Yesterday was a good ER day. The patients weren't all that interesting and most of them didn't need to be seen in an emergency room. The residents, student and I saw a lot of patients in the 12 hours we were there and that is always good from a revenue/RVU generating point of view. It was a good ER day because of the people with whom I worked. Working with learners is a tricky business, especially in the ER when you have 12 hours out of a 3-6 year training period to teach something and/or make an impact while simultaneously trying to keep patients alive and keep up with all the electronic documentation. When evaluating these kids, the students and the residents, unless they have committed some egregious errors, they get the equivalent of an A+ from me even if they've really only performed at a B + level, mostly because it's hard work and just showing up and doing your job gets you a B and if you have some enthusiasm and a good attitude, then you get pushed over into the A to A+ column. Very rarely, I have a C student or resident and recently I had my first ever F resident (and I'm still reeling from that one and have yet to formally document her poor performance). Yesterday I had some genuine A+++ individuals.
One kid, in particular, really had an impact on me yesterday. At the onset of the day I thought I might be working with a couple of duds. They were both kind of quiet and one was a urology intern and the other a family medicine intern so automatically they were suspect for laziness (urology) or dumbness (family medicine). I fully admit that I'm an internal medicine snob. As the day progressed they proved me and my prejudices wrong. The family medicine resident was smart and hard-working and had the air of internal medicine elitism, which I appreciated. But, it was the urology intern that has kept me up most of the night thinking. It's his story to tell and I don't have his consent to disclose it, but he was remarkable and it was not because he was really, really knowledgeable or really, really accomplished. He was remarkable in his ordinariness, decency and humility. This kid seems to have had humble beginnings and then a series of adverse life circumstances and despite this he has extracted all the character developing aspects of the situations and moved on without anger or bitterness.
Surgical interns have a tough job. Despite new duty hour restrictions that are supposed to put limits on the number of hours an intern or resident can stay in the hospital, the supervising surgeons and the surgical programs often ignore these rules. The interns, who are powerless, are subject to the whims of whomever they may be assigned to for the month. This intern had been assigned to an esteemed surgeon but one also notorious for abusive behavior towards his interns and residents. He shared a few stories of his month with the supervising surgeon and I wanted to cry and hug him and he wasn't trying to garner sympathy. After about his third day on the service with this supervising surgeon, he realized he had to just take his knocks and move on.
What I want to do is find this kid's mother and tell her, "job well done. Despite all the shit you and your family have experienced, this is your real treasure standing right before you. If I could fast forward 10-15 years from now and see that my boys had the character, humility and humor of your son, then I'd know it has all been worth it."
I don't know if I'll ever work with this kid again and I certainly hope that 6 years of a surgical residency doesn't alter his character. I don't think it will because I think he has a rare trait called resiliency. I'm not sure he learned anything from me. Maybe I demonstrated to him that not all supervising physicians have to be assholes to prove they are in charge and it is possible to treat your residents decently and humanely (both residents were amazed that I let them leave before check out. I saw no point in them staying there. They had finished their work and I had to stick around anyway and they are the ones working the 60+ hours a week for minimal pay). I certainly learned volumes from him.
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