I'm ba-ack

It's been over a year, but since my wife can write a blog I figured I restart mine. A good place to document the upcoming Big Vacation to the Motherland and then of course The Big Move in June.

Hard day today. Hopped on the bronchy donkey at 7:30 AM (courtesy of the pulmonary consult team, letting a lowly resident do the BAL) and then off to all day clinic where 12 of 13 showed up. Only took me till 7 PM to get through all of them.

We have around one clinic day a week, where we see patients that we follow through our 3 years of residency. Actually how it works is that intern year you get a hodge-podge of new clinic patients and overflows from your "clinic pair" who is a 3rd year resident. Then July 1 of your second year comes around and suddenly you have this whole continuity clinic of patients who have been seen by the same progression of doctors since the mid 1980s, of which you are the latest in a line.

Well, it has taken me over a year and a half but I know this collection of 80 or so unfortunate souls pretty well. I know which ones need extra coaching, which ones need a shoulder to cry on, which ones are on the button, and which ones are dumber than a bag of hammers. I don't get intimidated by 15 bullet point Problem Lists that include things like "amiodarone induced pulmonary fibrosis" and "multisystem sarcoidosis" and "Wolff-Parkinson White" and "gastric cancer status post Bilroth II." I imagine that it is almost like a real doctor's practice except that a real doctor may actually have ambulatory skillz, something which I decidedly lack. Don't let my patients know, as the last 4 or 5 residents who ran the clinic were God-like and inspired adulation from my collection of fawning old ladies who make up the core of my practice. I guess I'm breaking the streak, but I'm really trying to eke out the last momentum of that adulation and hope it lasts me until The Big Move in June.

What's starting to get me is that they know what is coming. They are starting to get a bit of the abandoned puppy dog look in their eyes. They know the goodbye form letter is coming. Oh to be sure, I've connected with a good number of them and I'll miss them too. It is just our clinic is so under-emphasized in our program that it seems that the only way to keep things from careening out of control is moxie and gumption as opposed to competence. I lack all three, as it happens.

What also gets me is that I have to get things a little tidied up so I can successfully hand off these slow-motion train wrecks to two soon-to-be-overwhelmed junior residents (my clinic is now so large that it will be split in two). I know quite well how to do that in the hospital. But besides from making sure everyone has had a colo and a tetanus shot, I have little idea how to do it in the clinic. I'm hoping that these soon-to-be-juniors have a bit more moxie and gumption than I ever had.