Twenty minutes of cardiopulmonary resuscitation. Fifteen beats per minute. Seven nurses. Five doctors. Three paramedics. Two anesthesiologists. One transcriber and me. And then the eerie silence of the trauma room as the death was called. Four years of medical school and two years of clinical rotations to prepare you for various medical scenarios — but no one prepares you to face death. Whether it is the first time or the tenth time, it still hits you like a ton of bricks. As physicians, we see it all, the miracle of birth and the eventuality that is death. It is humbling, rewarding, fascinating and even tormenting. It changes you, breaks you and then ultimately remolds you.
Through the first year of residency, there were several cases that would resonate with me. Among them, an elderly women stricken by Alzheimer’s but still struggling to retain her functional independence. A middle-aged man terrorized by post-traumatic stress disorder who needed a shoulder to cry on. Another was a young child who presented with acute abdominal pain and was found to have testicular torsion. In retrospect, some make the simple things complex and some, the complex things simple. Both can be disadvantageous, even harmful to a patient but medicine requires a balance of both. Medicine requires simplifying things when they are too complex to understand and not undermining the complex and often dangerous conditions that can present as common symptoms. The story goes that as you get more comfortable in your skin as a doctor, the less you feel an obligation to glide your stethoscope over a patient only to send for numerous unnecessary tests anyway. You become more focused on reason and comprehension. Rather than playing the game of defensive medicine, you learn to defend your medicine.
Residency prepares you to make medical decisions and not order tests that are unwarranted simply because we feel an obligation to find an answer to a medical dilemma. Residency teaches you to apply the principle of Occam’s razor and not always look for the zebras. It prepares you to learn to communicate and interact with people. It teaches us to be find reason when there is none, find compassion when we are indifferent and have an open mind when we are biased. It trains us to challenge ourselves, to constantly find a balance of work, health and social activities. It is in itself, a test to the human body. As doctors, we are a different breed. We are stubborn, resilient and determined to respond and adapt to the curve balls thrown at us. Through basic and often convoluted encounters, you learn so much. I have learned so much. In all sense of the word, residency is like no other life experience which changes a person. But change is not always a bad thing. Perhaps the most important thing to remember is to find the light in difficult situations when we are confined to the caliginous halls of the hospital.
In conclusion, as interns, we are inexperienced and naïve, but nevertheless eager to learn. It was ironic that the beginning of my career was met with the end of another’s life. It was a rude awakening, but one that confirmed the passion for the medical field. At all times, we must be equipped for any given situation, and be the primary and often the secondary defense for our patients. When it is out of our control, however, it becomes that much harder to walk away. We have to endure and learn from the suffering, joy and hardships that our patients face. We cope so that we can become better human beings and become the astute observers, diagnosticians and practitioners that are demanded in this field.
Image credit: Inauguración del Hospital Municipal de Chiconcuac by Presidencia de la República Mexicana licensed under CC BY 2.0.