According to my bilingual friends, the real test of fluency is when one begins dreaming in their foreign language of choice. I can't say I've had any recent nightmares "en espanol," but I can say that my unconscious thoughts often place me right back at work, transporting me back into the familiar emergency department halls, worrying about some physical exam feature I failed to mention on conversation with an admitting physician, a lab test left unordered, or seeing patients who are simply complete figments of my own imagination, my sleepy mind revolting against the obsession that monopolizes and challenges my conscious mind on a daily basis - internship. Ten-hour shifts that too often become eleven-and-a-half in a bustling emergency department, admitting almost one-third of my patients, and praying I'm consistently doing the right things quickly dominates the majority of my waking hours. I've learned recently that the responsibility of patient care infringes on my peaceful slumber.

It's not that I feel abandoned or abused. On the contrary, my attending physicians, my "bosses" who oversee me as I evaluate and make clinical decisions concerning patients, will often bring to my attention some clinical pattern that I've left unrecognized, gently reminding me of an extra lab test or two that I should consider, and are always available if I'm stumped on what to do or who to call for an especially complicated patient. I can trace my paranoia to a couple of sources. First, I desperately want to conquer the steep learning curve that is residency and especially internship. My first day made me feel as if all the patient care I'd particpated in during medical school had left completely unable to evaluate and examine a patient. It felt like square one, like I'd never talked to a patient before. I'd forget to prereform a physical exam alltogether and have to apologize and explain to my bewildered patients that I really ought to listen to their heart and lungs and push on their belly since they'd complained of 3 hours of 10/10 belly pain in the right lower quadrant. Appendicitis is hard to rule in or out without even a cursory physical exam. Second, I've come to the very real conclusion that in just 3 short years people like me will be asking me how to manage their difficult and confusing and vexing patients. While I'm glad for the help now, soon enough I'll have to do this on my own. I'll be the attending some wide-eyed intern trusts to provide insight and advice or I'll be out on my own who-knows-where and help from a seasoned veteran emergency physician won't be sitting next to me at the desk. That's a little scary.

So, I find myself caught in-between my desire to learn and improve and fear of disappointing the attending physicians I respect with a whole bunch of terror about doing the wrong thing to the wrong patient at the wrong time. I can't imagine I'm alone. The few conversations Ive had to address this topic with my fellow interns seems to support the notion that this type of apprehension commonly afflicts interns. When we whisper in the hallways and in the back row of conference trying not to doze off after a night-shift or all-night call, the common theme remains - fear of doing the wrong thing, of hurting someone you meant to help. I'm trying to learn to embrace the fear, turning it into the stimulus to prevent mistakes, kind of like the dread of failure and losing I felt before playing soccer matches in high school. I was able to constructively funnel that anxiety into intensity and focus. The same technique helps me to carefully examine and double-check myself as I manage and present patients at work.

Work-related dreams will probably persist I'm afraid. But maybe a little taste of fear in my stomach isn't the worst of all possible emotions during my second month of residency. I have, after all, been able to rightfully call myself doctor for approximately ten minutes. I saw a patient's face drop last week when I entered the room. I introduced myself. She asked, "You look young. When did you graduate?"

I couldn't lie, "May 27th." I responded.

"This year?" she inquired.

Maybe some butterflies in my gut will remind me to be extra careful and to treat my patients like they're my mom or dad sitting in front of me worried the person who just introduced themselves as doctor has too-long curly hair and looks more than a little green around the edges.

Andrew Jacques ('05)