My Physician Alter-Ego

We are hardcore.

We don’t like to say it. Doctors, nurses, and other folks in the medical profession known for the long shifts, the 80-hour weeks and the life-and-death scenarios, we like to say “Ah well, it’s just what it is. We signed up for this.”

That may be true, but that doesn’t make it any less ridiculous.

I say this as someone who is on the “softer” side of the medical profession with my choice of specialty; this week I will have only worked 72 hours in six 12-hour increments. I’m in the emergency department as part of my overall intern-year curriculum, though it is not my area of study – it is expected that I be able to manage these patients with the help of my attending physician and make halfway decent decisions if I have an unstable patient while waiting for the real expert to show up. I feel tired probably 70% of the time, and when I look back on my week I wonder how in the world I made it through. It takes a huge amount of energy to go to work every morning and deal with serial emergencies (major props to my friends in emergency med and internal med – I really don’t know how y’all deal with this forever).

I’m not saying this to be all “hey, look at me,” I’m saying hey, look at us. We live weird lives compared to everyone else – that’s why they make television shows about us, along with cops and military folks. Those three groups are the fodder for countless stories because it’s just generally something that most people will not experience in life. We made some of the most critical moments in life our jobs, every single day. The majority of everyday people will not see day after day of psychosis, suicide attempts, and crippling anxiety. They don’t routinely welcome new humans into the world or watch as children die way too young.

Maybe it’s different for people from medical families, but from my perspective, this life is incredible. When I was a kid doctors were somewhat mysterious (perhaps more so for me than other people – my mother didn’t really believe in doctors). They didn’t seem like fully formed people; they were mystical folks who fixed things and knew things. Surely these people were just born this way. No one becomes a doctor, they just are. The universe declared them so.

I was almost old enough to drive when I came to the seemingly obvious realization that doctors were people who went through years of school to learn a profession which is way beyond the realm of normal experience (turns out that the few doctors I met as a kid were the most educated folks I had any contact with – who knew?). It was a shock for me to find out that I could be one – a kid who grew up in a town of 6,000 people, raised by a single mother who cleaned houses and waited tables. They let people like me into school, with the right grades and extracurriculars.

Turns out this doctoring thing really is an acquired skill, or so they tell me. I’ve officially been a doctor for six months and I still have a hard time believing I’m part of this world. “Dr. Cooper, radiology for you on line two,” the department secretary calls over the loudspeaker. Dr. Cooper, who? Why are nurses looking to me for advice and direction? Plenty of them are close to twice my age. Surely not – surely not me.

I believed every day for the four years I spent in med school that I was going to fail out, despite never failing a class. Every board exam was another opportunity to prove that my admission to med school was some kind of mistake. I was not born a doctor; any time now, they’re going to figure out that I’m a fraud dressed in a white coat, trying to pretend I’m one of them.

I passed my third and final licensing exam a couple weeks ago, and now I can’t really make that argument anymore. I didn’t just pass it, either – I did well, so well that you’d almost think I was one of those doctors spontaneously formed from the fabric of the universe.

In six hours I start an overnight emergency shift. I will bike myself up the hill, take off the tie-dye and don hospital-issued scrubs. My nametag says “Physician,” the whitecoat inspires confidence. I’ll hit the floor running in my tennis shoes, ready to take on whatever comes in. I’ve been on the service long enough that the attendings have started to trust me.

I think I’m slowly getting to the point in my life where I’m beginning to trust myself. I’m not sure that the title will ever merge with my identity the way I imagined it as a kid. Healthcare providers are people, some of them people just like me. Tie-dye, fantasy writing, and all.

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The Healer-Writer and Other Reflections on Med School

When I started writing I was faced with a decision: how much did I want to reveal about who I am and what I do to potential readers? At the time I started conservative. I decided to be a bit vague on my location, generally indicate that I have cats/not kids, and made reference to being a “medical professional.” I’ve been thinking about that last part a lot lately, and anyone who knows what’s going on in my life knows why. Five days ago I graduated from medical school. I’m a doctor.

There. I said it.

I had been reluctant to be upfront about what I do because of interviews and residency-related things that were taking up my time. Medical school is a long and treacherous journey in which any single person’s opinion of your “fitness” as a physician can bite you, and bite hard. I wasn’t sure what others might think if they dug into my creative pursuits. My imaginary world is rather personal – it reflects a lot about my values and identity. I’m proud of who I am, but I’m also an unassuming person who tries not to offend people in real life, particularly if they’re my supervisors. There were plenty of reasons not to specify my profession and schooling at the time, so I didn’t.

Having graduated and secured a residency, I’ve come to re-think this whole thing. At this point book sales are going relatively well by my standards (this isn’t saying a whole lot, mind you, but it buys my sandwiches), and I have a few people who are reading this blog stuff. With the increased attention I want to talk more – the trouble is finding things to say. I find that there’s always this block in front of doing anything besides promoting books and showing off snippets, because when you get down to it, >50% of my time in any given week is devoted to medical things. So much of what I could be saying has to do with what it’s like to be a med student (now a physician) and how I balance that with being a creative person.  Until today, I’ve avoided all that.

Another reason I’m doing this is because I wrote a piece a couple nights ago about my experiences in med school. I tend to reflect a lot (as so many writers do), and ended up with a decent writeup on what what the last four years look like from down here at the med school finish line (also known as the residency/actual job starting line). I was thinking, hey, I’ll post this on facebook, tag these friends that I’m talking about…

…and then I thought about how I could just put it on the blog where I post the rest of my writing anyway. People I meet in real life seem to find the ‘published a book in med school’ thing pretty interesting, so maybe you, dear reader, might also find it interesting. If you’re a medical student you might even find it inspiring regardless of whether you have any interest in my fiction. I know that I found it inspiring to read about students and docs who were still functional, complete human beings, especially during first year before I figured out how to make my life and my work jive together.

Many people have asked how I ever “found the time” to do what I’ve done, so I’d like to address that briefly before I go on. Those that ask the question act as if my writing was some tedious, required activity, a massive feat that must have taken dedication and strength. I always laugh when I get this question, because I’m not sure I would have survived the process without it. I wrote more during rotations I found distasteful (hello surgery, peds and OB-GYN) than on any other rotations. In fact, the entire scene from the temple in Torvid’s Rest was written in between delivering babies while I was on labor and delivery nightshift. I would love to encourage anyone in the medical field (physicians, NP’s, PA’s, what have you) to indulge in their passions outside of medicine, no matter what that passion is. I haven’t been in the profession that long, but I’ve already seen my share of burnout – I’d like to think that having an active non-medical life is one of the keys to avoiding that.

I could tell you a lot of stories about being the ninja fiction writer in med school, but this post is already getting too long, and there’s the whole thing about the reflective piece I wanted to share. I’m attaching that particular bit below.

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Somebody told me once that the best part of medical education is the time between when you get your acceptance and when you matriculate. Well, I’m done with medical school now, so I guess I can have an opinion on that. For what it’s worth, I don’t necessarily agree with that assessment. I see things a little differently.

Med school is an insane ride. Even periods of time that seem innocent like “after the match” or “before matriculation” can be fraught with anticipation, stress and busywork. Every step of the process had a little bit of horrible and a little bit of wonderful in it, in different proportions. It was akin to a giant swing or a poorly-constructed carnival ride wherein there are periods of abject terror – reaching the top and fearing you might fly off and die – followed by periods of the swing-back, where things are better, and even great.

I have snapshots of the last four years in my head, all floating free now that graduation is over. Sitting here and analyzing it, there was more than enough of the fear and anguish part – of thinking, “why didn’t I go into marine biology?” or “maybe I should have been a starving author,” or better yet, “I can’t tell if food service was better or worse than this.” I saw classmates who struggled personally and professionally at times, not one of us immune to the episodes of self-doubt, wondering if we did the right thing or if we would even make it out the other side. There was drama and professors who drove us batty, gossip and class-wide turmoil. More than anything else there was a whole lot of frantic studying just hoping to pass a test, bargaining with one’s preferred higher power (be it deity or luck) for one more day where we could prove that we belonged in this profession. On clinical rotations we saw the beginning of life and its end, people in pain, torn-up families and good people who were suffering for what seemed to be no greater purpose. We witnessed both the triumphs and the failures of medicine, sometimes because of holes in our science and other times because of simple human inadequacies.

Each one of those despairing memories is contrasted with events that still make me smile. I remember very clearly the first time my friend-crew got together, and the first of many times we celebrated following a test. There were late-night study sessions interrupted by hysterical bouts of laughter, trips to conferences and the fun we had after. There was time spent in class, chatting with the almost-back-row-gang, turning white as a sheet when a certain professor asked uncomfortable questions. We daydreamed about our future lives, and watched those dreams grow and change into what they are now. I worked alongside colleagues who were resilient in the face of unruly hours and ridiculous expectations, who met every challenge without sacrificing their compassion. We were privileged to meet and care for some incredible patients. We all have those private memories of the patients who called us “doc” when we insisted we were students, the ones who thanked us for our kindness, and those who said we were going to be great physicians.

The thing I remember best about this whole mess is the laughter and the people who I call friends – great human beings, and now, some of the greatest doctors I’ve ever met. We have stories that nobody can take from us and share a bond that is entirely unique.

In many ways I grew up in medical school, and I think that probably goes for a lot of us, no matter how old we were when we started. The changes induced by a medical education are inescapable. For some people, sadly, it stole things from them; surely I lost my share of hobbies and knowledge throughout this process, but I’d like to think that I’ve gained far more than I’ve shed in order to become the person I am now.  Intern year is going to be another swing upward with the stomach-dropping fear that goes along with it, but I have faith that all of us are going to make it. We made it this far.