Let me clarify: all of these patients would have been totally fine without me. I am nothing special. Even though they seemed "critical", basically anyone in the ED would have been able to handle these patients. This brings up one of the most important lessons I've learned (or rather - I'm learning) since I became an intern. The critical patients aren't the ones that actually wrack my brain.
My residency director brought this up with me very early on. I was talking to him about the critical/resus beds and I said something along the lines of "I'm afraid of walking into a critical patient's room... I don't know what I would do". And he responded with "actually, the critical patients we know exactly what to do with - it's resuscitation - it's definitely tough, but you know what to do". "The tough patients, for me at least, are the ones who are undifferentiated - like the back pain patients. Is that the guy who pulled a muscle after lifting something heavy? Or is that the guy who has a leaking Aortic Aneurysm and is about to crash? That's what keeps me up at night".
And boy, was he right. And I'm realizing this just a month and a half into my intern year? Clearly wise words.
Don't get me wrong, I am by no means a master (or even a padawan) of resuscitation. I've got a ton to learn, but I feel like it's something I can learn. What is really challenging - and this is one of the cornerstones of why doctors do years (and years) of residency - is differential diagnosis. It's a process doctors go through to make a list of diagnoses that we think explains why the patient has X symptoms. Then we play detective and try to figure out what is more or less likely.
And yea, it's hard.
For some complaints, you can have a differential over 10 items long. You are forced to think laterally - to think outside the box. Take the back pain example - sure he may have lifted a heavy box and now has back pain... but what if it's actually an infection in his spinal cord that decided to get worse at about the same time as him picking up that box?
Unfortunately, doctors (just like all humans) are at risk of falling into various biases when trying to make decisions. While one part of our training is to help us figure out what should go on the list of differentials, another equally important part of our training is learning to circumvent (as best we can) all those annoying biases. These are things we've been trying to learn throughout medical school. And these are the things we will continue to learn well past our residency days (or so I'm told).
This is what I see as my greatest challenge in residency: building that differential, keeping it wide, and avoiding pitfalls. Or so I think now. Check with me in a month - maybe something else will be my "greatest challenge".
But I've got to say. Through all the doubt and disappointment (when I'm wrong, and I'm wrong pretty often at this stage) - medicine is an amazing field. I'm humbled every day that I get do this. Sure, doing 8 days of 12(ish) hour shifts back-to-back can really grate on your resilience (and social life). But where else do I get to feel like:
Image from www.explodingdog.com
And seeing that look on a patient's (and their family's) face when we are able to help them? Best feeling in the world. It's not always roses and it's definitely not always easy. But maybe that's what makes those "stand out" moments... well. Stand out.
- Karthik
#DrKarthik
