Bad Days

Today was one of those days when nothing seems to go your way. I woke up at the ungodly hour of 3:27AM, rolled around in bed for another hour or so, and forced myself to get up and work on a presentation I was giving at noon. Naturally, I had neglected it to the best of my ability this past weekend and past few days. I scrambled to put together a PowerPoint on a poorly-selected, ridiculously broad topic (infectious disease in pregnancy) and managed to cover about 30% of the material I wanted to cover. Utterly dissatisfied with the bare-bones presentation that was my final product, I trudged my way to work, not at all looking forward to the slew of patients we would see in clinic throughout the day.

This is my first week in the clinic, and I've been struggling more than I have in any other rotation this whole year. Working in any clinic always involves a bit of a learning curve and is usually somewhat awkward the first day. However, by the second day, most people get a feel for what is expected/required by the preceptor and become more comfortable with the patients they see. I felt like this was the case by the end of yesterday, after a morning of pre-natal visits (which are uncomplicated routine check-ups) and a hectic afternoon/evening at the local Planned Parenthood clinic.

I started the morning somewhat anxious about my presentation, but relatively certain I would fare comfortably with my patient encounters and teachings with my preceptor. I was in for a rude awakening. Perhaps yesterday was a busier day with less time for focused teaching (hence less questions asked), perhaps the patients were easier to discuss yesterday, or perhaps I was just off my game/out of my element today. The answer, as always, probably involves a little bit of all three of these possibilities.

I saw patient after patient this morning, and yet I repeatedly failed to look up certain pieces of information, failed to ask certain questions, failed to perform certain physical exam maneuvers, or failed to answer my preceptor's questions appropriately. Unfortunately, this preceptor isn't the type of teacher who holds your hand as he walks you through the learning process. He expects you to know what you're doing and will criticize you mercilessly and emotionlessly if you miss even the slightest detail. On the positive side, he appears to be fairly objective and his comments are difficult to take personally. Still, by the end of the morning, I felt like he transitioned from being frustrated with my shortcomings to no longer interested in me as a student. I felt like he had given up on me - and to be perfectly honest, I couldn't blame him.

The noon presentation went better than I expected, all things considered, although it was certainly shorter than I was originally planning. Again, I got the impression that my preceptor was completely disengaged, especially given the fact that he did not comment on the presentation at all - not one word. Ordinarily, I wouldn't find this surprising, given his personality. However, he has been in the habit of at least saying a few sentences following other students' presentations and usually offering a somewhat sincere "good job."

In the afternoon, I worked with him for another hour or so and continued to demonstrate my ineptitude in various ways. My Spanish would not flow, I would botch the order of different parts of the exam, and at one point, even when I was seeing a patient by myself, I found myself completely blanking on what questions to ask for the most basic of medical student tasks: taking a history. My confidence was shot. At this point, another attending doctor (who had most likely been witnessing my failures throughout the day) took me under his wing and saw several patients with me, asking less questions, cracking more jokes, and teaching with minimal criticism. I slowly began to relax a little at this point.

Of all the times during third year I had expected to freeze up and fall apart under pressure, OB/GYN was not at the top of the list, although in hindsight, I guess it isn't too surprising. Today was like a self-perpetuating downward spiral that I could not control. I thought, having done surgery already, I was perfectly capable of maintaining my cool during stressful situations; if there's one thing I learned after today, it is that I was sorely mistaken. Granted, there were a lot of predisposing factors in the environment that probably exacerbated the situation. 1. The preceptor himself. 2. The general awkwardness of breast/pelvic exams. 3. My sleep-deprived and already-anxious state (due to presentation).

There are several lessons to be learned from a day like today. First and foremost, it is important to understand the value of holding on to your confidence and maintaining your composure when faced with a difficult situation. This preceptor may have been the first doctor to challenge me in this way, but I'm sure he will not be the last, given the many years of training I have yet to complete. Second, it is equally important to realize that you will always have bad days. But in the end, that is all it is: one bad day. The only way to move on is to look at the bigger picture, pick yourself up off the ground, and try harder next time.

I went to Barnes after work for a few hours in an attempt to decompress and relax. I pulled out a crossword (New York Times) I had started yesterday and found, to my surprise, that I was able to fill in most of the boxes. Ordinarily, a Tuesday crossword is well within my ability to complete. Yesterday, to my frustration, I found myself stuck after only a few clues. It only took one day and a fresh new setting for me to come up with the answers to other clues, which eventually led me to solve most of the puzzle. Yesterday was a bad day...

...and tomorrow is a new day.