Two weeks into my inpatient medicine subinternship, I am tempted to dwell on the shortcomings of the rotation thus far. I can talk about how few patients I get to see on my own or how I have long since given up trying to impress anyone, much less my attendings. So, when I have very little good to say about myself, it's easy to think about the people that have made this rotation memorable thus far.
In the past, the patients have ruled this forum. Tonight, this honor belongs to a senior resident--not my senior resident, but the one on our sister team who I was reunited with after having her for a week on my M3 medicine rotation.
DP was a second year resident when our paths first crossed. What struck me was how assertive and forthcoming she was in both asking questions and finding answers. She was one of those self learners who would be any educator's dream. She was one of the few residents who aggressively taught the medical students anything. I still remember the first sit down session we had on EKGs with us.
She was the first person in medical school to openly espouse Wikipidia as a legitimate source of knowledge. After all, many of the medical entries were straight from Harrison's. Her advice was as follows. Whenever she found something that worked, she would keep doing it and doing it until someone told her she was doing it wrong. If said person could then explain convincingly why his or her way was better, she would be willing to change. Otherwise, she would persist in her ways. She was the first to tell me that despite what we were taught, that closed-ended questions were essential to efficiency. Ask your questions first, then let the patient have their say. Find out what's important to you as a physician first, and then let the rest of the history guide your decisions.
I realize that while her advice seemed to fly in the face of what I had been taught, it makes sense in a lot of ways as well. Especially when one is working with high volume, indigenous, low educated populations. In fact, I saw it work for her. She was not worried about making mistakes, because she was always wanting to learn from them.
Over the last couple weeks, she has shared some of her life stories, and the stories have sharpened my understanding of her. She was top 5-10% of her state in India, meaning she got free tuition. Before then, she worked as a lab assistant in the states, learning English in the process. Her husband was also in the states pursuing education but due to their limited opportunities they were often in different states. She ended up in Alabama by UAB and she told a story of how sent 170+ emails to different labs asking for an assistantship or any kind of opportunity. Of those emails, two replied and neither with good news. One of them, however, told her that her English was terrible and that her writing was chalk full of errors. The author proceeded to rewrite her letter for her and gave her a version to send out to employers.
After medical school, she applied to 180 residencies. She received 19 interviews and went to 14. The place in New York that she ended up at was, for all health care purposes, horrendous. The residents she met all had their stories about how they ended up in a dump of a residency. Many of them were tragic and undeserved for their caliber of clinician and quality of person. There was the former ER doc who was blackballed after standing by his principles to defend a clinical decision that rankled his superiors. There was another who left years as a critical care nurse to pursue his dream. Another was from the Caribbean and fully trained EKG tech who was happy just to train in the states. Every person had their story, and despite the crap she dealt with, Dipa wouldn't have traded that one year for the world.
Eventually she transferred to Peoria to join her husband. It was during the weekends on call where I would hear her stories and listen to her rants on how internal medicine was 80% social problems and 20% clinical. She would talk about ungrateful, entitled patients, lowlifes that used and manipulated the system at no disregard to cost or others. She was tired of dealing with these people and with many of them she would not hide her disgust. On one hand this seemed appalling for a doctor to act this way, but in many other ways, it was refreshing because it showed a certain degree of conviction. She was letting these patients know that she knew what they were doing and while she would still help them, she wouldn't bend to their demands.
In the end, she wants to do GI. If not that, then a hospitalist. Wherever she ends up, this I know. I will be grateful to have cross paths with her, and in many ways, I hope that I can learn to pursue my interests with as much tenacity as she has in her own life. Stories like her's make me immeasurably grateful for the opportunities I have been given; her story gives me hope that despite my deficiencies, I have been fortunate to have people such as her who have helped me to get this far.
