One year down…

Well, this has been an interesting beginning to my attending career. Mostly it has been terrifying.

I trained at a large academic institution, seeing some of the sickest patients in the state of Alabama. But I always had my fellow residents and attendings to look to for advice, help or insight. I had every specialty known to man at my disposal via some resident or fellow. On my own, it’s a whole new ballgame. Now there is no one to ask, no one to decide, no one to punt to. It’s just me. It has been a year almost as terrifying as being an intern, only as an intern, no one expected you to know anything. Now, as an emergency medicine residency graduate, I am supposed to know EVERYTHING. Or so it feels like it.

I am very fortunate that in my group, although we practice alone a lot, it’s not all of the time. When I work a swing, there’s always another doc there to answer a question or even look at a weird rash (I still really suck at those). For the first 2-3 months as a new attending, you always work with another doc. It helped with the terror and anxiety.

In September the scheduler put me on at night in our rural hospital. It’s 17 beds, and after 11 p.m., there is no extender and you’re it. You’re it for the whole hospital. And there are some sick peeps that roll through those doors. I’ve been called to the unit to intubate, to the floor to pronounce a DNR. I’m sure a lot of you practice like this all the time, but 2 months out of residency, I was having a vagal response when I pulled into my parking spot.

Luckily, we have some kick butt nurses at night. But this first night of being all alone, I had a patient in renal failure with hyperkalemia and hypotension, almost coding, right next to a pleasant gentleman having an MI. As I was yelling out vent settings on the lady I intubated, I was calling for an aspirin, chest xray and troponin on her next door neighbor. I had to get both patients transferred out, one to the cath lab, and one to a hospital that could do emergent dialysis. A scary night, but a real confidence builder as well.

In February, I had an unfortunate gentleman with metastatic lung CA, who came in cyanotic and dyspneic. One look at him I figured he had a PE. After getting the guy to CT after intubating, sure enough, he did have massive bilateral PEs. BUT he also had a huge pericardial effusion. Stat ECHO showed tamponade and I drained 700cc of fluid off his heart in the ED! Of course, I had only done pericardocentesis on coding patients, but when push came to shove, my training kicked in. I had several pats on the back from several cardiologists and the ECHO tech. It was a good day to be an EM doc.

Now it’s the end of the year, and a new group of residents will be thrown out into the world as new attendings. It’s gonna be hard y’all. Some days you’ll just want an adult beverage after your shift. Some days you’ll want many adult beverages after your shift. But I keep telling myself that these patients that we see, most of them have no where else to go. Sometimes you do wonder, “Why did you come at 3 in the morning for something that’s been going on for 2 years?” But by and large, these people need us. We are the only ones that will never say we’re closed, on vacation, not taking new patients, we don’t take your insurance. Any they do appreciate it.

Good luck to all the new attendings this year. I would be worried about you if you weren’t just a little bit terrified.

  1. #1 by Sara Baker - June 8th, 2011 at 21:44

    Congratulations on finishing your first year out, Lisa. Sounds like you did more than a good job!

  2. #2 by Lisa Bundy - June 8th, 2011 at 21:55

    Thanks Sara! I’m sure you’re kicking butt down in Florida too!

  3. #3 by Frederick Sallaz - June 10th, 2011 at 13:10

    You are very brave! Sometimes admitting you are scared is the bravest thing of all. The important thing is that you pressed on in spite of your fear. Hearing your story helps others to know if they are frightened it’s OK, and it will work out for them like it did for you.

  4. #4 by Ernie Anderson - June 15th, 2011 at 12:41

    Very cool of you to put your feelings out there. Good luck with the rest of your career. I wold be honored to come across you as my doctor some day. Very inspiring. Keep up the good work. Selfless people like you are hard to find in this world, at least it seems that way. this just confirms that they are out there.

  5. #5 by Schumacher Group - June 24th, 2011 at 12:35

    Congratulations on finishing your first year residency! It is so great to read the first hand insight you offer to new residents or those considering a medical career.

  6. #6 by Dr. Michael Svetlov - January 4th, 2012 at 13:33

    Not a bad start for a new doctor! Success in future work too! Russian MDs found an effective way to deal with critically ill. These patients surely have a lot of free time, So, a great option is to practice breathing exercises using the diaphragm and get closer to the medical norm so that boost blood and cell oxygenation, but without hyperventilation that is unfortunately too common. That relates to people with cardiovascular problems, oncolgies and many more. Dyspnea is a huge problem, but it can be solved with better breathing as well. More details are here: Dyspnea

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