Okay, so, my plan to write more and not less during Nate’s Summer Away From Home has not panned out. I probably should have expected that an audition/away rotation would take up more of my time than I thought, but I was pretending otherwise.

To recap, I spent last month taking shifts in the ED at a large county hospital on the West Coast. Like everything else here, it will remain unnamed out of the remote possibility that I can be identified.

This is probably a legitimate concern, if only because I’ve had posts entitled, “Nate Does Not Have A Career In Critical Care,” “It’s Always Turner Syndrome,” and “Big Pimpin’.” I was worried enough that I emailed one of my mentors here (the aforementioned Dr. C. – hi Dr. C) who recommended that I strongly consider taking it down.

THEY DON’T WANT US TO PUBLISH.

Anyway, I had a total blast out there. I started a zillion IV’s, tapped a knee, helped with codes, got to explore a new city, and perhaps most importantly did not anger anyone enough to ruin my chances of matching somewhere. I think.  I’ll get my feedback in a couple of weeks and will let you know if I need to pursue my alternate career plan of professional wingsuit pilot.

This month I’m abroad, learning how emergency care works in a totally different setting – the developing world. My home school has an agreement to help train native doctors in emergency medicine, a totally novel idea for residency here and it’s fascinating to see what true rationing of care looks like (people enjoy saying that socialized healthcare will lead to death panels and rationing of care and yadda yadda bullshit, but they’ve never seen actual rationed care, which is deciding if you’re going to use your one central line kit in the entire hospital on a patient who stands a fairly good chance of dying anyway. Rant over).

I will write more later on my time abroad since I’ve only been here three days, but for now I would like to give voice to a brand new set of anxieties as residency applications loom. Hi, residency directors, I promise I am not as incompetent as I appear on your screen.

OR AM I? Welcome to… IMPOSTOR SYNDROME XXVII.

Enter: the medical student, fresh off a sub-internship in emergency medicine in May and a toxicology/ultrasound combo month in June. Enter: experience, confidence, swagger.

Enter: other away rotation students, all of whom are from prestigious top-notch medical schools. Enter: the competition. Enter: non-pass/fail curricula. Enter: anxiety and self-doubt.

Exit: ALL CONFIDENCE AND SWAGGER. I HAVE NO IDEA WHAT I AM DOING PLEASE HELP ME.

The away rotation, as I wrote last time, is simultaneously an audition, interview, and exploration for you to figure out if the hosting hospital would be a good place to do residency. It is also your first real exposure to other medical students at other institutions, and your first real opportunity to measure your own generically positive* evaluations against those of the competition.

*(except when you are told that you do not have a career in a field related to your actual, desired career.)

Part of the rotation included ‘didactics,’ which for some reason is what graduate schools have decided to call lectures. Maybe it sounds fancier or something. The didactics were the first time I got to see what kind of training my fellow away students – all 14 of them – have.

The answer is A LOT. I felt pretty good about my training right up until the moment someone rattled off the entire AEIOU TIPS mnemonic for causes of altered mental status on insta-demand. The AEIOU TIPS memory aid is also way longer than the nine letters it suggests, since some letters actually represent multiple causes: alcohol/acidosis, endocrine/electrolyte/encephalopathy, etc.

And yes, I had to google that.

AEIOU TIPS is not a mnemonic I have memorized, because I cannot memorize a set of directions from the Bringer of Life (“clean your room and bring down your laundry”), much less a complicated and non-intuitive list of random medical things. I have memorized a grand total of 1 mnemonic in medical school, because mnemonics are stupid.

(The one I memorized, FAT RN, represents the clinical manifestations of a disease called thrombotic thrombocytopenic purpura. Fever, anemia, thrombocytopenia, renal dysfunction, neuro dysfunction. It is also a stupid mnemonic, but it is easy to remember becau- well, let’s not go there. It’s funny. Shut up.)

(This is why Dr. C recommended I take down this site.)

Anyway. I was immediately confronted, once again, with my old friend Impostor Syndrome. I haven’t learned to regurgitate anything besides my name and home phone number! Holy crap I am dumber than everyone else here.

Other students chimed in, answering questions left and right. One of them knew the entire workup, by heart, for “symptomatic hypokalemia,” (low potassium levels) which is an absurdly long list of tests and causes.

For my part, I knew that the knee bone is connected to the thigh bone, and that eating too many Tylenol pills will kill you. I also knew that if you see black stuff in the abdomen while ultrasounding, that’s bad.

I felt light-years behind. Clearly I did not belong here. What is my school teaching me?!

Of course, as time went on I realized that I knew some things – very few and far between, but some things – that others did not. I guess interacting with other med students is a little like studying for board exams: you’ll know things others won’t, and others sure as hell will know things you don’t.

The major takeaway: I will always have impostor syndrome, which is okay, because you can’t remember even a tiny piece of the monster we call Medicine even part of the time.

… That’s what UpToDate is for! <ducks>

PS – I passed Step 2 CS. I guess I washed my hands an appropriate number of times! Go me.