I've written about the medical magic of July 1st once before, and damn it if we aren't here again. The great day when post-graduate medical education renews itself and the hospital abounds with new energy, good intention and fresh meat as the old residents become attending physicians (or fellows), the weary interns become residents and freshly minted medical school graduates become interns.
The first day of July snuck up on me a bit this year because I've had a terribly busy week with sick patients big and small to attend to amidst other administrative duties. Not much sleep this week, so when I dragged out of bed this Saturday morning at 5 AM to round in the newborn nursery before weekend clinic (thank you all-knowing bosses!), I was cognizant of little else other than the cold glow of the electronic medical record (EMR) and the sweet taste of a carton of chocolate milk when at 6:30 AM, three young ladies walked down the hallway with the slow walk of butterflied stomachs. Having met them informally as part of a larger group over the two weeks of intern orientation, I supportively mustered a smile and said "Good morning, Happy July 1st!" They grinned and said "thank you", each taking a very deep breath and smiling for an uncomfortably long time, not sure what to say or do next.
Continuing the small talk I asked who the new interns who their attending would be that day. One of the new doctors answered, "Dr. Levin, I think." Dr. Levin was my teacher and is my friend -- he is well-known at our program as an excellent senior clinician and a teddy bear of a man. Dr. Levin would be the perfect mentor for these new doctors on their first day -- compassionate, disarming and clinically strong. However, knowing him fairly well, I was aware that he'd left on a vacation out of state the day before (in retrospect, this might have been a skilled and cunning move to dodge the folly that is July 1st). When I broke the news that Dr. Levin would not be their attending that day, a a different intern piped up with, "Well then I guess it will be Dr. Kramer". Dr. Kramer is another wonderful physician -- more junior faculty than Dr. Levin but still quite seasoned. She's known as a skilled diagnostician, a calm leader and an enthusiastic educator. Given that Dr. Kramer is also my friend, I knew that she was just finishing up a vacation with her family out of state and had not yet returned. I casually informed the trio that she would not be their attending this morning. At this news that Dr. Levin and Dr. Kramer, stalwarts of the newborn nursery faculty, would not be rounding with them, the third intern mustered a simple "oh" and they then walked on to their work room, a little sadder than when the conversation had started (this was not my intention!).
But back to the fact that I'd had a crappy and stressful week, I returned my attention to patient care, documentation and getting my ass to clinic before the first patient of the morning arrived. I forgot all about the interns and made my own rounds.
About an hour later, having seen all my babies, counseled parents and put in all the orders for the day, I went back to the work room to drop off the ophthalmoscope and grab my bag. The interns, each at a computer, still seemed positive in their smiles but glazed in their eyes. I had not planned for their presence, but needed to get to clinic so just offered a quick "good bye and good luck". These first day interns, more aggressive than I remembered previous versions to be, needed more from me. One quickly asked, "Are you sure you're not our attending today?" She wasn't joking. "Yes, I would know if I was your attending". The other asked, "what do we do if no attending shows up?" She was serious. I was in a time crunch, so I with minimal tact retorted "See the patients and if no one show up by 8:30, call the Chief Residents" and walked out. And then I had a moment of remorse. Perhaps I'd been too sharp in my response. So I popped my head back in the door, said "actually, call the Chiefs if no one shows up by 9:30" and I was gone. Was that a gasp and a sniffle I heard?
And so I went to clinic for five hours, treating various mild ailments and completing well child checks and physicals. Again documenting in the ever present EMR, I closed charts, prescribed refills and answered mychart messages. I wrapped up my clinic duties by about 1 PM and headed back to the nursery to check on some premature twins that I'd been following the whole week before finally heading home to see my own very neglected family.
At 2 PM, I'd finished my second set of nursery rounds and thought I better run by the workroom -- after all, there might be leftover breakfast treats! Just a few strides down the hall and damn it! No treats! Well time to go home. "Hi Dr. Shaftacular!" I startled, spun around on my heels and there were all three of the interns, again bubbling with happiness and enthusiasm. "Oh, hi! Um, did you all have a good day?" "Yes we did!" came the reply with enthusiasm. And that's when I saw Dr. Li in the corner of the room at a computer by himself. Dr. Li is also a long-tenured faculty member and well-loved by the residents. Somewhat more focused on research, he is nonetheless well-regarded as a patient teacher. Primarily a neonatologist, Dr. Li was moonlighting in the newborn nursery this morning which should have been a nice walk in the park compared to the sick and premature neonates he usually cares for. The look on Dr. Li's face said it all -- he'd not realized that he'd signed up to moonlight on July 1st! Turning from his computer, Dr. Li appeared little frazzled and quieter than usual, but still his usual cheerful self. "I see you found your attending, and a good one at that. Happy July 1st, Dr. Li!" A rye smile and an exasperated "thank you".
And this is where my story stops for a moment. Ten years ago today was my July 1st. I started out in the neonatal intensive care unit (NICU) on July 1, 2007 and had no idea what I was doing. My first of eight patients on that sunny Sunday morning was a baby who had been in the NICU for six months (an incredibly long time by any standard). The baby had a tracheostomy that allowed him to breathe through his neck due to the need for chronic mechanical ventilation. This chronically ill child had six months worth of records, was technically too old to be considered a neonate. I had two hours to comb through his and seven other sick neonates' records before rounds. Back then the EMR wasn't as savvy as today, and vital signs were recorded on large blue quad-folded paper grids that when unfolded looked equivalent movie pirate's treasure map. Overwhelmed and clueless, the NICU nurse (perhaps at once the nicest yet most protective tribe of RNs) turned the vital signs chart around when she saw that I was looking at it upside down and backwards. And by 9 AM on that day, with my sympathetic but preoccupied senior resident struggling to see her own patients on this first day of service, there I was left to round one on one with my attending. "Hello, I'm Dr. Li. Are you ready to talk about your patients?" When we arrived at my six-month-old with the trach, I was clammy and disorganized. My summary assessment for the him was "This baby is alive" and my plan -- "keep doing what we are doing." The nurse snickered. But Dr. Li kept a straight face, stating "Very good. Very good." And practicing both patience and practicality, we moved on to another baby's room.
This is the story of how a very rough week on-call for a relatively young but old-at-heart attending physician finished with an unplanned dose of perspective. Dr. Li works in a lab often, and while I've seen him on several occasions between July 1, 2007 and July 1, 2017, it's high unlikely that we'd meet on this day of all days. Believing as I do that God has a sense of humor and the universe teaches in numerous ways, I know that this series of occurrences was meant to remind me that it costs nothing to be empathetic and it can mean everything to someone else.
But still, it'd been a rough call week and I just wanted to be home with my family. I stuck out my hand and said, "Dr. Li, it's great to see you. Today is the tenth anniversary of the day we first met." Dr. Li shook my hand and about as underwhelmingly as possible said "Oh wow. Woo-hoo." He then swiveled back around in his chair and resumed charting.
The first day of July snuck up on me a bit this year because I've had a terribly busy week with sick patients big and small to attend to amidst other administrative duties. Not much sleep this week, so when I dragged out of bed this Saturday morning at 5 AM to round in the newborn nursery before weekend clinic (thank you all-knowing bosses!), I was cognizant of little else other than the cold glow of the electronic medical record (EMR) and the sweet taste of a carton of chocolate milk when at 6:30 AM, three young ladies walked down the hallway with the slow walk of butterflied stomachs. Having met them informally as part of a larger group over the two weeks of intern orientation, I supportively mustered a smile and said "Good morning, Happy July 1st!" They grinned and said "thank you", each taking a very deep breath and smiling for an uncomfortably long time, not sure what to say or do next.
Continuing the small talk I asked who the new interns who their attending would be that day. One of the new doctors answered, "Dr. Levin, I think." Dr. Levin was my teacher and is my friend -- he is well-known at our program as an excellent senior clinician and a teddy bear of a man. Dr. Levin would be the perfect mentor for these new doctors on their first day -- compassionate, disarming and clinically strong. However, knowing him fairly well, I was aware that he'd left on a vacation out of state the day before (in retrospect, this might have been a skilled and cunning move to dodge the folly that is July 1st). When I broke the news that Dr. Levin would not be their attending that day, a a different intern piped up with, "Well then I guess it will be Dr. Kramer". Dr. Kramer is another wonderful physician -- more junior faculty than Dr. Levin but still quite seasoned. She's known as a skilled diagnostician, a calm leader and an enthusiastic educator. Given that Dr. Kramer is also my friend, I knew that she was just finishing up a vacation with her family out of state and had not yet returned. I casually informed the trio that she would not be their attending this morning. At this news that Dr. Levin and Dr. Kramer, stalwarts of the newborn nursery faculty, would not be rounding with them, the third intern mustered a simple "oh" and they then walked on to their work room, a little sadder than when the conversation had started (this was not my intention!).
But back to the fact that I'd had a crappy and stressful week, I returned my attention to patient care, documentation and getting my ass to clinic before the first patient of the morning arrived. I forgot all about the interns and made my own rounds.
About an hour later, having seen all my babies, counseled parents and put in all the orders for the day, I went back to the work room to drop off the ophthalmoscope and grab my bag. The interns, each at a computer, still seemed positive in their smiles but glazed in their eyes. I had not planned for their presence, but needed to get to clinic so just offered a quick "good bye and good luck". These first day interns, more aggressive than I remembered previous versions to be, needed more from me. One quickly asked, "Are you sure you're not our attending today?" She wasn't joking. "Yes, I would know if I was your attending". The other asked, "what do we do if no attending shows up?" She was serious. I was in a time crunch, so I with minimal tact retorted "See the patients and if no one show up by 8:30, call the Chief Residents" and walked out. And then I had a moment of remorse. Perhaps I'd been too sharp in my response. So I popped my head back in the door, said "actually, call the Chiefs if no one shows up by 9:30" and I was gone. Was that a gasp and a sniffle I heard?
And so I went to clinic for five hours, treating various mild ailments and completing well child checks and physicals. Again documenting in the ever present EMR, I closed charts, prescribed refills and answered mychart messages. I wrapped up my clinic duties by about 1 PM and headed back to the nursery to check on some premature twins that I'd been following the whole week before finally heading home to see my own very neglected family.
At 2 PM, I'd finished my second set of nursery rounds and thought I better run by the workroom -- after all, there might be leftover breakfast treats! Just a few strides down the hall and damn it! No treats! Well time to go home. "Hi Dr. Shaftacular!" I startled, spun around on my heels and there were all three of the interns, again bubbling with happiness and enthusiasm. "Oh, hi! Um, did you all have a good day?" "Yes we did!" came the reply with enthusiasm. And that's when I saw Dr. Li in the corner of the room at a computer by himself. Dr. Li is also a long-tenured faculty member and well-loved by the residents. Somewhat more focused on research, he is nonetheless well-regarded as a patient teacher. Primarily a neonatologist, Dr. Li was moonlighting in the newborn nursery this morning which should have been a nice walk in the park compared to the sick and premature neonates he usually cares for. The look on Dr. Li's face said it all -- he'd not realized that he'd signed up to moonlight on July 1st! Turning from his computer, Dr. Li appeared little frazzled and quieter than usual, but still his usual cheerful self. "I see you found your attending, and a good one at that. Happy July 1st, Dr. Li!" A rye smile and an exasperated "thank you".
And this is where my story stops for a moment. Ten years ago today was my July 1st. I started out in the neonatal intensive care unit (NICU) on July 1, 2007 and had no idea what I was doing. My first of eight patients on that sunny Sunday morning was a baby who had been in the NICU for six months (an incredibly long time by any standard). The baby had a tracheostomy that allowed him to breathe through his neck due to the need for chronic mechanical ventilation. This chronically ill child had six months worth of records, was technically too old to be considered a neonate. I had two hours to comb through his and seven other sick neonates' records before rounds. Back then the EMR wasn't as savvy as today, and vital signs were recorded on large blue quad-folded paper grids that when unfolded looked equivalent movie pirate's treasure map. Overwhelmed and clueless, the NICU nurse (perhaps at once the nicest yet most protective tribe of RNs) turned the vital signs chart around when she saw that I was looking at it upside down and backwards. And by 9 AM on that day, with my sympathetic but preoccupied senior resident struggling to see her own patients on this first day of service, there I was left to round one on one with my attending. "Hello, I'm Dr. Li. Are you ready to talk about your patients?" When we arrived at my six-month-old with the trach, I was clammy and disorganized. My summary assessment for the him was "This baby is alive" and my plan -- "keep doing what we are doing." The nurse snickered. But Dr. Li kept a straight face, stating "Very good. Very good." And practicing both patience and practicality, we moved on to another baby's room.
This is the story of how a very rough week on-call for a relatively young but old-at-heart attending physician finished with an unplanned dose of perspective. Dr. Li works in a lab often, and while I've seen him on several occasions between July 1, 2007 and July 1, 2017, it's high unlikely that we'd meet on this day of all days. Believing as I do that God has a sense of humor and the universe teaches in numerous ways, I know that this series of occurrences was meant to remind me that it costs nothing to be empathetic and it can mean everything to someone else.
But still, it'd been a rough call week and I just wanted to be home with my family. I stuck out my hand and said, "Dr. Li, it's great to see you. Today is the tenth anniversary of the day we first met." Dr. Li shook my hand and about as underwhelmingly as possible said "Oh wow. Woo-hoo." He then swiveled back around in his chair and resumed charting.