Update: Trial by Fire

I don't know if everyone feels this way, and maybe its because I am the person who is choosing ER as a career, but I find challenge enticing. Not just enticing, but thrilling and desirable.
So when the program I interviewed at recently, told me they have all of the qualities below, I found myself undeniably attracted....

1- 110,000 inner city patients.  This does not feel like a program with a 'large patient volume' its more like a 50 bed clinic in the middle of Africa. They are SWAMPED. Patients actually wait DAYS in the waiting room. Most ERs have a patient per room and sometimes in the hall by the wall, all neat and organized. But they actually have minimum of 2 patients per room and patients in the middle of the hallway, at the nurses station, at the entry, they even converted the staff locker room into a pelvic room. There literally is NO space there isn't a patient.

2- Underfunded & Unionized nurses. This doesn't just mean that there aren't as many resources or staff. It actually means that once the hospital hires a nurse, they cannot fire them, for any reason. So they cut their costs nad their staff. The ER has on any 1 shift, a total of 5, yep as in # of fingers on your hand, nurses for this HUGE ER.  For residents, this means that they put in their own IVs, draw their own blood and urine labs, transport the patients to and from radiology, and if needed transfer them to the floor upstairs for admission.  The nurses give medications, unless its needed stat. If you want anything done fast you have to do it yourself. There are a few techs that do EKGs, but for the most part you learn to be a doctor and a nurse or as some people call it: self sufficient.

3- $$$.  This is located in an incredibly expensive city. I don't think its giving anything away to say its in New York.  And to pay for rent, parking, and food is just ridiculous!  Plus working all crazy hours is not condusive to public transport. Espeically for unsafe areas of the city, alone, in scrubs. I'm actually worried I wouldn't be able to afford rent much less all the cool things I could do in New York.


However, with all these patients and this huge workload-- there isn't much time left over for teaching.  All the residents I talked to said it was literally a 'trial by fire' residency.  Where they were put in multiple situations that they had no idea what to do next and nobody to ask questions to.  Several residents say they spend the whole peds shift with a nurse and no attending.  It was crazy!

But secretly, I love this idea.... I WANT to know if I will have what it takes to undergo a trial by fire. I WANT to be so overwhelmed and overworked that I have no other choice but to learn to be a kick ass doctor. I WANT the confidence to know I could walk into any situation, and when I don't have any idea of what is going on, I still can succeed.  This is the ESSENCE of what ER represents. And... working and training at this place would have the potential to be exactly what I want.  It would be the crazy dramatic medical drama that you see on TV.

Of course, that also means that in reality world, it could also be horrid. Often the drama in the shows we watch is not the norm. And overcoming ALL odds is rare and freakin exhausting. I am about average intelligence-- do I have what it takes to get no feedback, no real teaching, and after a hard overworked day still go home to study to save the patients I may encounter tomorrow??

I honestly don't know. And that is what makes me hesitate. To take on this challenge and fail, would be a disaster. Not only would my confidence be shot, my cynacism be maximized, but my skills as a physcian might not improve. I might actually learn to hate medicine, which is a big risk.  Too big maybe?