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It's 6:30 AM on Sunday. Lisa and Katie are still asleep . Actually, it's a bit unusual since Katie has a distinct habit of waking at 6AM on weekends and insisting that we rise as well. I'm already on my second mug of coffee.
I was supposed to have today off - time to spend with my family in the great bay area outdoors. However, financial realities dictate that I must moonlight at a local emergency room for twelve hours today. I do this two or three times a month. My last vacation in April was spent doing this as well ( 5 days - sixty hours).
Few people realize the financial sacrifice it takes to train as a physician. After accumulating nearly $100,000 in debt to pay for tuition, you are forced to take an 80 - 110 hour a week job which pays about $30,000 a year. This goes on for 3 - 7 years while the interest on your debt compounds. Then if all goes well, you can get a job with an HMO which pays you around $100,000 a year (minus the 30% or so that the government takes off the top). Well, anyway, it leaves me with no choice but to moonlight.
Interns and residents are not covered by any labor laws (at least not in California). We are considered "students" and are given "stipends", not salaries. We are not protected from any abusive labor practices. A friend of mine currently in a surgical internship told me that his first day off was November 28th (he started the residency on June 22). Recently, I saw him after a 36 hour shift. He was barely coherent. He couldn't complete a single thought. I want a guy like this cutting me open - NOT!
Residency is also the ultimate mind-fuck. A fellow resident once described it as being "boy by day, man by night". He meant that during the hours when the attendings are around, you are forced to assume a submissive role. You are second-guessed and humiliated for any lapses in reasoning which may have occurred at 4AM. When the next night rolls around, however, you are expected to stand tall on your own and make life and death decisions without the aid of your attending. The cycle repeats itself - ad nauseum.
I remember my residents at Duke. Those guys worked like dogs. One day at the VA, my senior resdient admitted ten really sick patients to the ward. I saw him at 4AM with a stack of charts on his desk. When I asked him what he was doing, he replied that he was filling out the laboratory flowsheets on each chart. It seemed that the chief of the department went ballistic when the laboratory flowsheets weren't properly filled out. Never mind that the patients were expertly cared for. Never mind that the resident had been up for thirty hours. Those flowsheets better be completed or there was hell to pay. Needless to say, Duke fell a few notches on my rank list.
The other thing that drove me absolutely crazy was the "days of the giants" attitude among the attendings. The would say things like "we would have to do our own Gram stains and spin our own urines." Great...so what? They practiced in the days before AIDS, before intensive care units, before thrombolytic therapy for MI's. People with crushing chest pain were admitted to the ward and given morphine until they recovered or died. They usually died...allowing the resident some sleep.
Anyway, it's no wonder that most people look back on the residencies with fear and loathing. I certainly do. I think that residency took a lot of compassion out of me. It's hard to care for someone who's just taken an overdose in a feeble suicide gesture when you've been awake all day and night. It's hard to empathize with their pain when all you can think about is your own.
Well, it's time for my third cup of coffee. I know the caffeine is starting to kick in when I feel anxious and my stomach begins to hurt - I still have a ways to go. Twelve hours of work today (a short day), then 6 hours of sleep if I'm lucky and then back to my real job.
See you next week.
-Mo
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