Working Hard

There is a phenomenon that happens in medical training where you work harder than you ever thought you could. Perhaps you think pulling all-nighters and camping out in anatomy lab for an exam is hardcore. Then you get to your obstetrics rotation and find yourself being woken every half hour for a delivery. Then you rotate onto the general surgery service and find yourself in the hospital for 36 hours straight. You arrive one morning and leave the following evening. You call your very best friend (there's no time for anyone else) and tell them about your experience.

Then you get to be an intern, and maybe the hours are fewer - just thirty - but you find yourself more exhausted than ever. Now you're really responsible for patients. Hour after hour, you get admission after admission, and then nurses page you and you're not sure what to do and you can't get a hold of a consultant and then a patient's labs come back totally unexpected and then a patient has to go to the ICU and you're being paged by the pharmacy to adjust your vancomycin dosing. Plus, there's cross-cover. You frantically get orders in but get behind on writing your H&Ps so that by the time 2 or 3AM rolls around, you have a stack of papers and an empty head swirling with exhaustion. You try to keep your patients straight.

A year later and you're a resident overseeing a gaggle of interns, trying to catch their errors before they happen. Or maybe you're an anesthesia resident in the operating room learning a totally new field, working with a machine you barely understand, surgeons that intimidate you, a constant fear that something will happen in front of you that you can't solve. You work harder than you ever thought you could.

Let me tell you, this doesn't end. It is true that being an attending is generally much easier. But I'm in the middle of a week where I'm learning how hard I can work. The intensive care unit hit 18 patients, and I'm the only ICU doctor here. One patient, young, has a failing heart, lungs, kidney, liver, bone marrow, and immune system. Another crossed death's door and we pulled her back with an unbelievable resuscitation. One has an unexpected stroke. Another throws up a pint of blood. There are arterial lines, central lines, intubations, and dialysis catheters to place. There are code discussions and family meetings to address. Consultants wait and tap their foot. Nurses need orders. The unit clerk needs transfer orders because there are no beds. Over the day, I get four new admissions. No notes get written until evening, and now, because I am ultimately so responsible, I sit for hours trying to make sure I didn't miss anything. Driving home, it occurs to me that this one patient really ought to have a central line, and maybe I should drive back and put it in. I don't see my spouse; I don't talk to family; I haven't been on facebook in days; I check my email at red lights. I eat one meal a day, and it's in the hospital cafeteria; at least, I have a lot of Halloween candy. Three days down, two more to go.

I'm sure there will be a time where I work harder than this. But for now, I am being pushed beyond what I thought I could do. It feels like a familiar experience, and surprisingly, I like it.