The residents
[slideshow url="2010_10_14 The Residents"]
A hushed lull settles over the fourth floor as patients sleep. The clamor of nurses giving IVs, crowds of clinical teams walking on rounds, babies crying and machines beeping has slowed to an almost peaceful pulse. It’s 10 p.m. and pediatrics intern Eric Coon, M.D., has already been at work at Shands Children’s Hospital at UF for four hours.
It’s his third shift this week on “nightfloat,” the aptly named rite of passage for residents who stand watch over 20 or so patients from 6 p.m. to 7 the next morning. Just three months into his first year of a three-year residency, Coon is the first responder for anything that goes bump in the night. He sits down for a moment in the resident breakroom but is soon interrupted by a piercing alert from his beeper.
Madison, 3, needs her ostomy bag examined. Her small intestine was removed and now a bag collects waste from her tiny body. A nurse follows Coon into the room and they gather around Madison’s bed as her grandmother explains that the ostomy bag fell off. Madison’s elfin face, framed by unruly blond wisps, peers up at them with questions.
“There’s salt forming on her ostomy. I don’t want to force it,” her grandmother says.
“Do you want anything on it?” the nurse asks Coon.
He looks down at Madison. “I’ll page the senior resident,” he decides with caution, referring to the third-year resident supervising him.
As an “intern” — a first-year resident — Coon is in a curious in-between stage of medical education. Having earned the title M.D. after four years of medical school, but not yet practicing independently as a full-fledged doctor, residents are both students and teachers. Residency is their time to gain valuable hands-on experience in their chosen specialty in the clinic or operating room — with supervision — before striking out on their own. The term dates to the mid-20th century, when “housestaff,” as they are also known, actually lived at the hospital.
Known for enduring grueling schedules of 80-hour workweeks and graveyard shifts with few breaks, they are the workhorses in the hospital and the first in line to help patients. From pediatrics to urology, each residency program is a microcosm within the microcosm of the UF Health Science Center, and each forges its own unique culture of camaraderie from shared adversity.
Peds
In “peds,” for example, caring for kids fosters a family-oriented environment.
“I feel like all my classmates are married and some have kids,” Coon says.
Indeed, many of the 48 residents are married and have children. In the resident class of 2010, three interns and three third-years were pregnant and an intern’s wife had a child.
Co-chief resident Teresa Lynch, M.D., planned a wedding, got married in Tennessee and recently had a baby herself.
“Life doesn’t stop,” asserts Lynch, who has completed residency but now serves as a leader and mentor to the residents in her role as co-chief resident. “You’re never going to have as much time as you want to do the things you want, but you can find some time.”
Co-chief resident Meredith Mowitz, M.D., who had a baby her intern year, agrees. If you want something, you can make it work, she says.
“If you look at the ages of people who are in medical school and residency, that’s the time of your life when you’re making those decisions,” Mowitz observes. “For me, I know I can’t be a good physician at work if I’m not in a good place at home. Being in a good place at home is having a good marriage and my daughter.”
Flexible leadership and support at home make it work, and as Mowitz acknowledged, not many other programs would be willing to allow so much time off. Her husband helped by bringing her baby to the hospital at night to be nursed. Some nights they eat dinner with her there.
“My daughter has seen the inside of the hospital more than other kids who are not sick,” she jokes.
The long hours, napping in the same on-call room and shared experience of suffering and death form lasting friendships. Mowitz worked Thanksgiving Day during her intern year. In a curious switch of traditional gender roles, husbands brought in dinner for their wives during their nightfloat duty.
It can be difficult, being caught between two worlds, she said.
“I think it’s hard that no one else comprehends where you are or what state you’re in. You’re in this odd place,” she muses. “My grandmother keeps asking me, ‘When are you going to be a real doctor?’ ”
Likewise, parents sometimes doubt that “doctors-in-training” are qualified to care for patients. “I was told by one parent that his child was not a guinea pig. I said, ‘No, you’re right, he’s not,’ ” Lynch reflects.
But, she adds, the best, safest care for patients is always the primary focus, and most parents are very receptive. To further ease potential concerns, residents are creating a brochure and video to not only explain to parents who each person is on their child’s care team, but also to describe what to expect during a typical hospital stay and what resources are available.
And attending physicians, whom parents view as the “real doctors,” often help explain the role of residents.
“That goes a long way,” Lynch said.
Vet Med
Across Archer Road and across species, Katie Baxter, B.V.Sc., checks on her dialysis patient. Pearl, an elderly Welsh corgi, lays on a plush pillow and smiles at Baxter as she kneels down to gently stroke Pearl’s head.
“She’s doing much better today,” she says in her soft British lilt.
A third-year internal medicine resident in the College of Veterinary Medicine department of small animal clinical sciences, Baxter approaches Pearl with the same tenderness and care one would expect from any physician.
“A number of people equate pediatric medicine with veterinary medicine because we are dealing with people’s children,” she points out. “They’re fluffy children, but we have a large number of clients who tell us, ‘This is my baby, and I want you to treat it as such.’”
Vets, however, treat more than one species and see huge variations between them.
“Even two dogs can be quite different if you compare a Chihuahua to a Great Dane,” Baxter explains. “The types of diseases they suffer from and the treatment options available to them can be very different.”
Vets also form emotional attachments to their patients, who like children, cannot always tell them where or why it hurts. The team structure in a “vetmed” residency is similar to that of pediatric rounds, too. Teams of faculty members, residents and interns take turns seeing appointments and taking emergency patients. Long days and overnight shifts are expected.
While the Accreditation Council for Graduate Medical Education limits medical residents to workweeks averaging 80 hours, there is no such limit for veterinary residents. But even after a long day, they don’t go home until they feel comfortable leaving their charges alone — sometimes staying overnight.
“The people here are of such quality, they don’t bail out,” affirms Michael Schaer, D.V.M., a professor in the department of small animal clinical sciences.
The American Association of Veterinary Medicine also does not require veterinarians to complete a residency. After four years of veterinary school, about half go on to private practice. Schaer says those who continue their education do so out of a “desire to be state-of-the-art, to be all that you can be.”
The only veterinary school in Florida, UF offers a variety of residency programs from small and large animal clinical sciences to the more exotic aquatic animal medicine. There’s even an acupuncture program.
During a monthlong program at Cornell University, Baxter began to see vet school not as the end of her training, but rather as a steppingstone.
“The idea of practicing only within that specialty was very attractive to me,” she says.
Though Baxter does not work directly with the two other internal medicine residents, they share an office and a sympathetic ear.
“The resident class changes every year — we lose one, gain another — but I’ve been lucky to have a good resident class the three years I’ve been here,” she says. “It’s just essential for surviving your residency, especially when you’re new here. I felt enveloped by my resident mates, and that was a great feeling.”
Urology
Another closely-knit, exclusive program, urology’s highly specialized nature attracts those seeking excellence. The surgical urology program accepts just three residents each year and is five years long.
“Each resident has a lot of responsibility. We need to have a culture of camaraderie because if one person is missing it affects us all,” says Dan Willis, M.D., a fourth-year resident. “I also think we have a great working relationship with our faculty members that a lot of other residents don’t get because they don’t have that continuity. We’ll work with them all five years and they will be there with us every step of the way as we develop as surgeons.”
Willis starts his day around 4 a.m. At 4:30, he prepares for rounds by taking patients’ vital signs, collecting bloodwork results and checking results of tests. At 5:30 or 6, he and a team of residents, and sometimes an attending, go on rounds and see anywhere from five to 25 patients. Almost every day at 7, there’s an educational conference to prepare for boards or discuss interesting surgical cases.
Willis performs surgeries most days, usually until 6 or 7 p.m. He often stays another hour or so to check on his patients and get an update on their progress.
Contrary to what some people might think, his motivation has never been about the steep salary he’ll earn after residency.
“The biggest thing I’ve learned from residency is what motivates me. After four years of residency, you’re not motivated by the money or by what people think of you,” he reflects. “What motivates me and keeps me happy during a long day is the satisfaction I get making a difference in the lives of our patients, to be honest with you.”
What he was not prepared for, he says, is the commitment it takes to excel in residency. The hours are especially taxing when you spend the day operating and taking care of patients, only to face a research project and more studying when you get home.
Willis, who is married with four children, returns home to a family that requires just as much care and attention as he devotes to patients.
And like Lynch from pediatrics, he too has encountered family members who doubt his credentials.
When Willis’ daughter took a spill in the house, he tried to stitch her head in the emergency room himself. She was scared, and he wanted to help.
“She looked up at me and said, ‘Daddy, I want a doctor to do it!’ ” he recalls. “So, the non-surgeon ER physician sewed her up. Just when I thought I could mesh work and family, I was foiled again.”
Willis is “100 percent committed” to both work and family. He enjoys what little leisure time he has working on his house, visiting local springs and going to the beach with his family.
But in pursuit of excellence, he pays a price. He’s realized he can’t do it all. The key to residency, someone once told him, was to learn to live with guilt.
“I like to play golf and have a bunch of hobbies, but my wife reminds me I chose my career and to have a family,” he says. “There will be a time and a place.”
Until then, it’s business as usual.