Entry 1

Entry 1

Entry 1
A weeklong electronic journal.
July 22 2002 12:13 PM

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My residency ended two weeks ago, and last week was my first week of work as a real doctor. Many people think that medical school is the hard part of becoming a doctor, but in fact, you don't really learn how to be a doctor until you're in training. In med school, you memorize biochemical pathways, but in residency you really learn how to take care of patients.

Residency is generally considered an unpleasant time of life, but there are varying degrees of unpleasantness, depending on the specialty you've chosen and where you do your training. There are "cush" programs where call is once a week, from home, even for surgeons, and there are "malignant" programs, where call is every other night for the interns and you never sleep and you are treated like dirt. In New York City, the programs have had to go a little easier on the residents since the famous Libby Zion case, where a young girl died. It was a complicated case, and whether or not the fatigue of the resident caring for the patient contributed to her death is still controversial. Nevertheless, it did call attention to the long hours residents work. New York passed a law limiting residents' work hours, and recently an advisory committee to the American Medical Association recommended revising resident work schedules to shifts of no more than 12 hours straight. This would be a radical change. The word "resident" comes from the fact that medical trainees used to actually live in the hospital. For years, the misery of residency was perpetuated, whether because of tradition—the old "I suffered, you should suffer, too" philosophy—or, as some people say, because it allows for the most amount of training in the least amount of time.

I trained at Emory University, which is known as one of the more rigorous programs. We staff four hospitals, including a busy inner-city hospital with a Level 1 trauma center and a university referral-based hospital, where you'll see patients with diseases so rare they're known as "fascinomas." (Since my immune deficiency is so unusual, I've been a fascinoma myself a few times.) All residents work hard at Emory, but there's hard work, and then there's hard work. I was a dermatology resident. I had it easy.

There is a definite hierarchy in residency programs, and the more you suffer, the higher you stand. At the top of the heap are the surgeons, especially the neurosurgeons, the trauma surgeons, and the cardio-thoracic fellows. They get to wear the mantle of heroes, but their sacrifice is huge. They're on call every second or third night; that means every
second or third night they're up all night. Some of them thrive on it. I knew one trauma fellow who bragged that he'd taken only one day off when his wife had twins—for the birth itself. He neither needed nor wanted any paternity leave. (I never met his wife, but I wonder if the marriage survived residency; many do not.) On the other hand, some feel the sacrifice acutely. I had a friend who was a neurosurgery resident. She had a baby during her sixth year of residency, when she was given a respite from her grueling schedule to do some research. I saw her in the hospital during her seventh, and last, year of residency (count that: four years of college, four years of med school, seven years of training before you get to start your life). I asked her how the baby was doing, and she said, "I haven't seen my daughter awake in three months." She left for work at 5 a.m. and did not get home (if she got home at all) until 8 p.m. When she finished her residency, she decided not to work, at least for a while. She wanted to see what it was like to live again.

Dermatology residents are at the lower end of the misery hierarchy, along with radiologists, pathologists, and psychiatrists. I worked a pretty regular schedule, staffing clinics during the day and taking call from home. Most people at cocktail parties are more impressed when someone announces that they do brain surgery than that they treat acne, but the tradeoff is that I do get to go home at night. Since my daughter was born, I've been able to give her a bath and read her bedtime stories every night of her life.

Doctors are expected to be 100 percent devoted to their patients, but the truth is we have families of our own, needs and desires of our own, and although we have chosen the noble profession of caring for human lives, it doesn't mean we never want to take a trip to Italy or watch our own kids play soccer. Do these desires make us less noble, less dedicated? Perhaps, but they probably also make us more human. This is the balance we must strike between our own needs and the needs of our patients.