I quit today

[Doowai]

God damnit this is the 3rd time I am writing this. This damn thing times out as i type long posts. It pisses me off. Please don't reply too this until I finish the story.

I formally quit my residency today with a signed resignation, returning pagers, ID badges etc.

After selling 16 year old chiropractic business, doing a Caribbean medical school, failing to match for 2 years, teaching in a violent inner city heavily gang-infiltrated and subsisting on a below poverty level income for those 2 years, .... finally matching, moving 1400 miles away from my family, especially painfully from my 4 children. I quit.

It really has been tough. Senior residents say I am cursed with a dark cloud and I believe it.

TODAY : I get up off the bare floor where I sleep, in the smoke filled apartment (my neighbors chain smoke and it seeps through the walls and floor into my non-smoking apartment - which I h-a-t-e ), way before the sun came up. I have no furniture other than my pillow. Largely because I have yet to get paid a penny. Nothing for 2 weeks of orientation lasting 12 hours a day. Nothing for 3 weeks of rotation so far. Some attendings really feel they are doing you a favor to make things as hard as possible, - if you could do something with one step they feel it is a privilege to make you do it in three steps.

I am supposedly doing one of the easier rotations for the year. I was told it would have a census of 2 to 6. No senior resident as its slower. The attending comes around mid day. I have been very busy, more than double what I was told would be my max. Often having more admits in a day than the total census usually is. Skull fractures, partial small bowel obstruction, sickle cell, intrauterine fetal demise,cholecystitis, pancreatitis, urinary tract infections, pyelo, meningitis, gastroenteritis, sepsis, and more.

So first thing this morning I see 2 newborns, and then go visit with their parents. Then as I go down the hall, an angry husband comes up and starts yelling at me....... end part one

---

Members don't see this ad.

 

[Doowai]

His wife was admitted a few weeks ago, with abdominal pain. She is filthy.I mean homeless dirty. One of the nurses steals her bra and hand washes it, it is like a oily rag you use to work on cars. She has 2 other kids, not in her custody. He is an insuline dependant diabetic.

Ultrasound and HCG indicate an ectopic pregnancy. The surgeon goes in, and viola its an ovarian cyst. Slightly larger than a normal cyst. But they remove it. HCG keeps rising and another ultrasound reveals what looks like an early intrauterine pregnancy. Finally she is released with a prescription of Lortab.

The Lortab runs out early, and she goes to other nearby hospitals for abdominal pain and also received Lortab prescriptions. Which she "loses" and asks for a new one when she returns to our hospital. Plus at one of the other hospitals they did an ultrasound and told her they still saw some small (normal) cysts on her ovaries.

 

[chrisisinnocent]

Oh man sorry to hear that. But I have to ask what god forsaken hole did you end up matching at? That place sounds horrible...

 

[Doowai]

She was a pain in the ass. She would call nurses and have them hand her the phone which was within reach. or ask them to straighten the sheets --- of her husbands bed next to her, while he is sleeping in it. He is perfectly well except for his type 2 insulin dependant diabetes.

So this guy gets in my face, literally no more than 6 inches from my face and starts yelling. How could we discharge her when she had (normal) cysts. Then he tells me she is gestational diabetic and I missed it. Wow....okay that shocks me. Yelling on he tells me she is now a type 1 diabetic because her blood sugar was low. It was 50. Now I am wondering if he is giving her insulin to create reason to be admitted again or sue. He tells me type 2 is when blood sugar is high and type one is when it is low

 

[Doowai]

Please don't reply too this until I finish the story.

Oh man sorry to hear that. But I have to ask what god forsaken hole did you end up matching at? That place sounds horrible...

 

[Blade28]

I'm sorry to hear about your experiences at your program. You're officially out now? No turning back?

What's your plan for the near-term future? Do you have med school loans to pay back?

 

[Doowai]

I explain diabetes to him. he calms down, and then informs lucky me that they have made an appointment with me at the outpatient clinic to act as OB.

I go back and see 3 day old c section baby. Looking a bit yellow. he was yellow yesterday but his bilirubin was normal. Then the nursery manager comes and yells at me because this very baby's parents are claiming I did not see them. I go to see ALL newborns parents the same day. I know I have met them. I go , with the nursery manager, to greet them again. I walk in the room - oooops never seen them before. My mistake. I have had days recently where I have had 8 newborns in a day. Somehow I checked them off the list without seeing them. I apologize, explain whats happening. They want a circumcision done today. I explain I can do it (Yay, a procedure for me) how long it will take - but also that their baby was looking a bit yellow, like the day before, and I ordered another total bilirubin.

 

[Doowai]

I go back to the nursery, and talk to the attending about doing the circumcision. The babies nurse says I could not do it. My jaw hit the floor. I could not believe she was telling my attending that. She said there are doctors there that have done thousands and she is not letting an intern do one.

Then I get the bili back. Its too high, the baby needs to stay another day and get bili lights. The nursery manager freaks about telling the parents and insists the attending go with me to tell the parents. We go to the room, the dad has left insisting they be discharged and so per the patients orders the nurses have already written the discharge. unfortunately we have not discharged the baby - the parents live an hour away and want to only breast feed. The mom starts cryng about having to tell her already angry husband.

 

[Doowai]

The dad comes back, we tell him and he starts yelling. Nurses 100 feet down the hall in an enclosed room can hear it. The attending starts yelling back, then walks out. This dad calls my program director. The program director calls my attending and the nurseery manager.

 

[Doowai]

Meanwhile I am asked to do my first lumbar puncture on a baby with fever of unknown origin we suspect and have suspected meningitis. A couple of days ago a senior resident and an attending tried a tap and used 4 needles and only hit blood - really was a spinal CBC. Then we found a source - major bladder infection. We begin antibiotics while waiting sensitivities. However a bood cullture comes back positive for gram negative rods, and the iinfectious disease doctor wants another tap.

The pediatric intensivist is against it, the ID doctor is for it. I end up trying.

 

[Doowai]

I try to tap that baby and it does not go well. Then a pediatric specialist comes and tries 6 times - blood. Now he suspects herpes since it is just a gushy bloody tap. But he calls the pediatric intensivist who reluctanty tries - and fails.

 

[Doowai]

For me this is a bit sensitive since the first day of orientation, while I am 1400 miles away I get text message from my oldest son that my youngest son was hospitalized with meningitis. I cannot reach my wife, due to my cell phone carrier not working well in this area and hospital walls.

Plus the nurse holding the baby is another one I have had problems with.

So then I have to order a serum herpes PCR on the baby.

Then my attending pulls me aside to tell me about the discussion with the program director and that she has received 2 complaints from nurses abut me.

 

[Doowai]

One nurse complained that i said she looked like she listened to rap music. I was being facetious, she is as white as white gets. But the complaint is true. I have no idea where the second one came from - a nurse claimed I told her I came to the residency only to eat a local food and get laid. This is not true.

 

[Doowai]

By now its not even close to lunch time. I have left out ass chewings for everything. I got ass chewed because I got a little too far from the attending at one time. I was in the same room, within ear shot - and got chewed out for leaving my attendings side.

 

[jdh71]

Oh man sorry to hear that. But I have to ask what god forsaken hole did you end up matching at? That place sounds horrible...

Pay attention nOOb he's not done with his story yet

 

[sirus_virus]

One nurse complained that i said she looked like she listened to rap music. I was being facetious, she is as white as white gets. But the complaint is true. I have no idea where the second one came from - a nurse claimed I told her I came to the residency only to eat a local food and get laid. This is not true.

Sorry dude, but I could not resist.

 

[Doowai]

I really cannot finish the whole story. It just never seemed to end. Admits in the ER that I called in admission orders for- that never got admitted. So in between ass chewings and patients literally screaming at me, i run across the street to go to the ER to find an acute patient with a possible acute abdomen for 5 hours who has not even been weighed (damn lazy ER staff) or had an IV access started, who I have to physically admit - with written orders to call me when they make it to my floor. While I am dealing with paperwork this possible acute abdomen patient is brought to my floor and I am never informed. This results in another ass chewing from the attending for not having the H&P done.

Why write orders when they aren't even followed. That patient sat in a room on my floor,for a long time - after sitting in the ER for a long time - nobody telling me she was there - and I get chewed out. "A new patient is your priority over paperwork, why are you dictating admissions and discharges while a new patient is sitting unattended in a room on your floor"

 

[jetproppilot]

By now its not even close to lunch time. I have left out ass chewings for everything. I got ass chewed because I got a little too far from the attending at one time. I was in the same room, within ear shot - and got chewed out for leaving my attendings side.

YOU'VE COME TOO FAR TO BAIL, DUDE.

Thats some heavy s hit anyone would have a problem dealing with.

Theres a HOLY GRAIL if you hang.

I'D LIKE TO TALK WITH YOU.

PM me and my phone number is commin' your way.

 

[Doowai]

So the end of the day comes. A day filled with yellings, ass chewings, doing everything ****ing wrong, missing my kids more than I would miss a body part, lonely not having a single friend in this place, sore as hell from sleeping night after night on the floor - looking forward to 24 hour calls because it means I might get a few hours on a mattress.

 

[Doowai]

And at the end of the day, when I am releived of patient duties, the attending wants me to go to clinic to check messages from outpatient clinic nurses and I tell her word for word:

"Dr. P, I have made a decision and its final. Its nothing personal against you or the program. But this is just not working out.I am leaving the program. Here are my pagers, my ID, my Tungsten TX. I need you to sign this sheet confirming I have returned them, that I am resigning and that I do not want the program to contact me. If anyone needs to contact me from the program, have the universities attorneys contact me. I am almost 50 years old and I am too old for this crap"




Almost done

 

[uclabruins47]

major props. you got balls bro

 

[Doowai]

I dread my parents finding out. My dad is this old time WWII war hero who counts the time he spent in POW camp as the best of his life. I think I will hear about how what i went through is not as hard as his POW experience. As well my brothers have been veery successful and I am the loser in the family.

I have notified my immediate family. Only my oldest son is cool with my decision.

okay i guess i am done now

 

[billydoc]

Doowai, sorry to hear about your troables. Will you try to scramle into any other place? May be closer to home. I think that's what's gotten to you bud. I know being away from my wife and kids in the Carib almost killed me. Being away in the States is probably not any easier. Or may be your family could move. I know you already quit, but it sounds like from what you're describing they'll be happy to get you back in that ****hole place.

Best of luck bud. I really hope that somehoe it will all work out for you in the end

 

[Doowai]

Doowai, sorry to hear about your troables. Will you try to scramle into any other place? May be closer to home. I think that's what's gotten to you bud. I know being away from my wife and kids in the Carib almost killed me. Being away in the States is probably not any easier. Or may be your family could move. I know you already quit, but it sounds like from what you're describing they'll be happy to get you back in that ****hole place.

Best of luck bud. I really hope that somehoe it will all work out for you in the end

No, I really do not think I am all that competent to be in medicine. I have made alot of mistakes, and although I complain about some specific nurses here, I have had several really help me out a bit. I really do not know what I am doing. I really think I might have stabbed that baby in the sacrum attempting the spinal tap, Shizen

 

[jdh71]

Tactically speaking, might not have been a bad idea to get that first paycheck before pulling the trigger.

I guess it sucks - your situation. You just seem to have come so far . . . I mean the inefficiencies and bull**** a$$ chewings are all a part of residency. But it sounds like you were seeing a lot of good pathology, which to my thinking means good experience, which translates into training if you're paying attention.

As a non-trad, carib grad, who finally got a shot and then walked . . . sounds like career suicide.

Good luck. You will need it.

EDIT: Its not like I don't understand. I TOTALLY see why you did what you did, but . . .

 

[Southpaw]

I don't know your whole story Doowai, but I know you've gone through more than most would ever dream of putting themselves through to get where you are. I hope your decision was the best for you and your family and that you're able to find happiness. Best of luck in the next few months and thereafter.

 

[Bobblehead]

Are there hospitals in the US where they would put their patients at such extraordinary risk to allow an intern in his first month to perform unsupervised procedures or try to play mediator between multiple consulting services without proper backup? Are there programs that would expose their patients to such risk where they have a single overworked intern in his first year stretched so thin that it sounds like true harm could come to several acutely ill patients?

It would be interesting to hear the program's version of events. Somewhere between, the truth lies.

 

[Long Dong]

Are there hospitals in the US where they would put their patients at such extraordinary risk to allow an intern in his first month to perform unsupervised procedures or try to play mediator between multiple consulting services without proper backup? Are there programs that would expose their patients to such risk where they have a single overworked intern in his first year stretched so thin that it sounds like true harm could come to several acutely ill patients?

It would be interesting to hear the program's version of events. Somewhere between, the truth lies.

Sounds like a county hospital to me.

 

[Shinken]

God damnit this is the 3rd time I am writing this. This damn thing times out as i type long posts. It pisses me off.

For long posts, type your post in Word (for example), edit it there, and when you're ready to post just log on to SDN, cut and paste into the SDN text window and hit "submit reply."

 

[Shinken]

So the end of the day comes. A day filled with yellings, ass chewings, doing everything ****ing wrong, missing my kids more than I would miss a body part, lonely not having a single friend in this place, sore as hell from sleeping night after night on the floor - looking forward to 24 hour calls because it means I might get a few hours on a mattress.

This sounds like internship.

Did you talk to anyone before making your decision or did you decide to quit on your own? (by anyone I mean people not on SDN)

I realize you've quit already and there's no turning back. I'm just surprised at the fact that you simply quit. Did you talk to your wife about quitting? Do you have contacts at other programs that might consider you for a transfer or for reapplying for next year? (places you interviewed at that liked you but you didn't match at)

You're almost 50, have med school debt, and have quit your internship after a really bad day. I sure hope you really thought this through. I wish you good luck with your next steps in life and I hope things end up working out for you (really).

 

[8744]

Are there hospitals in the US where they would put their patients at such extraordinary risk to allow an intern in his first month to perform unsupervised procedures or try to play mediator between multiple consulting services without proper backup? Are there programs that would expose their patients to such risk where they have a single overworked intern in his first year stretched so thin that it sounds like true harm could come to several acutely ill patients?

It would be interesting to hear the program's version of events. Somewhere between, the truth lies.

See one, do one, teach one, screw one up.

 

[8744]

No, I really do not think I am all that competent to be in medicine. I have made alot of mistakes, and although I complain about some specific nurses here, I have had several really help me out a bit. I really do not know what I am doing. I really think I might have stabbed that baby in the sacrum attempting the spinal tap, Shizen

Dude, better to get out early if you really don't like it.

 

[8744]

...Theres a HOLY GRAIL if you hang.

No, no there's not.

 

[Fro]

welcome to the world's best medical care system. free market at it's finest!

 

[futuredo32]

Doowai, I really hope that things work out for you in the future.

 

[Doowai]

This sounds like internship.

Did you talk to anyone before making your decision or did you decide to quit on your own? (by anyone I mean people not on SDN)

I realize you've quit already and there's no turning back. I'm just surprised at the fact that you simply quit. Did you talk to your wife about quitting? Do you have contacts at other programs that might consider you for a transfer or for reapplying for next year? (places you interviewed at that liked you but you didn't match at)

You're almost 50, have med school debt, and have quit your internship after a really bad day. I sure hope you really thought this through. I wish you good luck with your next steps in life and I hope things end up working out for you (really).

Thanks.

After the second patients husband yelled at me, I was texting friends and family like crazy. I got texts back that said things like "Oh that is awful, but you will make th right decision". Usually when I complain about things I don't want advice. This time I wanted advice. What i got was votes of confidence, but my confidence in myself was shot at this point.

A few minutes after I gave my resignation in the evening I started getting texts and calls saying "You can't quit, hang in there". But it was too late, it was done. There is a 2 hour time difference between here and back home where my family and friends are. About an hour after I quit the guy I did my anesthesiology rotation with called and said "You can't quit" - to which all I could reply was "too late, its done, thank you for calling, I really don't want to talk now". A half hour sooner and I would probably still be in residency.

If you are not in residency do not expect anyone to do anything other than make you feel inadequate - and many of the people (like nurses) to completely enjoy making you and seeing you feel inadequate.

About 40 minutes ago the program director called me. While seeing how I was doing, he told me that he had received a satisfactory evaluation from my first preceptor. I was told, after asking, that the nursery manager had said I handled the angry dad well and professionally. The program director told me that my preceptor had told him that it was the angriest and rudest patient they had ever seen, and the worst patient encounter they ever had. It really really really really would have meant alot and changed my feelings about quitting if anyone had told me those things at the time. Instead my preceptor chewed me out for not being right by her side when she marched angrily out of the buthole patients room. I followed her soon after she marched out, but I guess she expected me to be shoulder to shoulder with her. When it was done, I was sure I could not even walk by someone correctly.

Its a shame there really does not seem to be room for a bit of kindess in the methodology of residency training. People have been about as friendly as you can be to strangers, which is what I am to a program.People have been helpful and willing to teach. But everyone is very quick to tell you where you are inadequate, but if you do something well they might mention it to others but they never will tell you.

Seriously, I have put up with alot to do this - one person saying I did a good job at something would have relieved alot of pressure. Give some feeling of hope. That constant barrage communication of "you are no good" just reminds me too much of my childhood upbringing - and at my age, I just am not willing to put up with it. Those of you who can put up with it, and still retain heartfelt kindness to patients - my hat's off to you. Its more than I can do.

I expected it to be hard. But I guess I expected either a bit more encouraging atmosphere (or at least a blend of positive comments with the negative comments), or at least them to be funny when giving you the negative comments - like Dr.Cox on scrubs. This place is not too "malignant", nobody has cussed at me or called me names. But the general atmosphere of residency here is such that it seems nobody will tell you that you are doing okay, - and if you are a confident person you can handle that, and if you are not it sort of eats at your self confidence and your sef esteem. I am not - at least not anymore.

 

[radslooking]

If you really don't want to quit, I am sure you could talk your way back in.

 

[radslooking]

ok, you say that you are on a service of 2-6 patients, its very light, and so no senior. And you are getting OVER double that? Like 10+ patients...running across the street to the ER, seeing "skull fractures" in addition to all newborns etc.

10+ patients for an intern who started a week ago with no senior is malpractice. honestly

a nurse saying you came "only to get laid" is really weird

2 weeks of 12 hour orientation? Who the hell has that? That's nowhere near anything ive ever heard of.

It sounds like you're having a terrible time, and I understand that. But this is an odd story. I hope you find some resolution to all this.

 

[radslooking]

...

 

[futuredo32]

Doowai, it sounds like your PD didn't have any problems with your performance and it also sounds like you may be regretting your decision. Any chance that your PD would let you change your mind about quitting, if that's what you want to do?

Again, whatever you end up doing, I wish you well.

 

[Tired]

im a little confused at a few things...weight in an acute abdomen patient would be one of the last things i would be worrying about

Really? Because last I checked all fluids and meds were weight-based in Pediatrics. Weight is the very first thing you need on a kiddo, even before the history and physical.

 

[Doowai]

im a little confused at a few things...weight in an acute abdomen patient would be one of the last things i would be worrying about

When calculating meds and IV fluids it is required

 

[Doowai]

Doowai, it sounds like your PD didn't have any problems with your performance and it also sounds like you may be regretting your decision. Any chance that your PD would let you change your mind about quitting, if that's what you want to do?

Again, whatever you end up doing, I wish you well.

Thanks , man.

I was settled in my heart about it until he called. I ended up asking if I could come back and he said No.

 

[Shinken]

Doowai, it sounds like your PD didn't have any problems with your performance...

Actually, it almost sounds like damage control. Since Doowai quit suddenly after several bad episodes, it seems like the PD is trying to create some sort of paper trail of good evals and praise in case of a lawsuit.

Or, maybe I'm just paranoid about these kinds of things.

 

[futuredo32]

Actually, it almost sounds like damage control. Since Doowai quit suddenly after several bad episodes, it seems like the PD is trying to create some sort of paper trail of good evals and praise in case of a lawsuit.

Or, maybe I'm just paranoid about these kinds of things.

I'm just a student, so you could totally be correct. I would just think that if his performance had been that bad, he wouldn't have received a satisfactory evaluation and that steps would have been taken to improve his performance. Interns that I have worked with did make mistakes, so did residents, but they had a lot more supervision and support than it sounds like Doowai had.

Doowai, the path to becoming a doctor isn't easy for anyone, but it sounds like you had more struggles than the average student. I read your posts in the FP forum (particularly the business advice) and you're a smart guy. I don't have any advice on what the best next step is for your life, but I think that after having a little time to reflect on things and gather your thoughts, you'll come out of this just fine and you'll go on to have a happy and successful life.

 

[Doowai]

ok, you say that you are on a service of 2-6 patients, its very light, and so no senior. And you are getting OVER double that? Like 10+ patients...running across the street to the ER, seeing "skull fractures" in addition to all newborns etc.

10+ patients for an intern who started a week ago with no senior is malpractice. honestly

a nurse saying you came "only to get laid" is really weird

2 weeks of 12 hour orientation? Who the hell has that? That's nowhere near anything ive ever heard of.

It sounds like you're having a terrible time, and I understand that. But this is an odd story. I hope you find some resolution to all this.

Yeah I have had quite a few days of 15 patient census.

yeah we had 2 weeks of orientation-not all days were 12 hours, mostly just ACLS , PALS. However a friend of mine in New York who is in PMR said his ACLS training was like 4 hours. I don't know. We had 4 days alone of how to use the clinic EMR and hospital EMR. Some of the days of EMR training only went to 2 PM, so saying all 2 weeks (10 days) were 12 hours is an exaggeration, but some of the days were 12 hours.

Maybe one of the things that made the ACLS so long was how many new residents were taking it - 2 family practice programs like us, pediatrics, neurosurgery, internal medicine etc - all under the auspices of the same university. Each resident has to run a mega code, where they direct a team to perform CPR - direct compressions and respirations administering fluids and medications, delivering cardioversion etc.

The skull fracture had already been seen in the ER and admitted. The two patients I had to run over and work up in the ER were a patient with choleycystitis and a patient I really liked named Billy, that came in for nauseau and vomiting and an incidental EKG showed atrial fibrillation with occassional v tach (with pulses). Cardioverted (Cardizem) and admitted them.

 

[radslooking]

Really? Because last I checked all fluids and meds were weight-based in Pediatrics. Weight is the very first thing you need on a kiddo, even before the history and physical.

my bad. not a pedi doctor. thought you meant an adult. disregard my comment doowai.

 

[jdh71]

haha

"you're awesome"

"can I come back?"

"no"

wah, wah, waaaaaaaaaaahhhhhhhh

 

[Doowai]

haha

"you're awesome"

"can I come back?"

"no"

wah, wah, waaaaaaaaaaahhhhhhhh

Damn dude, that is awesome

 

[Doowai]

So I am going to apply for plain old jobs today. Truck drivers can make $50 grand.

Then if that sucks I wil go back to phoenix and either try to open a chiropractic/aupuncture service out of the pain management/ anesthesiologists office - we had spoken about this before and we are pretty good friends. or see about getting some sort of med tech job combining my chiropractic license (which allows me to examine, diagnose and draw blood) with ACLS, PALS, etc certifications.

Maybe reapply to ERAS again (laughter roars)