I'm sorry

I said that phrase a lot last night during evening patient hours.

With an overfilled schedule, I mostly said it to patients who waited twenty, thirty, even forty-five minutes for me to see them.  "I'm sorry for your wait.  I appreciate your patience."  I say these sentences far more often than I should. Why is it so difficult to stay on time?

I could blame my inadequate supply of nursing staff; our health system thinks that I only need one nurse to room, vaccinate, and phlebotomize my patients.  I could blame a convoluted rooming process and the occasional lack of available rooms.  I could even blame my patients, who somehow seem to show up early or late but rarely within their allotted appointment time.

But, mostly, I have to blame myself.  "Yes, I'll freeze your warts" even though there wasn't enough time for that when we also dealt with this patient's recent Emergency Room visit.  But I know that she can barely afford her co-pay and hated to ask her to return.

And I just couldn't seem to rush telling another patient that his nagging cough and recent "bronchitis" was probably a new asthma diagnosis.  Or telling the patient after him that her wet mount didn't show yeast, as she predicted, but sheets of white blood cells - which, along with the frank cervical discharge on exam, indicated a likely STD from her new partner.

I believe that these issues deserve time, but I still don't like inconveniencing the patients who come after.  "Can I put off that bloodwork until the next visit, doc?  I can't keep the babysitter waiting much longer."  What else could I say but "of course"?

The worst "I'm sorry," though, came with the last visit of the night.  Follow-up high blood pressure with an overweight teen.  While reviewing the labs from our first visit with her and her mother, I realized that the A1C I had ordered (given her weight, family history, and the acanthosis nigricans on her neck) was not there.

Correction: the A1C I thought I had ordered.  The order was not there.  And I would have to stick her again to get it.

"I'm sorry," I said yet again.  "Remember the test I ordered to check for diabetes?  Well, it looks like I forgot to enter it into the computer.  I'm very sorry that I made that mistake.  To get that test, we'll have to draw more blood from you."

"You mean from the elbow, like before?" she asked calmly.  When I nodded "yes," she said nonchalantly, "okay."

I was so grateful for her undeserved graciousness, as I was for my earlier patients who had shrugged off my apologies for my tardiness.

Thank you, my patients.  Thanks for accepting me, mistakes and lateness and all.

Beyond Match Day

I can distinctly recall many details from my own Match Day, now eight years ago.

I remember sitting in the big auditorium at Ohio State under a restless buzz of noise.  Most students had spouses, family, and close friends with them; my parents made the trip to be with me.  They brought me a bouquet of flowers, and I still remember the crinkly cellophane creasing under my sweaty palms.

I remember walking up to the edge of the stage with my peers and being herded alphabetically.  I headed to the middle of the rows of boxes and was handed a crisp, ivory envelope with a sticker that had my name on it.  We all marched back to our seats and waited the interminable minutes for the clock to strike noon, for the announcement stating we could legally open our envelopes.

I remember sliding my finger under the envelope flap with deliberate slowness.  Everything would change after I opened it; I had been a student my whole life, but a new label was about to define the rest of my life.  Three months later, I would graduate from medical school and take my shiny new MD off to this place listed in simple typeface on that perfectly creased slip of paper.

I thought I knew what was to come.  I had worked with a lot of residents and attendings in medical school, had laughed with and wept for many patients.  In these ways, medical school had prepared me well for the demands of residency.  But nothing had prepared me for the crushing responsibility of being the one signing the orders, giving the diagnoses, consoling the bereaved left behind by my failures.

The Singing Pen has been absent for nearly two weeks now while I've been inundated by clinical work.  On the worst day during that time, I rounded on 21 inpatients with the residents before going to the office for a full schedule that included calling a mental health crisis team for a patient having a psychotic break.  I finally drifted into a restless sleep that night thinking about my application essay for residency.  I couldn't concretely conceptualize, back then, just exactly what all of that "dedication" and "hard work" was going to entail.  And yet, even in the most grueling moments, those old noble ideals still call to me; eight years later, I still love what I do.

4th years, may you all be able to say the same come March 2019.