This Resident Roundup post comes from Sean Pirkle, MD, a second-year resident with the Department of Orthopaedics and Sports Medicine at the University of Washington, Seattle.
I never thought I would be capable of yelling at a pediatrician. A general surgeon or neurosurgeon would have at least made sense, not that it would have ever been justified, but a pediatrician was a wakeup call. After a year taking call as the consult resident, I am a different person now than I was when I stepped into this role. In many ways for the better, in other ways, clearly for the worse.
Multiple times in recent memory, I have walked away from a conversation so deeply disappointed in the person I have become. I cannot help but make excuses, thinking, “That anger is not me, that’s not who I am. It must be the chaos, the volume, the never-ending to-do’s forcing me to act this way,” as if I had no volition and anybody in my shoes would do the same. When I finally have time to debrief, I think back to the attendings I have worked with since medical school and intern year, some of whom I have witnessed behaving the same way, and in those moments, I find myself standing in the corner, silently judging them for their seeming inability to control their emotions.
Just because somebody is the boss doesn’t give them the privilege to be disrespectful, and the interesting relationship between providers in the emergency department and the orthopaedics consult resident is that, by nature of training and expertise, in this sphere involving patients who have sustained orthopaedic trauma, we are the boss, maybe for the first time in our lives. I know that was the case for me. And when I am 17 consults deep—with fractures waiting to be reduced, getting hammer-paged by the ED for admit orders on a stable patient, while running between a patient with a suspected septic knee refusing to have his joint aspirated toward the trauma bay to see a hypotensive patient with an open-book pelvis—I realize that there are times not infrequently when it might be only the collective “we” as orthopaedists in the room who carry the gravity of a situation on our shoulders.
In these circumstances, I think this is the first glimpse into the kind of attendings we are going to be, a perverse look into the depths of our character: at our most desperate, most stressed, most hungry and sleep-deprived. It really is not unlike when a patient is open on the table and the attending surgeon is the only one in the room who has the fund of knowledge and ability to appropriately treat another life. When the stakes are this high, I notice that there are certain attendings around whom everybody breathes a sigh of relief when they walk into the room, and others, when they leave. I think this is a product whose reactants are formulated during the consult year with every reduction, every phone call, every action and interaction.
If I could go back to the beginning of second year, I would tell myself that there will be times when you will be pushed to the limits of fatigue and anxiety, that you will work with patients whom you know you can help but who will not accept your care, that you will face “pimping” through morning sign-out with only 3 brain cells still generating action potentials. I would say that you will fight so hard for what you think is right for the patient even when it feels like nobody else wants to help, and in those moments, you will learn who you are as a doctor, a colleague, and a citizen on this earth. Sometimes you will falter and yell at a pediatrician and realize that’s not who you want to be, but the beautiful thing about this year is that you can see, in real time, who you are shaping into and that there is seemingly always another call shift to be better and to redefine that path. It just requires a little self-reflection.
Before I moved to the Pacific Northwest, consult residents at my institution made it a point to return pages with the phrase, “Hi, this is so-and-so with ortho, how can I help you?” When I first heard this as an intern, it seemed like such an innocuous greeting, but I now understand how hard that can be to say because, sometimes, I want to say one million things other than that, and I know the voice on the other end of the phone is about to give me another hour of work. No doubt, there are reasons to be frustrated by this job, but to avoid the reflexive temptation of anger is to uphold the commitment to helping your colleagues in the emergency department and your patients.
To future consult residents I would say: you are going to do amazing things this year and help so many people who need you, and at the end of the day, if you are doing your best and respecting those around you, you should rest easy with that knowledge. There will be days when you will walk home bleary-eyed, feeling like nothing went right, and other days, when the reduction holds and you are operating at peak efficiency when you will see just how much you’ve grown and how cool this job can be. Hold onto those days, that feeling of curiosity and sense of anticipation that washes over you when waiting for a new radiograph to load on the PACS machine, because soon enough you will be an attending, and the fundamentals that are laid during this year will translate into the kind of person that you will be when it is you calling the shots and everybody else is trusting you with their lives.
Sean Pirkle, MD
Dr. Pirkle is the author of 2 previous Resident Roundup posts: Am I a Bad Resident? Facing Self-Doubt in Orthopaedic Training and, with Max Coale, MD, What I Wish I Learned in Medical School: A Crash Course for Intern Year.