Beyond The Coat

Today is July 1, 2018.  On July 1, 2007 I walked onto the unit of the 5th floor of Georgetown Hospital as a pediatric intern.  A newly minted and inexperienced 20 something DOCTOR.  Look, here I am later that year in a photo to prove it.

If you look closely, there is a small black calculator dangling from my ID badge – because this photo predates smartphone calculators and there is a lot of math in pediatric medicine that you don’t want me to calculate in my head or on the back of a napkin.

I used to get “You look too young to be a doctor” about weekly.  Then it turned into monthly, then occasionally, and then gradually it faded out without much fanfare.   That very first day I asked my attending if I was required to wear my white coat.  It’s not that I didn’t need the pocket space.  I already had impostor syndrome.  I thought I didn’t belong in that coat.

Medicine is a series of ups and downs.  You become the best 4th year medical student only to wake up the next day as an intern who is struggling to keep up.  You go on to become a great resident and then you are either onto drilling down into fellowship or you are ‘set free’ into the world as an independent practitioner; both of which are extremely challenging.  There’s no real good way to prepare young doctors for what lies on the other side of all of those years of training.

If you stay in academic medicine, you must learn the art of balancing clinical care, research, and section citizenship.  You are expected to become a leader.  If you get out of academics, you may have to learn how to run your own practice, negotiate with hospital administrators, group owners, procure insurance, market yourself/your practice…the list goes on and on.  None of this is taught in training.

Those of us on the inside of medicine know that there is a tremendous problem with physician burnout and physician suicides are at all time highs. I don’t have the expertise to speak on the specifics of why this is happening but I do know that most of the disappointments I have experienced or been witness to,have been a result of failure to meet expectations.  Unfortunately, we are often not great at communicating what our specific expectations are and are even less inclined to ask others what they expect of us.

If I could go back and whisper into my 27 year old ear, I would say, “Put the white coat on.  You earned it.  Set your expectations and go ask your attending what expectations she has.  Listen more than you speak.  These will be some of the best years of your life.”   I am by no means at the end of my learning.  Every day I come across something new I need to learn or study.  Every week I ask my colleagues for advice.  Every week I partner with my families to provide the best care that we can, on that particular day, to that child.   There is no perfect day.  There is no perfect job.  There is no perfect life.

To all my new interns – remember now and forever that being a physician is most definitely a privilege, but we all must take care of ourselves and each other.   Like any job, this one can chew you up and spit you out.   Remember the feeling of that first ‘doctor’ adrenaline rush – whether it be the first chest tube you placed, the first baby you delivered, the first time you got the piece of history that nailed the diagnosis – and hold on to it.  

Remember why you started this journey.  Set your expectations.  Ask others what they expect of you.  If you stumble along the way.  Ask for help.   If you think you are in the wrong specialty, talk to someone.   If you do something well, be proud of it.  You will make a mistake, everyone does and you need to own it and learn from it.

Most of all, remember that some days will take you to an exhilarating high and packed with all the good feels, while others will be painstakingly long and soul crushing hard.  There are lessons in each of those days and days don’t last forever.   You are on your way to being an amazing doctor, but it will never define you in totality, hold on to the other things that make you who you are too.

This is July 1, 2018.   There are more wrinkles and grey hair.  My pager goes off far less often than before.   There are no more 30 hour shifts, but there is a 24/7 job that is asleep on my chest. Tonight she told me she wanted to be a doctor like me when she grows up. I hope if that stays true, it completes her as it does for me.