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My son is an extroverted feeler.

I started a family practice residency when he was six months old. He decided to stop nursing. Perhaps he sensed that I was worrying about it. I wondered if the milk tasted sour under stress. I was sad and relieved.

When he turned two we practiced two word sentences. It became a game. We were getting ready to do a rural rotation where we would be away from our house for 10 weeks, over Christmas, and living in a double wide trailer for those 10 weeks. I tried to explain that our pink house and his toys would still be there when we got back and that he could take some toys but we were limited by the size of the car.

We were playing our two word game.
"Where does (his name) live?"
"Pink house!" he said with delight.
"Where does daddy live?"
"Pink house!"
"Where does mama live?"
"Hospital!"

Mom about had a cow. "Mama doesn't live at the hospital. She lives in the pink house too. But I am at the hospital a lot. I can see why you would think that. I don't want to be at the hospital so much."

Logical child. Every time he asked daddy, "Where mama?" the reply was hospital. Gosh, sure as hell seems like she lives there.
I went and yelled at my residency director. I didn't yell, I just said that it really sucked and that I often really genuinely hated the system. He was used to me by then, and said, "Uh-huh."

I accidentally got revenge in my third year. Or, to phrase it more diplomatically, I had the opportunity to bring the topic up with the faculty.

As third year senior residents we helped interview and voted on interviewees for the next year's class. We interviewed a very nice medical student, very bright, who was a single mom.
We voted. I voted against her.
A faculty member questioned me. "Why would you vote against her? I thought you would be supportive of a medical student with children."
I replied, "Oh, because she asked if this residency is supportive to parents and would be supportive to a single mom. I think this residency is not at all supportive of parents. I have not felt supported as a parent at all. I've talked to other residents who are parents too. I'd be happy to give you more information if you want. I don't think she should come here because this is not the supportive place she wants."
He did not ask me any more questions. At least I got to bring it up and in front of a number of faculty and residents.

I had one more opportunity to bring up the lack of residency support. My third year our residency director was new. He had to write an end of the year letter or evaluation sort of thing. In it he wrote that on two rotations "Dr. Lizardinlaw did show some signs of stress." and listed the rotations. I totally lost it when I read it and wrote a total rant reply letter.

In the first rotation where I "showed signs of stress", I said, HELLO, I WAS STRESSED. I had a 1 year old at home. We never put him to bed until 9 because that way he'd probably get to see mom on 2 nights out of three. On that rotation we had no call but we were admitting patients that came in during the day. Because of the way it was set up we rarely got home until 11 pm and I had to be in by 7. I was not seeing my son for days on end. It was worse for me than call. I tried to talk to the resident who supervised me about it but she said essentially, "well, you were the one who chose to go to residency AND have a child." I went and ranted to another intern, who was really smart, and he said, "Why are you expecting sympathy from idiots? Come talk to me any time you want." Later in that rotation the resident acquired a kitten and then confided in me that she was worried about leaving it alone for so long. I had to bite my tongue quite hard. I wanted to bite her. As you can imagine, our relationship was not the best.

The second rotation where I "showed signs of stress" was the VA ICU (Veteran's Hospital Intensive Care Unit). We were on call every third night as interns. Alone. There was a resident who technically was there to help but he/she was overseeing the floor intern and all the other patients on medicine in the VA. There also were cardiology and medicine faculty "attendings" in charge but they were at home. You Did Not Call Them unless the cardiologist had to cath someone. It Wasn't Done. I had a really hard night. I started with nine patients, all sick and admitted nine more. Three with chest pain, two with COPD (Chronic Obstructive Pulmonary Disease) and a GI bleeder vomiting blood all over the place and the lab said their blood count machine was down. "DO IT BY HAND!" I yelled into the phone. I wanted to sing my admissions: "On the third day of call, the ER gave to me: Three men with chest pain, two COPDers and a GI bleeder in the ICU." The cardiologist wandered in in the am and asked, "Did Mr. So-and-so have chest pain?" "They all had chest pain," I snapped, "wait until rounds!"

We got through rounds. I tried hard not to mix the patients up. Then I got paged. It was the daycare. They said, "Your (then) husband was in a motorcyle accident. He's ok. It's just his hand. He's going to the nearest ER. By ambulance. We have your son. Don't worry about him."

By now I'd been up for over 24 hours, missed meals and would have freaked out even if I hadn't been exhausted. My internal response was, "Fuck his hand, what about his head?" After all, they are called murdercycles and donorcycles for a reason.

I tried to figure out where he was. Which was the nearest hospital? Paged again. He'd had them bring him to my hospital, which was right near the VA. The resident said immediately, "He wasn't riding it."
What? Wait, back up. What?
"He was cleaning the chain and turned it on and his hand got sucked in."
Holy fucking god, thank god. Whew. Only fingers. Ick.

I was released to go to the ER. He was going to surgery. His hand was wrapped up. "I want pads on my fingers. I want to be able to play the piano." he said groggily. I followed him into the OR until the surgeon kicked me out. I retrieved my son, who was 18 months. I called the chief resident. He gave me the names of the people to call in the order that I could ask them to cover. I was too shocky to say "You call them!" I had to make more than one call. He finally helped and got me one day of coverage. He said, "So, Friday (two days away) you're on call again, we'd like you to be back." Uh, I guess so.

I took my son to see his father, took my son home and then the phone rang. It was my mother-in-law. She happened to be coming for a visit the next day. "Will (her son) be picking me up at the airport?"
"Uh," I said. "Oh, yes, one of us will be there." I felt entirely incapable of explaining at that moment.

I picked her up at the airport next day.
"I'm surprised to see you picking me up. Did you get a day off?"
"(Her son's name) hurt his fingers in the motorcycle chain but he wasn't riding it and he's still in the hospital and he's really ok, it wasn't his head. Okay? We'll go see him now." Whew.

My then-husband came home that afternoon. He had cut the tips off his index finger and his middle finger, back to the first joint on each. People kept asking "Did they sew them back on?" "Picture a motorcyle chain running. It is not neat. Kind of grinds things up." "Oh, uh, yeah."
If you grind off the two fingers to the first joint on each, your hands let you know. They hurt like hell. He held his arm over his head for months to keep the swelling and pain down.

Next day back to the mines and on call to boot. "A little stressed." The next week I walked in to clinic and my residency director said blithely, "Hi, how are you?"
"Whaddaya mean how am I? How do you think I am?"
"Uh, did something happen?"
I explained. And that I was coming home from the hospital and my then-husband would say, "He kicked me in the hand today." and slam into the bedroom and I would take care of the 18 month old. It is extremely difficult to diaper an 18 month old or pick them up or anything else with one hand. I was furious that the chief had never checked back on me and that the residency director didn't even know about it. He listened but didn't do anything else.

So much for support in my residency.

I wrote in my rant something along the lines of "Should I have not seemed stressed when I damn well was stressed? Is that what doctors are supposed to do? I think much of residency training is antiquated and is induction into a cult and is stupid and I won't stand by while these evaluations say that I "appeared a bit stressed" as if that is a problem. Why aren't we helping residents when they are stressed? The goal is not to show it?"

I turned in my rant. My third year residency director called me up. "I didn't know any of this. I didn't know what happened in those rotations. That is appalling. You are right. I can't believe how little support you got."

He also said, "I'm sorry. I'll rewrite the letter. Also, would you give me permission to share your letter with the rest of the faculty? I think that we need to start addressing this. I think it will help with change."

"Yes, I be delighted if you shared it with the faculty. Thank you." And that felt good.

And that is how the extroverted feeler made me yell at my residency director.

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