(Gentle readers, I present the following which is mostly written in Marine-speak. You have nothing to fear and yet, if you have a weak constitution or are easily upset I implore you to skip this article, perhaps using the time saved to peruse the latest Peanuts comic strip in the newspaper or anything else that is similarly non-threatening.-PB)

Is That Smoke Coming Out of Your Ass or Mine?

You are loved. No doubt about it, the one lesson of your intern orientation is that now, finally, after four years of medical school where you were beneath contempt in the medical hierarchy you are now one of the gang, a valued colleague, someone who will be treated collegially. After all, as the designated speakers will point out with heroic rhetorical flourishes, whereas up until now you didn’t count, now you do and with your great responsibilty as real doctors comes the expectation that you will be treated professionally and courteously.

Then of course you will actually start intern year and they will treat you like a piece of shit, both institutionally and professionally. Need some sleep? “Fuck you.” Want some time off? “Screw you, you big fucking baby.” Don’t know where anything is or how they run the service? “Fuck you, moron. We sent you an email. Didn’t you read it?”

And so it will go. Now, I am not the smartest Asian bear-mammal to ever lumber out of the bamboo grove but I can tell when I am having smoke blown up my furry ass. You can tell me that I’m going to be treated like a valued junior colleague and you can make nice noises but the reality is that for your entire intern year, and possibly your whole residency, the default position of everybody with whom you work will be to treat you like a sweat-shop laborer.

So welcome to the dysfunctional residency training system which was designed, literally, by a cocaine-addicted physician and which has changed very little since its insane beginnings. Sure, some of the hours have been limited but the system still depends on depriving you of sleep and making you work the kind of hours that are considered war crimes in most other countries. Heaven forbid you point this out. Apparently when it comes to an abusive medical training system, everybody is a hoary old conservative protecting their peculiar institution from reform. Swing low, Sweet Chariot. Them residents sure can sing! Why brother, it would be a sin to set ‘em free seeing how happy they are. Lift that bale, tote that barge!

Ol’ Man River he keeps rollin’ along.

This is what they really mean to tell you at your orientation to intern year:

“Welcome to our hospital. We’re so glad you’re here. the first thing I want all of you to do is to reach down and feel your testicles. Ladies, go ahead and palpate your ovaries. Feel those things? Well, we own them. Oh sure, technically they are attached to you but for all practical purposes they are ours and we have them gripped firmly. If you step out of line we will give ‘em a squeeze. Step too far and we’ll tear them out of your body and present them to you a la Bruce Lee before you die.”

“Just wanted to clear that up so you folks don’t get too uppity. Your contract? Hah. We call it a contract but it’s more of a receipt for your indentured servitude. We agree to practically nothing and in exchange you are ours for the duration of your sentence…I mean your training. Don’t like it? I think we can fire you for just about anything and at any time. Not too many other professionals would work under those conditions but as long as there is a steady supply of you stupid motherfuckers ready to mortgage your souls to get into medical school we can pretty much do whatever we want. You can leave of course, but good luck getting another residency position after we shake our heads sadly and opine that you are a trouble-maker. Not to mention that we have the system set up so even if you manage to escape you can only do it one time a year and only if the stars and planets align just right. So shut your stinking gob-holes. You’re in it now.”

“And we don’t give a rat’s ass about your sleep, your rest, your health and your well-being. Oh, we’ll pay the usual lip service to these things and in later orientation lectures we will encourage you to take naps on call and instruct you how to best use caffeine to optimize your wakefulness but the fact is that we are going to beat the crap out of you for at least a year and hopefully for as many years as we possibly can. We just don’t care. Now, because some disloyal pussies couldn’t keep from whining to their mommas and killing themselves on the exhausted drive home from the hospital we are only supposed to work you eighty hours a week. I can not stress enough what a bunch of fucking crybabies that makes you or how sick I am of looking at your fat lazy faces sitting there knowing that you might actually get some time off. It makes me physically ill to think about it so I expect all of you to uphold the highest ethical traditions of the medical profession and lie about your actual hours if it comes to it. I suffered and because I have a personality disorder, you need to suffer too. Besides, everybody knows that we only have to obey rules if we agree with them…and we certainly don’t agree with this one, do we?”

“If you complain too much we will ressurect some dinosaur who trained back in the days when they were still using poultices as a first line therapy to try to shame you into keeping your mouths shut. Obviously everything was better fifty years ago, especially when interns were all geeky white males with no families and no responsibilities outside the hospital. Man! those were the days. We owned those motherfuckers. I mean, we own you but we really owned them. There was so little that could be done for patients in those days that we could waste their time with wild abandon. Those were the golden days of scut work my friends, the likes of which we will not see again.”

“As to your pay, well, the federal government is giving us a shitload of money for your training. Almost twice as much as we are reluctantly going to pay you. We’re going to cry poverty and feed you a line of bullshit as to how expensive it is to train residents, how much you are damaging our efficiency, and how this extra money doesn’t even cover the economic damage you will inflict to our bottom line but this is just fragrant smoke wafting up your ass. Try taking a day off or calling in sick when you have call and see how we are going to panic. As if it isn’t bad enough that many of you little pussies can’t work more than eighty hours a week and we can’t always screw one of your colleagues to cover your call, we may have to actually pay somebody real money to do your job which is really going to eat into our bottom line.”

“And who is really going to suffer? Why, The Patients of course. Your insistence on not working with hospital-grade gastroenteritis or your gay desire to spend a day or two every month with your wife and kids is stealing, yes stealing, precious medical care from the poor underserved wretches frequenting this hospital. Don’t you stupid fuckwits understand that Patient Care comes first? Patient Care is our primary responsibility and with the exception of the nursing staff, the respiratory therapists, the Physician Assistants, the phlebotomists, the lab techs, the janitors, the cafeteria ladies, the attendings, the parking attendents, and those ladies slopping the hash in the cafeteria everybody in the hospital is expected to sacrifice their entire life for Patient Care.”
“So we need you to work a lot. Unfortunately we have to give you little wimps four (and I weep to think of it) days off every month but we’re going to send you home a little early post call and call this a day off, even if it is less than 24 hours and you will sleep through most of it. Those pesky rules again I’m afraid but we’ll subvert ‘em somehow because you guys are a fucking goldmine. Have you seen what Hospitalists are charging (not to mention PAs and other midlevels who will do in a pinch)? Let me tell you, they ain’t cheap. Not by a long shot. You poor sons of bitches, however, are ridiculously cheap. Insanely cheap. And the more we work you the cheaper you are because, get this, we don’t have to pay you overtime. Try getting the janitor to work some extra hours. Even my taco stuffer gets time-and-a-half if he goes over forty and all he has is a GED.”

“Who’s yer’ daddy now?”

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