it's not a fun blog article

I was inspired to write after having visited my friend Sarah's blog site. I find I have so little time to email, no matter what my good intentions are to spend 1 hour emailing a week, and her blog is a good way for me to see what is going on in her life. My residency director encouraged us to try to keep a journal during our first year, because we will have gone through so many new and powerful experiences that would be good for us to remember; so here's my attempt to kill two birds with one stone. Now warning: I try not to get too sermony on these blogs, as who wants to read all these deep thoughts about my struggles with my faith? Yet, I am finding more and more that it is impossible to separate how I'm struggling with my intern year from my faith, because without it, I think I would be a quivering, wailing mess. So sorry if this is a long discourse on my spiritual struggle!

I have just finished my outpatient rotation, which was exhausting. I was expecting it to be an easier rotation, as I technically had normal office hours and had the weekends off (two days in a row, wow!). But, I was rarely done before 7-8PM and outpatient is...frustrating. One of my preceptors told me my only real criticism was that perhaps I was coming off as cynical to my attendings, and I was surprised to hear her say that because I've talked plenty with the other residents and I'm not any more or less cynical than they are. But on reflection, I can see why she would have said that. We are an underserved clinic. We help people mostly without insurance. Most of my patients are very sick, disabled, former drug users, current drug users, homeless, formerly homeless, don't speak English, don't have high school education, have a psychiatric illness, etc. Not all, but most. And you would never, ever believe how hard it is to get one single thing for them. For every medication I want to give them, if I don't have samples, I have to send in what feels like 10 forms and referrals, and I still often get denied. If I can get my diabetic patient insulin free, well, I still have to figure out how he's going to get syringes, glucometer, strips for the glucometer, transportation to come visit me every two weeks to figure out how much insulin he should get, etc. I have a patient who needs a simple anti-fungal powder, as the cream she is using doesn't keep her rash dry and a powder would help to keep the area dry. Simple enough, you say? Wrong. Apparently, medicare doesn't cover that. It's a cosmetic thing, they say, this rash. Even though it's red, scaly, itchy, hasn't gone away in years, and makes it hard for her to wear anything around her waist, it's cosmetic. So either I have to go to a hearing and tell some sort of arbitrator from the insurance company why I think she needs it medically, or she has to pay out of pocket. I'm told I should be grateful, that medicare pays for my salary. Why should I be grateful to be in a system where the poorest are left behind, and the rich can get whatever they want? Why should I be grateful that they pay me to fill out their paperwork for hours and then deny me anyway?

So yes, I am getting bitter. But I'm trying not to. Yes, it's a flawed system; yes, I need to do something to help change it, and not just complain. I don't want to forget this anger. I don't want to say, "well, I can't do anything about it, let me just learn to be realistic, work within the system, do what I can, and beTo help them best, I need to know how to work the system best, and in the most cheerful way possible, for my own mental health. But at the same time, it's NOT ok. It's NOT ok that some people have to fight for anything they can get their hands on and others can have anything they want. But I understand that to be sane, and practical, and wise, I need to learn to do both, work within the system, and change it, and do them both with a cool head. So I'm trying to learn.

It's so hard. I came to medicine for one reason, and one reason alone: because I felt this was the way God wanted me to love people as Jesus did, through medicine. That is my goal. I can't cure people; no one can, but God. But I can help them, and love them, and let them know that there's someone out there who has at least a tiny bit of their well being in mind. And it frustrates me so much, to feel so helpless and incompetent and useless. I want to be this well of knowledge for them, a place where they feel they can get help. I want to have resources for them and help them with not just their cholesterol but also to be there when they're about to run out of housing or their daughter ran away or they can't get food. I want to know everything I can to help them, and I know so little. Both book knowledge, and practical knowledge. I know I'm learning book wise. I feel like I'm failing when I try to find someone to help them with housing and food and cough syrup---there just aren't enough resources to help all those who don't have enough money or family support. But in both aspects, the more I know, the more I realize I don't know! It's impossible to keep up with all the new meds; all the questions your patients will ask you, all crazy medical conditions out there. I know a lot of it is experience. But boy do I want it now!

When it comes to my atittude towards my patients, I think I'm doing ok. I think my patients like me. I have had a few patients tell me that they feel I've tried to do more for them than any doctor in many years. One man told me he spent most of his life feeling unloved, until he started going to the church he's been going to for a few years, and now I make him feel like he has a doctor who loves him too. This was a success, I told myself. Because I know that medically, I haven't really done much for him. He has such bad medical conditions he's trying to sell his house of many years because he can't take care of it, and nothing I do is making any difference. Yet, he thanked me for caring for him anyway. And it's those moments that remind me what I'm doing all this for. It's those moments in which God reminds me that He doesn't care how smart I am or how many people's blood pressures I get under control. I know my love is a shadow of His, but it's enough.

And of course it's not always easy to love all your patients. There, I struggle with cynicism again. It's hard to love the self-destructive patient, the one who continues to use heroin even though it means they come in over and over again for detox or fights or because it makes their other medical conditions act up. It's hard to love them when I spend a lot of time trying to get them medicines they say they can't afford, yet they have enough money to buy heroin. It's hard not to feel used, and not to feel like it's all futile, why even bother? But God loved the prostitutes and tax-payers and reached out to them first; so, so will I, and try to have a good attitude about it.

Finally, it's hard to know how to grow and learn from all this. If I don't know a particular medical condition or how to treat it, I can look that up and read about it. But what do I do when I want to know how to make sense of all the emotions being an intern brings? How do I learn to deal with my feelings of incompetence and worthlessness, and sometimes sheer terror, that I might kill someone in my ignorance? How do I heal my own emotional and spiritual hurts from this process, and figure out what I was supposed to learn from it all? Some days, I get through the day with a smile on my face and an air of confidence that I know is fake, and wonder no one figured it out. Maybe they did, but kindly didn't say anything. But those days, I get into my car at night and cry all the way home. Not often, but sometimes. And then I remember that all I need to do is lay it before God. Because truly, we look for all kinds of ways to heal ourselves and talk about things and group therapy, etc, etc, etc, but really, God can carry all my hurts and teach me all things. He wants to take them from me, but I have to remember to give it to Him! And when you're tired and just want to sleep, it's hard to get the energy to do so. But I'm trying to remember that it's like jogging for me. I often don't feel like jogging when I get home; I'm tired, it's dark and rainy, I just want to eat dinner and lay on the couch. But when I do go, I love it. It invigorates me, it give me energy for the rest of the evening, and my body feels so much healthier later. And so my spirit is too. I may be weary and don't want to do it, but once I do, it's amazing how refreshed I feel, how comforted, to know that God can take it all, and make something beautiful of it in my life too. And week after week, I run the same circle, forgetting to trust Him, struggling to remember God and take the time to seek Him out; but He is patient and faitful and helps me anyway.