Day Ten on the Job

I am now into my second full week of being a doctor, and it's beginning to feel a little more like I really belong here. The first week was really challenging - constant feelings of inadequacy, uncertainty, and overwhelming fear. For every patient I saw in the ER, I forgot parts of the history and exam, bumbled through the assessment, missed key elements of the differential diagnosis, guessed (usually wrong) what tests to run, and was completely clueless about dosing and how to write orders for medications. After three days, I was seriously struggling with doubts about my ability to ever be a good doctor.

Now, though, I think I'm beginning to turn a corner. I'm still on my emergency room rotation and still as "green" as ever - not sure how to work up and manage most of the cases I see. But I'm getting to know most of the ER doctors and what they expect. They have been very encouraging, reminding me that I am only just beginning my training, and I WILL learn with time. So, I have been trying to focus on what I can learn from each case and patient. Amazingly, I really am learning a ton. Not that I feel at all ready to take care of patients on my own, but it feels a little more comfortable.

This past weekend, I worked a couple of night shifts in the ER. Night time brings a lot of drug and alcohol related cases, as well as some trauma (accidents, injuries). One of the coolest things I got to do this week was put in a chest tube. A young guy came into the ER complaining of shortness of breath and chest pain. He didn't have any risk factors for a heart attack. He turned out to have a pneumothorax - complete collapse of one of his lungs! The chest x-ray was pretty impressive. Even I couldn't miss the diagnosis! In a pneumothorax, air collects in the pleural space between the lung and the chest wall, making it impossible to inflate the lung. To fix it, you need to get the air out, which you do by inserting a tube and connecting it to suction. I've seen chest tubes placed before, but I've never put one in myself. The ER attending allowed me to do most of the procedure. It's weird and sort of awesome to stick a scalpel into someone's chest wall, to basically cut a hole between the ribs into the inside of the chest. But now that I've done one, I can't wait to do more. I've also gotten to do a lumbar puncture (spinal tap), an arthrocentesis (where you stick a needle into someone's joint - in this case a knee - and aspirate fluid to send for analysis, then inject steroids and numbing medicine to relieve pain), incision and drainage of abscesses and suturing of lacerations. I'm not that good at these things, but I know I can learn the skills and be proficient and confident eventually.

Once again, I am reminded of God's goodness and faithfulness. He is with me and is able to provide all it takes for me to be a good doctor so I can serve him. The process may be painful at time, as I learn humility and dependence on God. So I have renewed hope and joy that I am in fact growing and learning, and it will all be worth it in the long-run.

Well, that's all for now. I am yawning and can barely keep my eyes open. Tomorrow is clinic day - instead of being in the ER, I'll be seeing patients in the office. Keep me in your prayers - for a good attitude, humility, patience and joy!