August 3, 2021August 3, 2021 monicarose

Block 1: Emergency Medicine

Residency

During residency, each month I’ll rotate in different “blocks” or rotations. For me, my first block was in the Emergency Department (ED), and it was a great way to start residency. 

Leading up to this block, a lot of big life changes happened, which is actually very common as anyone makes this transition from medical student to resident.  Dominic and I planned our wedding and honeymoon, got married in Lake Tahoe, and then celebrated our reception a couple of weeks later.  Right away after Match Day, we started planning our move 1500 miles away to Corpus Christi Texas, and we were extremely fortunate to be able to buy our first house! I hope to eventually write some separate posts about these life transitions and the process, but needless to say the weeks leading up to July 1st were hectic but also wonderful and fun.  Even with all of these recent life changes, I started residency this month feeling grounded and ready to work hard.

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On July 1st, I worked my first shift in the ED! The entire month was filled with so many firsts, but day 1 was definitely its own whirlwind, and struggle.  It was the first time I’d ever introduced myself as “Doctor”, and even one month in this still feels very new and awkward at times. Overall, one of the most difficult challenges of this first month was learning a new EMR (electronic medical record) system, and learning how a new hospital system operates.  I am so grateful to be at a program where they have extensive mentorship built into the schedule. My program has third-year residents that they call “pretendings”, and those third-years’ job is to help us interns with anything we need. (And we need a LOT of help.) The pretendings don’t see patients independently during these shifts, they just help us interns with ours.  Having the support of these third-years helped me feel more comfortable seeing the sicker patients, trying procedures for the first time with them right by my side, and all while still allowing me a strong sense of ownership and responsibility for my patients.  Even though it is absolutely terrifying at times, I knew that I wanted to be at a program where I was allowed to see the sickest patients (with a lot of help) right away, and my program definitely meets that expectation. 

Some of my main thoughts this month: 

I am excited to be seeing patients again! Prior to this month, I hadn’t taken a history and physical since October 2020, and I really missed the process of talking to patients. 

Even on the days where I feel overwhelmed 100% of the shift, I still have this underlying gut feeling of happiness and excitement. Under the anxiety, I still feel very calm and centered at the thought that this is definitely what I am meant to do, and where I’m meant to be doing it. 

I have to constantly remind myself that this is the starting point, and I’m grateful for my co-residents reminding me of that as well.  Right now it seems impossible that I will be as competent and calm as the second year residents 11-12 months from now, but I just have to keep putting in the work and have faith in the process. And a personal goal of mine is to keep a positive and happy demeanor during the process too.  I learned during medical school that if I focus too much on the “destination” or the end goal, it can be very easy to forget to enjoy the journey along the way. I hope to keep this lesson in the forefront of my mind, especially on the more challenging days. 

I keep reminding myself that I’ve always dreamed of being here, that this is what I always wanted. This thought is a little bit overwhelming at times, but mostly it helps me stay grounded and excited. One of the third-years shared with a patient, “this is my dream job”, when the patient was being apologetic for taking our time, and that was honestly so beautiful to hear. I hope to keep this sentiment in the forefront of my mind as well. 

The looks on patient’s and their family’s faces are so different now that I’m “the doctor”, and are a constant reminder of how much responsibility this is.  Patients and their families look at me with so much more intensity and trust now that I’m the doctor instead of the student.  It’s a strong reminder to choose my words purposefully and carefully, and to be honest, especially when my answer is “I don’t know, but I’ll find out”.  The patients don’t know that I’m an intern, that I’m new at all of this; they just know that I’m a doctor that’s part of their care today.  This is such a privilege, one that I hope to never take for granted, and definitely one that I’m still getting used to. 

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Specific patient experiences from my first month: 

I got to deliver a baby this month in our trauma bay! Our hospital does not have OBGYN or Pediatrics, so when a patient came in in active labor, it was the emergency medicine residents and attendings who were there to care for her and her newborn. My pretending that shift was gowned and gloved right next to me, but he let me deliver the baby and it was an experience I will absolutely remember for the rest of my life. It was so awesome to see the emergency medicine team stepping up to these roles that are not very common in our practice setting, and doing so with such calm.  Seeing that was definitely one of the many moments this month where I was just so in love with the emergency medicine specialty.  We truly have to be ready for anything to walk through the door.  Thankfully the patient and her baby both did well and were very stable as they were transferred to the hospital location where OBGYN and Pediatrics are present.  Before they were transferred, a chaplain from the hospital came and did a family blessing with all of the ER team that helped deliver the baby.  Sharing this moment in the trauma bay, where I know I will see a lot of death and sadness these next 3 years, was so special. 

I also ran my first two codes this month, with the help of my co-residents and attendings.  This means that I was the doctor leading the resuscitation of a patient in cardiac arrest.  This is a very intimidating role, but again one that I wanted early exposure to with a lot of support.  After the first one, I watched as the attending delivered the bad news to the patient’s family that the patient had died. After the second one, I was the one delivering the news to the patient’s family.  I practiced with my attending beforehand, and I had my pretending by my side for the process.  Doing this for the first time was difficult, and my primary concern was that I was as respectful and kind to the family as possible. I definitely had a quick flash back to the time when I was the family member sitting in the “quiet room” receiving bad news about my Mimi, and this reminded me again how big of a responsibility it is to be in these family’s lives on some of their worst days. 

I also saw my first trauma patients this month, and those were definitely some of the encounters that I carried home with me.  It’s an odd experience, because at the moment I’m doing a procedure, I’m just focused on those steps, on that anatomy, so that I can play my role to the best of my abilities.  It isn’t until afterwards that you really have time to process the human side of what you’ve just seen. Seeing patients with devastating injuries from car accidents and then thinking of their grieving families was heart wrenching. This may sound selfish, but it definitely made me want to go home and cling tight to my own loved ones.  Seeing that pain and loss up close is still a new experience for me at this stage. I know that I can handle it, it doesn’t deter me from this specialty, but it will still take some time to process and time for me to grow as a physician who is more accustomed to seeing things like that on a regular basis. For now, I am glad that this hasn’t gotten in the way of me caring for my patients when I’m needed, and I’m grateful that my co-residents and attendings are open to talk me through anything I am feeling. 

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I have a lot of personal goals for residency; one of my goals is to take some time to reflect after each month, so hopefully I’ll be posting again after my next block. Writing this today still doesn’t feel real; I still can’t believe I’m “a doctor”.  I have so much to learn, and so much growth ahead of me both professionally and personally.  As intimidating as that can all be sometimes, one month in I am feeling so grateful to be here in Corpus.  I think I’ve found a program and the people that will help me grow to my full potential, and that’s really all I could have hoped for from the Match process.

For my second block, I’ll be at the children’s hospital for a Pediatric Emergency Medicine block.  So here’s to learning a whole new EMR system, meeting a new team, and continuing on the neverending list of “firsts”.