I’m drawing a blank. In these instances, I have learned, the optimal solution is to post something you’ve written in the past. I wrote this in the beginning of my second year of residency. Looking back I realize it’s kind of immature, but, right on the money!
Tomorrow, 7 am sharp, I embark on a new journey. I will be head of the team. This team will encompase one Attending, one Resident (that is I), two Interns (first year residents), one Sub-Intern/ fourth year med-student (from here on the “Sub-I”), and two third year med-students (a.k.a. “Students”).
To serve the readership yet unfamiliar with the medical hierarchy that governs today’s fine medical establishments I will now take the time to explain this stepladder of ass-slurpers. The understanding of this is essential for our future relationship and so if you have any questions feel free to ask.
I will comprise the list to range from least kissed ass to practically dripping. Remember, each member of the team has a primary goal, a secondary goal (if applicable), friends and enemies. It is long; I am sorry for this, but essential for the upcoming month. Let us begin:
1- The Students/ Third Year Med-School
Primary goal: To impress Attending and Resident with knowledge we were sure they never had. Secondary goals: To cloud a simple clinical scenario by suggesting that the patient has as many extremely rare diseases as possible, to name a disease the Resident hasn’t heard of and to send out for as many of the most expensive blood tests we have as the Resident allows. The sub-I is their best friend as he is closer to the resident and is always up to date on their performance thus far. Enemy: Interestingly enough, they are each other’s enemy as they are always being judged comparatively to each other. This undercurrent of hate is masked very well and only a thorough Freudian understanding of the subconscious can uncover it.
2- The Sub-I
Primary goal: Impress attending, Sub-I’s need recommendation letters for the residency match so they too can be taken advantage of by residency programs and government. Secondary goal: Discharge patients, less patients mean less work and try not to sound like Student by naming any rare disease.
The Sub-I’s friends are the Intern and the Resident, possibly third year but only if they agree to do his blood draws. Enemy: Patients with extremely rare diseases (makes Sub-I extremely uncomfortable as he now has to sound like Student).
Primary goal: Discharge patients. Intern will do or say anything to achieve this goal as he/she is usually overworked and would love to have one less family and upcoming tragedy to deal with. Secondary goal: Anything that ends in less patients (I cannot stress this enough).
Their friends are the other interns, amazing bonus point if able to really swing Resident to their “point of view” (often wrong!). Enemies: Patients!!!!
4- Resident (my new position)
Primary goal: To impress Attending and Chief of Medicine while also keeping Intern happy, motivated and feeling that Resident is truly on his side. Secondary goal: Constantly remember that Interns LIE! Again, they do anything to get patients out and Resident must continually double check Intern behind Intern’s back as INTERNS LIE! Friends: The Attending and other Residents. Enemies: Everyone on a certain level: as Interns LIE, Sub-I wants information primarily for Student, Student wants to name rare disease and make Resident look bad. To counteract Student, Resident must immediately say “I don’t know that but why don’t you give us a presentation on this tomorrow morning” (Gotcha Ya Bastard!).
5- Attending Doctor
Primary goal: Come for 2 hours in morning, teach, and leave as fast as possible, keep name out of chart so no one knows who to sue later. No Secondary goal. Friend: All. Enemy: No one. Remain completely oblivious to the ass smooching going on a round you. Wipe ass off after morning round.
6- Chief of Medicine
Primary Goal: Teach and run Medicine Department. Secondary goal: Absorb all ass-kissing, taking it all in as one continuous lick that lasts for many years. Secondary goal: Try to remain seemingly very humble, once in while give a lecture which makes every resident in the room feel like he knows absolutely nothing/ give up his medical license and go back to medical school.
This is the system within which we all operate. If there are any questions please feel free to ask. Tomorrow, I will do my best to avoid all questions and appease Intern to join my view of things. This will be my greatest chess match yet.