Monday, November 2, 2015

Ten-Hut! (Or "The Order of It All and Why I'm Probably Going to Continue to Get into Trouble")

There are some folks who should never enter the military. Often, those are the same folks that need the discipline and structure the military provides. I am one of those people. Compared to most flowcharts, chain-of-command hierarchies never impressed me. Too linear! (Yawn.) But the well-oiled machine known as the American Health Care System relies on such hierarchies to ensure care is given in an orderly and predictable manner. I understand that. I even appreciate that. The structure and hierarchy that I've stepped into is both instructional and protective. For this, I am grateful.

Like all good hierarchies, each wrung in the ladder knows her place. I am keenly aware of mine. I am there to be stepped on when convenient. Fortunately, that's not a daily occurrence.

For those of you unfamiliar with the hospital hierarchy, let me elaborate. The attending physician sits at the pinnacle. When things go wrong, this person is the one who bears the brunt of all "official" action. Sure, attendings are know for being demanding, but it's her license on the line when an underling screws up, so that edginess is somewhat understandable.  Next in line is the senior resident, the person who paid the dues of being an over-worked lackey just one or two short years ago. The intern resident is lackey to both his senior resident and his attending. He's the one who has to carry the most pagers and document the majority of clinical interactions--a task which has proven to be far more time-consuming than I ever imagined. (Yes, they make us practice writing "notes" ad nauseum.) The intern is fresh out of medical school, newly anointed with the title of "doctor," and terrified of messing up. And then there's the medical students. We've passed Step 1, which means we've ingested volumes of medical knowledge. Of course, most of that knowledge seems to have disappeared once we regurgitated it during our licensing exam. And to remind us of how little knowledge we've seemed to digest in the learning process, residents love to ask us questions preceded by the statement "Step was more recent for you, so you should still know all these details."

Luckily for me, I'm blessed to have a few good interns who've got my back. The Family Medicine class ahead of mine has been there for our little group, offering support and encouragement throughout med school. I'm grateful to know that these are the people I will be lackey to next year!

After wrapping up my week in the medical intensive care unit (MICU), one of the Family Med interns checked in on me. (Pardon the typos.)




Earlier in the week, Dr. MICU had asked the senior resident if he remembered what Abraham Lincoln had said. (Hello? Abraham Lincoln said a bunch of stuff!) When the senior resident said, "No, sir," Dr. MICU shared a beautiful and inspiring quote which I seemed to have forgotten. As we walked out of the room, I leaned towards my senior resident and said, "I wouldn't have guessed that quote either. I thought he said, 'Gee, Mary! Do we have to go to the theater tonight? I've got a headache.'" Dr. MICU heard my not-adequately-whispered comment and shook his head. Yes, I have got to learn to shut up. 

At the end of my Internal Medicine rotation, one of the attendings wrote on my evaluation that I needed "a thicker face to handle criticism." That same physician ranked my performance as "honors." I'm fairly certain that it was Dr. MICU.