Transition to Terrified

Two weeks ago we medical students spent a week in Transition to Residency, a required week-long course designed to prepare us for one terrifying, inevitable, and rapidly approaching reality: in june we will all graduate from medical school and actually become doctors. Shockingly, there is a certain amount of responsibility that goes along with this title. And if you were to think that four years of medical school is enough to prepare you to handle that responsibility, you would be wrong.

Fortunately, we just had one week of lectures and workshops that sorted everything out. Our lectures included such responsibility-laden topics such as Medical Malpractice, Death Documentation, Preserving Medical Evidence, Medical Licensing and License Revocation, Ethics and Liability, and Managing Your Student Debt.

We went through a two hour emergency medicine workshop where we were taken through acute scenarios such as "you are in clinic and your pediatric patient starts seizing - WHAT DO YOU DO?" or "you are called into the hospital bathroom and find an unresponsive man slumped against the wall - WHAT DO YOU DO?" or "you are the first responder to a cardiac arrest code and the patient is pulseless and not breathing - WHAT DO YOU DO????" And even though I know lots of things about medicine, and can make a long differential diagnosis for any list of symptoms, and have a thorough understanding of pathophysiology, and have taken and passed two different board exams, my first internal response to these scenarios is usually: "Holy shit. I have no idea what to do. Someone should probably call a doctor."

But as I was reminded approximately 4,000 times over the course of that week, in 4 months I will be the doctor. The doctor will be me. I will have a long white coat and the initials M.D. on my ID badge, and people will expect me to know what to do. Man. That is down-right freaky.

The first station that my group was assigned to was the "you are called into the hospital bathroom and find an unresponsive man slumped against the wall - WHAT DO YOU DO?" scenario (which was enacted in the student locker room by a nice young gentleman who was made up to look pale by white face paint.) Unfortunately, I happened to be in the front of the group, and actually had the thought that since I was going into emergency medicine I would maybe know what to do. Ha. So I valiently stepped forward and kneeled down next to the pale fallen man. Moments later, the following words literally came out of my mouth: "maybe we should do CPR or something?" Brilliant. Such confidence, such command of emergency medical resucitative techniques. Look out, unresponsive slumped-over patients, because Dr. Garlich is about to kick your ass back into the world of consciousness.

In addition to the humiliating realization that I am in no way prepared to handle a medical emergency, I learned the following things during that Transition to Residency week:

1. I can get sued for literally anything. The head hospital lawyer gave us several examples of residents who had malpractice claims brought against them. One resident biopsied a suspicious-looking mole, received a benign diagnosis from the pathologist, treated it like a benign mole, and then was sued when it turned out to be melanoma. One resident was sued for just being in the room during a labor that went bad. He didn't even touch the patient.

2. Getting sued for malpractice, even if there is no validity to the claim or if the suit is later dropped, will make your malpractice insurance go up, and might leave you unable to practice medicine.

3. I will be in debt for the rest of my life. The average student debt load for an OHSU medical student upon graduation is $120,000. I will be over this. The most common timeline for debt repayment is over 30 years.

4. Fortunately, I will be able to qualify for a deferment to postpone payment on my loans until after residency. The cause for deferment: Economic Hardship. The reason: with my salary as a resident, a monthly loan payment would put me below the federal poverty level. The federal poverty level! I never thought that I would hear the word "poverty" so much in conjunction with the phrase "becoming a doctor."

5. If you add up the total number of hours I will be working as a resident, I will be making less than minimum wage. I guess that explains the poverty thing.

I just realized that all of the things I just listed have to do with money. That is very pathetic and I apologize. I suppose that among the many things that I am worried about right now, money is certainly on the list. And it is the most tangible, quantifiable thing on that list of worries, especially since I will soon have to borrow money from my dad to cover my pre-residency expenses. But I do recognize that I am fortunate in my career choice in that I will do just fine financially in the long term. Most people that I know can't say that. But I think it is justifiable to feel extremely lucky and extremely stressed out at the same time.

Fortunatley, I now know how to fill out a Death Certificate, so I am able to sleep easier at night.