Day 1: Shifting Dullness
A series of essays from Round and Round We Go, an anthology of thoughts and reflections during patient rounds.
The start of the month is always challenging. For doctors-in-training, it often means the beginning of a new rotation. Rotation, again, is one of those words that mean something else in the English language, and then puts on a new costume in the medical field. A rotation means a new assigned area to work in. It differs per hospital and subspecialty, but it means you move from one set of job descriptions to another. In January, you handle several patients in the ward; in February you meet a new set of patients in the emergency room. It’s meant to expose the trainee to as many areas and patients as possible, because, as with most careers, experience is always the superior teacher.
Changing work areas, shifts, and patient loads requires quite the transition. It’s your first day of work over and over again. The first few days take some getting used to before you find a comfortable rhythm again. We like to call it “shifting dullness” - an actual medical term and clinical finding, but what we jokingly use to describe ourselves during this weird transition period: dull.
Such was my predicament on today’s first day of the month. I’ve been handed a list of patients, their diagnoses, and their medical treatment, but it’s always too much to absorb. My colleague J did her best to hand over the patients as smoothly as possible, but these details go right over my head when taken all at once.
When I start rounds, I try to be as welcoming as possible. It’s my first day, and my one chance to make a good first impression. I knock on the door, greet them, introduce myself, and shake their hand. I tell them that I’m the new doctor assigned to them and will take care of their diabetes for the rest of the month. Some patients, I find, already expect this to happen. I have a patient who, on the last day of the month, really opened morning rounds with, “Doc, isn’t it your last day for rounds?”
There will be, of course, bloopers. Names are particularly challenging. No matter how often I refer to the list, I still call the patient by the wrong name. I call someone Randy when it should have been Ramil, or I call the wife Mrs. Daisy instead of Mrs. Rose. And even when I get it right the first time, you can bet I’ll be scrambling for the right name again tomorrow. Plus, you have yet to get used to the hospital floor maze. Today, I expected to meet Mr. C, a 40-year-old man with diabetes, but instead, I found Mrs. A., a 78-year-old grandmother gasping for air, clearly not looking at all like Mr. C.
The worst part is that I feel like an intruder. Some of these patients have been here for weeks and months, and then this little newbie walks in claiming to take care of everything. And I’m afraid that it shows. It’s not just names and faces I mix up, it’s the symptoms, too. And since it’s my first day, I admit that I haven’t got the treatment plan down pat just yet, and I panic when they ask questions I don’t know how to answer. Most likely, I’ll answer in broad strokes, something like “We’ll have to review the case,” “We will continue to monitor your symptoms,” or the noncontributory “We’re doing the best we can.” I infuse as much confidence as possible because I worry about sounding too uncertain. I will get the answers to their questions, and I usually am better at explaining treatment plans and outcomes, just not today. Not on the first day.
I fear that patients and their families can see through me as if I’m being judged as a doctor who knows nothing. I’m worried about sounding unsure. I worry that someone would read my uncertainty as incompetence and insincerity. I feel Impostor Syndrome every day, but it becomes more alarming with each new first day. I’m afraid that someone will one day call me out for it – that I don’t know what I’m doing, and I’m just faking my way through it.
But isn’t that what we’re all doing? Faking our way through it? Through life, through sickness, through love, or pain. It’s all about finding our rhythm again. No one ever becomes an expert on the first day, and even the true experts realize there is still so much yet to be known. New beginnings are meant to refresh your body, declutter your mind, and reenergize your spirit. The discomfort allows us to examine and interrogate with fresh eyes. It can be uncomfortable, but we have to start somewhere, right?
*Names and details have been changed to protect anonymity.
