Anti-Social Breeding Ground

Guest Contributor  9 Apr, 2007  Medical Students

From MDAlien

Greetings from the glorious time of life referred to as the third year of medical school/the breeding ground of antisocial personalities. I’m presently in the midst of my surgery rotation after having done IM, neurology, EM, family med, psych, and OB/GYN.

The following is exactly how I felt during an evening at the end of my day. Don’t try to say you will never sound as angry, cynical, or crazy as this. I didn’t think I would either, but trust me, it happens.
—————————-
There was a time when I was a nice person. I vaguely remembered that time, but after the 14th hour of being at the hospital, I’m sitting in the ICU - waiting for the attending to finish his stupid story about the fish he caught that one time that was ‘this big’ – and a horrible thought crosses my mind. “We still have 4 more patients to round on . . . “

I drop my eyes to our patient census and skim the list. There is Mrs. Smith, 85 YO WF w/COPD, CAD, CHF, past MI, recent ileostomy. Look she has pneumonia and she’s on a vent. Even better, she hasn’t been conscious for a week, lived in an ECF, and her family left her full code. Mrs. Smith is on three different antibiotics, which aren’t doing anything to budge her raging sepsis and she’s on the dobutamine drip that seem to not be raising her BP the least bit. Our other three patients are in pretty similar sad shapes. They are all going to die.

Then the next horrible though crosses my mind, ‘can’t these fricking people just die so I can go home already?” Yes, I did just wish some innocent grandma to die because her terminal illness is ruining my day. All of our efforts are completely futile in her case, but when she starts coding tomorrow, I’ll have to go with the team to attempt to save her. Which will put us even further behind on our ever growing census. Thanks dumb grieving family for putting ME through this.

Now I glance at my resident who is still nodding at the stupid story. I’m so annoyed with you that if I had an uzi I’d be gunning for you. Why the hell haven’t you let me go home? The med students don’t even see the ICU patients because this is our surgery rotation. I’ve been here doing nothing for two hours. I can’t write orders, I can’t see patients by myself, and the patients we are seeing I don’t even round on. You aren’t teaching me – no, pimping isn’t teaching – and since you’ve ignored my existence except when I failed to give you that imaginary crucial bit of info the attending scooped you on, why am I still here?

Attending, if I shot the resident, you’re next. Stop telling the fucking story and let me leave. You didn’t bother to show up here until after 7pm to round on your patients, and I know your last surgery ended at 4pm because I was there. I was that med student who held the retractor for two hours that you periodically yelled at for not being able to identify random things in a body cavity that I was too far away to even see beyond my retractor. Don’t you dare start whining about how much harder you worked in residency before the 80 hour work week. In case you haven’t noticed, the 80 work week is a joke and I was here 100 hours last week. So fuck you and shut the hell up.

You know, the hospital doesn’t have metal detectors to use on the staff. I look around at the members of my team and try to figure out which one of us are going to snap, go postal, and start mowing down the patients and the oh-so annoying nurses. Who has been abused the most? The other med student who is getting treated like shit for stating he wanted to go into peds? Or maybe the intern that was left in charge of 50 patients alone while the residents went to the OR and is about to getting it for not knowing Mr. L’s latest potassium. What the hell, it’s totally going to be me, the sweet innocent seeming seething ball of rage that I am.

One hour later, we are sent home and reminded to be back before 5am tomorrow. Thanks, like I’m going to forget that since it means I’ll be heading to bed immediately upon getting home. I see people coming out from dinner at the local resturaunts and I hate them for having real lives. I debate briefly about whether I can hit some of them in the crosswalk and get away with it. Probably not, but prison seems like a good alternative to going back to the hospital tomorrow.

As I finally get ready for bed, I think back about how much I hate the hospital and how awesome it would be if it got hit by an asteroid or something between now and when I’m supposed to be there. Then I have the horrible thought – in the event of a natural disaster, I would have to stay at the hospital even longer.
————————-
**MDAlien would like to point out that most of the anti-social feelings went away after she got off the service – except those toward the attending. No patients were harmed or mishandled in the survival of that rotation. **

Popularity: 22% [?]

Did you enjoy this post? If so, consider subscribing to my full RSS feed and adding MSH to your Technorati Favorites.

Related Posts

14 Comments so far »

  1. Tiny Surgeon said

    April 9 2007 @ 8:40 pm

    Beautiful post. I think almost everyone has reached that point at some time, but few of us could put it into words. Thank you.

  2. Zuwie said

    April 9 2007 @ 11:53 pm

    Here is a good last year SDN thread, which basically shows that 80 hr work week in surgery is a big joke, and how proponents of the “surgery way of life” are up in arms against it:
    http://forums.studentdoctor.net/showthread.php?t=316231

    Makes you really think twice, or three, or ten times if you consider going to surgery.

  3. Hoover said

    April 10 2007 @ 12:19 am

    Zuwie, I have a post coming up with a study that proves the 80 hour week is political bullshit as well.

  4. Et al. said

    April 10 2007 @ 1:56 am

    My state just expended it’s medical program. Is there a way to make this better such as talking to the Legislature about dropping down to a real, reasonable work-week? Truckers have limits and required time off so they can get sleep (and they have persons of ill repute to make their sleeping experience so varied hanging around the truck stops!) Is the AMA for getting something reasonable going? Whose job is it to regulate this?

    I’d really like to get something going and bring this to someone’s attention who can do something. Politicians take the path of least resistance and where I live, they all leave state anyway when they are sick. (They don’t want to risk locals knowing about their STDs and what-have-you. They really do leave state for everything from minor to major things. I have worked for a few and gossip is plentiful with people with comparative time on their hands!)

    Do we have to have residents and interns really mess up in order for the higher powers to acknowledge that there is a problem? I hate to think that our brightest students are being dimmed in this manner and treated like this and that those who just can’t make it have to drop out as failures because they lack physical stamina.

  5. Et al. said

    April 10 2007 @ 1:58 am

    http://590klbj.com/news/article.aspx?id=1095778

    Don’t end up like this poor guy– I’m shocked this doesn’t happen more often.

  6. The Lone Coyote said

    April 10 2007 @ 8:14 pm

    Great post. I had hoped never to feel pain like that again once Surgery ended, but now I am re-living it on Medicine. I have had similar thoughts re: naural disasters. And like you I have concluded that even if an earthquake took the place out, it would be the medical students who would end up bured in there since our call rooms and “lounge” is the seismically-unsound older part of the hospital.

  7. Aviva said

    April 10 2007 @ 9:45 pm

    Though I have only finished my premed courseload as an undergraduate, I used to feel that I was the only one who felt this way about the hospital because everyone else seemed so gung ho in the hospital about learning all they could and saving lives. I probably shouldn’t admit it, but I do find it a comfort that other people have feelings similiar to mine. There was a time when I was doing work in a hospital and I was taken into the ICU to observe a patient and wasn’t told he had HIV until we left his room. I have to admit, that incident made me feel very anxious. I felt guilty that I was worrying more about my own anxiety than in having enough empathy for the patient. I don’t want to become a doctor that resents his patients and profession…

  8. Panda Bear said

    April 11 2007 @ 4:43 am

    Nobody is gung ho. Well, almost nobody but there are zealots in every profession. Maybe once you finish residency things are different and you look forward to your day but third year medical school? Residency? Please. Don’t make me laugh.

    This is not to discourage anybody but you need to know the truth of it. Medical training is a friggin’ grind. When you’re a pre-med, you dream about healing the sick and strutting around as a doctor. When you’re a resident you dream about getting a day off.

    In residency, a week (or a month) with no call and a regular schedule where you get home at a decent time without having to have gotten up with the cows is a rare event. When you get to go home before five on a Friday that is even rarer. A full weekend off is rarer still and, except that you may have vacation, a three or four day weekend is almost unheard of.

    And nothing quite blows like Friday-Sunday call which, for those of you who don’t know, is call on Friday until Saturday morning at around ten or eleven…and then you come in on Sunday, the next morning, at seven or eight and work solid until ten or eleven on Monday (or even one in the afternoon at programs that are determined to screw you as hard as they can). This is 55 plus hours crammed into a weekend, for crying out loud. And you still have to work the normal week, whatever that is, and you may have call the next Wednesday of Thursday.

    If there’s one thing that makes me want to burn the mother down it’s Friday-Sunday call. It makes me hate medicine and regret that I ever got the wild hair to apply to medical school. You start fantasizing about how nice life would have been if you had a normal job where they wouldn’t even think of having you miss two nights of sleep over the fucking weekend (for crying out loud), work a full week in two days, and then come in for the rest of the week with absolutely no compensatory time off or oncreased pay.

    And you start resenting, as the author of this post pointed out, the patients who couldn’t wait a few hours to come in, instead deciding that three AM was the time for everything to come to a head. And no, the author of the post is not the only one who thinks like this. I don’t understand why thngs are busier at night. When I’m working as an EM resident I don’t mind because it’s a shift like any other but when you are rotating on medicine, cardiology, pulmonary, or surgery you will see that not only will you work hard durting the day but you will work twice, hell, three times as hard on call.

    It blows. Sorry.

    And a pre-emptive “fuck off” to anybody who says we should just suck it up. Well no shit. I am sucking it up. You are not and you should think about it before you pull the trigger.

  9. Sydney said

    April 11 2007 @ 7:53 am

    What fun I have to look forward to! All goes to show that it’s not just what you do but who you do it with. What jackasses these people are. Maybe it will help you survive a bit if you just remember that all these people probably aren’t assholes on the inside either. They might be, but it’s always helped me deal with the jerks at work. A bad work situation can change a person from normal to EVIL.

  10. Anon said

    April 12 2007 @ 2:38 am

    Panda — I’m getting ready to start my 3rd year and am seriously thinking long and hard about bailing now before I get any deeper in debt or put more time into a lifestyle & career I don’t want. Any thoughts?

  11. Panda Bear said

    April 12 2007 @ 3:17 pm

    No. Don’t bail. Match at a program that follows the work hour rules and has a night float system with minimal call. I did a rotation with a service that was like that and although I worked pretty hard, it wasn’t that bad.

    This is why the interview social functions are so important, so you can sound out the residents (albiet the ones vetted by the program) about how things really are.

    Or select a specialty with more benign residncy hours. You’ll work hard everywhere (except in PM&R) but working hard for 14 or 16 12-hour shifts a month in Emergency Medicine is better than having the same work spread over 29 days a month with Q4 call to boot.

    The other thing is, if you really love something like surgery and don’t mind giving up your entire life to it, well, that’s a completely rational, defensible decision. I would rather have a red-hot poker rammed up my ass which is also a rational decision.

  12. Panda Bear said

    April 12 2007 @ 3:21 pm

    Oh, and definitely tough it out. Third year is rough but fourth year can be as hard or as easy as you want to make it and if by fourth year you decide you are not going to practice medicine, you can slack off like a big dog and still pass. In your case, P does equal MD.

    You can take your MD and walk away with no regrets, something you may have if you quit now.

    You may find something you like, too. I disliked pretty much everything (I mean as a career, most of it is pretty interesting for a few months )except for radiology and Emergency Medicine. If you find a niche you will be all right.

  13. Panda Bear said

    April 12 2007 @ 3:24 pm

    You can also, by the way, slack off like a big dog in third year. Most people don’t because they are chasing the grades but you can, in fact, be the incredible vanishing medical student and still pass.

    I don’t think anybody even knew what I looked like on my heme-onc rotation where I took every opportunity to sneak home in the early afternoon.

  14. Hoover said

    April 12 2007 @ 4:49 pm

    Once I got the hang of things, I too became the vanishing medical student on more than one rotation. With some rotations, such as surgery, it is harder to do this but for a good number of them it can be done.

    Just like Panda says, you will still pass and be home before nearly all of your classmates.

Comment RSS · TrackBack URI

Leave a comment

Name: (Required)

Email: (Required - will never be shown)

Website:

Comment: