Usually I associate the phrase "Another year older" with birthdays. In this case though, it came to mind during this past Fourth of July, and not necessarily because it was America's birthday.
Let me back up a bit. The entire month of June was taken up by residency orientation. Most residencies don't start orientation until mid-June, but my Air Force connection required two extra weeks of military-specific sessions (mostly used to establish military payroll and health insurance...very important...). This was followed by two weeks of orientation through the civilian program where I will be doing most of my work. [Because it's a common question, I'll explain what it means for me to be a "military resident." For all intents and purposes, I'm the same as the civilian residents in the Wright State University psychiatry department. I go through the same rotations at the same locations. In fact, everybody in the program works at some point at Wright Patterson Air Force Base. The only difference is I signed a contract with the Air Force, not Wright State University, and therefore receive my salary and benefits through the military.]
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[In keeping with the trend of my medical friends posting pictures of their shiny new residency ID cards, here's the sign I had to hold up for my resident photo directory mug shot.]
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But enough with the boring bureaucratic info. The point of that tangent was to say that June was all orientation, and my first day of work as a physician was July 3. Because I'm working at the VA inpatient psychiatry unit, this first day of work was promptly followed by a day off to celebrate the federal holiday of Independence Day. (God Bless America, and God Bless the VA Spa.) This gave me the opportunity to watch fireworks with my co-intern, Gib, at the local park. As we were watching the display, it occurred to me that exactly one year ago, I had arrived in Dayton to start the first of two away rotations at the Air Force psychiatry programs (one at Wright Patt and the other at Lackland AFB in San Antonio, Texas). In fact, I went back into my blog archives and pulled out the post I wrote at that time: http://lukeli.posterous.com/that-lovin-feeling
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[Reposting the photo of fireworks from July 4th, 2011, taken with my iPhone 3G]
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[Now upgraded to video of fireworks from July 4th, 2012, taken with my iPhone 4S]
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Rereading that post helped me remember the excitement I had as an M4 taking the first step toward becoming a psychiatry resident. This is in contrast to my first week as an intern, which I guess was an understandable whirlwind of adjustment. At times, I felt like I was at a loss for how to formulate plans on my patients, almost as if I were simply grabbing onto my attending's coat tails and hanging on while he explained what we were going to do for the day. (This is slightly hyperbolic because we don't wear white coats on inpatient psychiatry.)
However, I think the second week of work was a great improvement. Part of the change is simply decreased patient load. (At one point, our census was 22 patients out of a max 25. I think I was carrying 5 or 6 patients on my second day of work.) The other part was drawing on my training from Michigan. It helped that I was familiar with the VA computer system from my time in Ann Arbor, but more than the technology though, I started remembering the habits I had formed during medical school. I've come to realize that looking up literature and practice guidelines has become second nature to me, which reassures me that, yes, I do "know what I am doing." I also took comfort in the little teaching moments I've had with the M3 on my team. As interns we work with medical students, which brings back memories of another post I wrote last year: http://lukeli.posterous.com/med-school-360 (a post where, interestingly enough, I also said "I knew what I was doing"). Helping the medical student calculate the QTc interval on a patient's EKG prior to starting an antipsychotic (turns out, psychiatrists are still expected to know a bit of medicine) was a satisfying reminder that I can do work and still teach at the same time. Perhaps that's the Michigan Difference.
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[Tattoo #2 on my left shoulder blade, to commemorate my Michigan training. It's the Rod of Asclepius, the symbol of medicine, with a head of the snake sporting the winged helmet design as a subtle tribute to the University of Michigan. Designed and inked by Carrie Hoekstra of Temple Tattoo in Holland, Michigan.]
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All of this is to say that the transition to residency is going as well as can be expected so far. I might just make it out the other end, a few years older and (with a bit of luck) a few years wiser.