#358

Life could not get worse............

I hate having to write this post. It makes me feel like such a whiner. But I just spent the last hour re-reading this blog and I found that the medicine posts I sprinkled throughout are not only compelling, they're encouraging. So I feel the need to reflect on my day, here, publicly.

I started my pediatrics sub-internship on Monday. A sub-internship is a four-week rotation you complete in your fourth year, typically in the field you will match in. I am still torn between pediatrics, child neurology, and medicine-pediatrics, but it makes sense to complete my sub-internship in pediatrics because I feel weakest in this area. (My internal medicine rotation, which I have not written much about, was surprisingly awesome...and, dare I say, liberating and fun.) Over the four weeks of the rotation, you play "intern" (i.e. pretend to be a first-year resident).

Naturally, this type of experience is going to hurt. For starters, you'll be operating at 125% of your abilities, if not more. Secondly, my sub-I is taking place in July, the same month that the new, actual interns begin, so attendings hate everyone because they have to worker harder to correct mistakes this time of year. Thirdly, I'm exhausted, having just finished medicine and my third year a mere two weeks ago. (No rest for the weary.) Fourthly, I just went through the fabulousness that was the Third Year Comprehensive Assessment wherein I spent every day reflecting on how little I know, how much anxiety I have and how much it gets in my way, how poor my physical exam skills are, and the list goes on...It's hard to start at a new level of responsibility when you are so disappointed in yourself. And finally, I broke my cardinal rule and did not return from NYC (where I had spent the last week) until 8 PM Sunday night. I have a cardinal rule (okay, I have many of them) in that I try to be home all day the day before starting a major rotation. This facilitates grocery shopping, laundry, resting...and keeps you from feeling discombobulated your first week when you want to concentrate on sleep hygeine and studying.

I've been assigned to pediatric hematology/oncology, and just like the last medicine service I finished two weeks ago (which was also hematology/oncology), the world of these patients is complicated and intense. I choose this field specifically for the challenge, but now I'm wishing I had chosen the regular floors with the "bread and butter" conditions of asthma, eating disorders, cystic fibrosis tune-ups, and inflammatory bowel disease.

Part of being a sub-I is taking overnight call every 4th night. Which means every 4th day you work a 27-30 hour shift. Last night was my first call. I started the day on Wednesday with one of the most ginormous panic attacks I've had in a while...I had to hide in the bathroom on pre-rounds at 6:15 yesterday morning and contemplated asking to go home, I was that nervous. The day progressed nicely (for a change), and I was entrusted with sole responsibility of our 7 patients at 8PM. (Okay, I had supervision, but being first call for any problems is a scary thing, even when your patient census is so low.) The night was progressing smoothly, even though we had one patient who had just finished her bone marrow transplant yesterday afternoon and was in a fragile state, and I retired to the on-call room at 11:30 PM. I stayed in the crappy bunk-bed (and I was grateful for a place to lie down) until 3:30 AM. I think I slept a total of 2 hours, I was so nervous. At 4 AM I started rounding on my patients when all hell broke loose...and I bungled the management in concert with the upperlevel (i.e. supervising) resident.

Details don't matter. Suffice it to say, I think I blew it with the attending. I really need Honors in this clerkship in order to secure a good residency, and I need a glowing letter of recommendation from this attending. Sure, I have 3 more weeks to go, but I'm not sure showing improvement will be enough to recover from her first impression of me. No bueno. And so I had a mini-meltdown on the phone with Tom this morning after I was post-call at 10 AM. Okay, it was a major melt-down. I haven't felt this overwhelmed since my senior year of college the weekend before my honors thesis was due. And that was nearly 10 years ago. I'll get through this. As my dear grandmother says, "Life has many chapters." But it would be a whole lot easier if they sold confidence (and competence) at the grocery store.