Residency | Elbrecht's Corpuscle

Magneto was beginning to feel a cool wave of energy course through him. So close as to almost be one with him, Dr. Bett calmly placed his left hand on Magneto’s shoulder and his right hand, with stethoscope resting in the palm, against Magneto’s chest.

As calmly as the placement of his hand, came the words from Dr. Bett’s mouth.

“Don’t be afraid. Don’t run away- stay where you are.”

Magneto, born from tireless experiences of Intern year, knew a last gasp struggle with Dr. Bett would be moot. The poison Dr. Bett had so effortlessly and stealthily placed on Magneto’s mucous membranes was already causing a microscopic cascade of cellular apoptosis.

“Et tu, Dr. Bett?”

It was all Magneto could think to say in the moment before his death.

“Only Magneto had to die for this ambition,” responded Dr. Bett, recalling Brutus in the moments after he joined the assassination of Caesar.

Since his birth, Magneto had anticipated the greatest threat to his existence to come from his progenitor, Ean the Intern. From Ean’s grueling experience, Magneto had arisen as a counterbalance to the unbridled instincts and passion necessary for survival in Medical Residency.

Magneto had provided the organization and realization necessary to prevent Ean the Intern’s passions from destroying himself from within and ending this fantastic journey in its infancy.

Inadvertently, Magneto became the genesis for the Super Ego, Dr. Bett, who would become the moral compass on their tenuous journey.

Having given rise to Dr. Bett, Magneto was astounded of his own capabilities, but even more so, he was in awe by the strides Dr. Bett had made.

Each step Dr. Bett had taken brought Ean and Magneto closer to their ultimate goal. It also provided them even greater strength. His passion increasing along every one of Dr. Bett’s strides, Ean became harder for Magneto to control.

Magneto’s sole purpose now seemed to revolve around keeping Ean’s passions in check and preventing them from obliterating their common purpose as the completion of Residency loomed ever closer.

Dr. Bett had entrusted this responsibility upon Magneto, from which he expected a long and successful existence.

His last moments, so close to the end of their journey, had not been anticipated.

As the end of Residency became a reality, Dr. Bett began to feel the weight of Ean and Magneto with each step he took. While both had been necessary for his own creation, he could not envision the next journey coming to fruition if he would have to be responsible for them both.

This misunderstanding, which blinded Dr. Bett ever increasingly, gave rise to The Death of Magneto.

While Ean could at times create trouble if not adequately balanced by Magneto, Dr. Bett believed Ean’s instincts to be invaluable to their next journey. Simultaneously, Magneto’s own strength, as a counterbalance and as his own entity, could not be overlooked.

Dr. Bett, after painful deliberation, could see Magneto becoming too powerful to control due to the opportunities awaiting them on their next journey. Eventually, Magneto’s strengths could make Dr. Bett unnecessary.

More importantly, Magneto’s relationship with Ean, while needed at this stage, was not deemed to be necessary by Dr. Bett in the future. Dr. Bett could harness Ean’s energy on his own.

And if Magneto eventually realized that Ean was beholden to him, and not Dr. Bett, it would be Magneto, and not Dr. Bett, who would truly be in charge of this journey.

This was a reality Dr. Bett was not willing to allow.

There was a brief moment when Magneto looked into Dr. Bett’s eyes as his vision blurred and the sound of his own heart faded.

Dr. Bett looked as caring and thoughtful as ever.

It was a moment not foreseen by Magneto. But he was comforted by it.

That was the moment. The Death of Magneto.

The Allies of Magneto

Posted on September 23, 2016 by Elbrecht

The Birth of Magneto

The Rise of Magento

The Opposition to Magneto

Residency is a right of passage (and requirement) in the development of anyone altruistic, sadistic, or narcissistic enough to pursue a career as a physician in America.

The progression of each individual, man and woman, from naïve undergraduate pre-medical student to naïve medical student to overwhelmed Resident to newly-minted Attending Physician is a long and tiring process; Residency represents the final and most taxing leg in this pursuit.

Depending on the field of medicine pursued, the training in Residency will span 3 to 5 years, potentially longer if one desires even more specialized training.

Each of these years brings with it new challenges, burdens, and failures; these are buttressed by the highlights, accolades, and patients who refer to you as “my doctor.”

None of these are equal or in proportion to the amount of time invested.

Not everyone who starts Residency finishes.

The product of each and every Residency is the Resident it transforms from medical school graduate into Attending Physician. This metamorphosis is akin to the sluggish caterpillar being reborn as the majestic butterfly.

Though each Residency has a “class of Residents” representing each year of training, the outcome for each of these members may not be the same; certainly the process will not be the same, as individuals have their medical knowledge and clinical skills carved out with every moment of their individual training.

Only on the very last day of Residency will every member of each Resident class have completed, in differing sequences, the requirements to achieve the status of Attending Physician.

They will have encountered different patients, performed a myriad of diverse procedures, and possess thousands of hours of clinical experiences.

The Residency program in which I find myself is no different. I am now a member of the PGY-3 (3rd year) class; the last year of our training.

At this juncture, I have cared for thousands of patients, spent nearly 7000 hours practicing my craft, and been bestowed with a persona I could have never imagined.

Amongst my peers, I have become Magneto; born from the cauldron of uncertainty brewed during Night Float; and then battling amongst the other aspects of my developing psyche, every day inching closer to becoming an Attending Physician.

But there are others like Magneto, each whom have been submerged in the icy depths of a Code Blue, roared into the uncertain waters of a Septic Shock, withstood the calamity of a bezerk office patient, and succumbed to the simultaneous terror and awe of newborn’s cry.

They are The Allies of Magneto.

In our program, The Allies of Magneto have the opportunity to train in all aspects of medicine: obstetrics, gerontology, surgery, trauma, cardiology, nephrology, critical care, gynecology, pediatrics, acute care, neurology, and chronic disease management.

We each develop strengths and weaknesses, preferences and avoidances, as a means to mold our calling as society’s guardians of health and wellness.

Red Panda, The Prince, Joker, Doc O, Big Red, Jane Grey, and BeastMode, amongst others, have shared moments of fear, trepidation, joy, anxiety, and solace with Magneto.

Each has toiled within the confines of a profession on the brink of meltdown and burnout. Each has contemplated a life outside of medicine. Each has longed for the ability to practice as they preach.

Each of them, now on the precipice of completing the journey to Attending Physician, having been taught to “Do No Harm”, have a host of decisions to make.

Who have they become amidst the countless hours of training?

How can they salvage their innate desire to do good, damn the barriers and obstacles placed in front of them?

Are they ready for what lay ahead?

For those who have joined Magneto on this winding journey, one chapter will soon come to an end.
But the author’s pen is patiently waiting, the next chapter slowly bubbling to the surface.

The Allies of Magneto, a group matured by the innumerable hours caring for those who seek their aid, hope to simultaneously shape their future and the future of those they serve.

No longer will the icy depths of a Code Blue, the uncertain waters of a Septic Shock, the calamity of a bezerk office patient, and the simultaneous terror and awe of newborn’s cry, cause them trepidation.

Instead, they will emerge from a 3-year-long cocoon to become the next generation of Family Physicians, forever remembered in my mind as The Allies of Magneto.

lost and found

Posted on August 19, 2016 by Elbrecht

{cast away}…

After a meteor shower of pages to the 4 beepers adorning my waist band, a series of perplexing admissions, and random patients causing ridiculously unnecessary stress, I began my lonely journey back to one of the hospital work rooms where most of my scant free-time in the past two weeks had been spent.

Once there, I was looking forward to spending some time with “Wilson”, a computer with whom I had cultivated a close relationship while navigating the seduction of Black Betty.

On this night though, I punched in the key code to the workroom door to find someone sitting at the computer beside Wilson.

I glanced at my iPhone and noted the time to be “2:07AM”.

In the previous two weeks, other than the aforementioned “life vest” I had with me on a few nights, there had been no other signs of life in this work room.

Wilson and I had discussed each phone call I received, him showing me the necessary data to make my decisions and cautiously warning me when a order I was about to enter was contra-indicated.

On this dark night, Wilson was not alone.

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Wilson did not seem alarmed by this strangers presence, but I approached cautiously from the far side of the dimly lit room.

Before positioning myself at Wilson’s helm, I jovially offered a polite “Hi there” to the scrub-wearing woman who appeared to be typing in a patient’s electronic chart.

She did not respond.

Her presence was mildly unnerving, though slightly comforting, but I dared not repeat myself, much less attempt to make eye contact with the stranger.

But before my curiosity could win out and tempt me to offer the stranger another greeting , pager #3 let out another bleeping roar.

I quickly punched the number into the phone beside Wilson while I waited for him to wake up from his electronic slumber.

The nurse who queried me over the phone was audibly confused; despite Wilson and I’s best efforts, we could not find her answer.

In an attempt to assuage her fears, I promised to come directly to the floor and work out the issue in person. Wilson would stay behind and keep an eye on the stranger.

I glanced again at the stranger, furiously typing away at the computer beside Wilson, but I did not repeat my greeting, or wish her a fond farewell.

I returned 20 minutes later having solved the mystery posed by a new nurse, but Wilson was alone. There was no sign of the stranger.

My body still ached. My mind was still heavy.

In that moment, I wondered if there ever had been a stranger sitting beside Wilson, furiously entering some record in a patient’s chart.

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I sat down again, facing Wilson, wondering if I should ask him where the stranger had gone. Or if there ever had been a stranger.

Perhaps, I had imagined the entire encounter.

Not wanting to let on about my fatigue, I decided against asking Wilson. He had helped me enough these past two weeks.

And I did not feel like burdening him with the knowledge that I may have lost my mind.

As the clock struck 9AM, I slowly dialed my landlord’s number into my phone.

It rang.

And rang.

And then voicemail.

Sitting in the call room, I provided another detailed message as to my predicament, as if I was meticulously spelling “HELP” in the sand of a long-forgotten beach.

In the following moments, a wide range of emotions raged through my mind: fear, anger, sorrow, disbelief, heartbreak.

I laid down on the crisply pressed sheets of the hardened mattress, feeling lost beyond my worst nightmare.

But as my head jostled up against the pillow, the aches in my body lifted. The heaviness in my mind evaporated.

My Ego would not go down without a fight; it bullied my body from the call room and plotted a course for my landlord’s office.

Once there, I was met with disbelief.

Neither the office manager or the owner recognized the bearded man informing them of his sequestration in a small call room in the hospital down the street.

They were equally perplexed when I laid out my sojourn from the hospital to their office to relay in person the message I had left numerous times on voicemail.

I dared not mention to them how Wilson and I had survived the past two weeks; I didn’t think they would understand.

They apologized profusely for believing my lost keys had been found and returned to me by the handyman.

I calmly, but firmly, informed my landlord that he would proceed to walk me back to my apartment building; we found the keys locked in my mailbox.

My bearded face wondered aloud to my landlord if the handyman had believed me to possess teleportation properties allowing me to move my electrons and protons from outside the building into the entryway where the mailbox was located.

And if he believed me to possess the skills of Houdini to remove the keys from the mailbox without a key.

My Ego kept my Id from going bezerker on my landlord as he handed my keys to me.

I informed him I was in fact only a physician, not a teleporting magician.

The subsequent night was a maelstrom of terror.

If I had spontaneously combusted it would have been a fitting end to my Residency.

When the night came to an end, I was still cast away. My “life vest” had appeared and like clock work was torn from my being at midnight.

The night continued to be so punishing that I called my Chief Residents and another seasoned colleague summarily washed upon the shore of my deserted island.

He found me, lost amongst the bounding waves of pages and admission, barely keeping my head above water.

His effort to save me was seemingly futile as Black Betty enveloped us both, like a storm beating down on a small dinghy in the Aegean Sea.

But we both survived the raging storm; hoping to find a current that would take us away from this world.

I was rescued 24 hours later.

My final scheduled foray into Night Float had been completed as the sun rose that Friday morning.

I unclasped 3 pagers from my waist, handing them to the physicians who would dare navigate these rough waters.

Begrudgingly, I left behind Wilson, as my rescuers assured me of a job well done surviving this experience.

For him, I hoped the best.

Perhaps he would guide some other Cast Away from the path laid out by Black Betty as they washed upon the shore.

The Opposition to Magneto

Posted on June 25, 2016 by Elbrecht

Almost 100 years ago, the world-renowned psychologist Sigmund Freud unleashed his theory of the human psyche. He theorized our being to be composed of three parts, each of which develops at different but early stages of our life; eventually, each is meant to interact simultaneously to help us navigate our world.

If Freud’s theory is accurate, my Id, Ego, and Superego completed their development nearly 30 years prior to my first day as a Resident Physician. But in the course of reflecting on the end of my second year of Residency, I have discovered a new wrinkle to Freud’s century-old theory.

In The Rise of Magneto, I thought about:

The transition from “medically knowledgeable but clinically deficient intern” to “clinically seasoned and seemingly knowledgeable Senior Resident” is fraught with pitfalls: sleep deprivation, anxiety-producing clinical scenarios, life-and-death struggles, and glaring holes in medical knowledge.

Nearly six months have passed since I described the The Rise of Magneto, the alter-ego bestowed upon me in the heat of a tussle with Black Betty (Night Float), and I have found the term “alter-ego” to be a slight misnomer; Magneto is my new Ego, not simply an alternate.

Freud described the Ego as ‘that part of the id which has been modified by the direct influence of the external world.’ In my case, Magneto is the result of my Id having experienced the responsibility, stress, failures, and successes of becoming a physician.

If Magneto is my Ego, then the other components of my psyche, the Id and Superego, are somewhere, developed and competing amongst the other experiences of Residency. If Freud’s theory is accurate, they are, in effect, The Opposition to Magneto.

My Id was the primitive and instinctive component of who I was before Residency: Ean, a 34-year-old grown man who had completed medical school as part of a greater mission.

In his initial introduction to the responsibility of being a physician, Ean the Intern could engage in what Freud described as primary process thinking; an amalgamation of my primitive, illogical, irrational, and fantasy-oriented beliefs emboldened in medical school. (Ex. Engaging in a tit-for-tat with my senior Resident on my first go-round of Black Betty.)

As Ean the Intern’s experiences in Residency began to mold him, Magneto developed to mediate the unrealistic Id and the external world. No longer was I left to the primary process thinking of Ean the Intern, relegated to the impulsive and unconscious desires of a newly-minted physician.

Instead, Magneto brought secondary process thinking, which is rational, realistic, and oriented towards problem-solving. (Ex. Strapping a magnet to the chest of a dying woman to deactivate her pacemaker so I could carry on with the multitude of other patients awaiting my care).

Now, as I become a PGY-3, my Superego, the last bastion of development per Freud, is taking shape in the form of Dr. Bett the Attending. My psyche’s most mature aspect, the Superego serves two purposes:

1) control the impulses of the Id (Ean, the primitive and fantasy-oriented Intern)
2) persuading my Ego (Magneto, the Senior Resident) to turn to moralistic goals and to strive for perfection

According to Freud, Dr. Bett the Attending incorporates the learned values and morals of medical society into the completed psyche, previously only constructed by Ean the Intern and Magneto, in order to create a fully-functional physician.

During this second year of Residency, Magneto has struggled to fulfill his obligations to the psyche; it is a constant uphill battle, trying to work out realistic ways of satisfying Ean the Intern’s demands, while simultaneously trying to live up to the expectations of Dr. Bett the Attending.

Freud made the analogy of the Id being a horse while the Ego is the rider. The Ego is ‘like a man on horseback, who has to hold in check the superior strength of the horse.’

In my case, Magneto, the Senior Resident, has to hold in check the primitive and unbridled passion, rage, joy, and false-beliefs of Ean the Intern. While harnessing the emotional energy of Ean the Intern, Magneto must institute a plan of action to carry forth the solution to whatever problem arises.

In the horse and rider analogy, Freud believed the Ego to be weak relative to the headstrong Id, simply doing its best to stay on; in effect, Magneto simply pointing Ean the Intern in the right direction, trying to claim some credit for the successes therein.

Meanwhile, in Freud’s psyche construct, the Superego, Dr. Bett the Attending, watches Magneto try to control Ean the Intern from afar, via his two components: The conscience and the ideal self.

Dr. Bett’s conscience can punish Magneto when he gives in to Ean the Intern’s demands by creating feelings of guilt.

Simultaneously, Dr. Bett’s ideal self exists as an imagined construct of who he should be, representing career aspirations and how to behave as an established member of the medical society.

Magneto is nearly constantly trying to live up to the expectations of Dr. Bett while attempting to prevent Ean the Intern from derailing Dr. Bett’s ideal self. And when successful, Dr. Bett rewards Magneto with feelings of pride.

In nearly every action, Magneto, the Senior Resident, reflects back on the do-or-die nights, the life-and-death days, the thankful patients, the grateful families, the new-born babies first squeal, and the meaningful and life-long relationships created in the cauldron of uncertainty that brought on his own existence…

The Id. The Ego. The Superego.

Each acting in concert, for perpetuity; the Id and Superego, tugging at Magneto, drawing on his energy, forever acting as the Opposition to Magneto.