Life after residency.

I feel as if this is the ever-present "weight" on my mind: life after residency.

So I didn't go into internal medicine because I: 1)liked kids too much 2) liked women too much and 3) liked primary care too much.  However...  now it's my last year, and I am confused beyond belief about what to do.

I am 200K in debt, not including interest.

I have a husband who currently makes 30K a year. 

I always wanted to be a good doctor, a family doctor, The Town's Doctor - but now I am overrun with fears of not being able to do it all...  but also not able to afford it all.  It's odd and disturbing and frustrating all in one, but I have gotten to the point of being scared of my future.  What kind of life did I choose?  Can I afford "average" luxuries like vacations and a decent house?  At age 30, I have no assets, only debt!  And primary care doesn't pay squat.

Ideals led me towards primary care.  Financial concern currently has the best of me.  Can someone offer me reassurance???

Heaviness.

Speaking of my so-called cranky patient... he left today.  Spent a good 45 minutes discussing rehab with him - reassuring him, applauding him, scolding him.  The best of both worlds, I tried.  His poor nurse, though....  his constant gripes, complaints - at least I could escape from it.

On  my drive home I received a phone call on my cell phone.  An unknown number, I answered it.  It was my 55 y/o female patient upon whom I did a routine pap on...  and it revealed trich.  She has been married 20+ years.  

It was one of the most difficult phone calls I have had.

I am praying for her tonight.

The difficult patient.

I have my difficult patient - much more obvious in the in-patient setting versus the out-pt.  He is whiny, he is cranky.  He is on a mega-dose of narcotics.  He doesn't move out of bed.  He belches every time I walk in the room.  He always, always, ALWAYS complains.

I try.  I try to be removed, to be impartial...  objective.

It is beyond difficult.  Sometimes it's damn near impossible.  How to get over that?!

Perfect Enough?

I may be in the wrong profession.  At first glance, that initial statement doesn't make much sense - I like the science of medicine, I like the human aspect of medicine, I like the versatility of medicine.

But what I don't like is that ever-pervasive feeling of wanting/needing to be the Perfect Doctor.

How can one even comprehend this? Is it rationalizing feelings of always wanting to do better, always wanting to learn - or am I just too insecure to be in this field?  I nit-pick, I overanalyze.  I wake up early in the morning with these thoughts in my head...  I dream about it.

Am I just trying to better myself, or do I just not believe in myself?  And if the latter is the case - is it really me or is it just my thoughts?

I wanna hold your hand...

I had an interesting encounter the other day.  Was assigned to tag along with a patient who was to undergo his first ect treatment....  things were delayed (shocking!), and it left me with a lot of time to, well, just chat with the patient.  He was in his 70's, admitted to the psych ward for a suicide attempt.  He was also a former physician.  So we chatted for a while (I love non-floors months), about his life, his family...  he, in turn, asking questions about my own.  I could feel his anxiety - it really was palpable -  which only increased as the minutes passed.  In the end - right before he was going to be wheeled to another room - he asked me to hold his hand.  For comfort, he said, to feel human.  

So I held his hand.  He in his gurney, me standing awkwardly aside of him.  30 year old resident doctor holding the hand of a 75 year old [retired] doctor.  An anxious resident holding the hand of a depressed doctor.

Interrupted by a nurse that walked in, I quickly dropped his hand, almost relieved to have an escape.  It was then I realized just how embarrassed I was.

It's interesting... I have grown to be the type of resident that is touchy in the frequent-pats-on-back way.  And I suppose I have given the occasional hug.  I realized, though, that they are always on my time; it is always me - as The Doctor - offering the compassionate touch.  It was surprisingly difficult to be on the other end of the spectrum, with the ball not in my court.

I thought a lot about the scenario later that day.  Glad to have been there for someone.  Humbled, really.  So why was crossing that boundary - that professional boundary - so hard for me?  

I think a lot of it has to do not just with boundaries, as there wasn't much that was crossed that day... but more so with identifying.  I could identify with this physician/patient - I know what it's like to be sad, depressed, anxious.  I get it.  But perhaps at that point, I didn't want to get it. I didn't want to empathize, I didn't want to be reminded of my own struggles in life?

Onward.  

Patience is a virtue.

On psych this month.  Heard "okay" things about it - supposed to be neither here nor there.  Err... I actually like it.  Unlike being on OB when we were there all day with sans duties (okay, I am REALLY beyond the med student role), I don't mind the sitting, the observing.  Men and their mid-life crisis...  the elderly woman s/p TKR that is doing SO much better than my own widowed grandmother....

I like the talk.  I like listening.

Onward.

Travel is good for the soul.

It is so refreshing to get away.  Go somewhere new, see other things, experience different cultures, meet new people...   I needed a break from medicine.

I was surprised how the "always-be-prepared" mentality followed me a bit.  You know, like being an intern on call in the unit, you expect - and prepare - for the worst.  What would I do if??!  Uhhh..  I felt it on the plane.  Hey, I am "just" a resident...  but I am also a doctor.  So what if something happened on the airplane, and "Is there a doctor on board?" followed?  I inadvertently thought about that a fair amount while at the airport and on the plane.  

Funny how that seemed to put a little damper on the mood when I was enjoying my glass of wine.   Ahh yes.  A break, but never far from the mind.

Onward....  but this time to bed.  Back to the daily grind tomorrow!

Jack of all...

Okay, I won't finish that one.  It's a pet-peeve-of-mine saying, but sometimes it seems oh-so true.

Like today...  from PCKD... to chronic constipation...  to the pre-op for my post-menopausal bleeding patient.  Oh!  And a bit of CIN 1 follow-up, plus an overweight female who may have PCO and diabetes thrown in.

I love the variety.  I adore the variety.  But at this point, it's that very variety that scares the crap out of me.  When will I feel comfortable with this stuff?  There is just, well, so much "stuff!" Perhaps it's that perfectionistic trait - I don't want to feel sorta comfortable.  I want to know it.  Do it.  Prescribe it.  Diagnose it.  BAM!

That fear of the unknown will always be there. Good? Bad?  Who knows. I hope at the very least that this will be a good doctor push. That's my attempt at a positive spin on it.

A good doctor. It's what I hope to be, and strive to be. So why don't I have that disgusting over-confidence that most of the med students or residents run around with??

Bleck.

Onward.

Anxiety Sucks.

For some reason my patient du jour is 60-something woman who have anxiety.  I guess that's where my eating disorder comes into play - instead of making snap judgments, I "get" their anxiety.... their worries and fears.  It's interesting, to have myself -  a 29 year old female interact so well with someone double my age.  I like it.  To me, that's family medicine. 

I have an eating disorder.

Much inspired by the blog on this med student who suffers from  a mental illness:

 

http://bipolarinmedschool.blogspot.com/

I have bulimia.  Had bulimia.  Whatever.

Eek!  Bulimia.  Gross.  Who is this?  A doctor??!  I can't imagine.

I am a doctor struggling with an eating disorder.   It ebbs and flows, certainly not as active as it had been, but still...  med school and residency don't allow much "healing" time for an ED (and no, ED does not just pertain to those of the Viagra type ;).  That may sound glaringly obvious, but it wasn't so at the time.    

Today I am just annoyed  and frustrated that I still deal with this, even if it is "just" feeling fat.

More later.  

Onward...

Does your work define you?

Been thinking about this lately...  when I was in undergrad, and more so, in med school, I clung to the definition of "becoming a doctor."  Perhaps for me it was the First in the Family aspect...  or rather, the "early planning" aspect - the fact that I had been thinking about this since the 5th grade.  But as I have progressed, I have swung to the opposite side.  In my down time, I now avoid the subject.

 I don't want to give advice on my friend's fatigue (really, she is just overworked and sleep-deprived, not b12 deficient, in my opinion), my sister's supposed bunion (err,  hallux valgus  - I am a doctor, after all! Regardless, why doesn't she just stop wearing her high heels everywhere), my sister-in-law's pregnancy woes (quite younger sister-in-law, for some reason a tough pill to swallow as I approach AMA with my sans children life).  This whole doctoring "thing" has been a goal - but beyond that, became my life's purpose.  Now that I am here - here more so than I ever was...  and I finally see that while "balance" was my driving force, how little I ended up letting myself be defined by other things.  

So what am I?

I am a daughter, a sister, a granddaughter.  A [new!] wife.  A lover of poetry, photography, and, well, people.   I adore stories.   A runner... when I can fit it in!  A friend - both new and old.  A confident and an optimist.  A love for the comfort of rituals, while despising the mundane.  A new cat lover!  While being an old dog lover.

I am a family medicine resident.  I love medicine at its best, and want to throw it away at its worst.   I am continuing to go forward.

Onward!

One big hug-of-a hello!

I'm a family medicine resident.  Year 2!  

Year 2 you say?  One more year.  Time to make money.  Time to step away from residency.  Time to branch out on my own.  Have a bit more autonomy.

Year 2 you say?  One more year.  Yikes!  Am afraid.  I need more time.  I need more training.  I need more support.  More and more and more.

Beyond that....

I always wanted to be a doctor - cliche you gasp! but true.   Like Dr. Quinn,  Medicine Woman (embarrassingly enough) - I wanted to be her, The Doctor - the town doctor, talking care of everyone.  And with her flowing-locks Sully in tow.

Since then I have grown, matured... and perhaps become a bit cynical, a bit jaded... but all the while am attempting to wade through the waters of my professional future, figuring out where exactly I fit.

Onward!