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....)

Tuesday, May 24, 2005


So it's only been twomonths since my last post, and I'm sorry. Blogging hasn't been my highest priority. Neither, for that matter, has been enlightenment, lovingkindness, or any of the other great virtues of the ages. Instead, I've been taking a crash course in the following professional issues I didn't learn about in residency.

1. Doctoring in a small town. Now, I thought Salinas was a small town, but now I've come to realize it was a growing suburb with a significant shadow population. I almost never ran into patients while I was running errands or dining out. However, 391 miles north of Salinas, here in Northern Humboldt County, California, I really am working in a small town. I can't remember the population, but even more notable is the small number of places to go to. For example, everyone shops at the local co-op, so if I drop by for a pound of organic carrots, it is more than likely that I'll run into a patient I've seen in the clinic. Ditto for evenings out--the last three times I've walked into a restaurant I've seen a patient of mine. Don't even get me started about the grocery store.

How to feel about this, that's what they don't teach you in residency. Is it supposed to be uncomfortable? Maybe. There's something unnerving about running into a woman whose baby you delivered, dining out with friends and family, and remembering her sweat, her cries of pain, or the stunned expression on her face when her baby was laid on her chest. Certainly it is more uncomfortable for those doctors who don't set clear boundaries for chance public encounters. One woman doctor reported to me that her patients used to approach her at the local farmer's market--a major community social event--and talk to her about their yeast infections, urinary incontinence, and other intimate medical malfunctions. Just use your imagination.

No one has approached me in public to ask me about their stool samples yet, but there is still something very...exposedabout popping into the local Safeway and seeing someone with whom you've just spent half an hour discussing presumably private health matters. It doesn't seem to matter if it is the significance of the Vioxx recall or the psychological underpinnings of erectile dysfunction--I feel put on the spot, as though I'm expected to stand by my opinion, right there next to the sale bottles of seltzer water.

And don't even get me started on how self-conscious I feel about being caught with my shopping laid out on the rolling checkstand.

2. On call at home. Now, you'll remember from my interminable reports from the front lines, that being on call used to mean 12 to 24 hours of house arrest inside the hospital. We never even left to pick up pizza. Of course, this was awful because you never get a decent night's sleep in the hospital even if you do find a few loose moments, but the one thing you get used to is being right there when something happens. I had more than my fair share of midnight sprints down the hospital corridors, on my way to respond to a Code Blue or a stat overhead call. Often I arrived, breathless and on the verge of collapse, and looking much worse than the subject of the code, but at least I was there.

Now, when I'm on call, I keep my pager and cell phone at the bedside and go about my real life until the pager goes off and the message is transmitted to my befuddled mind: ˆPrepare to get your butt in gear! What's nice about this is I often get to sleep through the night. Not so nice is the recurrent decision: Should I go in now, or wait? This comes up all the time when a patient is in labor. If it is early labor, I often go home and twiddle for a few hours, but once she hits eight centimeters of dilation, I go back to the hospital. The bigger problem is how often to go in and check on the progress of her labor, or, if this is her second or third baby, whether I dare to wait until the eight-centimenter threshold. Two weeks ago, I got called at 2:30am for a woman in labor with her fourth child. She was only three centimeters dilated, so I told the nurses I'd go back to sleep for a while. One hour later, I was called and told, "She's nine, and you should come NOW!" I broke the sound barrier to get to the hospital, and the baby was born three minutes after I arrived. You can imagine how I might become a bit hypervigilant when I hear the sound of that pager.

When to leave, and when to relax--these were decisions I never faced when I was an inmate at the hospital. Now they are the drama of my call nights. What I miss is the rhythm I used to have with call, even though it was always chaos and pandemonium. So far, I don't have that rhythm, with this new process of call. Instead, I twiddle randomly, and wonder, is that the pager going off?

Oh yes, there are more lessons I'm learning for the first time, but they'll have to wait for the next post. I promise it won't be a two-month wait.