A Month on Labor and Delivery

Day 1: I feel great. Excited for labor and delivery, have my lunch packed and my latte in hand. Hair is brushed, lipstick-ed mouth is smiling. Bring on the month.

Day 4: Kinda tired. Thirty-two people are now in the world that were not only a few days ago, and since it was my hands that guided them out, I am now responsible for seeing their mothers every day starting at 4:30 am.

Day 5: Hair brushing now seems like superfluous vanity. Give up in favor of extra thirty seconds of sleep.

Day 5, later: Am primary surgeon on a cesearean section for the first time. Realize that nurses do a "count" of all surgical instruments/sponges before I close the patient, to make sure nothing is left inside. Nurse reports to me "Counts are correct, Doctor." I smile. Thank you.

Day 6: How did my fridge get empty? I seriously don't remember eating all that.

Days 7&8: Don't have time to go to the grocery store.

Day 9: I am now grocery shopping in the hospital cafeteria. What do we need? Milk? Cereal? Fruit? Dinner? A recent trip to the cafeteria yielded 6 milk pints, 5 pieces of loose fruit, a box full of salad, three tins of cheerios, and a takeout box filled with cooked chicken breasts and potatoes. The cafeteria worker laughed at me, then realized I was serious and rang it all up. Swipe...and done.

Day 10: Baby count continues to climb, as does the length of my postpartum rounding list.

Day 11: Find time to go to Fresh and Easy. Please bear in mind that F&E is about 500 feet from my house. Someone with a good arm could throw a ball into their window from my front yard. Nevertheless, I feel a great sense of accomplishment and provision for my home as I drive over. Get there and realize that the coupon I have been carrying around in my scrub pocket for five days has expired yesterday. Frick. My smugness evaporates, and deflated, I buy the groceries anyways.

Day 11, later that evening: Realize I have forgotten to buy dog food. Rather than make the journey across the street again, opt to serve the dog a chicken breast mashed with potatoes, left over from aforementioned cafeteria shopping. He loves it.

Day 13: Thinking of the raw pork loin waiting for me in the fridge (it seemed like a good idea sitting there all pretty and healthy in the grocery store case), I opt to bring home dinner from the cafeteria. Chicken enchiladas- a favorite of my husband's- were being served, and I bought a plate and took it home. I slid it onto my own china, reheated it, and served it. About halfway through, he squints at me, and asked if asked if I had made these? I just laughed and asked...what do you think? He laughed too.

Day 15: I didn't have time to do my laundry, and ran out of underwear. Opted to buy a new pack from Target instead of devote time to mountain of dirty clothes. Must remember to maintain efficiency and get all other shopping done as well while I am there. Cat sand? Check. New mop? Check. Dog food! Yes! What else? I just cant remember.

Morning of Day 16: What is that smell? I turn my head. It's stronger now. I surreptitiously sniff my armpit. Oh God. That's what I forgot at Target. Deodorant.

Day 18: Deodorant still not purchased. Just when I'm about to give up and start changing my scrub tops thrice daily, I pick up a prescription for the hospital pharmacy and notice they carry deodorant. Hallelujah.

Days 20 and 21: Working both weekend days. Miss husband. He comes to hospital for lunch. I feel bad that he's driven 45 minutes each way to see me, but he insists that the Banner Bistro makes the best chicken sandwich in town, and he was hungry for a good chicken sandwich, so it's really not my fault. He also brings me and my fellow intern our favorite frozen yogurt treats, which I know is an additional 20 minutes out of his way.

Day 23: So, so tired. Realize that between the drive home and needing to come back at 4, I will spend only eight hours at home. Decide to sleep at the hospital, which allows me to sleep in until 5:30, and roll out of bed and into my patients room. Don't care that my hair isn't brushed, but realize the deodorant I've worked so hard to procure is at home. Dammit.

Day 23, later that morning: Purchase another deodorant from pharmacy. Pharmacist grins at me. "Didn't you just buy one of these?" I glare at him, and add a toothpaste to my purchase. He laughs at me.

Day 24: Baby count: 97. How is it possible that there is anyone still pregnant left in Phoenix? I must have delivered everyone by now.

Day 25: My first needlestick, while suturing a difficult vaginal laceration. Must figure out how to get to occupational health.

Day 26: Buy second pack of underwear and larger laundry basket.

Day 28: Mother, upon hearing laundry plight, mails me five pairs of Victoria's Secret panties. I'm sure the postage cost more than what I spent on Fruit of the Loom pack from Target. Gratitude for supportive family eases my tiredness and makes me smile.

Day 30: Had a slow day today. Only delivered one baby. Is it true? Did I really deliver everyone? I was kinda joking before. Hmmm...

Day 31: Never mind. Pregnancies, if not in Phoenix, have now appeared from surrounding areas, including, but not limited to: Camp Verde, Strawberry, Show Low, the Grand Canyon, Colorado City, Buckeye, Salt Lake City, and California. None of these places are within two hours drive of the hospital. Appreciate, really for the first time, that this is a true tertiary care center. Humbled by the fact that I am part of a program/medical center that people travel hundreds of miles to get to, because of what we can provide in terms of high-level care. I don't work with these patients right now- they go to the more experienced residents- but wonder how it happened, and will happen, that in a few months I will be helping to provide care that people drive hours to receive.

Final Count: Babies: 106. Husbands: 1. Supportive family members: more than I deserve. Lost hours of sleep: countless. Pairs of scrubs: 44. Hospital Meals: 61. New pairs of underwear: 17. Exhausted and humbled residents: 1.

Counts are correct, Doctor.

Pretty (Tired)

I used to be pretty.

Theoretically, I still could be. I have some decent raw material. Taller than average. Slender, athletic frame, if a little pear-shaped. Hair that is straight without intervention, light brown with natural strawberry highlights. Brown eyes, dark eyelashes, full lips. Clear skin with a few freckles. Maybe not beautiful, but okay. More than some people have to start out with, and I feel like I should make the most of it.

I'm working in the clinic right now. I adore office work. Things that most people take for granted- sleeping at night, wearing your own clothes to work, eating lunch- are joys that I get to experience in clinic that I don't usually get while working on the wards. I can put on pants that fit, a purple shirt that looks good with my skin tone, and put on thirty seconds worth of makeup. Undereye concealer, powder, a little blush, a lipstick that has been in my white coat for months. Four people stop me this morning to tell me how great I look. "Wow, are you wearing makeup?" "You look great!" "I like you in your clothes" (side note: does this sound inappropriate to you? Would you also like me out of my clothes?) "You are really pretty." They always sound a little surprised when they say that.

I smile and laugh a little. I tell them thank you, that this is how I used to look in my other life. This is how I looked before I went to medical school, became a doctor, and worked harder/got less sleep than a mother of perpetually newborn twins.

When I'm at the hospital, I wear the required men's scrubs. They are too short, hug my hips too tight, and gap in the chest. My hair is always up and never combed. Sometimes I wear my surgical hat even when I'm not going to the OR, just because I feel like it's cuter than my head. My skin is dull, I have pimples from my surgical mask, and I look bruised on the thin skin under my eyes. My joints ache with tiredness. I look weary. I feel old.

I always sort of wondered when I would start looking older. I look young for my age, and always have. Indeed, the "little doc" came out of people's surprise that I was old enough and accomplished enough to be wearing a white coat. When would I stop looking like the "little doc" and just a doctor? Now I know.

I think this process will age me. Like the presidents. Those guys always start out looking okay, and gradually their wrinkles form and deepen, the skin looks sallow, their hair goes gray. By the end of the term, they have aged much more than four years. And I think this four years of residency will do the same to me.

However, hopefully then I will have a stable practice that I love, a little more sleep at night, and more working hours during the daytime. I can wear comfortable scrubs that are made for women. I'll feel better, even though I'll be older.

And hopefully I'll make enough money to buy more expensive cosmetics, and afford a few units of Botox. I think I'll probably need them. :)

Like A Surgeon...Cutting For the Very First Time

Ok. I know that is a Weird Al song, parodying Madonna's "Like A Virgin." Nevertheless, this melody is what plays through my head as I learn to be a surgeon.

At first, it was little things. A "gateway" surgeon, if you will. I could sew up fascia, and close skin. Then, I got to come around to the surgeon's side of the table, and do a little more. A skin incision here, a fascial incision there. I'd retreat back to the assistant's side for the important things, like opening the uterus, delivering the baby, sewing the uterus closed

Today I stayed the whole time on the surgeon's side. And suddenly, all these little pieces of things that I had learned to do on their own added up to me being the primary surgeon, me being able to do an entire cesarean section on my own. I could ask for the knife, and retractors, and scissors, and all the things I needed and actually be able to use them. I could smile as my chief resident handed me the suture to close the uterus, instructing me to "sew like the wind" as blood poured out of the gaping incision. I could reach my hand into a person's abdomen, and feel their aorta pulsating under my touch, hold their uterus and feel the baby kick my hands, feel their pointy vertabrae from the inside instead of the outside.

It's kind of like working in the cadaver lab, but this person is alive! It always startles me how warm everything is to my touch, how their is so much movement in vessels, muscles, enclosed babies...how much life I can feel resting in my hands. And I think this is part of the draw of surgery...to be able to do this to another person, to have your hands deep inside them and not only have them live through it, but have a desired outcome from it.

Even routine surgeries are scary for me at this point. I am more focused then I ever have been, with time slipping away from me as if it was only seconds. I leave warm and sweaty, more tired than if I had run a race. It's scary, but exhilirating.

Like a surgeon...cutting for the very first time...

A Few Stories

Once in awhile, the residents get together and just laugh. We have to, with some of these patients. Here are a few stories from this past month's work:

A kind resident goes to evaluate a woman that has presented for multiple times for drug seeking behavior, on the premise of chronic pain. She probably does have pain, at least from being so addicted to narcotics, but we don't want to prescribe anything because it's not good for her, and not good for the baby. As I'm leaving triage, I hear her shouting at my (male) colleague: "Bitch, you don't know my pain!"

I enter the delivery room and greet a woman who is fully dilated and ready to push. I begin to give her my earnest speech about how to push with an epidural, how to pull your legs back and take a deep breath and curl up around the baby. This speech is complete with a demonstration that I think (hope) is helpful and I'm sure makes me look like a giant fool. As I talk, the woman sneezes and delivers her baby.

In clinic, my friend was performing a well-woman exam, and asking about any changes to the patient's breasts. The patient says, "Well, they've gotten bigger..." and asks the doctor to measure her breasts to fit her for a different sized bra! My friend, being a kindhearted woman who used to work in a department store and thus is qualified to do this task, considers it but ultimately decides this is a doctor's office and refers the woman (in all seriousness) to Victoria's Secret. Do you document that referral on the chart?

Meanwhile, on the antepartum ward, another resident is called urgently to evaluate a patient. She has had a cerclage, meaning her cervix has been tied shut in order to help her avoid premature delivery. It is much akin to the string tied at the base of a balloon. It appears that the cerclage has come out, as the nurse reports finding a long black string with a knot in it. The resident comes right away, and the nurse presents him with a paper towel spread between her hands. On the paper towel is a lone long black pubic hair, with a knot tied in it. He explains to the patient, Ma'am, the cerclage is fine. And no, I don't know how that hair had a knot in it.

Over on labor and delivery, I am working with the most anxious patient in the world to push. I'm trying to distract her, to calm her, so we are talking about her horses at home, and shooting animals in the wild, and her latest hunting trip. (Let me say here that I do not have much to add to this conversation, as I am a liberal almost-vegetarian.) Nevertheless, I act interested as she says she'll just die if this baby is a city boy instead of a country boy. She pushes a little more, and I tell her I can see the top of the baby's head, and he has some hair! She asks me if by looking at the top of the baby's head, if I can tell if he is a Republican?

The next delivery I have is normal, and uneventful, and to very nice parents. I hold the baby up and announce the arrival of their baby boy! Both parents start crying; the dad in joy, the mother in horror. What? I glance at their pink carseat, the baby's name written on the board. Oh. Yeah...this wasn't the Liliana they were expecting. The dad is ecastatic, and has already named the baby Jr. whatever his own name was. The mom asks me if I'm sure I got the right baby? I am sympathetic, even though this question is obviously answered as the baby is still attached to her via the umbilical cord. It's not often in this day and age that parents don't know what they are having, and even fewer times that it is not what they expected. On the postpartum visit the next day, she asked me if she could go home. Was she feeling okay? "Yes, and I need to get to BabiesRUs. I have a lot of exchanging to do."

A Different Life?

I've recently had a little more time for reflections on my life, my chosen path. I'm working nights, and when it's not too busy, I'm able to lay down in between patients. I don't sleep because I am always waiting for my pager to jolt me out of bed, but I can enjoy the quiet. It's getting cool again, and I'm able to run outside, putting one foot in front of the other as my mind untwists whatever is subconsciously present, much like a dream. In these moments of quiet, I wonder about what my life would have been like, had I not gone to medical school. I don't doubt that becoming a doctor was a good choice for me, but was it the only one that was right for me, like I had thought at the time?

Let me be clear. I don't regret becoming a doctor. But, I think about what my life might have been like, as someone else. Or at least as myself, having made different choices. I could be a yoga instructor. I would have been good at that. I could be a professor, with a doctorate in clinical nutrition- my other professional love- or maybe a dietitian, like some of my friends from college had become. I could join my friends on their travel, because I would have time and money too, without worries of massive school debt or a constrictive schedule where I celebrate two days off in a row. I could be a wife and mother, a homemaker, like so many of the women at my gym and who come to see my at the hospital.

I know I am already a wife. But I'm talking about being a different kind of wife. The kind of wife that takes care of chores, the kind of wife ever available for listening, and sex, and companionship. The kind of wife different from what my own husband has. He has the kind that spends every other night away from home and is away even more hours on top of that, who can be distracted, with a limited attention span and patience, who wants to use the bed only for sleeping and expects an equal contribution, if not more, to household chores. The kind that a "dinner out" consists of driving 45 minutes to the hospital and enjoying a cafeteria meal together in between pages.

I think in a different situation, I could have really enjoyed being a mother now. I feel separated from my peers as they have children, as their facebook pages are filled with darling photos and cute anecdotes. I look at my facebook page, and decline putting up another status, because I don't have much to say outside of my life at the hospital. I deliver babies every day, and hand them away to anxious mothers, eager fathers, most younger than I. I am a little jealous, not only for these couples starting their families but for the sole fact that the mother is in bed at 4 am while I am up making rounds.

My dad says that anyone can get pregnant, but it takes a special person to have a baby- meaning me, the obstetrician. He says that I'm special, because these choices that are difficult, and sometimes isolating, that set me apart from other twenty-somethings...they mean that I have worked hard enough to get to have this privilege of being different, of getting to do a really important and special job.

One of the very best things about my new job is the other residents. Aside from childhood friends and a few treasured college/med school friends, I haven't connected well with others as a young adult, I think because my life took such a sharp turn away from the typical twenty-something experience. I'd go to church, to small groups, gym classes, and parties, and find that I really didn't have much to offer to a conversation once the conversation turned away from medicine. Relationships shifted into a more familiar territory- ie doctor/patient- as acquaintances began asking me advice on their pregnancies, but it didn't do much for me feeling like one of the gang. Some didn't understand why I was gone so much, why I wasn't available to volunteer more or be more reliable. And now, I have seven other people that deeply understand my situation. We can never get together all at once, because at least two of us are always working at any given time. We can share these stresses and fears about being subpar spouses, worries about becoming good doctors, laughing at jokes that others wouldn't understand or find funny. They understand that a date is spending time together, regardless of whether it is at a cafe or cafeteria.

The reason I write these somewhat wistful and non-cogent thoughts down is that upon talking with other residents, I've found this to be a fairly common thought process, and not one that I think might be intuitive to someone outside of residency. A chief resident mentioned to me that she loved her job, but felt like she could be completely fulfilled with a different life as well- one as a homemaker and mother. A third-year resident who I adore has a craft closet and could stay home happily baking bread. My heart broke for another resident who came back sobbing back from maternity leave. My best friend from medical school wrote me that she was literally sitting in clinic the other day, looking at the patients piled up, wondering what she had gotten herself into, wondering if maybe she should have considered other options, like cooking school. One of my loved co-interns told me once that she thought what she did was important, and she wanted to be good at it, but at the end of the day, this was a job, and her life and family came first. The census overall is that we love what we do, but we'd love a normal life for once too, and fantasize a little about what our life would look like if we hadn't invested all this money and time, if we had made more typical choices.

Kinda makes me feel better about my half-fantasy of becoming a stay-at-home yoga instructor.

The Parking Garage

One of the perks of my new job is that I get to park in the physicians' garage. This may sound minor, but is a substantial benefit during the Phoenix summer. While initially exciting, it has proven to be an interesting insight into the sociology of doctors.

It is labeled "Physicians' Garage" and "Parking: Doctors Only." At first I thought, I'm a doctor. Sweet! I have finally reaped some reward from the eons of school and debt I have undergone. However, on further examination, the first three floors are "Parking: Doctors Only" with blue tape around the pillars. If you continue up to the 4th and 5th floors, there is red tape. I notice that my parking sticker is red.

What does this mean, you ask?

The first three floors are reserved for ATTENDING physicians only. They get a blue sticker. The resident physicians have a red sticker, and have to park on the 4th and 5th floors (the 5th is uncovered). So, the reward for completing medical school is a car that is equally roasting as the CNA's in the parking lot down the road, except I have to walk up five flights of stairs to get to mine. I pull in at 5 am, and wind up the garage past floors of empty spaces, and park in the crowded upper floor. The cars on the first floor are shiny, new, and mostly expensive. Undoubtably, they do not have a gas tank that is perptually one-third full. They have dark tinted windows, rendered irrelevant by the fact that their "covered parking" is actually fully covered. Later in the morning, the bottom floors become more full, and then empty again by the time I leave.

I have drawn a few conclusions from the sociologic observation of the physicians' garage:
1. I am not a doctor
2. I will become a doctor after residency
3. At this time I will
a) have more money
b) sleep more
c) be able to touch the steering wheel with my entire hand instead of two fingertips
d) said steering wheel will be attached to a choice car that will not be running on fumes
e) and generally have a better quality of life overall

I look forward to parking on the bottom floor of the doctors garage.

Just for Laughs

They say to smile instead of frown, since smiling takes 15 facial muscles and frowning requires 35. It's a simple matter of efficiency.

Some women take this advice a step further, and laugh instead of push. Every now and then I'll have a woman that is ready to deliver, and instead of pushing, something will make her laugh and she'll just pop that baby out. Instead of screwing up the face and pushing as hard as she can, the woman will give a laugh (creating some abdominal pressure) and the head will come out.

What a fun way to deliver. I love it.

Spinning

I grew up in Southern California. At least once a week during the summer, my dad could be persuaded to drive me down to the beach, where I would spend the day catching waves on my garage sale board. I loved it. Sometimes, I could catch them just right, and ride them all the way in. Other times, I would think that I had caught it, only to end up on the top of it. I could ride it for a split second before looking down and seeing only air between my board and the water, and then feel the weight of the wave crash on top of me. I would be spun underwater three or four times with the force of the wave, and then swim hard, only to run into the bottom of the ocean. I was disoriented from the spinning, and didn't know which way was up.

I really wanted to work out today. It was a long day on labor and delivery, and I had missed my last few days' workouts due to circumstances outside my control. All day, I planned to go to a favorite class at the gym. Another delivery? It's ok. I'll be out by 5. I didn't do that paperwork right? No problem, I can redo that. Did you see that postpartum patient? No, I'm sorry, I didn't realize I needed to. I will do that now, and it will be okay because in three hours, I will be pumping weights with friends. Dr. Kennard, did you see this patient's fetal heart tracing? Dr. Kennard, we need you for delivery. Dr. Kennard, you have a call on 2054. Dr. Kennard...Dr. Kennard...the med student is interrupting my charting again, to ask some inane question and interrupt my train of thought. Dr. Kennard, you have a new patient. My head was spinning. I just needed to leave, and go to the gym, and everything would be okay.

I ended up leaving late, and the drive that should have taken 35 minutes took over an hour for traffic and construction. I finally pulled into the gym, proud that I kept my resolve to go and not succumbed to the takeout and recliner that were now paging me. I was too late for the class I wanted to go to, but there was a Spinning class available, so I walked in for that. I set down my water bottle and scrub top that was going to double for a towel, and adjusted my bike. The pedals didn't work. I moved to another bike, not in the ideal position since the class was getting full, but it would have to do. Those pedals didn't work either. I was frustrated, as now I was missing the warmup and there was only one bike left. I went over there, and began to pedal. All of a sudden, the seat fell backwards, causing my feet to slip and the pedal to hit me in the shin. I burst into tears.

That was the low moment for me. Sitting in the bike with my knees above my ass, crying, wiping my face with the scrub top where my tears were probably mixing with amnion and blood from the day, disappointed and frustrated that this one thing, this one class I had wanted to do, was now full of people and broken bikes. And in that moment, this Spinning class reminded me of how I used to feel when I thought I had caught a wave, only to crash spinning into the ocean.

As I extracted myself from the bike, I wondered where these tears had suddenly come from. Rather than sadness, emotions that seem to bring tears to me include disappointment, anxiety, frustration, and fear. And the start of my residency has been laden with all of these emotions, among better ones. Disappointment in myself, that my skills aren't better. Disappointment of unrealistic expectations being unmet. Anxiety, elevated to a level that my baseline anxious self couldn't have predicted. Frustration, with myself and others, with the learning curve of learning a new job and a new lifestyle. Fear, that I'm messing something up. Fear that at best I will annoy someone or create more work for them, or at worst that I will hurt somebody. The first six weeks of my residency has left me spinning, not knowing which was is up. Just when I think I've caught the wave, that I'm on top of it, I find myself underwater, not sure how I got there or how to swim upwards, how to do it better next time.

I'm hoping I'll get better at catching the waves. I think I will, only because I watch the residents above me, confident in their skills and knowledge, able to manage multiple tasks and do excellent work. I have to hope that they were like me one day, desperate just to stay afloat. Somewhere between now and then, I'll get better, become more confident, and have the reserve to deal with a faulty Spin bike. Until then, I think I'll stick with the treadmill.

Medical Students

"HI!"

A loud voice jolts me out of my post-call, sleepwalking state.

"I'M SARAH! I'M A THIRD YEAR MEDICAL STUDENT! AND YOU ARE......."

(she peeks at my badge)

"DR KENNARD! IT'S NICE TO MEET YOU!" She reaches for a handshake.

I peer at her blearily, wondering why this woman is crushing my hand.

It wasn't that long ago that I was a medical student. I remember starting a rotation, wanting to make a great impression, and feeling like I needed to be super friendly and introduce myself to everyone. I was always a little hurt when a resident would blankly stare at me, looking like they wished I would just go away.

Now that I am a resident, I know why they looked like that. They were more tired than I ever knew was possible, and wished that I would just go away.

It's difficult to be a resident. It's hard to have a student breathing your same air, looking at you for scraps of knowledge and slivers of experience. You are jealous of them, because they have slept all night while you've been paged for insignificant notices (emergent Colace, anyone?) You are too tired to even reach for your coffee, never mind engaging in conversation with the bright-eyed, bushy-tailed mini doc sharing your space. Regarding teaching, the difficulty is twofold: I'm a first year resident, so I still feel like I know very little, and am unsure of teaching. My own learning curve is so steep, I don't have extra time or capacity to full engage someone else in learning. The other challenge is the kind of teaching that I do end up doing.

Student: "I went and saw the patient. She asked me if it was okay to play with her pet's poop. I wasn't sure, so I told her I would ask you."

Me: "I think what you're thinking of is the risk of toxoplasmosis to pregnant women, which can be transmitted through cat poop, so she shouldn't clean the litter box."

Student: "Oh okay. I thought that was it, but I wasn't sure what animal did that."

Me: "That being said, it is not okay with her to play with ANY kind of poop."

Student: "Well, I thought so, but I didn't want to say anything without talking to you first."

*Student leaves to readdress patient.*

Student comes back. Resumes earlier discussion.

Me (wondering): Are we still talking about this? Are you kidding me? It should go without saying that people should not PLAY with POO. You should know this, and you are fully authorized to give those instructions, without my explicit permission. We have now spent seven and a half minutes clarifying something that a three year-old knows.

At this point, the resident part of me is downing ibuprofen and reaching for a large, caffeinated beverage. However, the residual student in me sympathizes for this girl. Yes, it was a stupid question. But how much of others' time did I waste as a student? Granted, I'm sure my questions weren't as ridiculous/obvious as this, but I am certain that many good doctors spent a portion of their billable hours invested in my learning and being kind and patient with me.

It's hard to be a student. Even if you know an answer, you hesitate to say it to the patient, because what if your resident/doctor wants something else? Then you have to come back, and ask about the poop, and look absolutely worthless. You want to say, "No! I really did know the answer! I just can't do a normal patient visit because I don't want to step on your toes or screw anything up for you!" You look bad either way. You worry that silence makes you seem disinterested, so you ask questions to fill the dead space, which seems reasonable when you are just sitting there but distracts the doctor from their paperwork. Sometimes I would ask questions I already knew the answer to, just to seem smart and engaged. Looking back (see above reflections on being a resident), I'm sure this made me incredibly annoying.

So, it's hard to be a resident. It's hard to be a student. Each come with their own challenges. However, I think I prefer being the resident. Despite the less sleep and more responsibility, I belong somewhere. I have a job to do in which I am allowed to make decisions and exercise clinical judgement and practice good communication skills. I get to come to work at the same place every day and get better at what I do, and will graduate a competent doctor and masterful surgeon. I know the nurses. I know that I can always get a plain chicken breast at the cafeteria grill, and to stay away from the calzone. All of these small pearls add up to something that I craved as a medical student, and could never get, as I was essentially starting a new job every four weeks. Familiarity. Belonging. Security. Confidence.

Medical students, take heart. Know that your life will improve. And in the meantime, work on a firm, not enthusiastically crushing, handshake. And don't ask about poop.

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