I don’t remember all of the details. It was the summer of 1990, sometime in the first 3 months of internship. I spent those months on the 11th floor of the VA Lakeside Medical Center (now the vacant lot just east of the hospital). The VA was familiar territory for me. I spent 3 months there as a third year student, also on the 11th Floor. 11 East, to be exact. Another 3 months later that year on surgery. So I was back on 11 East, now with a longer coat. A long light blue coat — coats were all color-coded at that time.
It couldn’t have been in the first month. Maybe it was late in the second month. I don’t know. It was always busy, and the patients were very sick. Sick with really bad things: end stage cirrhosis with huge ascitic bellies; lung cancer presenting with tremendous pleural effusions; men with HIV and AIDS-defining illnesses; or gangrenous limbs. And also demented or disabled patients left at the hospital for 2 weeks of respite care, a benefit afforded to families of veterans so that they could have a brief break from caring for their family member.
There was always something to do for your patients, and always the sense that if something needed to happen, it was the intern who had to make it happen. Need an x-ray right away? Wheel the patient to radiology yourself. Need a peripheral smear reviewed? Go find it in the lab and bring it to the hematologist to review with you. Need that x-ray reviewed right away? Go back to the x-ray file room, pull the film (yes, it was still on film) and bring it to the radiologist to review. Need to get somewhere, anywhere, in the hospital? Of course you can’t wait for the elevator because it takes forever. Take the stairs.
My knees would ache by the end of the day. I wore through a lot of shoes that year. I wish I could go back and put a Fitbit on the 1990s me just for a day or two, just to see, you know?
It was that sense that I, as the intern, was all that stood between my patients and neglect and certain death, which started to get to me. To be honest, it was partially true. But it also fed into the innate perfectionist tendencies of medical trainees, that feeling that if you could just keep track of everything, then your patients would be OK, at least for today. Of course, it wasn’t sustainable.
What I don’t remember is what was happening that day. Well, all of this was happening that day. Everything. Hundreds of things to get done, results to collect, phone calls to make. Notes to write. I was overwhelmed, and I lost it. Picture me, losing it — does it involve tearing of hair? Screaming?
No, I lost it the way you’d expect me to lose it — you don’t know me, but I think you can imagine that for me, a quiet, diligent intern, “losing it” meant sitting next to my desk in the resident work room at the end of the hall, and just quietly crying. I was miserable. Sitting there, crying in front of my co-intern (the other intern on my team).
My co-intern was a wonderful guy. He said something like: “You don’t have to take care of ‘everything,’ every day. Some things can wait until tomorrow. What do you need to finish today? What test results need to be followed up, what phone calls need to be done, what notes need to be written today?”
I pulled out my stack of index cards and my to-do lists, started to calm down, and started going over it with him. He sat down, started pulling out charts, and started writing my notes, working with me to check things off my list.
I honestly think it was my first lesson in understanding, really understanding, when good enough is really good enough. There are a lot of places where I think you can fool yourself into thinking that you are nearing perfection, with all the i’s dotted and t’s crossed. Not at the VA. Not for me that summer.
Robert S. Golden is an assistant professor of clinical medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.