Leaves Are Changing

It's Fall in New England, and the year is going by rapidly.

I'm well into my fourth month of my residency in rural family medicine, and I'm amazed by how fast it is all going. I love the work I am doing, the people I'm doing it with, and the place I live. It's a miracle how much things have changed from my very recent life as a frustrated medical student.

I am currently covering the inpatient hospitalist service for our residency, and the hours are long and the cases sometimes frustrating. I can't complain though, as the patient interactions are almost always rewarding, and the work is interesting and diverse. From negotiating with a starved and depressed old man to eat, to sitting with another man while he died- only to watch him rise from the dead and be sent back home, to nursing a neglected baby back to health, to delivering babies and managing obstetric emergencies- just like the family practice clinic- I never know who will be waiting for me at work each day. It has been a bit difficult balancing work schedule, sleep, personal finances, and relationships, all while practicing good medicine- but I think I'm somehow doing it. Housework has basically been triaged to the basement for the next month or so, and I do sometimes open my eyes to find I've already gone to bed and am awakening for my work day without remembering having gone to sleep the day before.

Call has not been nearly as miserable an experience as anticipated, and overall the workload is basically manageable. I do seem to be running up against a wall however when it comes to managing both my outpatient duties and the busy hospitalist service. I get behind on prescription renewals, call backs to patients with lab results, and social service follow-ups, because I'm busy doing discharge summaries or managing sliding scale insulin regimens for inpatients. On other days I'm on top of my clinic, but I lose track of my patient list in the hospital and tasks get neglected.

Last month I covered the Emergency Department here in Augusta, and I enjoyed the luxury of shift-work with no call, the interesting cases coming through the door, as well as the large amount of procedures I was able to perform in such a short period of time each day. Work days beginning at 10 am were nothing to complain about either. I am grateful for the doctors I was able to learn from in the ER- both seasoned Emergency Medicine physicians from Boston, as well as Family docs who have transitioned their practices to full-time ER work. I gained a good deal of confidence in managing codes and emergent situations, that has translated well into managing emergencies on the floor of the wards. Yesterday I ran a successful code with no backup from any attendings, felt comfortable during the entire process, had a good outcome for the patient, and received great feedback in the end on how things had gone. If I hadn't had such good exposure in the ED, or such talented physicians training me throughout my time here, I don't think I could have managed as well.

All in all I'm still loving being a rural family doctor in training. I wouldn't change any of it for anything, except to be closer to the people I love- my friends and my godchildren. But a brief vacation is in the works for the near future, and home is only a call away.

Now for some sleep!