I'd had no idea

In my second month of internship, when I was a brand new intern on the medicine floors, I took care of a very sick man with a complicated family dynamic. I knew at the time that this made it unpleasant and difficult to take care of him--so much so that I wrote about it here. I remember thinking, "This is one of many complicated family dynamics with which I will deal. It's good that I'm getting some practice."

Several days ago, there was a conference at my hospital to talk about the case, and I attended. I settled into my chair in the auditorium and regarded the panel at the front of the room. Sitting in the middle was the resident who'd haplessly stumbled into this patient's care in his second month of being an upper level. To his left was the pscyhologist who'd cared for the patient and his family during the hospitalization. On his other side was the patient's cardiologist, whom I recognized with a jolt from another of the year's lowlights.

The conference began. The resident summarized the patient's hospital course; the cardiologist discussed the multiple subspecialty services and cross-covering attending doctors involved; the psychologist spoke about the family's dysfunction. Members of the audience contributed their thoughts.

As it progressed, I realized that I'd had no idea how difficult this family was. It's not that I wasn't subject to the same shitstorm that everyone else was--it's that I'd had no context for it. Voice after voice described the patient's wife as thoroughly brutal in her abuse of the housestaff. But in my newness to the profession, I'd had no idea I was being abused.

The consensus of the conference was that the patient should have been transferred to a nearby hospital where attending physicians take care of their patients without the help of residents. The goal of this move would've been to protect residents from the wife's abuse. The idea of a transfer had been broached during the patient's hospital stay, but I'd never felt good about it: I remember thinking that I didn't want to get in the habit of dumping every difficult family I came across.

Although I have a hell of a lot more context now than I did as a fresh intern, I'm not sure how much quicker I'd be to call foul on this family were I to encounter them today. Early in internship, the burden to take care of people feels very real and very serious. Both in spite of and because of its weight, and because of the personality features that so many residents share, it's hard to learn to relinquish that burden--even when it comes with a world of pain.

Walking out of the hospital afterward, I felt as if the conference had been put together just for me, as a reminder how much I've seen and how far I've come--of the principles I'm ready to leave behind in my intern year, and of the principles I don't dare let go of yet.

It was also a reminder that I have six more weeks to gain context. After that, I am the context.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

So, about that world of pain: I'm leaving it behind for the next couple of weeks. While I'm away cavorting in mountains and rivers and eating amazing food, I'll repost a couple of blog favorites that recall a younger, tender-hearted, clear-skinned Dr. Signout.

Try not to get too used to her. And no loud parties while I'm gone.