I recently decided to participate as an interviewer for our residency program. As a fellow resident in the same program who has since turned in to a “lifey” at our hospital, I felt that I had a unique background to serve as an interviewer. I can evaluate candidates for a familiar position and additionally, entice very desirable candidates with my positive experiences in their sought-after role.
Truthfully, I had a very favorable experience with my residency program. I remember talking to prior medical school colleagues who were training elsewhere and hearing of some of their horror stories. “I’m so tired. I worked 120 hours/week over the last few months.” “Our program still makes us round at 5 AM on inpatients while we are on elective.” “OMG our attendings destroy residents who don’t know something.”
I didn’t have those experiences. Yes, my residency was very tough. I won’t downplay that. There is a reason it has that reputation. I worked very long hours for less than minimal wage, often slept in the hospital, and worked 24 hour shifts where I felt more tired than I have ever felt in my life (before children of course). Expectations were often astronomical, and sometimes even impossible.
Despite this, I was hardly ever put down my attendings. Granted, I would say that I was a dependable resident and worked hard to accomplish my duties, but I made mistakes. I got things wrong, and I forgot things at times. After all, I am human. In residency, there is a hierarchy in place for a reason. As an intern, or first year, you get all of the dirty work. You have to do all the bedside procedures, write all the notes, see and know all your patients before the crack of dawn and get grilled on it. You learn things extremely quickly, and perhaps that is the reason for it. Your upper years serve as checkers. They make sure you don’t kill someone or fill in the gaps. It works.
But my program was benign. When searching for a residency program, this was my top priority. Future residents tend to label programs as benign or malignant. Malignant is what I would hear from friends at other hospitals or programs. They revealed noted complaints and the hatred they received for basically being a resident and not knowing anything.
Residency was good to me. I learned a lot, and I have come out with a comfortable position in practicing medicine. I feel confident in my practice, and I truly enjoy it. One of the hardest parts in dealing with my illness is the inability to work at times. I get a rush out of seeing patients, walking the hospital wards, seeing improvements and identifying new diagnoses that I can often fix.
One of the worst parts of my job is revealing bad news. A lot of the time, patients have received their bad news before I see them. Usually, they got pan-scanned in the ER and the emergency physician will inform them of a new cancer prior to me even seeing them. Sometimes, a consultant physician will get to my patient to tell them their kidneys are failing before I can see them. Sometimes, it falls on me.
Recently, I was driving home from a shift when I got a call that my mid-aged patient’s CAT scan came back with disseminated cancer. I had suspected it, and even briefly mentioned it as a list of differential diagnoses to the patient, but I hoped I would be wrong. I was paged with a STAT critical finding for her, and I knew. I had left the hospital and stopped at GIANT to buy a few things for dinner. I sat in the parking lot and called back the radiologist.
He plainly explained the findings while I nodded in my car and eventually stated, “Thanks. I feared this.” “OK bye,” he quickly replied.
Dammit. I sat in my car pondering what to do. Technically, my shift was over as I am currently doing partial hours and only paid for the same. I pictured my patient, sitting in her bed, not knowing the travesty that had been brewing in her abdomen.
I pulled out of the parking lot and headed back to the hospital. I phoned my husband to tell him I would be later coming home and filled him in. He understood.
As a drove to the hospital, I thought about how to tell her. I imagined being in her position. I had delivered bad news before, but it still feels unfamiliar every time. Everyone responds differently. I have learned that an individualized approach is important. Some people want it delivered straight. Others want gradual information delivered slowly.
As I approached her room, I filled her nurse in. “Oh no,” she responded. I double checked the CAT scan, in case I was wrong. I pulled up the imaging and confirmed her name and medical number a couple times. Yes, same patient. I then instructed her nurse to be on alert to check on her following my visit and that I would likely be prescribing something for related anxiety. I know that I would want that available to me.
I walked in and she smiled. “Hi Dr!” Nice to see you again today.”
I nodded slowly and explained that I had very concerning news based on her CAT scan. I asked if she would like to call her family when I told her. She explained that she would call her husband.
I stood there awkwardly while she phoned her husband on speakerphone. For some reason, this felt like the right thing to do for her, but I’m not sure.
I broke down the findings and the concerns. I explained that it was most certainly a cancer, but we would need to proceed with a biopsy to formally diagnose her. I noted the plan to get specialized oncology on board immediately, and that I would call them to see her today.
I held her hand during the conversation She squeezed back the entire time. There was not much else I could do or say, and I felt a little helpless.
After I answered some questions, I told her to take things day by day and await further information. I walked out of that room even more awkwardly. As I stood by her nurse, I must have said “Wow that really sucked,” several times. The nurse expressed understanding and told me she would go check on her in a few minutes.
That was it. As that was my last day on service, it was also my last interaction with that patient. I checked up on her progress for a few days after and then stopped. I think of her at times and know her journey ahead will be very tough, and unfortunately will conclude in months to a couple years. We are better with treatment and halting cancer progression for longer periods of time, but ultimately, the diagnosis is likely terminal.
Experiences like this are never smooth. I tend to reflect and think of how they could have been easier. I’m not sure they can be. Tragic news like this is complex and messy. I’m a messenger in this case, and perhaps that makes it tough as well. I don’t get to follow her through the journey and help celebrate minor accomplishments or counsel her through the failures. It is an acknowledged downfall as a hospitalist. There is beautiful flexibility in life, but with that, the loss of continuity of care and lasting patient relationships.
I conducted my first set of residency candidate interviews last week. It was inspiring, interesting and fun. The candidates were all truly stellar and unique in various ways. I think they have gotten even more impressive with time. I felt obligated to briefly share my recent experience with them and ask them how they might have handled it. It’s an impossible question, but I wanted to open the dialogue regarding tough conversations and self-care.
They all had great answers, although expectedly naive and generic. It dawned on me that they had never been in these situations. This was a task that they would be thrown into as residents in the near future. They would navigate it in their own ways and accommodate as best as they could.
I found myself giving them some advice. After discussing their thoughts, I switched the focus to self-care. I emphasized the challenges of our profession and the burden of emotional stress. I inquired about their approaches to self-care and strongly encouraged that they maintain them during busy times. I explained that taking the time to reflect on such experiences in some way was critical to maintaining a healthy balance as an internist. I found myself getting emotional and now wonder if these interviewees thought the same. I suspect my recent illness and reflections have made me much more in tune with my need for decompression. I now feel an obligation to pass this along to my future colleagues.
I hope that I made an impact on these future doctors in some way. I hope they listened to my advice and will remember it when they too have to one day tell someone that their future is knowingly limited in time. I hope they will take the time to sit and reflect.
Breath sounds and bubbles 