The Top Ten Things I've Learned In my First Week as an Intern

A List of the Top Ten Things I've Learned In My First Week as an Intern

10. An entirely new vocabulary of words, acronyms, abbreviations for all things ob and gyn

9. I no longer need a gym membership. I walked eight miles yesterday around the hospital. On that thought, it would be genius for someone to invent a pager/pedometer. It would let doctors know how far they've walked AND save space around the waist.

8. In reference to #9, I never fully appreciated just how many things could be clipped to the waistband of your pants. Cell phone, multiple pagers, wallet, pencil holder, etc. Better tie the drawstring of those scrub pants nice and tight.

7. I can now think in military time.

6. Keep extra underwear and socks in the call room at all times. I'm sure all ob residents have learned this the hard way. That amniotic fluid can really spray.

5. 3:30 to 4:30 am is the "witching hour", as my upper level resident says. Not night, not morning yet, it is the hardest time to be awake. It is physically so difficult, bringing intense nausea, faintness if I stand too long in the OR or a delivery, and achy joints. The older residents tell me this is normal, and why working overnight is so hard. They say you never get used to it, but learn things that make it easier on you.

4. My name is now Kennard. Not Anne. Not Dr. Kennard. Just Kennard. The nurse will say, "Did you page Kennard?" I call back. "This is Kennard, I was paged." I'm glad I like my last name.

3. My life is now indoors and fully climate-controlled. The only way I know the weather outside is by touching the inside of the windows in the call room. It was 118 degrees yesterday. Who would know?

2. The sound of my pager induces an acute stress response. I can't sleep when I'm working overnight even if I have a little down time, because I am just waiting for that thing to go off. And for God's sake (or at least my husband's), leave it in the car when I get home. Otherwise it will beep all night.

1. How big ten centimeters is. I know it seems obvious...ten centimeters is ten centimeters! But I am learning how to do accurate exams to know when someone is ready to have a baby. To facilitate this, I've taped a 10 cm measuring tape onto my mealcard. The cafeteria workers think this is hilarious and now recognize me and laugh every time I come in.

More to come...

Love,
Kennard

Thoughts from a Little Doc's [Dad]

Dear Annie,

When you were about 4 or 5 I took you to a weekend math conference I was speaking at in south Orange County. We stayed at the Westin Hotel and had a great time – swimming in the pool, watching TV, ordering room service. You didn’t even seem to mind sitting through my talk. After we got home, it was back to work as usual, and I don’t think we talked abut the trip again except for saying that it had been fun. About six months later we happened to be driving near the Westin and you said, “Look, dad. There’s the hotel we stayed at.” I said, “You’re right, sweetie,” surprised that you would remember the specific hotel. Then you looked right at me and said, “Room 405.”

It was then that I knew this was no ordinary child.

For you, information was always taken in, analyzed, catalogued, and stored in such a natural way that you were not even aware of the process. Details were useful, not threatening. Data about the world – both quantitative and qualitative – was always welcomed.

I think it has taken you most of your life to come to terms with the fact that you have a remarkable mind. Children can sometimes be unkind to a peer who seems a little different, especially if the genesis of that difference is intellectual. I know being a kid was rough on you sometimes. I tried to help – not always effectively – when you felt that the others did not understand you. The fact is, they probably didn’t. But I always knew that if you could reach the other side of childhood that you would have a remarkable adulthood.

And so you have.

At an age when many of those same peers are still trying to find their way in a complex grown-up world, you are leading the way. You are a doctor, Dr. Anne Kennard, perhaps the only palindromic OB/GYN in America. You are in a residency program at one of the top hospitals in the country, one of eight chosen out of more than eight hundred applicants.

They saw in you what I knew long ago: this is no ordinary doctor. Although just a first-month resident, your accurate diagnosis today of a breach presentation resulted in a good delivery in a situation that otherwise could have had a bad result. Once again, data was taken in, analyzed, and, now, applied. Mother and child are doing well.

I wonder if the mom, who is resting this evening after a busy day, is in room 405.

Love,

Dad

Changed For Good

I went to medical school at A.T. Still University, School of Osteopathic Medicine in Arizona. It was a brand new program, a school devoted to an innovative curriculum that gave students early clinical exposure, taught in a new inductive reasoning pattern, and valued underserved and primary care medicine.

Quite frankly, I didn't care much about any of these details. What I cared about was that this was the only school that I got an interview, and so I really wanted to be accepted there. Sure, I was fine with all the things that this school valued and taught. I think my natural bias was towards primary care to begin with, and I liked the idea of working with medically underserved people. But whatever. I would have gone to any school that wanted me, given that they were accredited and within the United States.

So, I was accepted. I started my first year with a trip with all my classmates to one of the Community Health Centers we would be rotating in during years 2-4 of school. And I was happy just to be there. The next year, our class of 100 was divided into ten groups of ten students, and we moved to our clinical sites at the community health centers. There were students in Hawaii, working primarily with homeless Hawaiians, students in suburban Seattle and Portland, urban Brooklyn, rural Ohio, South Carolina, and Alabama, Indian reservations in Arizona. My site was Central California, working with mostly Hispanic people who picked the great majority of the fruit for the nation.

I rotated through the different specialties, seeing these patients. I traveled to Hawaii's community health center, where I rotated through pyschiatry. I was exposed to different races, ages, citizenship statuses (or lack thereof), addictions, and problems, all united by poverty and limited access to health care. And I thought I understood, finally, why my school developed this new curriculum. They wanted to have us work in these settings to make us familiar with working in underserved medicine, in the hope that we might choose primary care and come back to be a doctor to people that desperately need one.

Then I graduated and started my residency, in a nice hospital that serves everyone from the very rich to people that just made it over the border. I thought more about my school, and the background it had given me with underserved medicine. And I think I understand that their vision, their goal in the grand scheme of medicine, was not to have doctors return to community health centers in primary care. Of course, this would be a wonderful bonus to their commitment to underserved medicine. However, I think they knew that by training young physicians within the lens of the underserved, we would be forever changed as doctors. Even if we chose the most sub-sub specialty in Newport Beach, California, we would always have the memory of working with those who had very little. And this, I think, is the heart of the program. Training doctors in the initial setting of underserved medicine forms a framework that affects the rest of a physician's career. I know for myself, my view of medical legislation, practice decisions and treatments are changed forever, no matter where or with whom I practice.

As I write this and think about these patients, I hum a song from my favorite musical, Wicked. As the song says, I have been changed for good.

I've heard it said

That people come into our lives

For a reason

Bringing something we must learn

And we are led to those who help us most to grow

If we let them

And we help them in return

Well, I don't know if I believe that's true

But I know I'm who I am today

Because I knew you

Who can say if I've been changed for the better?

(I do believe I have been changed for the better)

And because I knew you

I have been changed for good

Putting On My Gloves

Well, I've started work as a doctor. Two day shifts, one night...it hasn't been too different than being a medical student, except that I sign my own orders. But tonight was different.

It was about 10:30 pm, and I had just finished helping to deliver a baby. I sat down to write my delivery report, and heard a nurse call "911 to triage!" I watched a couple nurses run after her and then decided that since I am a doctor now, perhaps it wasn't a bad idea for me to go too. I wasn't stressed because I knew the 911 pager had been activated, which meant that a group of residents with actual experience and an attending would show up soon. But I decided I would go and just be there in the meantime.

It turned out to be a patient that had shown up to triage when completely dilated and was starting to push her baby out. I introduced myself, and asked her a few questions, in Spanish, keeping an eye on the door for someone that would know what I should do. No one came, and the nurse handed me a set of sterile gloves, and said "put your gloves on."

And I did. I pulled on the sterile delivery gown and pulled on my gloves, and delivered the baby just as the more advanced resident and attending arrived. I stood there holding that baby, knowing that this mother was my patient, and that me being there had mattered. I had put on my gloves, and was a doctor.

It was a great feeling and an I think an important transition, as I start my residency, and gives me a lot of excitement for what is ahead.

Thoughts From a Little Doc's [Mom]

Dearest Annie,

You indeed became a physician yesterday. As we have enjoyed the festivities of this weekend, I have reflected on the journey of the past four years. You have grown and changed quite a bit over these years. But you are not the only one who has grown and changed. I have also grown and changed as I have watched your journey. With that in mind, I will reflect on a few of the moments that were touch points for me.

Did you say “thank you”?

Although many years and experiences went into the making, the real journey began when we flew to Arizona for the interview at ATSU. You called excited with the news that you had been granted an interview, but that the interview was to occur within a few days. ATSU had invited you to bring a family member along. They were keenly aware that the rigors of medical school would require a support group that was “on board” with your goals. So, after a whirlwind trip to Nordstrom with your dear sister to pick out an interview suit, we were off to Arizona.

I knew that I had one job on this trip: to deliver you to the interview on time. Having never been to Phoenix before and not yet in possession of a GPS unit, I must have reviewed the route from the hotel to ATSU twenty times. I breathed a huge sigh of relief when we entered the parking lot. Because of my fear of screwing this up, we arrived forty-five minutes early. Not a moment too soon, in my book.

It was a grueling day for both of us. I was allowed to be with you for all but the hours of direct interview. You were poised, confident, and charming. I tried to strike a balance between sharing things about you that I thought the interviewers should know and coming off as a stage mom/helicopter mom/hopelessly doting and tiresome parent. You nodded enthusiastically as the presenter reviewed the curriculum and testing schedule that would be yours if you got in. I wondered if anyone could possibly live through it. After a grueling ten-hour day, we walked through the exit. Before I gave it a moment’s thought, I said, ‘Did you say “thank you”?’ The look on your face reminded me that this was not our usual exit together after a birthday party. You had just made it through a very grown up day. It was time for me to grow up, too.

“Back to School” Shopping

A favorite tradition in our family over the years was the annual “back to school” shopping trip to Staples for school supplies. The aroma of freshly sharpened pencils evoked excitement for a brand new school year. The list included the usual items such as binders, folders, college-ruled paper, a pencil pouch, and a supply box for the top of the desk. There was a yearly discussion between you and Jennifer on the merits of colored pencils versus felt tip markers. Crayons were a “must have” at any age. A box of sixty-four with the built-in sharpener could be counted on to increase your popularity when it came to choosing partners for group projects.

The night before, we looked at each other and wondered what one should bring to the first day of medical school. ATSU had issued you a computer “tablet,” which was the latest technology for new medical students. Were you supposed to bring the computer in a backpack? What else should go in that backpack? We settled on the usual assortment of items, including the crayons. Maybe you would need to color and label pictures of anatomy. Who knows?

*a note from the little doc: the other students laughed at me about the crayons in my bag. And then wanted to borrow them.

Over time, we knew that all of these items were necessary and useful. What we didn’t know is that Dad and I should have bought stock in the company that makes 3 x 5 note cards. You must have gone through thousands in the last four years. The other important purchase was “Phyllis.” Phyllis is a full size skeleton that shows important landmarks such as the origin and insertion of the major muscles. Phyllis has oddly been a source of encouragement, having been named for Dr. Phyllis Agran (a pediatric gastroenterologist) who guided you through a rough patch in your own health during your middle school years. Like the box of sixty-four crayons, Phyllis ensured your popularity in your early days of learning anatomy with your peers. She also provided comic relief when dressed up in a myriad of outfits.

Mom, I’m calling to tell you that I am on my way to the E.R.

In fairness to me, this was not the first time that I had heard these words from you over the telephone. You have had a series of mishaps over the years, including numerous painful ear infections, a broken toe, a concussion, a pierced eardrum, pneumonia…. Need I go on??? The fact that they were uttered at 10:00 at night did nothing to ease the immediate panic. You found my panic to be hilarious and said, “I’m working in the E.R., not going to the E.R!” Frankly, this possibility did not even occur to me.

For the well being of our patients, please leave your children at home.

I saw this notice when signing in for an appointment with Dr. Thanos, the gynecologist/obstetrician who delivered Jennifer. As every parent knows, memories of your children when they are young are very vivid and can feel as if they happened yesterday. Sometimes you are startled to see your child standing before you today and you wonder how she got there. As I absentmindedly read this sign, my sense was that you were home being cared for by Grandma while I was at the doctor’s office. I was glad that I had not offended anyone by bringing you with me. Then it occurred to me that you were actually in the office, because you were doing a rotation with Dr. Thanos. As a student doctor, you said that the sign was more appropriate than anyone knew.

*note from the little doc: Don't go to the gynecologist with your mother. Not as a child, and ESPECIALLY not as the doctor. Even if you are curious about her DEXA scan results.

Stay away from that, it has germs on it!

A mother should have a nickel for every time she has said these words to a child. With this kind of money, she could book a week in paradise, complete with margaritas. I spent years steering you away from anyone who was coughing, sneezing, or had a runny nose. I quarantined you or anyone else in the house that had a fever, and zapped every surface you touched with Lysol. I kept your little yellow immunization card in a lock box with birth certificates, passports, and the deed to the house.

Bird flu, swine flu, tuberculosis, flesh-eating bacteria. All of these were the subjects of sensational news stories during your clinical training, complete with dire predictions of uncontrolled global outbreaks. My usual admonitions to stay away from germs no longer applied. Those who suffered needed you. I could only pray for your protection.

Yes sir, that’s my baby. No sir, I don’t mean maybe.

By now, you have delivered numerous babies and provided care to many who are sick. You have shared joyful news with some families and devastating news with others. I know that you are ever mindful of the awesome responsibility and profound privilege of being present during a family’s moment of greatest joy or deepest sorrow.

In looking back over your life, your innate character and experiences have led you directly to this moment. I do not remember a time when you did not want to be a doctor. This drawing is from a school assignment that asked "What do you want to be when you grow up? What does that person do?" You drew it when you were about seven years old. Twenty years later, it is time to say, “Congratulations, DR. ANNE KRISTEN (BONSANGUE) KENNARD!” You finally made it. I love you very much.

Love,

Mom

Today, I Am A Doctor

I've watched friends go through bar mitzvah celebrations. This Jewish coming of age ritual occurs when the thirteen year-old child becomes responsible for his actions, is considered "adult" in the community, and is privileged to uphold Jewish law, tradition, and ethics. He undertakes years of preparation and study, and finally stands in front of his congregation, proclaiming "Today, I am a man."

Today, I am a doctor.

I spent four years preparing to get into medical school. I spent another four learning about the human body and how to help and heal. I took the Osteopathic Oath, promising to honor the medical profession and my patients, practice ethical medicine within my scope of practice, and to uphold the tenants of osteopathy, joining generations of healers who have gone before me. I stood before my family, friends, and teachers, and felt the weight of the doctoral hood placed on me, it's long length and green stripes proclaiming to all that today, I am a doctor.

The thing is, a bar mitvah-ed "adult" is still a thirteen year-old kid. I'm still a little doc, just in a long white coat. And even though I am considered a doctor, I still start over, for another four years, as a resident, the doctor who is the least experienced and needs to learn the most about her chosen specialty. I'm hoping that somewhere, in this transition to fully-trained physician, I'll feel like my new coat fits.

The transition is joyful. I can't help but grin as my white coat brushes my knee instead of my hip. I love writing my new name (which is a natural palindrome): Dr. Anne Kennard. I am humbled and honored to be considered an "adult" in the medical profession, at the same level as my teachers and role models. I think about an office full of people waiting, a patient on an operating room table, a tray of sterile instruments set out. How could these things all be for me? I've wanted to be a doctor since I was eight years old. This is truly a lifetime dream come true.

The transition is also scary. I think about what the added twelve inches on my coat hemline adds to my life. I am responsible for patients, and since I am in obstetrics, I care for two or more patients instead of only one. I need to be an excellent diagnostician, a gentle and effective healer; not because my malpractice premium depends on it, but because it is my responsibility as Doctor. My decisions, my words, my touch will tremendously impact others. Consequences for mistakes rest with me alone; I have lost the safety net of being a "student doctor." I could really hurt somebody. But, I can also really help someone.

Even though a thirteen year-old is still a kid, the bar mitzvah is significant, celebrated, and honored. To that community, he is an adult. I'm still the little doc. But today, I was welcomed as a physician into a community that includes Hippocrates (Greek "Father of Medicine"), Paracelsus (Renaissance physician who pioneered use of chemicals in medicine), Andrew Taylor Still (founder of Osteopathic medicine), the Mayo brothers (founded the Mayo Clinic), Jonas Salk (first effective polio vaccine), Donald Pinkel (my mentor, discovered ALL cure and founder of St. Jude Children's Hospital), and generations of surgeon generals, centuries of healers.

Today, I am a doctor.

Mother's Day

I am not a mother. Well, maybe except to the dog, but I wasn't expecting anything from him. So I was a little confused when a mother's day greeting found me today. It was from my parents, and I adored the message.

"Happy Mother's Day, Little Doc! Anyone can have a couple of babies, but you will have thousands. You are celebrated today along with the women you care for...Happy Mother's Day to a doctor of mothers."

The Gift of Health

I had two patients in the ICU today, next door to each other. One was a 92 year old woman who was sick, tired, and ready to die. Her body "had just wore out", she told me. Her family was grasping at every tiny diagnosis, not acknowledging the larger picture, that her body was just shutting down. They encouraged her to keep going, to sign a full code status. She wanted a Do Not Resuscitate order.

In the next room, a 92 year-old man was intubated, with shock, hypotension, kidney failure, and a bowel resection for an obstruction following the repair of a hip fracture. His wife knew he had wanted a DNR order, but was feeling guilty about honoring his wishes. She didn't want her husband of 52 years to die, but acknowledged that he had been a vibrant, outgoing person, and wouldn't want to live on a ventilator. She told me that he had never met a stranger, loved to talk and would leave someone new having learned their life story, and she was sure he wouldn't want to live without the ability to speak and give love to those around him. But she still couldn't bring herself to let him die.

As we left those rooms, my attending doctor shrugged and told me "All living things, big or small, eventually die. Why do people not know this?" He was frustrated, having seen many people die and even more live, because of the ability that we have to keep someone alive, which in many cases is more punishing than death.

I've been thinking about health lately. People think that health is a given, it is something they are owed throughout their lifetime. Doctors know better. With the intricacies of the human body, it is incredible that anybody is healthy. And while sad, it is not surprising when people aren't. Nobody is owed health; but it is something many people enjoy and take for granted. Young people, especially, do not know how precarious health is, unless something unusual has happened to them. My parents are beginning to learn, as their friends become sick with cancer or other things that can kill them. My grandmothers know this lesson well, as they survive more and more of their childhood friends.

My mother called me recently, telling me about her own frustrating diagnosis of osteoporosis and many grandmother's debilitating back pain that will preclude her from traveling to watch me graduate from medical school. I was sad, of course. I didn't want either one of them to suffer, and I would miss my grandmother on my graduation day. But, I gently reminded my mom, these things are okay. They are not comfortable, and will need care, but they won't kill you.

I am a regular person, overlayed with the knowledge of a doctor. I look at my family's medical problems through the lens of knowing what can really go wrong. But I also ache for the wife of my patient, because I understand her too. Her husband sounded a lot like my loving, outgoing, talkative husband, and I could see how, after enjoying fifty more years with him, it would be hard to not make a decision out of grief.

It had been a gift to me, as a young person, to deeply and intimately understand the frailty of the human condition. I ride my bike over to the diner with my husband, finishing my lunch in the time it would have taken for my elderly patient to finally get himself into the car. I look at how fast my fingers type, seeing the arthritic nodules of an elderly woman's fingers as she slowly signs her name. It's kind of a sad gift, a wisdom that carries weight along with knowledge. But, I am glad to have received it in my youth, and appreciate it throughout my lifetime.

Tales from the ER

I ended my one and only rotation in the emergency department today. I learned two valuable things:

1. It is correct when doctors tell you that the emergency room is 90% boredom, 8% interesting, and 2% terror.

2. I cope well with true emergencies, making fast and accurate decisions...but I don't like them.

Here are some stories from the ER:

Boredom

• A woman comes in for hand pain. Further elucidation reveals that she "slept on it wrong."

• Countless drug seekers, with some nonspecific abdominal pain complaint, who have had so many CT scans that you expect their belly to light up from the inside. They will moan and writhe so much that you finally cave and write the script just to get them to shut the hell up and get out of there.

• A kid with a rash x 3 weeks, which has been evaluated by numerous primary care providers. What makes you think that at 10 pm with a busy ER, I will be able to accurately diagnose and treat your rash any better than the other doctors you have seen?

• Colds and viruses. Please, go see your primary care doctor.

• Anxiety. Anxiety. Anxiety. You would not believe how often this diagnosis came up and how many insidious ways it can present. And how even thought you are 99% sure it is anxiety, they need a full, expensive, cardiac workup for you to be able to discharge them since they came in complaining of chest pain and/or shortness of breath. These typically present between 10 pm and 7 am.

• A parent wondering if permanent marker was toxic if absorbed through the skin (kid had done some "face-painting"). Definitely a firstborn child. Subsequent kids would walk around for months with marker on their faces.

Interesting/Funny

• A woman came in with numbness and tingling down her right thigh. She was dressed very nicely, and told me that she had just come from a wedding. The (male) attending wanted an MRI. I asked if she was wearing anything new. Turns out she had worn Spanx for the first time under her nice dress, and it had compressed her lateral femoral cutaneous nerve. She took off the Spanx, and the numbness and tingling went away.

• A poor ninety year-old woman came in after tripping and falling on her carpet. The carpet ripped away her paper-thin skin, leaving her patella and a good part of her lower leg tissue exposed. I spent an hour and a half putting in fifty stitches, and had a wonderful conversation with her while doing so, learning all about her long life. She loves to needlepoint, and asked how I did the stitches, and if sewing people was similar to sewing upholstery.

• A man came in under arrest after attempting burglary. He had fallen on glass while robbing someone's home and was brought in by the police to get his knee sewn up prior to going to jail. As per usual, I asked him what happened to his knee. He told me he fell on a rock while playing basketball. I commented that the rock must have been pretty sharp, given the perfectly clean laceration he had (a confidence afforded by the fact that he was handcuffed to the bed).

• A kid who had eaten a scorpion. Is it toxic if the venom is ingested?

• An old Hispanic man, yellow as a canary, coming in with abdominal pain and a big stone in his bile duct.

• A four year-old girl with a cut deep into her foot from a rotary blade. I made a game of wrapping her up in a sheet like a burrito, which she liked, and then cringed as I began to inject lidocaine and start suturing while she screamed and tried to flail the arms and legs that I had wrapped up so tightly.

• People on/withdrawing from drugs. Always interesting to watch.

• A heroin user with a kidney stone who begged for pain medication. Nothing worked. He was furious when I told him that since he had developed so much tolerance to narcotics, they weren't effective for him anymore.

• A heroin user who unscrewed his IV and left AMA ("against medical advice"), then used the line to inject mass amounts of heroin and ended up right back in his old exam room, now unconscious and apprehended by the police.

• A heroin user who had multiple abscesses from skin popping, each filled with several CCs of pus. They needed to be drained (fun to do). She had a lot of anxiety over the needle with the numbing medicine. I tried to refrain from pointing out that she put needles in her skin several times a day anyways, so what was the big deal?

• A woman complaining of vaginal bleeding during pregnancy. Normally this would fall under the "boredom" heading, but what made this unique was that this individual was transgender, and I was greeted by a penis and testes when I lifted up the gown for the pelvic exam. He/she was so desperate to identify as female that she had sought medical attention for a "female" problem. Definitely a psychosomatic diagnosis.

Terror

• Multiple trauma victims of a multi-vehicle crash, all coming in at once.

• A child bleeding to death internally after sustaining blunt abdominal trauma from a trampoline fall.

• A man with an eyeball hanging out of his socket after an injury.

• A drunk driver laying in the trauma bay next to the man he killed, separated only by a curtain.

• A ten year-old who successfully hung himself.

I'm glad I'm going into Ob/Gyn. There is some inherent terror in that specialty as well, and the emergencies affect two people, not one...but thankfully, they are few and far between. In the meantime, I can enjoy an overall healthy population and followup with the same patients for a long time. I missed that in the ER...I wonder about some of these patients and don't like that I will never find out how their story ends. It was a good rotation for me to do. And good that it's over.

Dr. Jekyll and Ms. Hyde

I am not a mean person. I think I am generally good-natured, thoughtful, reasonably patient, and kind. I am not unreasonable unless my blood sugar dips too low. I try not to sweat the small stuff, try to take good care of myself and others.

But everyone has a breaking point.

Mine seems to come after about being awake over thirty hours. If I have worked all night and sometimes the day before, I leave my house Dr. Jekyll and return as Ms. Hyde.

Dr. Anne Jekyll knows she is just tired. She can look at dishes in the sink and know that they can be done later, after a long nap. Email can wait. She knows she doesn't need to run with the dog right now, even though it is cool and light outside- a rarity in the Phoenix sun. She can recognize that even though she was up working all night, it is okay for others to be sleeping, doing nothing productive except restoring themselves.

Ms. Anne Hyde is unglued about dirty dishes in the sink. She thinks, "if I have been awake and working for the last umpteenth-and-a-half hours, at LEAST have the kitchen clean before I get home." She feels like she needs to immediately start her daily duties and rest later. She scowls at those that have been sleeping all night, expecting others to at least achieve partial productivity in the many hours that she has been gone. She has no patience for hearing that someone hasn't slept well, and even less patience for hearing that someone has.

Dr. Jekyll and Ms. Hyde are both predictably, undoubtably me. These characters of duality persist across level of training, rotation assignment, and seasons. And I have medicine to thank for introducing me to Ms. Hyde...I don't know if I ever would have experienced such impatience, discompassion, and crabbiness if left on a normal schedule. I don't think I would have believed that I could feel this way, that these emotions and thoughts could come from the person I thought myself to be.

I think many doctors struggle with this, and it partially fuels the burnout of medicine. Like Mr. Hyde in Robert Louis Stevenson's original novella, our meaner selves can grow from a part-time appearance to an ever-present alter ego. Dr. Jekyll saw the transformation too late, and lost himself to Mr. Hyde. Doctors enter medicine for all the right reasons, and, sensing their bitter change too late, leave for all the wrong ones.

They say recognition is the first step to recovery. Well, I don't know if I can ever completely recover. But I can recognize Ms. Anne Hyde, acknowledge her for who she is and the place of exhaustion that she comes from, and choose to go to sleep. I can wake up as Dr. Anne Jekyll, kindness and patience restored, ready to see another patient.