Knowing When You Don’t Know – Heme/Onc

note: this post was meant to be published on July 30th

To say that there’s a steep learning curve for Hematology/Oncology is an understatement. As a resident fresh out of the box, I don’t think I could have imagined a more challenging or intimidating service for my first month as a doctor. At the end of the first week, I had a nervous breakdown and cried myself to sleep. I’d never felt more out of my depth in my life.

Although I never carried more than 8 patients at a time (and that was only when I was covering on the weekend; usually it was more like 3 or 4), any given one of them had enough problems (and enough medications) for several patients on the regular inpatient service. I learned how to write fairly decent systems-based progress notes because most of my patients had medical issues in at least 4 systems. I got more comfortable than I ever thought I would ordering and prescribing narcotic pain medications. I even got a first-hand experience with septic shock, which unfolded practically before my eyes one afternoon when I was the only physician on the floor. The most difficult thing I had to do was something I had to do every day, from the moment I started. It wasn’t easy for me to go from med student mode, where the predominant thought process is ‘if I were the doctor, what would I do?’ to resident mode, where the thought process is now ‘I am the doctor. What do I want to do?.’ In addition to this uncertainty in my new role, I struggled (and continue to struggle) with an almost debilitating amount of self-doubt. There’s a voice that is constantly telling me that I have no idea what I’m doing, I don’t know nearly as much as I should and everyone knows how terrible I am. The effort required to ignore that voice while I tried to actually manage my patients would exhaust Hercules.

At the end of my third week in Heme/Onc, I had my attending evaluation and I was so anxious about it that I dreamt that Dr. F, an attending known for his stoicism, was garrulous with all the scorn he had to heap upon me. I gave myself a headache worrying about the eval but when it actually happened, the attending didn’t say anything I didn’t already know but what he did say turned out to be exactly what I needed to hear. He said that he could sense a timidness about me and that he could tell that it was due to a lack of confidence. After reminding me why I’d been chosen for my program (because I deserved to be, apparently) and assuring me that I was doing good work, he advised me to be more confident, in my comportment and my assessments. A few days later, the senior resident on service gave me some more encouraging feedback: he assured me that my knowledge base wasn’t as dreadfully deficient as I’d feared, but was on par with what was expected for a resident at my level. He cautioned me to be more mindful of time management but said that it was normal to feel like I didn’t know what I was doing and that feeling that way was actually a good thing because it would make me more careful and less likely to cockily do something foolish. He shared that he’d often felt that way as an intern and even as a 3rd year had plenty of instances in which he wasn’t quite sure what to do. “You never know everything; even attendings will tell you that. Knowing when you don’t know is good, because then at least you’ll look things up and learn. Thinking you know everything is dangerous.”

One of the nicest moments I had during the Heme/Onc block was on one of those Friday afternoons when the unit was mine to patrol and all the patients were under my care. There was a little girl who’d been admitted for neutropenic fever. Her dad needed to run out to take care of his other children and he asked if someone could check in on her while he was gone. I stopped by her room and found her playing with a bunch of identical Strawberry Shortcake dolls. “Want to play,” she asked me, so I spent 20 mins as a customer while the Strawberry Shortcakes served me pretend ice cream. When I was called out to attend to another patient, I accidentally sprayed hand-sanitizing foam all over my face and the girl erupted in giggles and said “You’re silly.” When I shared this anecdote with the resident who usually managed this patient, he said “Really? I can’t even get her to talk to me.” So even if I don’t know what I’m doing, at least I can get patients to smile.

Next up: NICU (又は、運命)

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4 Comments on “Knowing When You Don’t Know – Heme/Onc”

  1. Bob Says:

    Hey evilangelfish,

    I recently stumbled upon your wonderful blog, and I’m slated to start Ross in September 2012. If it isn’t too much trouble, would it be possible if you still have them to post/send any helpful files for any of the Minis or PBL or notes to scared first sem student?

    • evilangelfish Says:

      Hi Bob, thanks for stopping by to read! Unfortunately, I left most of my med school study notes/guides back home when I moved for residency. However, those old notes would be practically useless to you because it seems that while the basic curriculum is the same, the lectures and minis are constantly changing/evolving. My suggestion is to join some clubs once you get to the island and befriend 2nd, 3rd and 4th semester students – they will have information of much greater use to you than notes from ’08-’09. Also, on the network G Drive (if that’s still what it’s called), you can find old PACE quizzes that are good for practicing MCQs. I wish you all the best in first semester – it seems scary at the outset but with some determination and diligence, you’ll make it through!

      • Bob Says:

        Hi Evilangel,

        Thanks for the reply. How important is it to spend time in the anatomy lab in first semester? If you were in the Pace program, did it give you any advantage in quiz/minis?
        You should update more often, I’d be thrilled to continue to read about your medical journey
        Thanks again

      • evilangelfish Says:

        Hi Bob,
        it’s VERY important to spend time in the anatomy lab in first and second semesters. I can’t express how beneficial it is to be in the lab and study not just your own cadaver, but all the cadavers you can. Get familiar with those bodies! As far as PACE, I’ve heard differing opinions; the general consensus seems to be that there is maybe a slight advantage, but keep in mind that old PACE materials may be available to you for practice, even if you’re not in the PACE program. I hope I’ve answered your questions well.


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