Walking with giants
It was the first day of my academic clinical career. I remember it well: I was a third-year medical student with my first pair of work-slacks. The knot on my tie was crooked, but it was the best knot I had and I looked, well, like a grown-up.
As I walked into the hospital that morning, I was filled with a nauseating combination of dread and excitement. I was to start on inpatient wards at the university hospital, and I was about to round with one of the most well-respected services in the medical school – the hospitalist service.
That month, I worked with several of the most intelligent and well-rounded physicians that, to this day, I have ever known.
My first attending ever was Robert Pendleton (an adviser to this publication). One of the hospitalists that had helped build the University of Utah group from its infancy, his knowledge of pathophysiology, his ability to teach, and his skills as a physician were so honed that he could seamlessly transition from professor of medicine to model of communication.
I remember him asking us to explain the mechanism of portal hypertension that our patient had. After our feeble attempts at answering, he flipped over his piece of paper and drew out the presinusoidal, sinusoidal, and postsinusoidal mechanisms, walking us through the pathophysiology. A process that, 5 minutes earlier, seemed singular, static, gray, generic, and even dull, suddenly, under the flash of his pen, became alive, dynamic, complex, interesting, and best of all, understood.
Then, as we entered the room to talk with the patient, we watched science become art, professor become physician, and teacher become listener. He spoke softly and kindly, explained simply and empathetically at the level of the patient what we had just learned at the level of the cell.
As we walked away from rounds that day, my intern turned to me and said, "He just may be a Jedi Master."
My second attending stood only 5 feet tall, but her persistent pimping and piercing stare over her horn-rimmed glasses made even the most towering medical student feel tiny. Trained in both medicine and pediatrics, she had uncanny problem-solving skills, able that month to solve a case so perplexing it was nominated to be the center’s Clinical Pathology Case of the Year. The patient was a young, narcotic-using, previously healthy woman with acute renal failure, new ascites, mesenteric thickening on CT, and an elevated Ca-125. I watched and learned as Dr. Lamb sifted through the mountain of extraneous data that had accumulated and, pulling from her pediatric experience, suspect a tear in the bladder, an unusual mechanism that had been overlooked thus far. A urethrogram confirmed her suspicion, the tear was repaired, and the patient was discharged home. I was in awe.
These are just two of the attendings that were in this dynamic group, with niches that now range from medical informatics to palliative care specialists, thrombosis service directors, and basic scientists, to leaders in hospital safety and quality improvement. All are masters of "the literature."
So you can imagine my thoughts and feelings as now, 6 years later, I suddenly find myself sitting in meetings with these same "giants" of my academic youth – my professors, my name next to theirs on the schedule. They tell me to call them by their first name; I continue to address them as "Doctor." My office is in their hallway; I still get nervous when I talk to them.
How does one transition from med student/resident to colleague – amongst those you respect most? Though I am confident in my training, I still find myself sometimes questioning even minor decisions, not wanting to disappoint this group I hold in such high regard; remaining captivated by the breadth and depth of their knowledge coupled with the utmost thoughtful and introspective decision-making processes.
Then I remember a particularly bad call shift I had as an intern. It entailed clearing my pager three times, two codes, low K, high BP, psychotic patients leaving AMA, and shock. I had e-mailed one of my mentors to tell him I wanted to quit – I was not a good intern, I had made a mistake in my career choice. He gave me a piece of advice that became my mantra throughout residency: "Just keep showing up to work and keep working hard, one day you’ll get there."
