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Boy, I'm tired.
Larry, who administrates this website, has been on my case for the last few weeks trying to get me to turn in some pictures for the site. He must have contacted me about 6 times. I finally got around to checking my e-mail today and noticed the increasing (but polite) urgency in his tone.
Anyway, last week I worked over 100 hours. I'm at the VA hospital this month and the caseload is killer. Nevertheless, I enjoy being at the VA. When I was a medical student, I begged to get as many rotations as possible at the VA. Duke University Hospital is a great place, but students generally do not get the opportunity to do much. At the Durham VA, I was putting in central lines, doing LP's, intubating, etc (all under resident supervision, of course). I had practically done a residency's worth of procedures by the time I started my internship. Now, as an anesthesia resident at the VA Palo Alto I'm doing cases that are normally reserved for senior residents: abdominal aortic aneurysm repairs, craniotomies, thoracotomies, etc. I'm not special, mind you, it's just that the VA is filled with an older, sicker population of patients requiring more complex procedures. Everyone is doing big cases here.
Another problem has been a lack of time to read. While I feel more and more confident of my skills as a clinician, I feel progressively less confident of my command of the literature. It was a problem when I did Internal Medicine as well. On the one hand, everyone wants a doctor that has the skills to perform clinical duties - skills that can only be obtained from doing the manual work demanded by a residency. On the other hand, it would be nice to have a physician who is up to date on the latest body of knowledge - a goal that can be achieved only if there is adequate time to read. There has to be a balance between the two. Unfortunately, the most common complaint among my colleagues (in many different specialties) is the lack of time to read. Many of my friends state that they read in cram sessions just before the board exams - it hardly seems an optimal situation. Nevertheless, the vast majority seem to do well on their exams and to become excellent physicians.
I think much of the process of medical education is the systematic purging of old data from memory to make room for new information. For instance, ask me to describe the pentose-phosphate shunt and I'll give you a blank stare. I learned that ten years ago during my first-year biochemistry class and can honestly say that it never came in handy in clinical practice. Same goes for the molebdynum co-factor, the inumerable foramena of the skull and the sudanophilic dysmyelinating syndromes. Anyway, it's time to learn a whole new body of knowledge (I wonder what I'll have to forget to make room for it).
It's time to close up this journal and crack Miller's "Anesthesia - Fourth Edition" and start forgetting Harrison's "Internal Medicine- Fourteenth Edition."
See you soon.
-Mo
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