Sunday, April 8, 2012

Stories from Internship Part 02: Tormentor vs. Terrorist

As a clerk or an intern in any hospital, you are placed under (the care?) of future colleagues who are several years ahead in training: resident, fellow, consultant.  Simple-minded person that I am, I categorized my seniors into two groups, the tormentors and the terrorists.  The tormentors are those who seemingly exist to make your life a living hell because of the tremendous amount of scut work they pile on you, and the criticism you take from them.  The terrorists likewise seemingly exist to make your life a living hell for the same reasons an the criticism you also take from them.  At first, I couldn't distinguish between the two groups, realizing their differences in retrospect, but two years into the clinical part of training and I could easier pick out who was who.

The terrorists, well, I can't explain why they do what they do.  At this point in training, I don't think I can make excuses for them-I mean, we're all human, we get tired/hungry/angry/cranky/sleepy, but as a colleague, I think there is a certain standard I hold them to.  Initially, I would get so hurt and depressed whenever a terrorist would unload so much negativity in the air, but I guess an additional 11 months of training toughened me up a bit.  (Just a wee bit.)  I guess I learned to not let such things get to me and to just focus on getting things done.  This, all the while promising myself never to bring my family or friends to them for consults or referring patients to them in the future.

The terrorist will pile scut work on you because you are a bottom feeder who conveniently is somewhat dependent of their power to issue a grade.  The terrorist will tell you to get a stack of delinquent charts returned from records for completion and place ICD codes in all the diagnoses before he/she signs the attendance.  The terrorist will tell you to print eleven copies of a journal at 0545 AM on a post duty day and run across two long buildings in 5 minutes to a conference room where said terrorist needs to do a presentation that you are not even invited to.  The terrorist will leave signed forms and tell you to deal with patients on your own when you have absobloodylutely no idea what to do. The terrorist will alternately verbally abuse you for not knowing the answer to the most esoteric and specialized question on the old name of this certain structure present in 0.0001% of all people with a certain disorder that skips generations and for not asking questions anymore because you're too afraid to add to the terrorist's horrible mood because said terrorist hasn't had the requisite two cups of non-fat vanilla soy latte with sprinkles or a smoke.

The terrorist tells you off because you're in the way of the cautery when your fingers are in a pretzel holding 20 clamps up for the greater part of two hours already.  The terrorist fixes you with an annoyed look when the sponge handed to you was not dampened enough by the scrub nurse.  The terrorist elbows you on your boob inside the OR because the retractor you're frantically trying to keep in place is slipping and your other hand is trying to keep up with the massive amount of fluids leaking out of a friable vessel that was accidentally nicked.  The terrorist lashes out when you refer that 1 year old who pulls out every single IV line you inserted successfully and there's no other vein to use, swear.  The terrorist throws a tantrum because you can't finish fixing a specimen because all formalin jugs are bone dry in all OR complexes at 2 AM and you have to unscrub and plead with the grumpy lab techs to give you just another 20 cc of formalin.  The terrorist berates you in front of other people for not getting blood typed ASAP when you were the one who paid for the typing (without the white card!) and needled the poor tech on duty to get the blood typed in 15 minutes tops.

The tormentor may pile on scut work on you, but such work is in the end, for your benefit.  The tormentor may ask you to chart so many patient properly, which means spending a so much of your precious time on a crochety old man who smells of pee or that toddler with grimy hands and a never-ending supply of drool to decorate your previously pristine white uniform or that demanding and slightly histrionic hypochondriac who visits the clinic every single day or that grand multigravid who finally decides to consult a hospital on her 39th week of her 11th pregnancy.  In the course of learning to chart patients properly, the tormentor teaches you to pick out pertinent points in the patient's history and physical exam.  How else would your clinical eye be made better than this exercise?  

Perhaps the tormentor may ask you to extract 20 cc of blood from a patient who happens to be an 8 day old septic neonate whose parents tsk every time they see a needle go near the fragile skin of their baby who happens to be missing the normally accessible veins of 99% of humanity.  The best revenge for the stress of having to exchange a 4 cc purple top for the more expensive microtainer or the never ending tsking and rude comments of the bantays is successfully extracting enough amount of non-clotted blood to send to the lab tech who loves using that green pencil to mark tubes inadequate for testing because of the microscopic clot spotted on the rim of the tube; it becomes somewhat of personal achievement and something to tide you over the grueling 24 or 36 hour duty.  

The tormentor may criticize your technique of clipping that slippery suture with the dullest scissors on earth, your chart entry at 4:45 AM while the patient had just finished coding (and oh, your pen is running out of precious ink and your arms are shaking from pumping the patient's chest), or your rectal examination of a patient with multiple bleeding necrotic masses.  You seethe with rage and hurt, but then realize that it was all constructive criticism and held no note of malice at all, unlike the terrorist who just projects their stress all around and mouths off without making any point.  The tormentor makes you work hard for things or skills that will carry you further and make you a better practitioner, and in essence, becomes a mentor.  A mentor with a little bit of torment to make you remember forever.

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