Residency | Elbrecht's Corpuscle

Exercising the Demons

Posted on June 6, 2016 by Elbrecht

Scott and I walked into his apartment a bit lighter in the pockets and mildly sleep-deprived. The drive back to Los Angeles hadn’t been more than 4 hours, mostly through the barren desert highway, but it had given us plenty of time to reminisce on the previous 24 hours.

His roommate greeted our return with, “Hey, where did you guys stay in Las Vegas?”

Scott replied, “Oh, just some low-class Motel 6 off the strip.”

She pointed quizzically at the newscast on the TV screen. “You mean that Motel 6?”

We replied simultaneously, “Yeah, why? What’s going on?”

“A few hours ago they caught the sniper there who had been killing people in Ohio.”

I looked at Scott. He looked at me with the same look of disbelief.

We had unknowingly had an uncomfortably close brush with infamy.

The “270 Sniper” had been caught at our hotel in Las Vegas a mere 60 minutes after we departed.

We had spent the previous 24 hours gambling, drinking, and wandering the streets of Sin City. He had been hiding in our Motel 6, law enforcement hot on his trail.

So when Scott and I recently planned a return trip to Las Vegas twelve years later, we decided to class it up a bit, avoid the Riff Raff, and stay on the strip.

There was no telling whom we would encounter this time around, but we actively sought to avoid any serial killers at The Motel 6.

Scott and I have known each other since 8th grade. His and my parents shared the odd predilection for sending their children to a brand new school housed in a warehouse in the industrial sector of Wichita, KS.

Yes, we went to school in a warehouse. Not like something out of a Philip K. Dick novel, where we would by psychologically programmed to become superhuman automatons.

But more like a once-vibrant warehouse in the process of being transformed into a new age educational experience where grades were in flux and Love was bountiful.

Actually, Love was very bountiful there, as the up-start school was housed in a Love Box Company warehouse, likely something Walter Love, the company’s founder, would have beamed with pride about.

While there, Scott and I both were indoctrinated in Logic, Composition, Biology, and Roller Hockey {in reverse order of importance}.

Despite the humble beginnings of our friendship, in a warehouse school in a dusty midwest metropolis, the lessons we learned were paramount to our unlikely professional ascensions. [Except for the Roller Hockey. I don’t really use that for anything.]

Our friendship started over twenty years ago in a warehouse.

Then we managed to avoid a psychopathic serial killer 10 years later.

Now, only a few weeks ago, we found ourselves re-united in Sin City again.

In the midst of Residency, it has been hard for me to “catch my breath” at times. The completion of every shift, every day in the office, and every licensure task, brings on more things to do, more days in the office, more shifts to be worked.

It seems inescapable.

But that’s why it’s called Residency. In order to be trained properly and efficiently, you are seemingly living at the Hospital, in the office, or a desk trying to complete a seemingly endless list of tasks.

Which is why Scott’s suggestion of a reunion in Las Vegas was utterly brilliant. We both needed a breather from our action packed lives.

Over ten years after our brush with infamy, Scott and I are living lives we simply couldn’t have imagined back then. Scott is a successful Healthcare Systems analyst, having completed his PhD at Florida State after marrying a hometown girl, and now resides in our nation’s capitol with a daughter and another one on the way.

I’m me.

We have kept in close touch since our last destination vacation to Sin City, but if the last 10 years taught us anything, it was to upgrade from The Motel 6.

When I made my egress from the plane in Las Vegas on Sunday morning, Scott was there waiting; the mastermind to our 48 hour get-away already had the wheels in motion.

We made our way to the Uber pick-up and our driver quickly made a quick connection, identifying that his grown children live in the same city as me. The small talk was brief, as it only took 5 minutes to reach our destination.

Our destination, the MGM Grand, was a familiar location to Scott, as he had visited Sin City numerous times in the years since our last sojourn together; most typically he arrived with his wife, who would be the Chris Moneymaker to his Phil Hellmuth in a pairing of Poker legends.

But this time, he managed to wrangle a male side-kick, in a Zach Galifianakis in “The Hangover” mold, rather than a Johnny Chan.

At the MGM, Scott managed to finagle an earlier-than-typically-allowed check-in time by not-so-secretively leaving a $50 tip for the concierge. As we calmly and cooly proceeded towards our rooms, I had the feeling our 48 hours of escape in Las Vegas would easily eclipse the 24 hours of chaos we spent there over a decade earlier.

When I landed back in Columbus on Tuesday evening it was nearly midnight. I was exhausted; and sun-burned. And slightly enamored with a woman I met on a plane.

In addition, I was neither psychologically or physiologically prepared to be a physician again in less than 8 hours.

But in Vegas, when the stakes are high, you can either fold or go all-in. I decided to go all-in this time.

We may not have had an indirect brush with infamy like back in 2004, but our 48 hours in Sin City made us hungry for more; just as with the genesis of our friendship, there would likely be more tales to tell.

Black Betty

Posted on April 23, 2016 by Elbrecht

At 2:17AM on a recent Friday morning I couldn’t sleep.

Not in the sense that I was laying awake in bed, thinking about the cosmos, or wondering how “The Walking Dead” Season Finale would play into any future cross-over series that might be developed, or anxiously awaiting the sun to rise again.

I was actually physically not able to sleep.

As my body was beginning to shut down at the cellular level, the efflux of potassium and phosphorus from every cell beginning to overwhelm my blood stream, the pager holstered upon my left hip started chiming again.

The pager transmitted electrical energy, similar to that of a defibrillator, into my body; the potassium and phosphorus blasted back into the cells, preventing a super-saturated metabolic derangement which would have caused my cardiac activity to cease.

Simultaneously, the loudspeaker in the Emergency Department blared, “Septic Shock Alert, ED 47.”

“Septic Shock Alert, ED 47.”

I unholstered the pager from my hip, quicker than Doc Holliday when he penetrated Ringo’s brain with a lead slug, and glanced down at the message awaiting me.

As I swiveled and rose from the stool I had been atop for only a matter of moments, I read the message. Thankfully, it only read “Septic Shock Alert, ED 47”, the electrical companion to the overheard communication, instead of 555-9095.

Or 555-9030.

Or 555-9494.

Those numbers belonged to the Hospitalist medicine service, the Intensive Care Unit, and the ED Nursing desk, respectively.

Responding to any of those calls would have meant either another patient was waiting for me to admit them to the hospital or an already admitted patient was trying to die in the ICU.

If any of those three numbers had been present, I would have needed to take over the care of the actively dying patient in the Septic Shock Alert, while simultaneously trying to:

1) figure out how in god’s name I would possibly get all of the work done I still had to do

2) supervise my junior resident

3) not lose my mind.

I also probably would have taken the pager and rifled it into the closest wall, hoping to have it explode in a wave of energy like the Death Star in Episode IV.

My Junior Resident sat beside me, near catatonic from Night Call’s siren song; I tugged at his scrub top, motioned for him to follow along, and let out a long sigh.

I could not sleep.

I was the Senior Resident on Night Call.

Or as I prefer to call her, Black Betty.

Black Betty is the anthropomorphic representation of Night Call, the overnight shift when physician staffing drops to a skeleton crew and the statistical probability of all hell breaking loose starts creeping up on 100%.

As the sun begins setting on a hard day’s work for most of the physicians, nurses, and ancillary staff in the hospital, Betty begins to rear her ugly head.

Her darkness requires the fortitude of a special type of physician.

Unless you are a Resident like me. Then you are required to show up to spend some time with Black Betty as a part of your training.

You are not a special physician. You are a Resident. And the only thing special about you is your ability to not spontaneously combust from the lack of sleep you have sustained.

Every Resident dates Black Betty. Some for a night here and there, with no specific frequency or expectation. She does not discriminate.

Others join her for a two week stretch; where her smooth skin becomes chapped and dry by the third night, her velvety caressing hands become stiff and arthritic by the seventh, and her formerly gentle kisses become vicious flesh-tearing wounds as the sun rises on the tenth.

Black Betty invites the denizens of the night to start shuffling into the Emergency Department.

And the critically ill whose lives are sustained by technological marvels in the ICU to begin their physiologic derangements.

They are joined by the sickly and elderly who become unpleasantly delirious as a result of her rancor.

—–

To this point in my Residency, I have spent over 20 weeks with Black Betty. A majority of those weeks have come in two week chunks, spread over In-patient Medicine, Surgery, and Obstetrics.

But as a now as a PGY-2, the Senior Resident, I have also had more than my fair share of random Saturday date nights with ‘ol Betty.

She and I have been intimate more times than I would care to admit.

Each date brings about something unique, whether it’s a patient hurtling a chair through a 7th-story window, a near-dead woman’s heart beating in full view of the audience in the trauma bay, or stabbing a needle into a man’s chest to hear the whoosh of air escape and provide his lung the opportunity to re-inflate.

She is fertile with opportunities for us to perform our duties as physicians.

Black Betty had a child, the damn thing gone wild.

dont-scare-your-kids

At 2:43AM on a recent Friday morning I exited ED 47 with my Junior Resident in tow.

Black Betty had provided us an opportunity to exercise our clinical judgement, initiate resuscitative measures, and stabilize an elderly gentleman who had tangoed with the Grim Reaper several times in the past two months.

The Reaper’s grasp had tried to choke off the man’s air supply. But we would have none of that.

Black Betty didn’t care. She shrugged it off.

She knew other opportunities awaited.

And my Junior Resident and I would be there. Waiting.

I would not sleep.

Not when Black Betty has anything to say about it.

The Birth of Magneto

Posted on September 13, 2015 by Elbrecht

—-

After hurriedly caring for two newly admitted patients, while receiving pages from nurses about the other patients already admitted to my service, I took a moment to “run my list.”

At 2AM on a Thursday morning, my brain required a succinct “to do” checklist to assure nothing of importance had been forgotten. Fortunately, I simultaneously happened upon my senior resident, Jacob.

He calmly asked how things were going, having left me hours before, in a trial by fire, to go about the business of running an in-patient service on Nightcall. Not that he had abandoned me, but rather, he had given me the reigns of our service and asked that I not make any decisions which caused him to question my ability as a soon-to-be second year resident.

—–

I collected my thoughts and began rattling off updates, allowing both of us to check off a multitude of things on our list. As I made my way to the middle of our list, I let out a quick a deep sigh.

He gave me a quizzical look, to which I responded, “I need to go check on Ms. Smith’s EKG. I was supposed to do that two hours ago.”

—–

Jacob and I had been paired to work together for these two weeks since our schedule for the year had been published months earlier. It was likely intentional, as Jacob had been identified as a leader within our program, and thus someone from whom I could learn to become a solid second year resident.

Though several years my junior in age, I respected Jacob’s work ethic and pride in our residency. Despite the long hours, occasionally ungrateful patients, and stress of balancing work and a family life, he kept a positive attitude and welcoming countenance. I could easily imagine him becoming a Chief Resident, one of the designated leaders of our program who toiled in an effort to provide stability in a world of chaos.

—–

My response prompted his characteristic comforting Arkansas twang, “Oh, don’t worry, Magneto. Ms. Smith is just fine.”

—–

As a part of friendships, work relationships, and familial bonding, nicknames are a nearly ubiquitous part of life. Having been given a multitude throughout my years, I quickly realized Jacob had provided me the latest in a long line. But unlike most of them, which were derivations of my first or last name, and typically of little creativity, “Magneto” provided me a cache not previously recognized.

I let out a quiet chuckle as Jacob informed me he had wandered up to Ms. Smith’s room at midnight, the time I had told him an EKG would be performed to determine if her pacemaker had been deactivated, allowing her to pass into death comfortably. Once there, he learned of my own creativity, which christened the birth of Magneto.

—–

I first met Ms. Smith three weeks earlier, when I was working during the day as one of the interns on our in-patient service, Clin Med. At that time, Ms. Smith was struggling with advanced heart disease, a quartet of pathologies which I termed the “Unholy Alliance”; her heart provided her four diagnoses, which together carried a high level of morbidity and mortality: congestive heart failure, atrial fibrillation, coronary artery disease, and pulmonary hypertension.

Each of these diagnoses were intimately intertwined with the others, but I had yet to see any one person carry all four. During our initial encounter, Ms. Smith was easily conversive, despite her need for supplemental oxygen, and seemed ready to battle her disease and proceed well beyond her 63 years of life. On that day, she was flanked by one of her adult sons who reflected her success as a mother.

—–

The night I earned my nickname, Ms. Smith was flanked by that same son, as well as her two adult daughters, several grandchildren, and a couple friends. They wished to be present in her final moments.

Between these two days, Ms. Smith had a brief, but meaningful improvement in her clinical status, allowing her to return home. But her heart quickly worsened and she ended up admitted to our service again, this time in more dire circumstances. It was immediately recognized that her final days were upon her and the one daughter who did not live in Columbus was summoned from California.

—–

The final daughter’s arrival from California harkened a transition in care for Ms. Smith. She had made it known if she were to have a decompensation in her status, she would not want to be maintained indefinitely.

So while her mental status waned as a result of her poorly functioning heart, we provided her some medication to prevent it from going haywire, and more importantly, did not deactivate the pacemaker embedded in her chest. Her heart kept pumping despite the malignant nature it now carried.

When the daughter arrived earlier in the day, a decision was made to stop the medications and turn off the pacemaker, allowing Ms. Smith a nearly painless transition into death.

—–

But when I arrived to work that evening, I was notified Ms. Smith’s pacemaker was still quite functional. The nurse paged me, reporting she had waved a magnet over Ms. Smith’s chest, performed an EKG to determine if her heart was still receiving the electrical impulses from the pacemaker, and found the characteristic pacemaker spikes on the EKG print out.

Only five minutes earlier, I was informed our Clin Med service would be directly admitting two patients; these two individuals would not be coming up from the Emergency Department, where an initial assessment had been completed, but rather were being either transferred from an outside hospital or being sent in from home by one of our colleagues.

This would require assessing the patients while they were already on the floor being cared for and simultaneously providing orders by which the nurses could care for them.

Dealing with one of these would be a trial in and of itself, but dealing with two simultaneously, while responding to pages about other patients on our service, would be quite a task. Jacob asked if I could handle it, to which I responded in the affirmative.

—–

The lone impedance I saw was Ms. Smith’s pacemaker. So I hurried up to the 6th floor, walked into her room, greeted her family, and confirmed I would be deactivating her pacemaker. They thanked me for our team’s care and focused their attention on their dying mother.

I excused myself for a moment, proceeded to the nurses station, rifled through a drawer beneath a bay of computers showing the electrical activity of every heart on the 6th floor, and grabbed a large, doughnut-shaped magnet, measuring 8cm in diameter.

—–

Having been informed the nurse had attempted to deactivate it earlier and realizing the two direct admits were awaiting my care, my eyes began searching the nurses station for something I could use to secure the heavy magnet to Ms. Smith’s chest.

I found a strap with which I felt I could secure the magnet and walked back into Ms. Smith’s room. I greeted her family again, proceeded to her bedside, and lowered the gown from her left shoulder.

I intertwined the strap in the middle of the doughnut-shaped magnet and secured it around her shoulder, resting it snuggly against her upper left chest wall. I raised the gown back over her shoulder, informed her family I would return in a few hours to check on her, and proceeded from the room.

—–

After leaving Ms. Smith’s room, I found her nurse, asked her to perform an EKG at midnight, and informed her I would return shortly thereafter to assess Ms. Smith.

When Jacob christened me “Magneto”, it was two hours after I had planned to see Ms. Smith again. He had made his way to the 6th floor at midnight to check on Ms. Smith’s heart.

He informed me the EKG had, in fact, shown the pacemaker to have been deactivated, as I (and Ms. Smith) had wished. But deactivating her pacemaker was not like pulling the batteries from the back of a remote control, leaving her lifeless. It had simply removed the support needed to keep her heart beating more than 60 beats per minute, the lower level of “normal”.

—–

Jacob relayed she was still alive, with a slowly beating heart, when he had gone to see her. We proceeded to run the rest of the list, I informing him of the status of our two directly admitted patients, and he of Ms. Smith imminent demise.

I left him and grabbed the elevator to the 6th floor. I slowly walked towards Ms. Smith’s room, the lights in the hallway dimmed appropriately for the time of night.

I knocked on the door, entered, and found her family members still gathered at her bedside, though overtaken with fatigue. They had made her room a makeshift resting place, blankets on the ground, tired bodies resting amongst each other, each of them soundly asleep.

And there was Ms. Smith, laying peacefully in her bed, continuing to have slow, agonal breathing, her heart surely winding down.

—-

As I quietly left the room, careful to not disturb her children and grandchildren, I took a deep breath and let out a sigh of relief.

I strolled through the darkened hallway, making my way towards the nurses’ station, but ran into her nurse before reaching my destination. She was on her way to assess Ms. Smith herself.

I informed her of my findings and asked her to keep me updated.

Five minutes later, I received a call from the nurse stating she entered the room, found Ms. Smith’s agonal breathing to have ceased, and was unable to feel a pulse. She had died.

—–

I returned to her room some time later, having made another round through the Intensive Care Unit to assess the health, or lack there of, of the patients who were there. Her family was all awake, having been alerted to her passing, and profusely thanked me for our team’s care.

They thanked me by name and title, but were not aware of The Birth of Magneto.

Gray’s Anatomy

Posted on January 18, 2015 by Elbrecht

—–

The most prominent book on my mantle is Gray’s Anatomy, a text I received from a colleague with whom I worked at Man’s Greatest Hospital. After many hours spent working side-by-side in the Gastrointestinal Cancer Center, she felt it was a fitting gift as I embarked on my mission to becoming a physician.

Nearly six years later, I’m an Intern in a Family Medicine residency program, trying to learn how to become the quintessential doctor.

—–

I spent the first six months of Residency filling many different roles, each of them markedly different from the one before or after. I have been an Internist, Clinician, Gynecologist, Primary Care Provider, Nocturnist, Infectious Disease specialist, Pediatrician, Teacher, Obstetrician, Podiatrist, and Trauma Surgeon. I have also become an even bigger fan of sleep than I ever could have imagined.

The copy of Gray’s Anatomy which I received is a facsimile of the 1901 version, the 15th edition of Henry Gray’s medical masterpiece of the human body. Not much has changed in human biology in the past 113 years, but Gray’s experiences as a physician and lecturer at the Royal College of Surgeons is probably somewhat different from what I experienced in the past six months… or perhaps not.

—–

Day 1 of Residency I was assigned to our Internal Medicine service, responsible for running around the hospital admitting patients, providing them care, discharging them home, all while hoping I’d done a serviceable enough job teaching them about their medical ailment to prevent a hasty return to the Emergency Department.

Of the services we staff as Residents (service = four-week stint as a physician of a specific branch of medicine), Internal Medicine at my Residency is the most labor intensive, sleep-depriving, nerve-wracking, hair-splitting service of them all. The official name is Clinical Medicine, or Clin Med for short (or Clin Dred when you know the next four weeks are about to evaporate into the ether).

—–

Somehow I became one of the two “lucky” lottery winners to be a first-year Resident assigned to Clin Med. My partner was a friend from medical school whom I had known since the beginning. We were paired with two senior Residents, who ostensibly had been the highest functioning first-year Residents on the Clin Med service the previous year and were thus chosen to be our medical mentors.

The ensuing four weeks were so busy that I spoke to my friend for exactly 8 minutes and 11 seconds during the entire month (that includes the time it took to type text messages).

I was told being chosen to start on the Clin Med service should be considered an honor… basically meaning that during my time as a student at the same program the previous year, they had come to the conclusion I would not be responsible for the early demise of any patients who would be placed under my care.

—–

I thought it comparable to being told I would be allowed to be the first person to jump out of an airplane without a
parachute. Low and behold, not a single patient died under my care; or really had any significant downturn in their medical malady.

The days were filled with trying to learn how to navigate the choppy waters of a medical institution and its systems, and the computer programs which allowed me to chart on my patients, along with a physician’s responsibility of percussing my patients’ backs, feeling for pedal pulses, listening to a heart beat while gently pressing along a radial artery, writing perpetually changing orders, and allowing for my own bodily functions to occur when I had a moment.

—–

At the end of the month, I took a deep breath, realized I had survived my first service as a Resident, glanced at the
Gray’s sitting on my mantle, and wondered aloud, “what the hell just happened.”

—–

After a month of learning on the fly about how to be a functional physician in a fast-paced hospital environment, the following two weeks were a nice respite, a smattering of out-patient visits to social service providers in Columbus, office visits by established patients in our out-patient office… and a couple of shifts in the Gyn Clinic.

My experience as a medical student during the six week rotation of Obstetrics and Gynecology were by far the worst of my clinical training. I only survived it by forming a bond with two other colleagues who were equally averse to the responsibilities therein. After that rotation I spent the next two weeks traversing around the Eastern half of the US, visiting old friends, drinking away the memories on an adventure I called “The Journey to Reclaim My Soul.” Sticking a speculum, or even worse, my sterile-gloved fingers, inside women I had met only moments prior wasn’t exactly why I had decided to become a physician.

Stepping foot inside the Gyn clinic was a bit of a flash-back to days of yore. Days I would rather forget. But, I chose to become a Family Medicine physician because I wanted to experience a full-scope of practice, so I needed to use those memories to help the new women I would have asking me about their privates.

—–

In the midst of those two weeks, there were a smattering of half-days in the office, where patients would come to their appointment expecting to see me; not some doctor who happened to be available. They had formally been told I would be their physician. It was a bit of a culture shock unlike what I experienced on the In-Patient service, where people arrived in the hospital hoping for someone with a medical background to cure their ails.

This time, they were expecting “Dr. B.” Whether or not they liked me or thought I was helpful would determine if they would think of me as “Dr. Bullshit” or “Dr. Badass.”

Two short weeks of community clinic visits, office appointments, and speculum insertions were followed by flipping my schedule and going on night-call for two weeks.

It evoked memories of my life for the six months prior to Residency, when I had worked overnight; Except I was traversing the ED, the emotional rollercoaster of my equally sleep-deprived senior Resident, and the perils of septic shocks and intubations at 3am, rather than deciding which return bin to toss some junk into at Amazon.

—–

It had not started smoothly, as my transition back to nocturnal life stymied my brain’s ability to function on the level necessary for a physician. By the end of the second night (by night I mean at 6am, 12 hours into our shift), my senior Resident, 9 years my junior in age, and I had a tit-for-tat critique of each others performance.

—–

And when I say “tit-for-tat” and “each others”, I mean, I got my ass handed to me and had to sit there and take it like a man. By the end of those two weeks though, he and I were having a nice breakfast reminiscing about all the crap we had successfully lived through together.

Gray certainly didn’t write anything about that in his book; I checked.

—–

The first two months of Residency seemed to last forever, but at the same time, it seemed to be over before I knew it. The next two months were spent down the street at the nationally recognized Children’s Hospital, where it is customary for the Interns of my Residency to spend back-to-back months there learning the medical art of Pediatrics.

—–

I was only starting to get the hang of being a Resident by that time, making the transition a bit of a shock to the system as I needed to learn all new faces and an all new electronic medical record; all while assimilating to the hierarchy of a whole new medical specialty.

The Residents of Children’s Hospital learn the ins and outs of treating babies, children, adolescents, teenagers, and the occasional grown adult still suffering from their pediatric medical maladies… I needed to become one of them quickly. The assimilation process when you are a physician is expected to occur over the course of a couple of hours; not a few days or weeks.

So of course I started on the Infectious Disease service right as a never-before experienced scourge affectionately known as “Asthmageddon” swept the Midwest.

—–

Asthmagedden was a region-wide exposure to a newly recognized virus, Enterovirus D68, which was causing babies and children of all ages, with and without previous asthma afflictions, to show up in the Emergency Department in Status Asthmaticus, a diagnosis indicating the inability of the respiratory tract to respond to front-line medical therapy, causing a constant difficulty in breathing.

http://www.wcpo.com/news/health/healthy-living/watch-respiratory-illness-ev-d68-found-in-ohio

Enterovirus typically affects the gastrointestinal tract, causing horrible diarrhea and concomitant dehydration, but as evolution has shown us, a few changes to a gene here or there and all of a sudden a new Enterovirus emerges, now equipped to attack the lower respiratory tract.

Children who had never wheezed, the most common sign of asthma, were having their bronchi inflamed by the virus, making it difficult for air to pass. As somebody who grew up with asthma, I can attest that this is a terrifying feeling.

—–

http://www.youtube.com/watch?v=7EDo9pUYvPE

—–

Some of these children were so sick they were immediately admitted to the Intensive Care Unit to receive the most minute-by-minute care to assure they would not suffocate from a blocked airway. These critically sick children by-passed our normal Infectious Disease unit, but as their symptoms resolved, they would be shuttled to our unit to continue their care alongside the children who were not as severely afflicted.

Of course, a Pediatrics Infectious Disease unit is also full of little tykes with butt abscesses, whooping-cough, diarrheal illnesses, crusty eyes, and non-remitting otitis media (ear infections); and a whole host of anxious parents, who typically become the biggest concern of Residents.

After seeing all of this, I’m re-thinking my plan of having children one day, if at least so I don’t need any psychotropic medications when my kids get sick.

—–

The first three services were a whirlwind of cognitive adventure, psychological daring, and physical extremes. When I hung up my scrubs on the last day of Pediatric Infectious Disease, it was with the knowledge I was only a quarter of the way through Intern Year.

Gray’s Anatomy… continued