It's 2300 on a call night at a slow hospital and I am thinking back over the last few years about the different events and patients who stick in my mind.
I remember walking into this place, a little cocky, thinking how superior I felt to the CA-2 I worked with when I was on my MS-4 on my anesthesia elective. Could she really have forgotten all of this important stuff? I didn't even have a clue that I didn't have a clue.
My first day in the OR, my attending was the chairman of the department. He was close to retirement and I thought, "this old boy probably will be impressed if I try to do things the old fashioned way." I learned quickly that I didn't have a clue.
I will never forget the 3-year-old I cared for in the PICU. His mother couldn't stand for joint custody and so shot him through the head and then killed herself. It was hopeless, but we tried everything. It was my responsibility to consent the estranged dad for organ donation. That was the hardest thing I have ever had to do in my life. My son is 3-years-old.
I will never forget the 14-year-old with a low grade lung tumor. She was so scared, but her parents were even more scared. Never underestimate the value of a professional appearance and demeanor. I bet I had no more than 10 seconds to secure the trust of this family and I wonder how the interaction would have been with one of the more slovenly appearing providers. The thoracic epidural went in like butter and she did so well post-op. The parents were so thankful.
I will never forget the benign trauma patient I induced as a CA-1. We would later figure out that right about the time of induction he threw a PE that occluded a large portion of his left pulmonary circulation and, with the initiation of positive pressure ventilation, he developed a tension pneumothorax on the right. My world was going to s*** and my attending was already 2 floors up at an emergency intubation. Turns out, having a good clinical intuition and the balls to do something about it IS worth something. A 14-gauge angiocath to the right chest stabilized this guy just enough to get an x-ray and then get the surgeons in to put in a chest tube. Everyone else in the OR was standing around waiting for me. They didn't have a clue. A week later, I uneventfully anesthetized him for his ORIF. I was just starting to get a clue.
I started working regularly with one of the ortho attendings part way through CA-1 year. After a month or so he asked me what I was going to do next year after I graduate. I meekly informed him that I was not a CA-3. He still can't get over the fact that I am still in training. Don't ever forget that surgeons, nurses, techs, and janitors do note your professionalism and appearance.
I stayed late a couple of times to help out one of the residents who just wasn't quite getting it on their PACU rotation. It was only a few hours out of my life, but the attendings were astounded that I would take the initiative to help out like that. These attendings have since made sure to open doors for me. Professionalism pays off.
I won't forget the mistakes. Every one of them is still staring me in the face. I am a little pathological like that. It drives me to do it better next time.
The only time I couldn't intubate/ ventilate and we had to trach her. I will never forget the look in her eyes as she went to sleep. She trusted me, that I would take care of her. Nor will I forget my attending turning to the surgeon and saying, "Do the trach, I don't need to look. If he doesn't see it, neither will I." It was a huge vote of confidence from one of the attendings that I truly respect.
The high spinal I had on my first OB call night. I will never forget the patient looking at me and mouthing the words, "INTUBATE ME" because she didn't have the ability to phonate anymore.
The only time I froze in the OR. My wife paged me with a 911 when I was about 10 min into a c-section. My 2-year old had gotten a hold of my wife's peanut-buttered toast. He was having trouble breathing. We didn't know that he is deathly allergic to peanuts. I knew the paramedics were only 5 blocks away and would bring him to the hospital I was working in, but I wanted to go jump in the car so badly. I could have stayed in the OR. I was doing all the right things. My attending was standing on the other side of the OR watching and didn't realize that anything was amiss with me. However, I asked him to step in and take over. I just didn't feel I could give her my best job with the distraction. I made the right judgement, but I wish I had more control of myself.
I am still learning.
I won't forget the CA-1 who made it just a short time before succumbing to the pressures of the job. I worked with him his first week and man was I ever worried about him. It turns out, I had good reason to be worried about him.
I won't forget the medical students, bright, knowledgeable, but without a clue. They will know soon enough. At times I am overworked and overtired. Even if they can't see that and they think, "man how can he have forgotten all this important stuff," I like having them around. It reminds me of the spunk I once had.
There are a lot more patients, more stories, but I won't bore you with them.
I am at the end of a long road and the beginning of another. Four plus years of college, four years of med school, four years of residency. It has cost so much and it may cost me even more if recent personal events bear out.
No I haven't always acted professionally, and yes once in a while I have not projected the best professional image. But the further along I get, the more important Professionalism is to me. It isn't just about fundamental knowledge and fundamental skills. And I am not talking about the touchy-feely professionalism bs that is going around lately.
If this change was brought about in a few short years. I can only imagine what I will feel like five years into practice. I suspect I will be looking back saying, "Yeah I was just starting to get a clue."
) that I'm happy to run the show with (although obviously I'm still discussing those cases with a boss). 
