“Doctor, I need some orders for this patient. Can you do that soon so that I can get started?”
I was just bringing up a preterm infant to NICU due to concerns for maternal infections. Yes, it was July 3, 2016 — my first official day of residency where I was no longer “just” a medical student. I was a doctor!
My initial reaction was to look around me, thinking (and hoping) that the nurse was talking to some “other” doctor. I was terrified of putting these orders. Should I start the baby on amp and gent? If so, how much? Should I round up the dosing? Does he need IV fluids? When should I check a bilirubin? Should I put him on oxygen? All those not even running through my mind, thinking that I do not have to deal with this issue as this is not my patient and my “resident” has already thought about these issues.
But wait! I AM that resident now! I am that go-to person that nurses will come to with results. I am the person who will be “bothered” if the sample clotted or radiology has a critical read or his IV infiltrates! I am the deciding person who will adjust all small issues which I had seen my residents deal with in my short career of two years being in the hospital.
Not having the right answers, I ran to my “senior” who was doing another admission and putting things together for rounds. I was flustered, terrified and honestly just wanted to go home and watch Netflix — which I had been doing for past month. Then an important voice resonated in my head. “Check your own pulse first before checking the patient’s in a code situation,” whispered an elderly sounding and graying voice in my head. And you know what? That actually worked! Even through this is not a code, it was a code for me! My first admission — ever. I was now going to be responsible for this fragile child’s life until he stays in the hospital! Yes, just the thought of it definitely needs an Epi order STAT!
Let’s fast forward nine months later.
“My name is Dr. Bakshi, I am the doctor taking care of your child. As you know, she was born a little premature, so we are going to take some steps to manage her until she grows stronger and healthier. We are going to take her to our neonatal ICU, and we will observe her breathing.” I whispered in her mother’s ears who was still laying on the OR bed, waiting to be closed up.
“I want a D10W started at 80 CKD, start her on NIMV 40, 24/6 and definitely want her on antibiotics started now, labs six hours later because she is preterm and has numerous risk factors.” I share my decision with the attending and nurse while putting in those orders. All I see is a nod from the attending and a bright smile on the nurse’s face. She whispers, “They grow up so fast.” I pause for a second, look at her and realize that it is the same nurse from July; silently observing my (improved?) decision-making skills. I smile back at her, trying so hard not to be arrogant!
The learning curve in the first year of residency is rather steep. Now you have this strange power that things will happen automatically with just a click! Nurses will look towards you to make decisions on your feet. The attendings will silently evaluate your thought process before they give their recommendations. The respiratory therapists will follow your orders rather than waiting for you to check with a senior resident. Sounds terrifying, doesn’t it? Surely does to me! Difference between an intern at the beginning of the year and the end of the year is astounding.
Today, I finally had the opportunity to sit down and evaluate that process. Not because I want to sound smart or cocky, but because it is a fact. You are going to be scared putting your first official order in! The key to observing this difference is patience. You will make mistakes, and you will learn from them. You will screw up, and the attending will give you feedback on what you did wrong. In the end, just remember one thing: you will grow up fast. You will be the doctor you always dreamed of being.
Shubham Bakshi is a pediatric resident.
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