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WINDING THROUGH THE LAST MONTHS OF RESIDENCY

Every journey begins with small steps. As I enter this last leg of my residency, it is only now that I can look back at how far I have come. Whether it's surviving my own in-house call nights or guiding someone else through theirs, every year of residency has brought its own new challenges.

I begin my fourth training year as Senior Resident with mixed feelings. I feel a sense of comfort, because I have a few extra months as resident, but I feel angst, too, because my new title brings tremendous responsibility.

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Dr. Viveca Bhat: “I thought the comfort of my familiar abode would make home-call a laid-back and desirable experience after the past three years of working hard in the hospital. Little did I know that my new journey had more twists awaiting me.”

I am only slightly envious of medical and pediatric colleagues who started training with me. They are now rolling the words “fellow” or “attending” on their tongues and savoring the taste. I, on the other hand, feel as though I am crouching behind the title of “resident” for one extra year, despite feeling ready to move on to the next stage of my career.

FROM THE ER TO ‘HOME CALL’

Only a few weeks ago, I completed my last in-house call. I felt like I had completed one of the most daunting feats of my training. Gone were the days of stiff mattresses, freezing cold call rooms, and serving the whims of the Emergency Room and the night nurses.

Now I would be taking “home call” – staying at home but being readily available at any moment to answer questions, giving advice, and going to the hospital as needed. I thought the comfort of my familiar abode would make home-call a laid-back and desirable experience after the past three years of working hard in the hospital. Little did I know that my new journey had more twists awaiting me.

The ever-present pager on my right hip serves as a firm reminder. It binds me like a small torture device – a weightless but invisible rope that ties me to the hospital at all times. I have a little radius around my house and the hospital, which are now “safe zones,” where I can get to the hospital quickly if an emergency arises. Being available at all times means that even showers aren't sacred anymore – nope, my little pager buddy sits on the counter, warning me to “hurry up – just in case.”

Home-call also means I have had to learn to trust: to trust that the history and neurological exam taken by someone else – perhaps by an intern who was once just as overwhelmed as I once was starting out – will be reliable enough to guide my own management and treatment decisions. Trusting someone else is sometimes scary, especially in a field like neurology, in which the accuracy of the history and exam seem to correlate well with the examiner's experience and knowledge to ask and look for certain signs and symptoms.

LESSONS LEARNED

Truthfully, it took me a long time to feel comfortable with my own exam. Our patients can be complex, unpredictable, and they are often very ill. This has taught me the importance of sometimes erring on the side of caution, rather than taking unnecessary chances.

I know, however, that I am not alone. As a resident and on my voyage, I have backup if I need it. There is an attending physician always along for the ride – available by pager and always willing to help, and this is reassuring.

I took the first step several years ago, and it has taken me to a new and unique place. I feel a sense of pride in my training as a neurologist. The reward at the end of this journey may seem like just a simple graduation ceremony. But after that? I am confident that a career in neurology will bring me a lifetime of challenges – certainly enough to fill a series entitled “Life as a Neurologist.”

In September 2004, Viveca Bhat, MD, shared her impressions of life as a first-year neurology resident at the University of Maryland Medical Center in Baltimore (“Reality Bites – A Resident's First Night on Call,” page 8). As she enters her last year of residency, she shares what she has learned since then.