At the Still Point of the Turning World
Residency is over, NOW what? (While I'm waiting for the answer, I'll get some spinning done....)

Sunday, June 27, 2004


Graduation was today, and what a relief--we pulled it off. The photo above is of me receiving my diploma; the other two men on stage are our residency directors. (These photos were shot at a distance by my good friend Marie, who not only drove my mother and the Peke all the way down from San Francisco, but also bravely wielded my digital camera to take most of these pics.) Honestly, I don't think Steven Spielberg puts as much work into his films as we did for our little get-together this afternoon. At other, saner residencies, graduation is underwritten by wealthy benefactors and all the grads have to do is show up. At our residency, we had to do the following:

1. Choose the venue. In the past, an evening party with catered dinner and a band were favored, but this year--given the extreme budget cutbacks at the hospital--we, as a graduating class, decided to have a smaller, more modest "do" in the courtyard at the hospital. This was a way to acknowledge a sense of place (oh this building, where we've spent the greater part of three years) and to keep costs down. Now, there were certain people among the faculty and staff, to whom I will refer as Sourpusses, who hated the idea of the courtyard because it seemed "cheap" and "tacky." I feel--and of course I am 100% correct in this--that the tacky thing to do in a year of financial crisis is to spend too damn much money on a party. The private hospital across town opened their heart center about a year ago and held a $1,000,000 party. I think they might have hired Cirque du Soleil for entertainment. Meanwhile, at our County hospital we were laying off LVNs, closing the cafeteria and scaling back costs. That party, with filet mignon and three bands, that was tacky.

One unexpected bonus to our local: on-duty nurses, who couldn't come down to the ceremony, watched the from the windows looking down upon the courtyard. A few took the time to write down their good wishes:

(You see they've included a few of the key Spanish phrases used on L&D--translated "Don't push!" and "Breathe deeply.")

2. Hire caterers. Here's where my friend Cori managed a brilliant coup, to restrict the catering to afternoon tea--cookies, cake, little tartlets, and basic beverages. Really wonderful little petit-fours, mere mouthfuls of key lime pie, tiramisu, lemon curd and straweberry baby tarts.

3. Arrange for loudspeakers, stage and folding chairs. Again, Cori made about 10,000 phone calls and got the chairs laid out. Of course, there was a muddle at the end when someone decided to scale the number of (white) chairs to 120 from 200, and the housekeeping staff decided there had been a screw-up and dragged out a whole bunch of extra (blue and pink) chairs from the waiting rooms, which rather spoiled the effect of all-white folding chairs. If I were Martha Stewart, this would have bothered me, but I'm not, so it didn't.

4. Figure out who will receive the teaching awards. This is technically the job of the new Chief Residents (did I mention? as of May 3rd, I am now Chief Emerita, the office having been taken over by two R2s with more energy than me). This takes place by a chaotic system of nominations, first ballots and second ballots, and usually takes so long that the awardees don't find out they've won until too late, and they can't make it to graduation.

5. Figure out who will give the speeches. Someone has to present the teaching awards (me) and someone else has to give a little feel-good "thanks for the memories" pep-talk. Cori did the pep-talk, which was brief and let into the next item....

6. Embarrasing public humiliation. For some reason, there is a fine tradition of graduating residents having to put on some gawd-awful skit, karaoke or other form of entertainment, purely for "cuteness" value. This year, one of the resident's wives, Sarah, a talented singer, rewrote the words to Aretha Franklin's "Respect" to reflect something about residency--sorry, I don't have the lyrics with me but it was cute. Our role, since it is well-known that none of us can sing, dance or otherwise perform, was to doo-wop as best we could in the background. We had to "Oooooh" four times in a row, in proper time with the lyrics, and shake our shoulders about. This was about as awful as you can imagine, but the crowd loved it.

Here we are, stiff as cadavers and trying to dance. From left to right: Philipp, Brent, Sarah, Me, Jaime, Suzin and Cori.

After the ceremony--which was mercifully short, given that we were in full sunshine and sweating like warthogs--we got to say goodbye to some beloved faces. Below is a photo of a bunch of us with Dr. Santell, our Internal Medicine attending. He's been at Natividad for about 30 years. During that time, he has come into work 351 days out of the year. His wife makes him take two one-week vacations per year, under threat of divorce, and he goes very grudgingly. He LOVES medicine, and--he'd hate to admit this--he loves teaching residents. During the last financial crisis about seven years ago, he announced his retirement. The event was written up in the newspaper and a party was held, then the day after his retirement date, he showed back up at work and that was that. He is very strict and principled. He gives feedback directly and without any shilly-shallying: "You know, you really screwed up last night." That's what I love about him; he has none of this new-age, jargony, indirect bullshit about him--excuse my French. Either you do things right or you don't. And yet, he is a reasonable man. There are so many things in medicine that can be done a million different ways, and although he has his preferences, he will also listen to any reasonable argument in favor of another approach. So when he asks me, "Now, Theresa, what were you THINKING when you did this?" I can explain it to him and he'll nod his head and say, "Well, I wouldn't've but I suppose you got away with it." He is our conscience in the middle of the night. Many's the time I've sat up at 2:30am, gnawing my fingernails and wondering, what would Santell do? Over the last year, I've gotten in the habit of checking in with him when he arrives at the hospital at 5:30am, to find out if we screwed anything up on our admissions. "So, Dr. Santell," I say, "What did we do wrong?" And he looks at me and says, "Well, nothing so far. But I haven't read all the notes yet." This is what passes for high praise from this man. I can't imagine what life will be like without him to back me up.

From left to right, Dr. Santell, Cori, me, Suzin and Brent:

Dr. Santell was tickled by a gift all the residents gave him, a Palm Zire PDA. He's known as an old-school doctor, who looks things up in books and who has, very slowly and deliberately, learned to use things like computerized lab databases and Internet. Yet he's interested in new technology, and whenever one of us whips out our PDA (most of us have Tungstens), he leans over to see what all the tapping is about. So one of the interns took up a collection and we presented him with the gift "to drag him into the 21st century." I think he's looking forward to fiddling with it. When I presented it to him after the teaching awards, he gave me a hug.

You have to understand, this is like geting a hug from ELVIS!

So we all graduated, and I received a couple of awards, one for physicianship and "The Golden Fetal Scalp Electrode" awarded by the Labor and Delivery nurses for being the best Deck-buster of the bunch (of which I am VERY proud!), and a nice plaque for having endured a year of Chiefdom. Brent got the award for technical (procedural) achievement, and my friend Suzin got the Society for Teachers in Family Medicine award, which was well-deserved, because she's taught us all about decency, grace under pressure, and exemplary collegial relationships.

And yet it doesn't feel quite like the end. We actually have three days left before we're "off the job," although almost everyone is moving away in the next couple of days, except for me and Cori who will be doing some temp doctoring at the regional clinics over the summer. For me, this is a way of not saying goodbye all at once, because I hate goodbyes. The strangeness of finishing residency--that behemoth of medical training, the Scylla and Charybdis (if you'll forgive a mythological reference) from which some people don't emerge intact--hasn't sunk in yet. I have been told by other doctors that there is a period of "withdrawal" after graduating from residency, which might just be the restoration of normalcy, come to think of it. I'm sure I'll experience this in full, just as soon as the end, the real goodbye, finally arrives.