When the Hands of Time Come Down with Carpal Tunnel Syndrome: Surviving the Residency Rut

Isn't it strange how quickly time flies?

If I earned a dollar for every time I heard that as an intern, I would likely end this year by walking up to the Gods of Residency and Improbable Living On A Little More Than Minimum Wage, coolly handing in my sickly, pen-and-crumb-stained coat and announcing, "Later, suckers - The Good Life just called, and it wants me back."

Or would I? Well, maybe it's my annoyingly evanescent, cheery, comeback-kid naivete speaking here, but...the answer for me is no. Apologies, grouchy, disillusioned doctor brethren .

(And somewhere, a prototypical wizened, gray-haired, overworked, be-spectacled physician-father still owing $10K in loans watches in despair as his bright-eyed five-year-old dresses up as a doctor for show-and-tell, and heaves a sigh: "Sonny, let me tell you: stay far away from medicine, okay? Go buy some lottery tickets. Or maybe try out for that famous show - what do they call it - American Idolism or somesuch?")

You see, after years of desensitization to such things as, say, watching thoracentesis procedure videos while chomping on a lunchtime salad, or thumbing through "Nummular Eczema and Guttate Psoriasis: A Diagnostician's Dilemma" powerpoints while sipping a nonfat extra-hot extra-foam cappuccino at Starbucks, medicine has gleefully invaded my soul. As a result, it's hard to imagine doing anything else, even if someone offered me an Out.(Unless, I suppose, such an Out involved being a Mystery Shopper at Anthropologie...or the person who gets paid to write those airplane magazine travel articles where they critique various 5 star hotels and fancy restaurants. Seriously! I'm good at that kind of thing: "The creme brulee at Chez Panisse, a delectable, buttery vanilla-infused flan capped with a crispy wafer of perfectly caramelized sugar coating, is the exclamation point on a sophisticated, blissful gastronomical sentence." Yes? Do any travel magazine writer scouts read this blog?)

That being said, no intern is immune to the Residency Rut.

The Residency Rut comes on slowly, insiduously, just as that once-pleasant salmon pink shade of daily progress notes begins to resemble partially digested Pepto Bismol. It's the point where days seem to congeal together in endless repeat...where the passage of time is measured in cycles of laundry (and renewed resolutions to purchase yet more underwear, until my entire closet is brimming with an endless supply of socks, underwear and scrubs - no more laundry!!), numbers of acne cream tubes (futilely, sigh) purchased, bottles of multivitamins consumed (Trader Joe's Gummi Bear Vitamins are my secret weapon in the battle against hospital food).

The Residency Rut, of course, in true medical form, carries its own pathognomonic signs and symptoms. A sampling:

- IOWS (I Only Wear Scrubs) Syndrome: the repudiation of the social norm of wearing tailored clothing in favor of sporting reversible, drawstring-based apparel to locales other than the hospital. Associated signs include more than 2 sets of scrubs in afflicted person's dressers, relegation of all non-sneaker shoes to the back of the closet due to disuse, and wearing of scrubs to public places such as grocery stores and gyms. As a result, the sensation of wearing jeans, slacks and dresses becomes strangely foreign (not to mention, rudely tight (yikes). Unfortunately, scrubs are false friends; that drawstring reassures you that you're svelte when in fact you've grown by half-a-person.

- Pen-Resistant White Coats: White coats are unable to succesfully contain a black ballpoint pen for longer than 2 minutes. This may, in turn, provoke the telltale reflex manifested by the seasoned resident - See Stray Pen on Table/Hand of Unsuspecting Fellow Resident; Mindlessly Grab and Place in Own Pocket.

- Weather Dissociation: Sunshine and blue skies become phenomena to be witnessed in snatches, i.e. through hospital windows in front of the seventh floor elevator as one makes their way down to the emergency room to admit a patient. Moreover, such glimpses underscore the truth of the anti-intern weather truism: the sun is guaranteed to be shining, the temperature beach-perfect and the air glorious precisely on the day you are on call.

- Food Pyramid Remodeling: The definition of "edible food" grows more inclusive, embracing such items as 2-day-old leftover pizza abandoned in a tepid resident lounge, or an 8-oz can of prune juice that beckons nonchalantly in the communal resident fridge. (I will name no names, but I have sighted a fellow resident sipping from a can of Ensure - vanilla flavor, to wit - one particularly brutal post-call morning.) As a result, the "food pyramid" transforms into a "food square" founded upon the four C's (Croissants, Coffee, Chocolate and diet Coke.)


- Mint Aversion: Okay, this one requires some background explanation. So let's face it, medicine is full of Smells. One's nose quickly learns that, in order to survive in the hospital, it must recalibrate, raising its threshold for defining a Truly Intolerable Olfactory Insult. But when a scent tests the limits of even this recalibrated nose - manifesting a "Code Brown" of sorts - hospital personnel know it's time to break out the CPR/defibrillator of olfactory codes: oil of wintergreen. Oil of wintergreen is the aromatic equivalent of a fire extinguisher: every unit has an emergency supply, stashed next to the unit assistant's secret (or not so secret anymore, heh heh) oatmeal raisin cookie supply. At the onset of the code, simply uncork the diminutive-appearing bottle and let the battle of the vapors begin. Unfortunately, the result is often a disconcerting olfactory tug-of-war wherein your nose and mind are conflicted (Brain: think wintergreen thoughts! think wintergreen thoughts! Isn't that wintergreen just so pleasantly non-malodorous? Nose: I don't care how much you try to brainwash me with dubious mint; there is some stank going on in here). In any case, the result of this odor antidote is that over time, an intern quickly develops a Pavlovian aversion to the scent of mint. It's like one veteran nurse confessed to me as we braved through one particularly challenging aromatic emergency: "I can never eat another York Peppermint Pattie again."

When the Residency Rut hits, there's only one antidote. That is: the rite of passage \of being an intern, otherwise known as Complaining.

By mid-year, interns are apt to crab about anything that is crabbable: cafeteria food, the weather, parking/driving/traffic, 4-hour rounds (too long), 1-hour rounds (not enough learning), sit-down rounds (too passive), walk rounds (too much exercise), overnight call, call until 7, call until 3, the very task of being in the hospital, too much autonomy, not enough autonomy, last-minute admissions, early-morning admissions, lack of space/computers/TV's/pager battery life/bathrooms/coffee cups/coat-pocket room, computer-based medical records (where did my note go? why did it delete my note? the computer ate my note! I HATE COMPUTERS), paper-based medical records (My hand hurts. Why is this paper pink? Writing notes is so 1998), messy handwriting, too many lectures, too few lectures, conference food (a favorite complaint), too many forms, paperwork, the smell on the sixth floor ward (okay, the smell on the sixth floor ward is a legitimate complaint - hands down wins the Most Minty Ward of 2009 award. What is going on up there??).

Talking to fellow interns across the nation, it seems that Complaining is a universal attribute of residency. It doesn't matter if you live in a place with four seasons (too much variation and high heating bills, can't wear open-toed shoes in the winter) or one (too boring, can't really justify coat/boots purchases); if you live in a bustling city (too crowded; expensive; parking nightmares; why are there so many people on the road at this hour??) or quaint town (nothing to do; dust storms; why are all my patients truck drivers?). Case in point: one might be mere minutes away from a glorious beach, living in a city with 300 days of sun. And yet, even this scenario carries complainability (where the complainants invariably seem to be So-calite females trying to find parking on a foggy Friday night in North Beach...)

Lest the gentle reader begins to perceive America's future doctors as a crop of whiny, ungrateful minions, let me hasten to elaborate a bit further on the role Complaining really carries. Much like oil of wintergreen's questionable efficacy in masking unseemly odors, Complaining - more accurately, commiserating - is a coping mechanism of sorts...if we didn't have some way to vent, we'd probably explode. (And you can imagine what that would do to patient care.) Every intern is going to experience the "I Got Slammed" days, which evolve somewhat like a bizarro, macabre "12 Days of Christmas": 12 hours of working; 11 hours since a real meal; 10 new admissions; 9 notes to write; 8 labs that didn't get drawn (and have to be re-ordered and re-followed up); 7 family members waiting for updates from you; 6 studies to chase down (and a hibernating radiologist that can't be found); 5 discharge paperwork sets to complete STAT; 4 consultants to call; 3 rectal exams to adminster; 2 patients that are crashing/hypotensive/septic, and - all together now - a pager on steroids.

In such cases, the bond of commiseration is part of what draws interns close together. Chances are, during those two-month marathon sessions without weekends off, there's someone else who can empathize with the plight of eating Cheerios and chocolate for dinner for a week straight. Or someone else who understands the incongruity of waking a soundly sleeping patient at 6:05 am to chirp contritely, "Hi Mrs. Adams! How's that diarrhea? And how are you feeling today? Uh - that is, before I, uh, rudely and inconsiderately woke you up from the rare snatches of actual decent sleep you managed to steal - sleep made all the more valuable in the context of your noisy neighbor who keeps yelling for the pirates to leave him alone?"

And then comes the turning point: where the trivialities, trials and tribulations of internship begin to transform from mint-green-scrub-filled monotony to a bizarre, Scrubs-esque, zany and quirky world to which You, gentle intern, have now gained access. It's like celebrity gossip - you're amused, enthralled and secretly drawn despite having a million catty things to say (oh come on. Don't pretend you didn't at least look at the picture of Seal with a mullet.

So here's to surviving the Residency Rut in one piece. Did I mention how much I miss having weekends off like normal people? Or how my brain has completely forgotten what it feels like to get 8 uninterrupted hours of sleep? Or how Trader Joe's just stopped making my favorite chocolate-chip date-nut bar? Or why we no longer have papaya at our morning conference breakfasts?

Grrr.