September 4, 2013

How is the Fellowship Going?

Going into fellowship has been one of the most humbling things i've experienced in my life.  It stripped all the facades i had built up over the last five years bare and exposed my glorious ignorance for all to see.

In all honesty, i thought i was a good hospitalist.  And maybe i was, which was the problem.  In five short years, i had mastered the ability to expedite a hospital stay (maximizing DRGs) and had memorized enough time-tested spiels to guarantee patient satisfaction.  I could come in at 8am, round on 16 patients, discharge 3 before lunch and admit 2 after, and still be at the gym to do a few miles on the treadmill by 5pm.  Unfortunately, in the pursuit of efficiency, i had allowed much of my deep medical knowledge and critical thinking skills to atrophy.

The first few weeks were an eye-opener.  As i pored through the books and papers that comprised my chosen specialty, i realized that a lot of what i had known in residency (and even medical school) i had already forgotten, and whatever had come out in the past few years, i had not kept abreast of.  It was basic stuff, but i had stopped paying attention because i had learned to distill it down to "what is the most important thing i have to know to improve my throughput?"  My mediocrity was laid bare; everything i had consulted a pulmonologist and intensivist for in the past, i was being consulted for myself... with me having only a rudimentary idea of what i needed to do.  My biggest shame was that i didn't even know how to read a chest x-ray anymore; for the past five years, my chosen method of "reading" an x-ray was to pick up the phone and ask the radiologist on-call what he saw.  I felt like an idiot, like an impostor pretending to know medicine when all i was good for was asking others for help.  The only point in my career when i felt lower was when i had just started out as an intern.  I considered quitting and going back to my old "cushy" job more than a few times because i wasn't good enough for a subspecialty.  But i slogged and putzed my way through.

Things are a little bit better now that i have a whole year under my belt.  I've read more journal articles and book chapters in the past twelve months that i have in the past eight years (yes, including residency).  I can now interpret chest imaging without talking to a radiologist.  I can translate PFTs into their appropriate clinical correlations.  I can discuss most lung diseases from physiology to the latest treatment options.  I can (almost) put lines in with my eyes closed and do a decent diagnostic bronchoscopy without getting huffed at for poor technique.  While i still feel moronic most days, "most days" has come down from 90% to around 60%.  Of course i still make mistakes, and i'm deathly afraid that my errors will cost (or have already cost) someone their life.  So i work hard to fill in the gaps in my knowledge and correct my bad behaviors.

Most importantly, my fellowship is not all about hardship and self-loathing anymore.  Ultimately, despite all of my perceived difficulty, i am on the whole enjoying myself.  I love learning about things, be it "old news" (such as the Fletcher-Peto curve from 1977) or "hot-off-the-press" stuff like edoxaban for PE.  I am tired and chronically sleep-deprived almost all the time from all the hard work and studying, but when my brain and my body are running on all cylinders, that's when i feel like i'm truly applying myself, like i'm doing what i was built to do.  And i am loving it.

So, how is the fellowship going?

In a word: good.