PGY2

Well, that was a whirlwind.

The first year of residency is known to be a gauntlet. I thought I had dodged the bullet by picking a pathology residency instead of internal medicine. Nope! Sure, I bet they have it worse, but I have still experienced the absurd working hours and learning cliff of a starting resident. I have still been humiliated by my ignorance and deathly afraid of hurting patients with my incompetence. I've worked hard, burned out, burned back on, and struggled to find equilibrium.

And maybe, now, I've sort of found it? After a year, I don't think my inexperience has really harmed a patient. I've had layers of protection, from the Pathology Assistants (PAs) at the grossing bench, to the attending physicians at sign out. I've kept my wits about me and recognized my errors, and corrected them. I've had my senior residents, who are the perhaps the most understanding what what we are going through, close at hand with encouragement and wisdom. Perhaps most importantly, my lovely wife has nourished me, both with good cooking and emotional support. No one gets through this without help.

To be sure, the hours were unreasonably brutal. They remain unreasonably brutal, and will continue to be unreasonably brutal. Part of this is an artifact of my training path: college, 2 years in a lab, then an 8 year MD/PhD program. I am older than most used to be at this phase of training, but no more experienced in the specific area of practice. I have a lot of OTHER experiences that inform and educate my ability to do my job. I know some advanced math, computer programming, genomics and lab skills that could pay off someday. Right now it's all the time honored aspects of anatomy and histology, and I sure didn't come in knowing a whole lot of either of those.

(As a parenthetical: I continue to maintain that the way physicians are trained in this country is absurd. My friend from Ireland who had the benefit of entering medicine out of high-school, as is standard in much of Europe, and is arguably one of the most capable residents in the program. 4 year college before medical school is an extremely expensive luxury that might be totally pointless.)

I also have a wonderful family that demands time and attention. It's painful every morning to leave my son, and even more painful on days when I come home to find him already asleep. There's a different kind of pain reserved for when he wakes up at 4:30 AM on days that I have worked past midnight. I sometimes envy the younger residents who can devote themselves more fully to learning the craft.

But, as the new first years arrive, I realize how much has been learned while running this gauntlet. Sure, I could have learned more, but in one year I have gone from understanding extremely little about the discipline to knowing at least an outline of every area of pathology. Sure, I wouldn't in a million years trust myself with signing out cases at this point, but I now see the map of the territory I need to explore, and come to know. Its boundaries are mostly drawn, and some of the major features in the terrain are already sketched in.

In short, I am hopeful. Not that I will be working any less hard, but that my work is bearing, and will continue to bear fruit. I am learning more and more HOW to learn, and that ratchet will carry me up the cliff in safety. I look forward to the view from the top.