Unintentional Wisdom from an Existential Pager

 “You will be” was the message my pager showed me every morning when I walked over the threshold of the hospital.  While it was in reality alerting me that “You will be… covering the renal team senior pager,” the abbreviated preview that showed up on the screen has given me a lot more to think about over the years. 

Perhaps it was the lack of sleep, but what was my pager trying to tell me? 

Was it imbuing my existence with meaning, reminding me that my identity and profession were no longer separate?  Was it promising me something, that while I was not yet, I would eventually be?  According to my pager, did I not exist when I was not at work?  Maybe Descartes was wrong, maybe it is a pager that tells you when you are, not the act of thinking.  Or perhaps it was just giving me a pep-talk, reminding me that when I came to work, I was a physician.  

I like to think that it is the latter, because while being a physician is hard, becoming one is even harder. 

The transition from the last day of medical school to the first day of intern year comes with no change in knowledge and a radical increase in responsibility.  Residents often feel as though they’re solely responsible for the answer to the seemingly innocuous yet loaded question of “hey doc, what’s going on with me?”  I remember standing in a patient’s room on that first day, cloaked in my newly extended white coat as if it were a shield against the glare of suspicious patients questioning my doctorhood. It felt like the nightmare I used to have in college, attending class for the first time only to find out it is the final exam.   After years of learning, I expected to be prepared for this seminal moment, but I was not.  This unprepared feeling comes from years of being taught to take a test; it teaches the medical-student-turned-resident to think that there is always a correct answer and they are alone when making decisions. 

The disconnect between how we were taught to think in medical school and the ambiguous reality of patient care contributes to the imposter syndrome that nearly all residents suffer.  Personally, I have felt my imposter syndrome wane through residency not because I have learned more, as that has tended to underline how little I truly know, but because I have grown more accustomed to not knowing.  I am used to there not being a clear answer in all cases. I now put more importance on asking the question rather than knowing the answer. 

Just don’t trust it when it tells you that you are no longer

It takes time to get used to a new environment, and it takes effort to not feel defeated when you are confronted with a question you cannot answer.  But being a physician no longer means that you must know everything because that is impossible in modern medicine.  Being a physician means putting patient care before your ego, asking questions that may not have been asked before, and learning when you do not know.   

These are all things that can be done on day one of residency. 

So, trust your pager.  For the millennials who trust in technology more than their mothers, think of the pager as a kind of Google Maps for the professional soul, it is there to remind you that when you enter the hospital, you will be a physician.