Surviving My First Call Shift

It was my first call shift of PGY 1. Psychiatry at the Royal Alex. What a way to start.

But I was ready. I had made sure to wear my lucky statement necklace, to pick up my long white coat, to have my mom test page me the night before.

I excitedly headed into the ER to see my first consult. Pulling back the curtain of P10 I introduced myself, “Hi, my name is Dr. Ostrowerka and I’m from Psychiatry. Your emergency room doctor has asked me to…”

“You’re not a doctor.” the man sitting on the hospital bed interjected.

Uh oh. I casually glanced at my badge. Was I still wearing my med student ID? Had I been wearing it all day? Why didn’t anyone tell me? I looked down, only to see my CaRMs glamour shot smiling back up at me. I definitely didn’t look like that on call tonight. Or ever. “Dr. Ostrowerka, Resident,” was printed beneath.

Resident. It said it right there on my badge. He was right. I wasn’t a real doctor. Should I have not introduced myself as doctor? Am I supposed to introduce myself as a doctor? Did someone give us a lecture on this?

“You’re completely correct sir, I’m not a doctor, I’m a resident doctor. Resident doctors have…”

“You’re not a doctor.” he cut me off again.

Wait what? But I had just tried to explain that I was a resident and I know that I’m not a staff, but aren’t I technically a doctor?  Hadn’t I said I was from Psychiatry? Was it because I said I was from Psychiatry?

“Well sir, I am in Psychiatry, but psychiatrists are doctors too. Maybe we should get started with a few…”

“You’re not a doctor.,” he interrupted a third time.

I was officially confused. Was it because I looked so young? Was it because I looked so haggard? Was the statement necklace too much? I knew I shouldn’t have worn it.

This time, the patient continued on, “You’re not a doctor, because you’re too busy.”

Now I was curious. “Busy? Doing what?” I inquired.

“You’re too busy being Satan’s mistress.”

I had no idea what to say.

So I laughed. Out loud.

Welcome to PGY 1.

In residency, like I did that night, you learn to expect the unexpected.  The toughest moments you encounter will not always have an algorithm to follow, a pocket card to grab, a page on UpToDate. You can re-read your Toronto Notes, run the list repeatedly and fill your long coat’s pockets with books, but you will still encounter situations that you couldn’t have readied yourself for and are wholly uncertain of how to respond to.

Your moments may not come in the form a psychotic man questioning your employment decisions. They may come when you need to do a neuro exam on a 99-year-old patient who doesn’t speak English, or urgently discuss changing a patient’s goals of care at 2 a.m., with their entire extended family in the room.  Or maybe they will come when you have a family member admitted to the same hospital you’re on service in, or when you realize you’ve missed Christmas morning because you’re still rounding post-call.

But in your moments, whenever they may come, trust in yourself, in your judgment, in your knowledge. In your moments, look to others, inside and outside of the hospital’s four walls, for guidance and support. In your moments, know you’re doing your best. And that’s good enough.

Oh and in case you’re wondering, that satanic statement necklace hasn’t been worn since. And likely, never will.

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