The Most Important Lessons from Residency: Lesson One

“Slaves, obey your earthly masters with respect and fear, and with sincerity of heart, just as you would obey Christ. Obey them not only to win their favor when their eye is on you, but like slaves of Christ, doing the will of God from your heart. Serve wholeheartedly, as if you were serving the Lord, not men, because you know that the Lord will reward everyone for whatever good he does, whether he is slave or free.”  –Ephesians 6:5-8

When I decided to become a physician, no one took me aside to tell me how difficult it would be.  Residency has been the biggest struggle of my life.  It challenged my mind, my physical stamina, and my character.  Med school spoiled me with eight to noon hours, breakfast in PBL lab, full weeks off between blocks.  Sure, I had to study, but I’d been studying my entire life.  Biochemistry is certainly harder for me than Walt Whitman, but studying was not unfamiliar to me.  My clinical rotations required some call, some extra hours, but, aside from surgery, I didn’t mind gathering vital signs, writing up histories, and chatting with patients.  I was completely unprepared for residency.

July 1, 2005, I became a resident of the Department of Child Health at the University Hospitals and Clinics.  I knew where to find the lab, how to navigate the underground tunnels, the codes to enter the intensive care units.  In short, I felt at home in the hospital and in the department.  Pride always comes before a fall, they say.  I was only assigned one patient on my first day.  He was and still is the sickest child I’ve ever known.  This boy had 13 different medications being continuously infused into his little body.  I was responsible for knowing every dose of medication, every IV line, every dip in blood pressure, every fluctuation in his electrolytes, and the result to every culture he’d had in the four preceding weeks.  I was humbled quickly when a student nurse misunderstood a comment I made to his family.  She told his nurse, who told my attending, who stopped speaking to me from that point forward.  I didn’t realize that the natural assumption when dealing with interns is to assume that they are at fault.  This child was my responsibility, so anything that happened, within my control or not, was my fault.  As the weeks went on, I became responsible for other patients as well, and when my fellow interns weren’t nearby, my attending held me responsible for their patients as well.  For every order for medications or labs that I wrote, I was responsible to personally tell the family, the nurse caring for the patient, the clerk, the phlebotomist, and the lab.  I worked a 30 hour shift every fourth day, and my other days were 14-16 hours long.  I still didn’t have enough time to finish everything for each of my patients.  Between morning PICU rounds, ward rounds, conferences, radiology rounds, afternoon PICU rounds, and the meetings our senior residents scheduled to criticize us, I had very little time to attend to my patients, the little ones I had studied for 8 years to care for.

So, I found myself frustrated with my inadequacy.  I was unable to please my attendings and my senior residents.  I was unable to complete the work for each day for lack of enough time, and the hours I spent at home I spent catching up on precious little sleep.  On the rare occasion that I was off and awake, I was complaining.  My dear pastor overheard my struggles, and he casually mentioned that he thought it would be good if we spent some time studying what God has to say about work.

The following Wednesday night, my pastor presented Ephesians 6:5-8 in our regular Bible study time.  Then I realized who I was.  I chose medicine.  I chose residency.  I was a slave to my residency, and I needed to stop thinking that I had any freedom in the matter.  God looked at me, and he gave me grace–grace to accept criticism from my attendings and floor nurses, grace to keep moving when I had no strength or desire to do so, grace to help me see that rather than grudgingly serve my superiors, I should joyfully serve my savior.  In short, I learned to suck it up and give it to God.

Suddenly, residency became a little bit easier.  I stopped struggling against everyone around me and started looking for what they (attendings, patients, nurses) were trying to teach me.  I started listening, and I learned.  Honestly, I didn’t see any change in myself until I viewed my evaluations (6 months into the year).  My ward evaluation from July from my favorite attending was scathing.  She found me unteachable, unruly, and difficult to get along with.  Two months later, the same attending commented on my evaluation that she could not believe how much I had changed and how quickly.  I know now that this transformation had nothing to do with my effort or my studies and everything to do with God.

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