Is there anything you like about residency?

Well, it has it’s moments. I’m the the ICU senior resident this month which is kind of cool, especially because this is one of those rotations where you get paged to make real decisions and not, as is often the case as an intern in the ICU, to be guided to the right decision by the experienced ICU nurses. Not to say that this doesn’t happen but I do know a little bit more than I did two years ago (thanks in part to ICU and ED nurses) so even though the call is just as tiring as any call it’s not that bad. We still work for peanuts but I certainly don’t go home in the morning feeling like I was nothing but somebody’s cheap, place-holding labor. And we have a great set of attendings who give us a lot of latitude to make decisions.

It also affords the opportunity to do a lot of procedures and I haven’t done enough lumbar punctures, for example, to get tired of doing them.

Generally, however, with the exception of working in the ICU and the Emergency Department I have not liked residency all that much. I don’t think anybody does but the culture of medical training makes it very difficult for people to admit that they dislike any if not most of it. People complain about being tired of course but nobody wants to appear weak. As I am confident in my masculinity and so totally not into any of that macho bullshit I can, with confidence, state that I hate being deprived of sleep, treated poorly by people hiding behind their credentials, and working for taco jockey wages. If that disturbs anyone or if you feel that makes me a traitor to the Cult of Aesclepius, well, that’s your lookout. Deal with it. The fact that people have put up with this kind of thing for so long is the real tragedy. But that’s what you got when medical schools were full of people with no other life experience but the slow slog to becoming an attending. Things are different now. Medical training is no longer a monastic experience reserved for young, single, white men. Many of us have families and are not willing to sacrifice them to make the traditionalists feel good about themselves. This explains the popularity of the so-called lifestyle specialties with medical students and the relative unpopularity of specialties that guarantee brutal hours and divorce.

The key point here is that you cannot put your life on hold and say, “I will take my son fishing when I am done with residency.” Those four, five, or six years are precious and once lost are never to be recovered. And that is why, oh you who long for the good old days when residents kept their mouths shut and were prisoners in the hospital, I resent call and pointlessly long hours. It’s like theft. The two extra hours you keep me every evening which contribute almost nothing to my training, taken as a whole, are a large portion of the time I could spend with my family. If you can’t understand this or think that a regard for family disqualifies me for the medical profession, well, you can keep the motherfucker…and lament mightily the flight of otherwise decent, intelligent people from your malignant residency programs.

Now, realistically, as a third-year resident I have it pretty good. I work shifts and while I am worn out when I come home, I get plenty of time off to rest and recover. And while this may not be universal, at my program our attendings work hard to teach us and only ask that we bring our so-called A-game when we are in the department and charge hard for the entire shift. It takes some getting used to but that’s why I like Emergency Medicine. We work towards a goal, we work harder than anybody in the hospital, but I can tell my wife when she can reasonably expect me to be home. Most residency programs could be structured like that if education were the primary goal which is sadly not always the case.

How is Residency Different than the Marines

I compare the two often but mostly facetiously. They are not really similar. Being a Marine Infantryman is several orders of magnitude more difficult than being a resident. Memory being what it is I tend to forget how hard it was to hump (march) twenty miles with a ninety pound combat load or what it was like to be cold to the marrow with no expectation of going indoors in the near future. Residency has never once brought me even close to the limits of my mental and physical endurance, even taking into account that I am twenty years older now and, to be charitable, no longer the fine physical specimen that I used to. I complain about residency but it’s generally because I am annoyed by a lot of it. Some of the things we did in the Marines were so difficult that they were almost beyond rational complaint. So bad that all we could do was grimace and say, “Ain’t it great to be Marine?”
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Marines do whine and bitch about things of course, but mostly about the petty indignities and bad luck that follow the infantry like a plague. When things get really bad we just suck it up. I remember a training operation where my unit came ashore after a twenty mile ride through heavy seas on our unit’s twin-engine boats (my unit was the designated small boat raiding company for the Battalion Landing Team). These boats were modified Boston Whalers and had enough power to jump from wave top to wave top. After a harrowing launch from the well deck of our ship we spent the next hour getting beaten to pieces as we thrashed through the moonless night towards Sardinia. Not only was it bitterly cold (although it didn’t seem that cold while we staged on the flight deck) but the spray soaked everything and I had the wind knocked out of me every twenty seconds or so. Clinging grimly to the rails we finally got under the lee of Capo Teulada and, after a brief run through smooth water, beached the boats and literally crawled ashore as hardly anybody could stand.

An hour into the operation with five days to go most of us had already taken a beating the likes of which many of you cannot imagine. But we unstrapped the guns (I was the Mortar Section Leader at that time), shouldered our packs and moved out for our objective several miles inland. What else could we do?

So my point is that physically and mentally, being a Marine Infantryman is a good deal harder than being a resident. We may complain about being tired but I have never actually gone more than 36 hours without sleep as a resident and at the end of it I knew I could get some sleep in a nice, comfortable bed. As a Marine you often have nothing to look forward to after a week in the field but another week in the field and an uncomfortable couple of hours of sleep, on the ground, with nothing but a poncho liner for warmth. Try thinking coherently after three days of sleep deprivation. What keeps you going is self-discipline and the sure knowledge that if the Marines ever lose their reputation for toughness it won’t be because of you. We’re very idealistic that way.
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Sleep deprivation is required for combat operations. Our military is not that big, especially the pointy end of it, and what we lack in numbers we have to make up in mobility and lethality. That’s just a fact of maneuver warfare and we should train under the same conditions that we fight. Sleep deprivation is not required for medical training. Very few praciticing physicians pull Q3 call or work 100 hours a week doing the kind of labor-intensive administrative tasks that are allowed to exist in the inefficient residency training system.

But I digress. I want to also add that in the Marines, if you complain about how hard it sucks (and in fact we sometimes refer to the Corps as “The Suck”) nobody thinks less of you. You’d have to be a retard or a kiss ass to pretend everything is hunky dory. Of course we also laugh at the complainer and say, “Oh well, I guess it sucks to be you” but as long as that man carries his weight and charges hard when required no one thinks less of him. In the medical world, however, to even suggest that you’re tired of pointless bullshit and would prefer to go home is to invite screeching and hand-wringing from the usual cadre of zealots who are flabbergasted, totally flummoxed, that anybody could utter one single criticism of their precious career.

What Kind of Health Care System do You Favor?

I favor a Cuban-style approach. First, we need to abolish political parties and if necessary imprison, exile, or execute politicians who refuse to accept the new order. Then we should severly curtail the traditional civil liberties that we currently enjoy. I’d start with the press and shut down newspapers and television stations that did not support the government. For good measure I’d gradually abolish private ownership of print and broadcast media turning these into propaganda organs of the state. I’m sure we wouldn’t have to execute too many reporters before they fell into line. Maybe establish re-education camps for those who don’t quite get it.

We would also need to get rid of freedom of speech and the right to protest because these kinds of things are messy and make running a modern utopia impossible. Not to mention that it can be embarrassing to the Leader who is, after all, a perfect father to his people. Religion is unessential and unless it can be corrupted to serve the needs of the Party we can ban it too. It’s just an opiate for the people and restricts our ability to condition them for obedience. We can’t put God in a concentration camp so we will need to make the people forget about Him. A good start would be giant portraits of our Glorious Leader along with other heros of the revolution. You know, to give the people somebody to respect. Oh, and marching, lots of marching. Lots of parades.
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Poverty is also essential. It’s too hard to keep our hands out of the economy. Besides, we know better than anybody else how to run things. We have college degrees. How hard could it be? At least we can ensure that everybody is at the same low level of poverty. It is a lot more fair that way and the people will not be envious. Envy is bad. Inequality is bad. But party members do deserve some perks. Running a country is hard work, harder than cutting sugar cane, let me tell you!

We also need to keep people from leaving. If we lived on an island it would be a lot easier but maybe we could fortify the boarder and put guard towers every few miles or so. It’s regretable that we don’t have 90 miles of shark-infested ocean to keep people honest but we have to work with what we have.

Oh, and we can have free health care. Nothing elaborate, mind you. Just some low level primary care. What are people going to do, complain?

(To be continued…)


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