Cycles

Ohh, I'm so glad this week is over. Actually, the week itself wasn't so dramatic (I was home sick Wednesday and Thursday, after all), but, I'm just so glad it's the weekend.

I need some vacation time. Fortunately, I have a week coming up, but I'm not anticipating that to be very relaxing, since I'm going back to Chicago (the week of New Years, for those who might have a vested interest in that). Good, of course, just kind of frenetic.

The coming week is going to be...um, let's go with...interesting. I'm on Walk-Ins Monday through Thursday (there's a long involved story about why Ed and I switched Fridays...so I have four days this week and one day next week, and then I'm on call twice the week of Christmas...). Walk-Ins refers to the Walk-In clinic, which is just what it sounds like - ideally, an urgent care clinic (I need my meds today because I'm about to run out. I'm going to kill myself. I'm going to kill someone, possibly me, if we don't get this depression treated quickly. You get the idea). You also cover the ER during the day. So it's like daytime call. Or as I tend to refer to it, Day Float.

What's nice is that it's 8:30-5. You plan accordingly and you sign out to the incoming call team at 4:30. Done. What's...um, let's go with...interesting about it is that we have this group of social workers and psych NPs and such that's supposed to be doing all this with us. They're part of the "crisis team" and are salaried to do Day Float things. This sounds great in theory, right, because in theory it would free up the physician (there's only one) to do doctor-y kinds of things. You know, stuff clinical social workers can't do (meds) or aren't really trained to deal with (complicating/complicated medical issues, physicals, orders, etc). Problem is, our crisis team tends to be...um, let's go with...inefficient. They're nice people, just sort of...unmotivated. With a different work ethic than residents tend to have. And rather than firing their asses encouraging efficiency (it doesn't have to be the threat of unemployment that's used to motivate them. How about praise? Incentives? A higher standard and expectation?), they're coddled and stroked because we don't want them to leave.

The residents this year have all been like, so let them leave. They either need to get moving, or get out of the way. We...you know, we're a hard-working bunch. We'll get in there shoulder to shoulder and fight through the roughest of shifts. And, fine, so residents in general are more used to hard work and long hours, we're sort of a masochistic group anyway, etc, but, damn it, if we're in there hip-deep, we expect the people who are paid a heck of a lot more than us to do this very job to be in there with us.

We'll see how it goes. There's a new guy, Charlie, who seems promising. We hired him away from one of the community hospitals, and every time I've worked with him on call he seems to be busting his ass. He's been doing this for a number of years, so I don't think he's going to burn out, and he doesn't seem like the type to be lazy just because everyone else is and he can get away with it, so, maybe the rest of the crew will have to step up to keep from looking bad.

A girl can hope...

I went to this talk this morning for the PECC (more about that in a minute), and the speaker was talking about what he referred to as The Lead Rule - do unto others as others have done unto you. It's so simple and obvious (and sardonic), but damn if that doesn't sum up a lot of issues in medical education. We get into these ruts of "this is how it's been" and "if I had to do it, so do you." This is particularly rampant in the surgical disciplines, but, I think it's pervasive. And I think it occasionally translates into, if no one else has to do it, why should I?

Sometimes? Life kind of stinks. Sometimes you have to do things because it's the right thing to do, or they have to get done, or whatever, even if they're unpleasant or tedious or not what you'd rather be doing. But, if we ALL do this, then it tends to mean less unpleasantness for everyone.

Amazing how many people look at that and say, well, too bad. You can take my share of the unpleasantness. I'm going to go over here...

Also at this talk this morning, I met up with one of my colleagues who told me some disappointing things about our current chief class and how unhelpful and minimally mediocre they've been for the intern class. This upsets me. Because, last year? Our chiefs rocked. They weren't always perfect, but, they always made an effort. And we were all interns once. And it sucked, but we got through it, and that support made it so much easier. This year? You know, I think the thing that bothers me most is that their attitude is contagious. Like, I've always jumped in when someone was sick. I took on May's work when she was ill when we were on together at State Hospital. I took calls for Cleo and Fang on less than 12 hours' notice (about three hours, in Fang's case). I dug in and took on some of Mike's work when he was overwhelmed or had a bad night on Family. I was q2 for a week when Peng had dental surgery. You get the idea. We help each other out, you know? Two weeks ago, when I had a 102 temp and needed my call covered? It was next to impossible to find someone to step up (Sparrow = goddess. Have I mentioned that? JD also rocks) and Ruthie said there was a lot of "fighting" about who was going to take it. I just sort of shook my head at this, because I think it's spilled over from the "I don't want to do more than I have to" attitude that's at the top of our pyramid right now. I think the next three chief classes look promising, though. And you know...as much as I rant about things sometimes....

Holy freakin' cow am I glad I'm here.

Yesterday was an interview day. We had I think seven candidates, all in their smart black suits, all on their best behavior. It's cute. They seemed like a nice bunch (one of them reads my blog! How cool is that?!! Hi, D!!). In general, this year, I've been so pleased with the candidates. Anyway, they'd assembled in Corrina's office and got escorted off to lunch, leaving Peng and me and a couple of the other residents to talk about them, er, discuss recruitment. And we were like, I hope they realize we're all pretty much as we seem, here. We get along. We're a quirky but genuine group of overall good people. The interns lost their tiny little office space? A bunch of us stepped up and procured for them what I now like to call the Intern Rec Room. The Child/Adolescent month was too scattered, we got it changed to being just Adolescent. The faculty supports us, the chair is very interested in how we think things are running, and overwhelmingly people are interested in teaching, learning, and being colleagues. We like each other. We respect each other. I can't even express how important that is.

This time of year always leaves me a little retraumatized nostalgic about life at the Emerald Palace. I remember talking to one of the candidates that would eventually become one of the interns in the class after mine, whom I liked a great deal. I remember thinking I should tell her to run screaming (RUN. RIGHT NOW. AS FAST AS YOU BLOODY CAN. RIGHT. NOW), but what I told her was, intern year is a hard year. The dynamics here are difficult sometimes, and you have to watch out for yourself, but if you know that coming in, I suppose it's easier to handle ("But, gosh, the program has so many positives, too." Like...uh...the way our labor deck is set up. And the cool robotic system in the OR. And, uh, the scrubs are free. And working at Student Health (not here). And the off service months (not here). And the ER attendings (not ours)...). Yesterday, I'm interviewing this guy (I got to interview! It was fun), and I was like, you know...intern year is a hard year. Harder here that most places, but gosh, you learn so much. You come out of it so much stronger in your professional sense of self. And the faculty is supportive, and the upper classes are supportive, and people are genuinely interested in you here. And we're social, and we have fun, and we work hard but we're encouraged to get the hell out of here and be well rounded people. And yeah, not everything works perfectly, or even as well as we'd like it to. But even when there's nothing that can be done about that, they hear us.

He asked me if I was happy. I said, without a second thought, "I love it here." And I meant it. And then he commented on what a good research program we are, and I thought about that for a little while, and he said, all nervous, "Well, you may not agree with that, I guess." And I said, no...actually, I do agree with that. But don't think we're just about research...and then we had a nice discussion of how we're very patient centered and we emphasize psychotherapy and how many opportunities we have here.

The Emerald Palace taught me a lot. In my time there, and in the subsequent cleanup, I've learned a lot about myself. I learned a lot about interpersonal dynamics and group psychopathology and systems errors. I learned a lot from them about what I don't want, and a little about what I do. I learned what it means to be "the doctor" - the program might have rarely let me be that person, but my patients did in spades. I even learned how to do a colposcopy and run the cool robotic system in the OR and do a wicked good circumcision. But the best thing they did for me? They got me here.

I wish I was the kind of person that could thank them for that. I'm still going to go with, "Fuck you."