Insights on Residency Training

Dr. Bergman Lewis is a senior resident in Pediatrics at Seattle Children’s Hospital.

 By way of introduction, I am finishing my pediatric residency at Seattle Children’s Hospital, have enjoyed being a resident editor of Journal Watch Pediatrics and Adolescent Medicine for the past 3 years, and will write as an interim blogger for the next month or so. Greg left big shoes to fill but I’ll do my best to pave the way for the next resident blogger.

Just over a year ago, my daughter Anya arrived and has made my residency experience both brighter and more challenging. Her arrival also left me with three extra rotations to make up for maternity leave. Starting in the fall, I will be doing locums work in two primary care clinics. So I stand with one foot in residency and one foot in the real world. It’s a unique vantage point and I appreciate the opportunity to share a few of my observations and would love to hear about yours.

When I realized that I had to extend my residency, I decided to take a month off while my classmates graduated. I spent the month preparing for my sister’s wedding, taking Anya to music class, and trying to be normal. It was fun  — but not easy — to throw on the brakes after 7 years of working hard. But I adjusted, as did my loyal husband, and by the time I was starting to feel acclimated, it was time to go back to work. The weekend before returning, I felt nauseous most of the time. On Monday morning, I nursed my daughter while she was still asleep, put on my pager, and walked out the door.  

I was starting an adolescent rotation in a gynecology clinic with an attending I had looked forward to working with. My mind was still at home as I followed her to see our first patient who turned out to be a patient I knew. She was a previously healthy 16-year-old who presented to the emergency department last year with fulminant meningococcemia. She sat before us in her electric wheel chair, status post four-limb amputation, reporting that she needed to be “checked out” as part of her evaluation for kidney transplant (she is dialysis dependent secondary to her horribly long illness). In this young woman’s many encounters with the medical world, she has never failed to amaze me by her optimistic and down-to-earth spirit. After rattling off the 15 medications she is taking, we chatted about how she hopes to couple a back-east college tour with a Make-A-Wish Foundation trip to meet Beyoncé in New York. She said she was scared to return to high school for the first time but relieved that her friends were still there. I walked out of the room feeling noticeably lighter. The sense of dread and apprehension I felt going back to work was replaced by inspiration from this resilient young person.

Photo courtesy of Dr. Justin Heistand

It is easy during residency to get bitter and complain — it is after all a difficult time — but it is not necessarily helpful. Throughout residency, patients such as this young women have restored my energy when I needed it most. This intimate human connection is what drew me to medicine and has kept me on this path. During my first rotation senioring on the wards, feeling somewhere between a secretary, tour guide, and camp counselor, I felt dull and tired. Only when I started seeing patients with the medical students did I get my spark back. For all of us, that spark is essential. For some, it may be cutting in surgery, while for others, it may be building a differential diagnosis on a puzzling patient. Whether you are an intern who is scared of making a mistake, a junior resident who is worried that you aren’t scared of making a mistake, or a senior resident who is pondering if you have learned anything at all, notice what recharges you and seek it out.

This photograph was taken by a fellow resident from our call room at Harborview Hospital, the county hospital where we do our rotation in pediatric burns and trauma. I have stared at this view post-call and find the majestic mountain steadying after a crazy night. Rounding during pre-dawn hours, we spend plenty of time in windowless rooms, but sometimes we happen upon a view that is magical. Staying charged can help you not miss the magical views when they come along.

I would love to hear what keeps you charged.