roller coaster/ transformative/ at times impossible/ at time inspirational year.

Top 10 ways to rock intern year.

1. Make friends with your co interns. Your nurses. Your seniors. Basically, anyone in the hospital. It is the place where you will spend the bulk of your time, so having people you look forward to seeing, talking to, working with, will make the tedious hours go by shorter, the hard times a bit easier, and the terrible days a little less terrible. You may even have fun.

2. If you ever are doubting your abilities, teach something, anything, to a medical student. You will be amazed at how much you actually do know. You will help them learn something. And you will feel like a better, kinder, and more capable person for it. Teaching also helps solidify information, so if there is something you struggled to know the day before, teach it to a medical student today. Believe me, it is a huge ego boost and a way to help out someone who will one day be your colleague.

3. DO NOT LIE. If you didn't order a test, or do a complete exam, or replete lytes, or order an antibiotic, DO NOT LIE. Just be honest. Admit mistakes, and work to correct them.

4. Invest in really comfortable shoes. I wore worn out tennis shoes for 6 months and my feet ached. every. single. day. When I finally bought a better pair of supportive, soft, arch-supporting shoes, I felt 100 times better at the end of a shift.

5. Check in with yourself. At some point, I realized that I (a little curvy to begin with) had gained 10 pounds during my first 6 months of residency. Check in. Run, Exercise, Eat right. Come up with a plan. Bring lunch instead of ordering in or buying cafeteria food. Skip the muffin at the free breakfast. The past month I have been committing to 2BMindset (on the Beachbody website) and I lost those 10 pounds. It was a lot of effort and commitment, but I feel better, healthier, and am inspired to keep on a weight loss track to lose the rest of the "curvy" that still has me 20 pounds over my pre-baby weight.

6. Find something you love and make time for it. I love cooking. I stalk instagram food bloggers, hoard too many cookbooks, and screenshot recipes compulsively. Cooking gives me a creative outlet and also lets me feed myself and my family in a healthy, affordable way. Having an outlet outside of the hospital is essential for your wellbeing.

7. Drink water. Being dehydrated is awful.

8. Remember your "Real life" friends. There was  period of time where I had not spoken to my best friends (non medical, live in a different state) in over 2 months. I missed the birth of their babies, kids' birthday parties, their birthdays. I felt terrible and lonely. I just wanted to go home and give up. Luckily, face time and whatsapp goes a long way and I was able to realize why I felt so lonely and make an effort to reach out. Don't forget those who loved you and supported you along the way.

9. If you have a significant other/partner remember them. Try not to come home so utterly depleted that you have "no nice left to give." Your relationship deserves it.

10. Make every day a learning day. and try to end every day with positive thinking.  When you get home, think about 1 thing you learned. Think about 1 thing that made you happy. Think about 1 think you are excited to do tomorrow. (Bonus: think of 1 thing you did to make someone ELSE happy.) Thinking positively and productively will help you sleep better and be happier overall.


* Bonus- remember that your kids will think you are the coolest person ever no matter what. Love them unconditionally, the way they love you. If you only have energy to cuddle in bed, then do that. They don't care if laundry isn't done. One thing I learned this year is that my kids are freakin awesome. Resilient. SO. Much. Fun. Way more social than I am. Adaptable. And as much as I feel like I am never home, they have taught me to appreciate the time that I am.

Off to Year 2!




Thursday, April 19, 2018

Open or closed? How do you deal with emotions?

My whole life is organized into boxes. (ie, my blog name). I like to compartmentalize, keep work and home life separate, keep public me and private me separate, emotional me and getting-through-the-day me separate. Usually, this works. I can be the happy, relaxed, fun loving mom I want to be to my kids, efficient and professional at work, and contemplative when I'm by myself on a run or on my own. But recently,  I have not been able to figure out who I want to be or who I am when I'm with my husband. The problem, I think, is that I want to be all of me for the one I love and built a life with, but I'm having a hard time putting it all together in a cohesive, not unpredictable, way.

A lot of what we as physicians see daily gives us perspective, and makes us confront our own mortality. It's heavy stuff, if you let yourself think about too much. So I try to leave work at work, keep the danger stories or cool saves to share with my family, and  compartmentalize. With the kids, it is easy. But it is sometimes hard to explain to my partner the intensity of what I do and see daily. I want to share, but sometimes I can't begin to explain or unpack my feelings. I have never been an emotionally open person and keeping things inside and putting on a happy face is how I have been able to overcome a number of difficult periods in my life. It has worked for me before, but now it is creating an emotional void between me and my partner that I don't want to get any deeper. As I write this, I realize more that the problem is that since I can't try to explain, I don't. I simply shut it down. And then, eventually, pandora's box opens and all spills out.

For those of you with non physician partners or partners whose days look very different than yours, how do you balance? Any resources that you have read, or used, to help me feel more comfortable expressing myself and verbalizing my thoughts?






Wednesday, February 21, 2018

Adventures in Pumping


Life is going pretty great for Team Kicks. Baby is almost 4 months old and is a complete joy. He has a sweet easygoing temperament and *usually* sleeps through the night. We are so spoiled and it is so easy to leave work behind and come home and cook dinner while we sing to each other - me from the oven and counter and Baby from his bouncy seat on the kitchen floor - then playing and rolling (!) until bedtime. Love.

However I grossly underestimated how not-fun it would be to be a resident and pumping. The number one thing I underestimated was how hard it is to keep and transport clean parts. There are CDC guidelines for this stuff - wash every time, let air dry, yada yada yada. Not happening. In the fridge the parts go. I have one friend who has an extra set of parts at work for each pumping session. Love the idea but my pump (Spectra) is huge. I was traveling with two bags for awhile (pump bag + work bag, not to mention a coffee thermos in one hand and a water bottle in the other) but I was clearly such a hot mess trying to keep all my things afloat my mom finally bought me a little wheelie suitcase that at least fits all my pump parts. So I wheel around the clinic and the hospital and started leaving my laptop at home which at least makes me appear a bit more together.

I told myself early on that breastfeeding was NOT going to be something I was going to lose my mind over. I was not going to schedule a middle-of-the night pump - if Baby is sleeping, I am sleeping. If I had to give up breastfeeding for any reason, fine. I was a formula fed kid and I turned out a-ok. As I tell my moms in clinic,  the best thing for baby is to be a fed baby with a minimally stressed mom. However, as I found myself pumping in my car on the way to work in a skinny little nursing sheath in subzero winter temperatures and a car that was slow to warm up, I questioned whether I was actually sticking to this sanity thing.

I would like to dedicate this post to my 3 pump-spirations - I have three wonderful co-pumping co-residents in my life. One has a similar go-with-the-flow (hehe pump puns) attitude towards breastfeeding as myself and was the first to recommend car pumping. One has a baby almost 6 months older and was answering my very basic pump questions via text months and months earlier. And one is so dedicated she has a middle of the night pump scheduled to keep her supply up and she is still a bomb resident every single day. My residency is so pump/breastfeeding friendly I've never seen a new mom resident without a breast pump along. So we can do this. Plus anything after 6 months I consider a bonus.

I still have so much more to share about pumping. Awkward conversations with older male specialists. An episode with a preceptor where I was about to run to my pump an hour later than planned when my preceptor started sharing this emotional story and all I could think about was...time to pump....time to pump.... So sanity = questionable. I do address pumping a lot more with my postpartum moms in clinic now - especially with my non-English speaking patients who I discovered I had been prescribing double electric breast pumps for but never addressing how/when/why to use it.

If I had any tips for pumping residents/students/physicians so far I would say 1) hands free pumping bra 2) pumping in the car is a game changer and 3) seriously go buy a wheelie suitcase with all the pockets if you don't have a nice pump bag. Anyone else have any tips? Still have a few months to go. Would also love to hear some ridiculous making-the-pump-work-at-work stories if you've got 'em.

Tuesday, January 23, 2018

Tales from intern year




I am now several months into intern year. The first few weeks... months... of intern year almost seemed like a daze. Wake up. Work. Eat, sometimes. Sleep, maybe. Rinse and repeat. It was only a few short months ago, which almost seems like a lifetime ago, that I was looking back at the trek through med school and wondering what loomed ahead in intern year.

Several weeks after that, I was sitting in an orientation for newly minted residents, listening through a whirlwind of talks about figuring out the EMR system, deciphering HR benefits, wellness talk by the program director, who predicted our intern year trajectory would go thusly: "first 2 months being scared s#@*less, next 2 months starting to feel little more comfortable, and the next 2 months, which puts us squarely in the middle of the long dark nights of winter, being depressed, the gloom of which will start to lift off with more daylight hours".

The beginning of intern year felt so jarring, to one day suddenly have people refer to me as "Dr. Lastname" instead of "Firstname" or "yo medstudent". Not exactly an unexpected outcome, I got plenty advance notice that was coming after 4 years of medical school. But I was so used to being either ignored by nurses or being treated as a nuisance, that when they suddenly started asking or paging me about whether to give insulin to this patient or Ativan to that patient, yeah, my thoughts at the time are illustrated above.

I remember agonizing endlessly over the smallest of decisions in the beginning. "Doctor, this patient is asking for Tylenol". "Let me call you back in 10 minutes after I do a thorough chart review to make sure I don't harm this patient with Tylenol with some contraindication that I haven't thought of as yet". I distinctly recall the jubilant moment of the first day of intern year when my co-intern and I high-fived each other after our biggest accomplishment for the day, figuring out where the restrooms were!

As months rolled on, just by the virtue of doing the same thing over and over, I started to feel more comfortable. Though I have soooo much more to learn and improve upon, reduction of that initial cognitive burden (figuring out the EMR, where the restrooms are etc.) has helped with efficiency. Some things have started to become second nature, with enough jolts to snap me out if I become to reliant on heuristic thinking.

There was something to what our program director said in the beginning of the year. We mostly followed his predicted trajectory, cluelessness --> tenuous comfort --> gloom. Which now brings me to the deep dark cold months of winter, which coincides beautifully with the peak of influenza season, everyone getting sick, chaos of finding coverage, and on a personal front, uncertainties of kindergarten/pre-K lotteries. Perhaps his predicted trajectory will continue, and when things settle down, and there are more daylight hours, gloom will lift?

Thursday, December 28, 2017

Chocolate Sprinkle Sandwhiches

I cannot believe it has been so many months since a post. A quick update...

1) Biking to work is so unbelievable. When we moved across the country, one promise I made myself was that if I had to fly 3000 miles to train in my dream specialty, there was no way I was going to sit in traffic every day. So we found a house that is a good bike-able distance from the hospital. I have composed so many posts in the many early morning and late (and odd, 2 AM post shift) rides home, but none have translated into an actual post. I'll catch up.

2) Time is a great healer. A great equalizer. A great decompressor. When we first moved, everything was so raw, so scary. It stayed that way for a while. That fear, uncertainty, difficulty, and stress was only compounded by having our moving truck arrive a month late, evacuating for a hurricane, and realizing that being a resident is really intimidatingly scary stuff. Also, my son HATED school. And my husband realized finding a job was not as easy as it seemed in a new city with no contacts or networks. But all that is over now.

Which brings me to now...

Some days I feel like super mom. I have prepped meal plan organized food in the fridge, menus written on the kitchen chalkboard, cut up fruits and vegetables to snack on. My kids have their backpacks and lunches packed by the door, clothing laid out on their beds. I'm rocking this mom/resident thing. But then there are days like tonight. I was coming off a really hard stretch of super intense 5 nights in a row. Working over Xmas in a vacation spot is like Target on Black Friday in the ED. So. Many. Patients. So. Many. Drunk. People. So. Many. Lacerations/Holiday Hearts/I left my meds in another state. Just. So. Many. So when I had a "switch day" from nights to days, I slept. Then I made a cake. Then I went out for a manicure. I had no energy for the market, meal prep, lunch making, and homework organizing, so we took a night off. But today, I had an early morning shift, that stretched from "I'll be home by dinner" to "I'll be home after a central line/LP/all my notes." Our wonderfully flexible nanny texted me at 5 pm asking dinner plans. At 5:30, I got a picture of my kids eating their favorite go to snack-for-dinner: Chocolate hazelnut butter sandwiches with rainbow sprinkles, on whole wheat bread. At least it's whole wheat? And the "healthy" brand chocolate butter instead of Nutella?

One thing I am learning as a resident/mom without my family around is that I can't do it all, and I can't pretend to do it all. I have learned to be okay not looking put together all the time (ie: show up to the holiday show post overnight in scrubs), be okay that my kids eat the provided lunch plan instead of a cute bento box, and be okay that I have yet to attend a single PTA function and don't really feel guilty at all.

Hope to post more often,
Boxes

Thursday, October 12, 2017

Waiting Waiting Waiting




Baby's official due date is 4 days away.

We are as ready as we are going to be. The hospital bag is packed. The date night(s) have been had. My last day in clinic was 4 days ago.

And I am going crazy just sitting here, waiting.

My husband is too - a few nights ago I was feeling uncomfortable/crampy, and he read to me off Google that "being uncomfortable might be a sign of early labor" - but then I took a bath and felt better and we were both disappointed.

I never understood women that were "so done" with pregnancy until I hit 38 weeks. After all, childbirth doesn't look like a whole lot of fun and I've never seen the point of trying to hurry it along. However, at 38 weeks, all of a sudden, sitting sucked, standing sucked, walking sucked, and so did laying down. My clinic patients would catch me wincing at work while waddling from room to room. One of my most complicated patients who has multiple serious concerns at each clinic visit told me I should probably go home and take it easy. Another one caught me making a face while I was auscultating his heart and told me he was afraid I was going to have the baby right then and there. No longer scheduling me in clinic was probably a good idea.

The rest of the last three weeks have been filled with research elective time. I thank my lucky stars my program director has had enough pregnant residents to know that research would be a great use of my time leading up to baby. I have probably been driving my research mentor crazy - I have nothing else to do to distract myself from the waiting and the constant discomfort, so I've been working ridiculously hard on my research project and I have a tendency to send her these long detailed emails only a day after we've met and hashed out the details on the last one.  I also find myself spending a lot of time on Google reading terrible parenting/pregnancy advice on blogposts (obviously not this blog!) and also relevant medical literature on PubMed to my situation (Fun facts: 30% of women will try some kind of non-pharmacological measure to try and start labor. And there is good evidence behind "membrane stripping" with a number needed to treat of 8 to prevent a formal induction!).

I haven't had this many nights/weekends off in a row since before med school clerkships. We've stopped making any sort of plans on the weekends. Last weekend I couldn't handle the not busy-ness any more and spent a day making 10 of those freezer meals for when we don't feel like cooking (never done that before).

I know I will want to cherish these moments of quiet, of resting, of the calm before the storm, but I still find myself silently pleading with baby to hurry up and meet us soon.

Sunday, August 13, 2017

Street Cred with a Belly

Hello everyone - I joined this blog so hopefully I would remember to take a moment to reflect on my experiences and have the chance to learn and share from you all, so I wanted to share some reflections from my last couple months.

I've always joked with people that I planned on starting a family as a family medicine resident to give me a little more street cred. I am one of those people that still gets carded walking into 18+ establishments - and hopefully someday I will be grateful for this, but at times it's hard to take advice seriously from your teenage-appearing doctor. The most common look I get when telling parents they need to wake up their baby more often because they are not gaining enough weight is the one-eyebrow-raised "mmhmm. Get back to me when you've had kids" look. So I thought on some level, baby = credibility.

I am enjoying being pregnant and seeing patients much more than I thought I would. I'm 31 weeks along now with a very obvious belly. One parent recently pointed at my belly in the office and told her 2 year old "See, she's having a baby too!". I am having so so so much fun seeing my OB patients in the office and commenting on our bellies at the same time. I feel like my advice is taken a little more seriously ("I know it's hard, but..."), but it's more so I am developing wonderful relationships with my patients. I have one patient that is due within a week of me - so we are hoping she goes first so I can still deliver her before having my own. We are delivering at the same hospital, so chances are, we'll be right down the hall from one another if that plan doesn't work out.

Something else that has been surprisingly enjoyable is the change in my interactions with patients in the hospital. Especially my lovely little old ladies. My rounds have become much less efficient as my patients are starting to ask me more about my life as I try to ask about theirs - but again, so much more enjoyable. It reminds me why I like medicine and connecting with people.

My favorite patient encounter this week was with one of my stroke patients in the hospital. She was recovering well from her stroke physically, but she continued to be unable to speak and express her thoughts. I was going in the room with one of my other senior residents to try and assess how much she was able to understand us. While the other resident was talking to the husband, my patient looked at me, looked down at my belly, looked up with a confused look at my face, looked at my belly again, and looked up at my face and smiled. I thought to myself "Ma'am, you know exactly what is going on here". She just left to a rehab facility and I hope she's doing well.

Thanks for letting me share with you all :) I am just eternally grateful for this experience right now. If you have any stories from times you were glad you were a mom or expecting while you're a doctor I would love to hear more!

Monday, July 31, 2017

MiM Mail: Residency applications and motherhood

Dear Mothers in Medicine,

I've been following your blog for a couple of years now, and every single post has worked for me as an inspiration to stay strong and fight for what I love, medicine. But today, I have found myself in a confusing position and I really need advice on a special subject, residency application and motherhood. I'm currently an MS4, yayy!! And as application day approaches, I have been working on my personal statement however, I'm encountering that one of my biggest assets (or so I feel) is being a mother. I have been advice by all my friends at medschool to not even mention my family, husband or 2 daughters (2yrs and 5 months). According to most people having a family will make me a less reliable resident than someone without strings attached. However, this is my story:

I married after college a few months before beginning medical school, my husband and I had been accepted to the same school, and things sounded great. During the first year we adapted to the new environment, developed our studying skills and set our expectations for matching one day.

Fast forward 1 year, and baby #1 came along. She was born during our 2nd year. We managed to fix our schedules for studying around the clock and created routines that allowed us to keep up with classes/exams while taking turns to care for our daughter. No LOA requested/no gaps, we were lucky enough that our baby#1 was born right before one break so we had 2 weeks off to adapt to our new family, and organize. Somehow, we survived and made it worked. Now, let's fast forward one more year and baby#2 came along (we wanted our daughter to have company as our families live across the country). Once again, we worked our way around it. I was able to get 1 week off during one of my rotations and resume the following monday. The attending was very understanding and seem surprised to see that I had decided it to keep going and again no LOA, no excuses given.

Today when I look back, I see that everything that I have done until this day has shaped me to who I am at this point. My desire to pursue medicine, and my determination to continue has remained strong while building the family that I always dreamt of. I always thought of medicine as a career choice not a life changer. As a mother, I feel that I learnt to be more organized and time efficient, I proved myself to be dedicated and goal oriented. So far we both remained on top of our class and have shown the same commitment since day one (I say we because this took teamwork). I took my step 1 and Step 2 CK/CS while breastfeeding/pumping because I wanted to continue to care for my daughters while working really hard to accomplish my goals. I wasn't willing to stay behind. Being a mother helped me connect with patients at more than one level, becoming very understanding of their concerns. I will applying to pediatrics because not only did I mentioned it on my personal statement when I applied to medical school as I always had a passion for peds but during these 4 yrs I realized that I'm drawn toward the field naturally. So I wonder, how can I write a "personal" statement of who I really am and why if I cannot mentioned how I became me and why I think I can be a good asset? I feel that a good physician should be able to show balance and commitment while remaining human and empathetic. Us moms, do this every day at home and on the field. Some people even believe in not even mention it during interviews but to be honest I am proud of being one and hope to become a great physician one day. Please any help or guidance. I am really confused right now.

Thanks in advance for all your help.

An MS4 hoping for the best!!

Thursday, June 22, 2017

Moving with Boxes

Hi! I am so excited to join this community. I have been following since applying to medical school 6 years ago and now, med school and 2 kids later, am honored to be able to share with this community more regularly.

I am usually an upbeat, sunny side up, West Coast girl. But I would like to introduce myself with a post that bares my soul and reflects a more raw version of myself. Below is what I wrote 3 days ago, the night before getting on a plane with my husband, kids, and dog, to fly across the country to start EM residency. With the chaos of moving I didn't have a chance to share until today. I'll hopefully post a more positive update later next week!

I'm flooded. And overhwlemed. and the dam that has been holding my emotions at bay has broken and every thought, fear, feelings of guilt, absolute fear, and sense of desperation keeps washing over me, unrelenting, like a wave, as I fight the current in the tumult of emotions  that keeps pounding relentlessly. 

let me backtrack. 

when I fell in love with emergency medicine the beginning of 3rd year, I knew that was the only field of medicine for me. the pace, the variety, the sense of camarederie, the fast paced atmosphere. I was hooked. I also knew that getting a residency position in my home town would be a stretch. my step 1 scores were okay, but test day was blunted by braxton hicks contractions and running to the bathroom with my 8.5 month waddling belly and I underperformed all my practice tests by about 10 points. so when eras and interviews started, i knew that moving away from my hometown was a real possibility, if not probability. 

on match day, i told me parents and grandparents and aunts and siblings  (who all live within a 5 mile radius of me and the med school) not to come. i knew i would not get in to the top 10 rated programs in my hometown. i was right, and opening that envelope ensured that my husband, 2 kids, and i would be traveling for an adventure across the county for at least the next 3 years. 

i went into GO mode. i found a house, registered the kids for school, hired a moving company, organized a goodbye party. but we leave tomorrow. and i am now terrified. 

i had my daughter, Chicken, a few months before starting med school and my son, Monkey, after Step 1. My kids go to my parents every day after school and most weekends when i need to study. They play at my grandparents' house on Sundays. My aunts and siblings have driven more carpools and orgsnized playdates and provided last minute babysitting more times than i can count. and now i am leaving the village that helped my little family thrive in med school and we are leaving so so far away where we have none of that.

i am just so scared. so scared that my kids will feel lost and alone. so scared that they wont be able to continue strengthening the amazing relationships they have with their grandparents and great grandparents. so scared that i will ruin or permanently derail my husbands career. so scared that it is all my fault because chose too competitive of a residency and wasnt good enough to get in at home. 

i love my program. i am going to love residency. im just so scared of what i am going to mess up in the process. 

Thursday, January 12, 2017

Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work?

Genmedmom here.

Let's talk about sex, sexual orientation, race, religion, and disability, and being judged by those things, in the workplace. Have you encountered assumptions/ prejudice/ racism/ sexism/ intolerance/ harassment/ discrimination at work? 

It's definitely an appropriate political climate to be discussing this issues. Even aside from the blistering rhetoric of the past year, let's face it, for many folks, a "real" doctor looks like Marcus Welby, M.D. You know, a white, gray-haired, suited man who exudes experience and wisdom. Not that there's anything WRONG with that...

These negative attitudes can manifest differently, and span a wide range of experiences. 

The way I see it, assumptions can be innocent. These can be sort of insulting things said by well-intentioned people. They may be based in inherent bias and unconscious attitudes. Like, for example...

How many times during residency training did I walk into a patient's room, and they assumed I was anyone BUT the doctor? I was asked to clear the cafeteria tray more than once. Even after introducing myself, I was often referred to as [insert non-M.D. staff title here] and asked to fetch things: a glass of water, blankets, a urinal.

Sometimes, those assumptions annoyed me, and I acted annoyed. Other times, I tried to be cheerful and helpful regardless. I have also been guilty of making assumptions about others, and have had to retrieve my Dansko-clad foot from my mouth...

Then, there are more obviously negative/ hurtful/ damaging experiences.

During residency, a senior physician (a Marcus Welby type) whom I respected greatly and had been working with for some time chose a younger, more inexperienced, pretty unreliable male trainee to lead an endeavor that I had been interested in leading. Oh, that hurt. I wondered and fretted, Why didn't he choose me? What secret glee I felt when the young lad never followed through, and the project collapsed! Karma, man. Karma.

A woman I trained with had a miscarriage, and the supervising physicians would not allow her any time off. It was a first trimester loss. "Think of it like a heavy period," they said. "Would you call out for that?"

What I observed throughout all of my medical training was that women received very little understanding, consideration, or flexibility during pregnancy, maternity leave, or breastfeeding. The prevailing attitude was "suck it up, buttercup."

Then, I remember as a fellow, when I was interviewing everywhere for jobs. I was singled out by a senior physician (Yup, Welby again) for being half Latina. I was asked to take on a faculty position in part "because then we'll be closer to meeting the requirements for minority recruits. You can really help the department to look more inclusive. That'll be such a bonus."

That felt weird. I did not take the position.

In that job search almost ten years ago, I sought out a flexible position in a positive environment at a progressive institution, and I am satisfied that I found all of that and then some. The few negative experiences I had prior definitely informed my decision, and helped me to recognize what I didn't want as an attending.

I'm aware that many of you have had much worse and many more negative experiences than I did, and I'm wondering:

What did you encounter?

How did you manage, supercede, overcome?

What did you learn from the experience?

Do you see things getting better, or worse?





Wednesday, September 7, 2016

10 myths about radiology

Hello MiM community,

It has been awhile since my last blog post. I graduated residency in June and I am currently in month 3 (where has the time gone?) of my breast imaging fellowship. I stayed in the same institution as residency for fellowship. My little C is less than 4 months shy of being 4 (!!). Big C finished his orthopedic spine fellowship on the east coast in July and after a nice 5 weeks of having a stay at home husband, he started his attending job in a city 2 hours from me and little C last month. It has been a busy summer!

I am currently surrounded by medical students applying to residency, which made me want to do this post. And now that I'm a PGY 6 in my radiology training, I think I feel somewhat equipped to dispel some myths about my specialty and I thought it would be a good opportunity to go into the medicine aspect of my life since most of my posts have been about my role as a mom.

1. We are anti-social. A huge part of our job is communication not just with patients but with other physicians. We talk to physicians from all specialties throughout the day. We often present at multidisciplinary tumor boards. I can't speak for all radiologists but the ones I work with and myself included, we are very extroverted and approachable!

2. We never see patients. This may be true if you decide to go into teleradiology post residency. However, during residency, we see patients all the time--whether it be giving results, scanning patients or performing image-guided procedures. As a breast imaging fellow, I spend half my fellowship doing mammographic-guided, ultrasound-guided or MRI-guided biopsies/localizations. In addition, we often have to speak to patients to relay biopsy results. There is the option to not see patients but this will not be the case during residency and the choice is always there for patient interaction post training.

3. We are lazy. Being married to an orthopedic surgery resident, I have the utmost respect for these grueling specialties. We may not wake up the hours of other specialties but we are definitely not lazy. The time we spend having to study plus the time we spend at the hospital would often sum up to 60-80 hours of week during the earlier years of our residency. In addition, our residency is 5 years plus an extra year of fellowship (which is typically not an option as everyone does a fellowship post residency.) Our radiology boards are 2 days--that includes 18 subsections including physics! The amount of reading on top of working in the reading room equals so many hours that we put in outside of work that most people don't realize.

= 4. We love sitting in a dark room all day, every day by ourselves. This is definitely not true especially during residency. Radiology is a unique residency in that we are often one on one with an attending all day, working together and learning from him or her. In fact, this also debunks the fact that we are anti-social as we need to learn to interact and get along with someone we work with all day. In addition, our dark rooms are often frequented by visitors usually in form of clinical teams and occasionally patients.

5. The job market is horrible and no one can get a job. The job market may not be what it was in the past but there's always a supply and demand when it comes to medical imaging. As the reliance on medical imaging only continues to grow with the increase in number of CT and MRI scanners, the job market for radiologists will always be open. As someone who is only looking for a job in one city (one that is super competitive I might add), I have been surprised at the number of listings as well as the number of responses as a fellow in only month 3 of fellowship. In addition, I have only just begun my job search (literally 2 weeks ago).

6. Radiology is boring. I may be biased but I find radiology incredibly interesting. We see different pathologies across specialties on a daily basis. We often get to make the diagnosis and provide a differential. We are not involved in the treatment but for me at least, coming up with the diagnosis is the most satisfying part of my job as a physician. In addition, it is a field that is constantly changing as technology evolves. Imaging utilization only continues to grow and different applications of imaging for both diagnosis and treatment are constantly being researched and incorporated into our specialty.

7. Women should stay away from radiology because it will fry our ovaries. I was pregnant my first year of residency. I have a perfectly normal, adorable daughter. Yes, to be completely honest, radiation can affect a woman's reproductive capabilities but you would need direct radiation to the pelvic area and the amount of radiation would have to in the amount that is used for radiation therapy in oncology treatment. Therapeutic doses are often 1000X more than diagnostic doses (even a CT). Furthermore, as a radiologist, we are shielded from significant radiation doses with the use of radiation equipment and radiation protection practice shields (lead, lead glasses).

8. Radiology as a profession is useless because physicians can interpret their own films. Physicians across all specialties order medical imaging and it should be their responsibility to look at the images they order. However, a formal interpretation by someone who trained in this field for 6 years is completely different. There are many times that the ordering physician has more clinical information that helps in the interpretation of the study. However, when it comes to interpreting the study as a whole that is what we are trained to do--we look to see if its an adequate from a technical point (are there any artifacts on the study? is there too much patient motion?), we look at the entire study (for example, CT abdomen/pelvis is ordered for belly pain and on the few slices of the lung bases, we find a pulmonary emboli), we decide on how to make image quality better (do we need to increase the field of view? what should the slice thickness of the images be?) and lastly, we often decide if the correct study is ordered for the right indication while minimizing radiation dose to the patient (does the study need to be done with contrast? can we do an MRI rather than a CT in a pediatric patient? what study should we order in pregnant patient?)

9. We make too much money for what we do. I can't speak for all specialties except my own but I find it unsettling when I hear this about radiologists. We put in our time with our 6 years of training. We take our boards. We have written reports that cannot be disputed--if we miss something, it is evident that we missed something. Just like any other specialty, we are learning a valuable skill set that helps our colleagues and patients. 

10. We are not real doctors. This one applies more to the general public. We are not the technologists. If I got a dollar for every time somebody asks what I do for a living and I say I'm a radiologist and I get the response "oh yah, I met a radiologist last week when getting my "insert imaging modality" done," I would be incredibly wealthy. However, for someone interested in radiology, the prevalence of this myth one is something to be aware of. I always discuss with my husband who often gets cookies/cupcakes sent home from his patients that as a radiologist you have to be okay with sometimes not getting the direct satisfaction of "saving a life." It's not always "saving a life," but often times we do make the diagnosis but we're not the ones who relay the good news (or bad news) to the patients. I am okay with that. People choose to go into medicine for different reasons and some thrive off the direct acknowledgement from their patients. For me, as a radiologist, the internal satisfaction that I am helping my patients is enough.

Lastly, good luck everyone in their residency applications regardless of specialty!

X-ray Vision

Monday, February 8, 2016

MiM Mail: A hard pregnancy during residency

Hi,

I've been a lurker on the Mothers in Medicine blog for awhile, and let me just say, the stories and posts have been so comforting to me, especially on my tough days. I'm a third year resident, currently in my third trimester of my first pregnancy in a two-resident household. I wanted to share my pregnancy experience to see if I could gather some advice from fellow mothers in medicine. I feel quite isolated as the only resident in my male-dominated program to be a new mother/pregnant in a long time, and at a hospital system where few female residents are mothers/get pregnant during residency, in general.

My pregnancy has been hard, to say the least. I envy all of those mothers who have the pregnancy glow, who have boundless nesting energy, and who just "love being pregnant!!!" My pregnancy has not been like that. First, it was unplanned, and happened about a month after my husband and I got married. I found out the day after my 24 hour call; I was so nauseous and I was late. I took the pregnancy test two times before I could truly believe that the two lines were actually there. After I confirmed the positivity and announced the news, it seemed like everyone was happy about it, but me. I had unknowingly performed multiple fluoroscopy procedures, and I was so worried about what the effects would be on the baby. I consulted my OB, a radiation physicist, and multiple radiologists, who assured me that this early, the effects should be all or nothing, and if the baby had made it through to this point, everything should be fine. My husband and I made the decision to proceed with the pregnancy. We felt that women go through pregnancies in worse situations and conditions, and we should be so lucky to get pregnant this easily with a supportive environment there to welcome the baby when he/she arrives.

Anyway, fast forward through first trimester, which was fraught with all- day morning sickness that even lasted through my night shifts and into my second trimester, to third trimester, where I now find myself having failed the 1 hour and 3- hour glucose tolerance tests. Just barely. I'm now diagnosed with gestational diabetes, and I feel like a failure. Prior to being pregnant, I was skinny, fit, and perfectly healthy. The only risk factor I had was being Asian. The news was terrible; I had been feeling like I couldn't excel as a resident, and now, I felt like I couldn't handle my duties to be a healthy pregnant mother. As someone who has been usually been able to balance multiple plates somewhat successfully, these two losses felt like huge blows.

I've been dealing with gestational diabetes the way that I deal with most challenges in my life; through hard work. I've been increasing protein intake, decreasing carbohydrates, logging my food religiously in a diary, pricking my finger 4 times a day, and walking at least 5 miles a day. My post-prandial sugars have been great. They're super tight, and well below the cut-off of 140. In fact, I haven't had an abnormal number. On the other hand, my fasting sugars in the morning are a touch high. The cut-off is 95 at my physician's office, and mine ranges from mid eighties to mid-to-upper 90's. Actually, there have only been 3 values from 95-100. My physician has given me until Monday to get the values down, before I have to go on insulin. I've tried everything to no avail. I still have 2-3 values hovering at 96. I feel like considering these numbers high is like splitting hairs. But I think my physician disagrees.

It's not that I'm against using insulin. I'm all for using insulin... that is, if I'm truly and outrageously hyperglycemic. I've done my research (on primary literature resources) and read that physicians will use cutoffs of less than 90, 95, 100, even 105. My range is in a gray area. There's also been a paper published showing that if the pregnant woman has no risk factors (the baby is not measuring large, there's no polyhydramnios, etc.), then the physician will let the fasting glucose ride to 105 before initiating insulin. The paper showed that aggressively treating lower risk gestational diabetes women (below 105, and with normal to smaller fetuses) with insulin may be associated with restricted fetal growth. I would be considered a "lower risk" mother, as my latest ultrasound this past week showed the baby was measuring below average, and everything else was normal. I also don't want to run the risk of being hypoglycemic, which I think is a valid concern, given that I'm about to enter a much busier rotation in which it will be harder to eat, and in which, if i become hypoglycemic, would be disruptive to patient care.

Do you guys think that my hesitancy about insulin in my situation is unreasonable? How should I approach the conversation with her? Of course, if more of my numbers are abnormal, then I'll definitely initiate insulin. I already superficially brought up this concern to my OB, which is why she has let me wait until Monday. But it seems like she is pretty set on starting me on insulin that day no matter what I tell her. She dropped the cutoff, saying that normal pregnant patients' fasting blood sugars run from 70-90's, and that tight control is necessary to prevent macrosomia and to improve the baby's transition (and to lessen NICU admission). I don't want to be "that patient." But at the same time, even though this is not my field of expertise, I do have health literacy, and I don't want to act too aggressively to make an already stressful situation more stressful. I don't feel like I'm as high risk as she's making this out to be.

I really appreciate your thoughts and opinions.

By the way, I have been and will continue to work 24 hour shifts and nights into my 9 month. But that's another dilemma for another day.

Thank you!

Thursday, February 4, 2016

MiM Mail: Turning Back

Dear MiM,

I was first introduced to MiM 7 years ago when I was on the path to do a clinical psychology PhD and considering changing my career to medicine. A great mentor was trying to encourage me in both my dream to someday have a family (I was single at the time) and to practice medicine. Fast forward and I am sitting in a "How to make a Match rank list" meeting, fighting back tears.

The problem is, I'm not sure I want to Match. Don't get me wrong, I love medicine and I don't feel that anyone led me astray. I can see myself practicing (probably part-time) in the future and being able to love my work. I am not discouraged by the notion of having a family in medicine. I simply do not think I have three more years in me. For months, I've been interviewing and trying to envision how my life would fit into each residency program and I've become increasingly discouraged. I am envious of my friends with their 8-5 jobs that support their lifestyle and am disheartened by the concept of spending a lifetime trying to make my lifestyle fit my career. My partner - who still loves me dearly and who has patiently supported me through a post-baccalaureate program and four difficult years of medical school (and poverty) - has talked about us splitting because he does not believe he can survive three more years of bending to my schedule and being alone so much of the time. (As an aside, I do not blame him for considering this, and I ask that you do not blame him either.) Add to that, there are no programs where we currently live. We have just begun to fall in love with where we live, we have many non-medical friends, my partner has a fantastic job (that is not transferable), and our families are within a reasonable drive. When I started down this path, a partner and a family were merely figments of my imagination. Now, I am the worst half of a relationship, the partner who is never available to be spontaneous and when I am, is exhausted and out of shape. I am the person who is hindering my partner's career and tying him where I need to be. And, perhaps even worse, I owe him everything because I could not have made it thus far without him. Plus, I have some health issues that may impede my fertility, and the clock is quickly winding down to when the risks of pregnancy far outweigh the benefits. Add all that to $400k of debt and I feel terrible while all my classmates around me excitedly making their Match lists.

So do I pack it all in now, graduate with my MD and move on with my life, ashamed but being free of the struggle for balance in medicine? Or do I go through the Match, probably lose my life partner and simply cross my fingers and hope that a) I make it through with my mental health relatively intact and b) I can overcome my resentment and still enjoy medicine? This is such a sensitive topic that I am afraid to reveal my reservations to my mentors and I have valued the fantastic insight of the MiM community thus far. Thank you, in advance, for your support!

Sincerely,
Struggling with the Match

Thursday, October 29, 2015

Season finale of “As the Residency Turns”

* DISCLAIMER: I meant to post this back in June as I finished residency but it got put aside as I filled out my umpteenth credentialing application. Here it is now. I wrote it 2 days before finishing my last primary care rotation of residency:

After 3 years of residency I have had some amazing interactions with patients. Amazing in the wonderful way the 9 month old whose well child checks you have always performed smiles and babbles when you walk in way and reaches out for you to hold her. Your heart opens wide, the parents are at ease and you think to yourself, “yeah, this is why I do this!” Or amazing in the way things go when a developmental delay I picked up is being addressed by Early Intervention and we can all see how the affected child is flourishing. Or when you talk that sexually active teen into being more assertive in communication with partners and you get her to get a Nexplanon.

Then I have had some intense interactions of the other kind. Intense in the I was so concerned that I called Child Protective Services and now a CPS worker is here with you and you are yelling at me and I am crying and I want to work with you so much but you hate me right now and won’t listen to anything I have to say kind of way. Intense in the way things go when a parent has what appears to be bipolar disorder and splits on providers and one minute says our hospital saved his/her child’s life and the next is cursing about how several of our providers did them wrong.

During the amazing ones, my heart soars, during the intense ones my heart plummets and I often get palpitations. I have been having a few day run of extreme highs and pitiful lows. I have 2 more days in clinic before my last day of residency at the end of June and there are so many loose ends. I realize that clinic is the only part of residency that resembles continuity; we do other rotations for a month at a time and are essentially visitors but in clinic you are like the cousin who comes home regularly for major holidays and family gatherings.  The end is in sight and I feel like I need some closure - so much so that I helped draft a letter to our patients from the graduating seniors updating our patients on where we would be going and now parents come in and say “Dr. Bee - you’re really leaving us?!?”.

There are so many amazing patients who will continue to grow and I will miss their new developments. And I have a few difficult patients who once I’m gone will literally have no one else who wants to work with them. 2 more days. What can and will I do? Why does it feel like such a huge deal? I think I’m scared and sad that things are coming to an end, it’s for the best, right? Why do I feel like a success and a failure all at the same time?

Thursday, August 13, 2015

MiM Mail: Not excited by the OR anymore

Hello all,

I was a huge fan of this forum as a woman in medicine, and now I am a brand new mother to a sweet 1 month old baby girl.

I have completed the 4th year of a plastic surgery residency at a competitive and busy program, and am currently taking a research year to have more time with my daughter. My husband is in medicine as well.

I am writing because when I decided to go into surgery (albeit plastics, which is a little bit less demanding), I had not even met my husband and did not think I wanted kids. Obviously my priorities have changed.

Since becoming pregnant, I have been strongly considering a change in specialties or leaving medicine altogether. My new priority is being a mom, being present, and being focused on my daughter's upbringing. Plastic surgery demands long hours to build a practice, rigorous call, and exhausting surgeries that take a lot out of me by the end of the day.

I know switching would mean lengthening my training at this point since I only have 2 clinical years (and probably fellowship) after this research year. But I can't help but think this will be so much better for us in the long run. It makes me a little sad since I have invested so much in my surgical training already, but I don't know if I would be happy continuing on this track. I am not looking for an "easy specialty" since there is no such thing, just one that better fits my priorities. Otherwise, what other options are there outside of medicine?

I liked PM&R when I was a medical student and found it uplifting since you got to see patients' long term progress. I also liked emergency medicine for the immediate feedback and fast pace (the same thing that drew me to surgery initially). I think I need to bite the bullet and find something with more of a fixed schedule that allows me to focus on my family when I am at home, rather than being a slave to my pager. I am just not excited about the operating room anymore, especially given all of my life changes. I have never loved surgery the way some of my colleagues do, and this confirms it.

Any thoughts or advice would be so helpful.

Thank you!

Monday, August 10, 2015

MiM Mail: Lost

Hi, I just started a 3 year residency program, and I'm feeling desperately close to quitting. In fact, if it weren't for the huge financial investment I've made up to this point, I almost certainly would have quit before I even got to this point.

I have a daughter who was born at the beginning of 4th year, and I think 4th year was probably the best year of my life. I loved spending time with her at home (despite being bored and lonely for parts of it). Now that she's older, she's even more wonderful and funny and fascinating, which I didn't think was possible. I dreaded the start of residency, which was, unfortunately, a black cloud over that otherwise wonderful year.

Now that it's here, I don't know whether it's worth it to continue. I don't find the work difficult or all that unenjoyable; I kind of like it and I definitely like the idea of contributing to our family financially. I feel like I could surely handle it all if I didn't have a child. I grieve every single day the lost time with her and the opportunity to watch her grow and be there for her babyhood, which is so fleeting and the part of my own life I want to experience more than anything. Add to this some chronic health problems that I am dealing with, and I feel so depressed. And of course there's no time to seek out treatment or professional help. I really have nobody to talk to about it. I feel like I'm drowning.

I have a supportive non-medical spouse who has a good job, though it would still be a blow of course to give up a future physician income. And I do have some loans, though well below the national average. So...I guess I'm looking for advice. Do I stay or do I go? Or should I approach my PD about some sort of part-time compromise (guessing that's a huge long shot). If I somehow make it though, and don't destroy all relationships in the process, my husband and daughter would probably be better off long term. If I go, I can start to recuperate some sense of sanity and mental and physical health, and I think it's better for me personally. Maybe I could convince myself it's better for my daughter since she'll be in a less stressful environment. I feel lost. -J

Monday, May 25, 2015

The end?!?

This morning I walked into my final official overnight call shift of residency. It is surreal to think that just 3 years ago, I began residency. I had absolutely no idea what it took, but having been a pretty good medical student I thought, “I can do this!”

Premedical studies, medical school, marriage, motherhood, and now residency have taught me about my ability to persevere, to thrive, to love and be loved. More so than the extreme highs and lows that come with providing care for a broad range of children from the critically ill to the chronically affected, you realize it is the day-to-day provision of care that is the most long-lasting. What you do on the average day at work, if your colleagues feel supported or unsupported, if your work leaves patients feeling cared for, if you managed whatever major things they were seeing you for, that’s what matters the most.

I think at the end of my shift tomorrow I’ll do a little happy dance to mark the end of an era. I am a lover of daytime work, of seeing the sunshine in the morning, of being at home when my family wakes up. I gladly mark the end of leaving home in the dark and trying not to wake up our toddler as I hustle to find my shoes. I gladly mark the end of back-to-back consult calls from the Emergency Department or outside hospitals for admissions. I sadly mark the end of seeing my favorite overnight nurses and of running efficient rounds. I sadly mark the end of being the “Senior Resident on call” answering questions for outside providers.

The end of residency overnight inpatient call and the beginning of Attending at-home call. Sounds nice to me.

Monday, December 8, 2014

MiM Mail: Geographically-limited MiM applying to residency

Hi there!

I'm a mom in my third year of medical school with young kids, lucky enough to be going to school in a city with a lot of family help and where my husband has a great job. I've recently decided to geographically limit myself to my current city for residency, for the aforementioned reasons. Although we are in a big city, my chosen specialty only has one residency program with about a dozen spots (at my home institution). I will also be needing to apply for a prelim/transitional year of which my city has three programs. I think I would be a reasonably good applicant in my chosen specialty if applied broadly, however I'm obviously making a risky decision. That said, I'd prefer to remain unmatched and do research for a year or two than move us to a new city at this point while my kids are so young.

The residency program director at my school meets with all students applying to residency, and I would like to get some advice on how to broach with him the topic of only applying to his program. I have only met him once and he knows that I have kids. I want to avoid looking not committed to medicine obviously, and I know that I could be a great physician but being close to my parents/sibs for childcare help and not uprooting my husband and kids would be quite important to my overall success and happiness. Additionally, my dad has metastatic cancer and I know if I was doing residency in another city I would not be around to see him much. Any advice for how to approach this conversation would be much appreciated!

Saturday, September 20, 2014

Birthday Call: from zero to 60 and then somewhere in the middle in mere hours

40 minutes into my commute to work, I had a pseudo-melt down. As I sang “Happy Birthday” over the phone to my three-year-old, I lost it. I realized that I hadn’t kissed him on his birthday, I’d forgotten my lunch and during a 28 hour call the cafeteria food begins to make me nauseous, and that I was exceedingly anxious about all of the changes our lives will encounter over the next few months.

Needless to say, I’m in the call room after a deluge of discharges, awaiting our next transfer, feeling the urge to write and release this tension.

My Little Zo is three today. Three years ago, on this day, I birthed a fabulous little human being into the world. He’s helped me grow in countless ways. I’ve learned to let go. I’ve learned to give my all in the moment and then pass things off to someone else (to hubby O, to my parents/in-laws, to the wonderful ladies at daycare, to his Pediatrician). I’ve learned that keeping your own kid alive and occupied means breaking lots of rules (my infant slept on his belly after weeks of sleepless nights, my 2 year old ate yogurt and spinach smoothies or oatmeal for dinner on picky-eating nights) and that I am so much more capable than I ever thought imaginable. I’ve realized what’s important (playing legos and dinosaurs before bedtime and leaving my notes until he’s gone to bed, sleep, couple time, giving my all at work and not worrying about my child since he’s taken care of at all times).

In less than a year, I’ll be an Attending and yet another goal will have been achieved. I have had a few successful telephone interviews and I have my first in-person interview in October with a community health system affiliated with my medical school. This morning when I was sobbing, a great friend, KJ, who is now a Pediatrician in private practice gave me her pep-talk. We have these at least once every few months. She tells me about all of the little and big victories she has in her life after residency. She has weekends off and time to be with her boyfriend and her dog. She tells me about her quirky colleagues and her amazing patients. She tells me how different things will be in a few short months.

So, on Little Zo’s third birthday, I went from zero (dragging myself out of bed after an exhausting month on inpatient service during asthma season), to 60 (sobbing in the Starbucks parking lot), to somewhere in the middle. I am thankful for three years of motherhood. Thankful that Zo is vibrant, healthy, active, super-smart, and super-sweet (when he’s not biting or hitting). Thankful for only 3 more days on inpatient service before 2 months of elective and that I've been able to do great work this month and keep folks' babies alive and healthy! Thankful for friends like KJ who understand the struggles of residency-based medical practice. Sad that I wasn’t at home snuggling Zo and our visiting family members. And hopeful of life after residency.

Happy birthday to my little roaring dinosaur - Mommy loves you!

Monday, September 15, 2014

Why Is Residency So Harmful? (And What Can We Do About It?)

Genmedmom here.

I'd like to thank "J the intern" for her post on physician depression and suicide on 9/9/14, as it prompted me to read Pranay Sinha's excellent New York Times Op-Ed piece "Why Do Doctors Commit Suicide?" He discusses what may have contributed to two recent intern suicides, namely, the shock of graduating from well-supported medical student to overburdened resident drowning in the macho medical culture. He describes his early intern year as "marked by severe fatigue, numerous clinical errors [], a constant and haunting fear of hurting my patients, and an inescapable sense of inadequacy."

Ah, yes. Residency.

In the comments to J the intern's post, OMDG brings up as additional factor to consider: "the elephant in the room... sometimes doctors treat each other like garbage".

Yup, I agree with that one, too. No one is more cruel to the suffering than the suffering. Many of my own emotional injury during training was at the hands of my colleagues. But, I know that I lashed out as well. We all hurt each other. I'd like to expound on that, if I may.

I well remember being humiliated on rounds, Monday-morning quarterbacked by someone fresh and showered. I cringe as I recall snapping at my intern for waking me up to check on a patient she was worried about. I'd been snapped at in a similar way as an intern. I remember with sinking stomach the disdain and sarcasm I received when I tried to teach a medical student a very simple procedure, and then couldn't do it myself. I still get angry when I think about the patients who suffered as my residents tried to teach me paracentesis, central line insertions, lumbar puncture- and failed on their attempts. I know my anger showed then. When our colleagues rotating at a small outside hospital transferred a sick patient to us in the emergency room, and it turned out to be a case of lab error, no pathology, there was derision all-around: "They dropped us a turkey, guys." When I was worried about a sick patient and called for an ICU consult, the ICU resident came, and told me I could handle it. "Don't be a wuss. Be a real doctor."

The cruelty towards women was pervasive. A pregnant resident had an early miscarriage. Still bleeding, she asked to be excused from her outpatient clinic. The chief, a woman, said no. "Just think of it like your period," she said.

A colleague went out on maternity leave six weeks early, for premature labor. Another resident was pulled from an outpatient elective to cover the rest of her rotation on the floors. The resident who was pulled was very resentful, angry to tears. "Why the f-- would anyone want to have a baby during residency? Why?" Another answered, "I'll never understand it. It's so selfish."

It's well-known that medical training erodes empathy. It took years for me to recover from residency, to feel like I could even begin to take care of people again. Literally. I did a research fellowship for three years, in large part because I couldn't imagine returning to clinical practice.

But, why did I feel this way, when my residency program was well- regarded, with many opportunities to share, reflect, even write? Why were so many of us injured and angered by our experience? So many of us recall their training with a shudder, vowing "I wouldn't revisit those years for all the money in the world."

That's just not right. How can we change it?

Open discussions confronting the cruelty of medical training may help. As a medical student, I was rotating on surgery. A rural hospital transferred a very sick patient to us, someone who had been misdiagnosed and suffered greatly. As the case was reported on rounds, there was loud derision and disgust expressed towards the rural docs. But one senior surgeon, someone so intimidating and revered that just a movement of his hand silenced the crowd, quietly admonished:

"There's no point in criticizing. Your fellow physician took the same oath you did. Assume that they tried, and that they feel terribly. We have all made mistakes, and we will all make many more. Don't waste your time on judgment."

End of that discussion, and it made an impression on me. Don't waste your time on judgment. I think, as teachers, we need to stand up and say that, and live that. Be real doctors.

We also need to dismantle that confusing paradigm of training: You are here to learn, but you should already know how to do it. Sinha also illustrates this in his essay. You were a coddled student in June, and then the doctor in July. You feel like you're supposed to know it all, because everyone is acting like they do know it all. Everyone's got a front. To ask for help is to be weak.

I remember very early in training, asking how, exactly, to write a prescription. I'd never written one before.

Oh, the rolling of eyes, the quick snappish explanation. I was so upset, I didn't catch it all. I spied on other people writing prescriptions and copied them. Seriously, how the heck are you supposed to know how to write a prescription if no one's really taught you?

How are you supposed to know how to be a doctor, if no one's really taught you?

I'm interested to hear what others' experiences have been, good and bad, with an eye towards practical suggestions. How do you think medical training be reformed?