Tales of a Twenty-Sixth Grade Nothing
Not a student anymore. Can I handle it?

MEDICINE MENSCH: Bidding the Classroom Adieu

For some people, 12 years of school is enough. Add four years of college and 10 years of a long M.D.-Ph.D. program. Finally, at the end of all that, I can say that I'm no longer a student. I'm ready to enjoy the benefits of my new station in life: sleeping late, meals at my leisure, freedom from subordination to institutional requirements.

Just now, though, medical residency stands in the way. I will be working the hours I am told; my schedule of rotations includes more than a few lectures. During my three-year program, I'll have to pass several challenging exams, including the feared American Board of Internal Medicine certification. I'll have to make presentations, turn in written reports, be deferential to my instructors, and remember everything I'm told in case I have to repeat it at a moment's notice. I'll have a locker and eat in the cafeteria. The cool kids will wear better clothes. Sundays will be for laundry and homework.

Suddenly residency seems a lot like the past 26 years of schooling.

I could leap to the cliché that we are all life-long learners, and that my transition from student to residency is merely an example of the transitions we all undergo. More accurately, we are all both teachers and students, with the two roles assuming various proportions during different stages of our lives.

Becoming a resident doesn't mean that I quit being a student; it just means that the teachers, modes of evaluation and goals are different. It also means that I have become a teacher myself, counseling and tolerating medical students who are just like I was two weeks ago. Someone will throw themselves to the floor in a patient's room, trying to find the cover of a ballpoint pen, and I'll have to strike the teacher's balance between friendly sympathy and calibrated advice. ("Maybe you should get one of those clicker pens?" I'll suggest, and the student will nod dutifully.)

I'll have to teach each patient as I give treatment, not knowing if my words are making a dent — or if the patient is just smiling and agreeing with me in order to get the heck out of my examining room (or so that I can leave him at peace in his hospital bed). In return, every patient teaches the doctor, though it's often not immediately obvious what is to be learned from the umpteenth sick person you've just met.

Something else came to mind during my graduation from medical school, a carefully arranged, flowers-and-champagne event with more popping flashes than pomp and circumstance. The commencement address was the customary sort, reminding us that now is an extraordinary time in medicine: Unimagined advances in science and technology can be brought to bear in the struggle against disease, but, on the other hand, premiums for malpractice insurance are high, and the wolves of overregulation are at the door. (Because the acoustics weren't so great, I might have missed a metaphor or two.)

But there are many times when nothing is being taught or learned and no death-defying struggles are being waged, long stretches of workaday medicine where no high-tech progress is made. It's just doctor and patient waiting for the most recently agreed on medical strategy to take effect, saying hello to each other yet again — like co-workers who keep passing each other by the water cooler in the hall, wondering whether they have to say "Good morning" every single time.

There will be times over the next three years when I'll be neither teacher nor student, just an average guy doing a job day in and day out. But if I'm to keep a proper balance, this ordinariness carries with it its own sort of responsibility: to remember that my job is not, in the final analysis, an average one. This means, among other things — and with every bit of my well-earned humility, sense of insignificance in the larger scheme of things and healthy respect for my own fallibility — that what I do is important. Thus, even as I trip over myself countless times during the first year of residency, I still have value, and my patients need me. I want to remember this during the first night on call, when my first bonehead move makes a nurse slap herself in the forehead once I've turned my back. And since this is my final column, I hope I'll still have the opportunity to write about my mistakes — and have readers to point them out to me.

If you'd like to follow the Medicine Mensch through his residency, you can read his blog, http://zackarysholemberger.blogspot.com. Bye for now!