(Not) Paging Dr. Nobody

I'm starting the first rotation of my fourth year tomorrow. The night before a new rotation, I always have jitters. It's like the first day of school rolls around every four weeks- new teacher (doctor), new classroom (office), new classmates (office staff, nurses, etc), new location. But this one is different. It's my first "audition" rotation, which means it is an out-of-town rotation at a place that I hope to do residency. There are only two for ob/gyn in Phoenix, where we'll be living because of my husband's doctoral program, so I really need it to go well. I always have "sunday-night" anxiety before a new rotation, but this time I am alone in an unfamiliar hotel room, white coat pressed and stethescope polished, counting down the hours until 8 am.

I wasn't sure why this one bothered me more than others. Obviously the stakes are high- I desperately want this program to like me, and for me to like them, since since there are only two residencies in Phoenix. But I think it's more than that. In this hospital, there are attendings, fellows, residents, interns, other students. It's associated with a large academic university. It's planned down to the last four page memo emailed to me last night, with a reminder to bring fifty bucks with me to pay for my badge so I can work. In my hospital- wait. I don't have a hospital. I have a collection of low-income clinics that serves high volumes of underserved patients. My school is a thousand miles away. Planning is scant, since I am part of the school's first class and the rotations are arranged the month, week, day before they start. And I'm intimidated that I am finally going to a "real" medical school hospital, where I perceive other students to be better trained than me. I'm nervous about being in a place where there are tiers of doctors to be hard on me, and to prove myself to.

For most students, this is a standard experience. And every time I wish my school was "regular", that I had gone somewhere else where I would be more used to a traditional, well-planned curriculum, I think about what I got to do in my second and third year. The feel of a warm, slippery baby that I eased out of a mother's body, instead of a handful of paperwork. The unique pressure to make a clean abdominal incision, instead of peering over some other student's head. I wrote prescriptions, chart notes, did patient visits and counseling on my own, made changes in meds. I put in IUDs and did pap smears and colposcopies, rather than just being responsible for cleaning the sticky mess at the end. I told a mother her baby had died. It was an underserved area with too much work, and I was given responsibility beyond my formal education level, with the expectation that I would grow exponentially in skills and knowledge.

My school says this is the benefit of their new, unique curriculum- that students will really be used to care for patients, and will learn more as a result. There weren't other students or residents- just me and the doctor- which is a much different relationship than the model I will be entering tomorrow. I worry that the doctors above me will see it as their right and duty to humiliate me, be hard on me, and overwork me with busy work that they don't want to do, but I more worry about opportunities that will pass me by as a senior student. I don't get to deliver the baby, because that's the privilege of the second-year resident. I get to scrub in on a surgery, but not touch. Now that I've had a taste of these things, I think it might be frustrating and boring to be sidelined. At this hospital, I'll be a nobody, a not-even doctor.

I'm hoping despite these probable outcomes that I will like the program and make a good impression. Despite the usual anxieties- I hope I find the place, can I bring a lunch? will I get to eat it? What time do I go home? Will they like me? Will they give me good patient opportunities? How can I be a good student for this rotation?- there are new ones, more permanent and worrying ones. Will they like me enough to offer me a position for four years of training? Can I compete in an MD residency as a DO student? What are they looking for in a potential resident? What if I don't like them?- a horrifying thought since that eliminates half of the local programs. How can I show them that I will be a good doctor, that in some situations I have already been a good doctor?

T- 12 hours and counting...