subintern

I've just returned from my first day as a medicine subintern. It was about as overwhelming and exhausting as the hype goes, but the core of it was intensely gratifying. And that's not rationalization of the semi-blind choices I've made and difficult path I've chosen, and it's not making the best of things. It's something I feel in my tired chest (why is it that fatigue localizes there, as though our beats and breaths really do consume us). Why else would I be staying up to write this, in a partly delirious state, after having slept less than two hours in the past thirty-two hours? There's so much to say.

A subintern functions much like an intern, which is the first year you legitimately call yourself doctor, except nothing about it feels legitimate. This means that every four nights, you are on-call at the hospital. This means that you work a 30-hour shift. During this time, you see patients who come to the hospital, try to figure out what they have, and try to treat them. You also take care of the patients who are already in the hospital, who are getting better, worse, or staying the same. It's an incredible jump in responsibility, and work hours, from being a student to subintern. I was terrified, and after the first day, still am.

My first day of being a subintern also happened to be my first day on call. So not only did we have to learn the ropes of this new role with parameters wider than my mind could wrap around, but we had to do it for 30 hours straight. Naturally I had a lot of fears about all this. Fears of incompetence, of willpower giving way to fatigue, of being lost in what's supposed to be our space. All of these fears came true. I must say that I did a horrible job on my first day and call. I didn't get morning labs scheduled on time, I didn't think of multiple tests needed for my patients, I made several unnecessary calls and missed other necessary ones, I didn't know how to find new patients in the emergency department, my admission notes were short not for conciseness but for lack of comprehensiveness, my morning oral summaries of the patients were choppy, I didn't gather enough information from past records, I didn't perform complete physical exams on my patients. On and on and on.

It's natural to feel a little frustrated with failure, but what I found myself thinking more than shit, I'm doing such a bad job was, I really WANT to do a good job. For the first time in awhile, I felt want in the purest form. I didn't want it out of frustration from doing badly or because we're always being evaluated, but because I realized 1) just how damn difficult it is to be a good doctor, and 2) how worth it is to be a good doctor. I was lucky to be working with doctors who are good in such complete sense--smart and efficient with the science, smart and kind with the people. People acknowledge that both of these areas take training and effort, but personally, it goes far beyond what I imagined. On the science end, there is an incredible amount of information to gather and most importantly, analyze, apply and synergize. There's the story of symptoms, the methods of the physical exam, the interpretation of numbers, the understanding of images, and how all these complexities interact. And for many patients at once, juggling the components of one patient and then juggling multiple patients--it's dizzying. There is so much to know, and the knowledge isn't empty. Lab values and squiggly lines might appear dry, but when you consider how they are created representations of raw happenings in your body, it's pretty amazing. The indirect ways we've designed to figure ourselves out--I respect them, and I want to know that language in the same way I value language in its conventional definition, as a means of communicating ourselves and something bigger than ourselves. It's never quite the thing itself, but is our approach to it, and a whole other thing on its own. Of course, much (sometimes the majority) of it can be logistics and errands, which I can foresee becoming old fast. But it also appeals to my nerdy, neurotic self and also to a human part of wanting to build when immersed in an environment where people are not rarely falling apart. In both science and logistics I don't pick up things that quickly, and so I know I'll be lost for quite some time, but that's not a source of bitterness--I'm glad to be pursuing something that doesn't come easily.

And I'm glad that the challenge isn't simply for the sake of challenge. Besides the natural appeal of science and systems, there are the patients, and there is the learning of how to be with patients. People think that this isn't as hard as learning all the other stuff; I used to think that way too. But I've learned that while being nice is easy, connecting takes as much of your mind and effort as knowing the science. More often than not I'm not very good at it. I get mixed up with my words and with my silence, I'm bewildered as how to translate my intentions, I find myself painfully aware of my simple experience. The workings of another person can be as foreign as the mechanism of an antibiotic, and I know it's a corny parallel, but the truth is, I often feel myself encountering the same boundaries and confusion with a person as with a drug. But just like with the science, the feelings of stumbling make me feel how much I want this, how much I want to be good at this because I believe in its worth as a goal. I've seen other doctors show such grace at it, and I want that.

It's one of the things I love most about medicine, the way it forces you to interact with people you would never, ever know otherwise. Even as the VA gets the reputation of catering to old men with similar shadings of gruff salted life, each of them carries biting character. The lack of teeth, the sweetness of ninety years of age, the inhibition of schizophrenia, the depression of age, the depression of a hard life, the response to talk about pain, the blue blue eyes, the contortions of wrinkles going this way and that, the leg no longer there, the missing fingers, the natural questions, the natural anxiety. There is such pleasure in coaxing out qualities, of trying hard to see what you can and respect what you can't. And there are fleeting moments where you stop discriminating, when the harsh becomes as welcome as the welcoming, because it's another thing to absorb, another way to hold quality. Of course you'll get mad and annoyed when someone makes things difficult for you; when you're tired and responsible, you aren't looking for this extra baggage and I know I'll never be immune to impatience. But still, isn't baggage the reason we do all this in the first place.