On feeling stupid

I have been cramming physiology, anatomy, histology, pathology, biochemistry and pharmacology into my head since August 4th 2008 and I am not one tangible iota closer to being able to effectively treat patients. It's not that I haven't learned anything, it's just that most of what I've learned is foundational. It's like building a house: when you drive by a newly laid foundation it doesn't look like much progress despite a terrific amount of work.

Yesterday I shadowed on the pediatric cardiology ward. This is a leading candidate for the kind of physician I want to be in the future and a field in which I have been published for clinical research. I didn't expect to keep up with the residents and fellows, but I thought I'd get some of it... maybe 10%?

Try less than 1%. About the best I could manage was knowing what the acronyms stood for. I knew why they wanted albumin levels and I correctly identified respiratory acidosis. But I couldn't tell you that the pleural effusion was protein or why, what the difference between a surgical and pigtail chest tube was, why you would withhold anti-fungals on the febrile baby with mediasteinitis, why a triple lumen catheter was better than a double, which port you put the guide wire through when changing a central line or what a 3/4 Fontan was. It was intense, thrilling and terrifying. How am I supposed to get from what I know now to being responsible for a pod full of patients like that?

Plenty of people dumber than me have become good physicians. I find myself repeating that a lot lately. I too will learn it and master it. But it was certainly a hip check to see just how long the road ahead is.

To end on a high note... I loved the day on the PTCU anyway. Despite feeling cluess most of the time, I loved it there. It's a great mix of medicine and procedures, acute care with repeat patients, interesting problems and enough good outcomes. One day my life is going to be amazing.