A Slice of Humble Pie

Since well before medical school, I’ve had visions of myself being a special kind of doctor. I wanted to work in indigent communities providing high quality care to those who need it most but rarely get it. I wanted to exude compassion, patience, and understanding. At the risk of sounding cliché, I wanted to make a difference.

Now, eleven months into my intern year, I am learning the hard truth of how difficult this is. It often feels like an uphill battle. My patients consist of poor, young women with little by way of education and opportunity and a lot by way of substance abuse, depression, poverty, and social chaos. They hold on desperately to men who bounce from woman to woman. Unplanned pregnancies and sexually transmitted infections are rampant and my patients have little to no negotiating power with the men they “love” to prevent this. As a medical provider, it’s hard to stay hopeful and easy to feel powerless. Sometimes it’s all I can do to stop myself from grabbing them by the shoulders and shouting, “Open your eyes! Don’t you want a better life than this?”

It’s one thing to feel overwhelmed by it all. But combine this with lack of sleep, 80 hour work weeks, and the social isolation of being on Night Float, and it becomes something dangerous. This sense of frustration becomes bitterness. After four weeks on Nights, this is what I’m struggling with. And I don’t like the kind of doctor it’s turning me into.

Last Thursday, in the wee hours of the morning, I sign up to see a patient with vaginal spotting in the setting of early pregnancy. I go through her chart and review the notes from her prior visits. She is 17. This is her fourth pregnancy. This will be her second baby. Her first is only 8 months old. I read some old notes from social work about her failure to fill her birth control prescriptions.

On a day with adequate sleep, exercise, and food, I like to think I would have seen this visit as an opportunity to reach out to this patient. On this particular night, however, I had had none of these things. I was tired, crabby, and could think of nothing but how irresponsible she was.

I walk into the room and find a baby-faced teen sitting on the hospital bed. Her boyfriend, who looked like he had left adolescence behind years ago, looked bored as he sat in the corner of the room. After the initial history taking, I ask her.
  
    “Your baby is only 8 months old – how did this happen?”
    “Well, I had the IUD, but it fell out.”
    “And you couldn’t use a condom?”
    “Well, he doesn’t like them.” as she gestured to her boyfriend.
    I looked at him. “Condoms are no fun, but this is going to keep happening.”
    He looked back at me. “Well that’s her problem,” he said casually.
    I glared at him. “This is both of your problems. It takes two to get pregnant.”

As I left the room, I was seething. I walked across the hall into our workroom to vent to a co-resident. “You’ll never believe this…” I started.

Five minutes later, I walk back into the room with my nurse for the exam. As I walk in, my patient looks at me. As she starts to talk, she looks down at her hands. “I don’t mean to be rude, but could you not tell everyone about me?” she says quietly. “It makes me feel bad. I mean, I know I’m young and everything, but it’s just hard to hear people talk about me, okay?”

I feel like a brick drops in my stomach. I realize in that split second how unbecoming my behavior had been. “I am so sorry. You’re right. I didn’t mean to disrespect you.” I say, knowing that I can’t undo the damage I just did.

“It’s just that I am trying really hard,” she continues. “I am meeting with child services, I’m meeting with my counselor every week, and I am trying really hard to get things straight.” I learn about all the things she is doing to get her life together. I learn about her life in foster care. I realize that she is dealing with more as a 17 year old than I ever had to deal with in my teen years combined. First and foremost, I had judged her without knowing her.

I am not proud of this moment in my medical career. I thought long and hard about whether I should write about it at all. After all, it would have been easy for me to post only the fun and exciting stuff about residency. Ultimately, I remembered that that is not why I started this blog. I wanted to write honestly about my life in residency. In addition, if I’m going to become the kind of doctor I described in the beginning of this post, I need to start holding myself accountable now.