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I've been neglecting my blog because by the time I finish reading all my friends' blogs and posting comments on them, I feel like I've wasted enough time.

I have a lot of stories; there is something new everyday. This not surprising in medicine, especially teaching hospital medicine, because we are constantly seeing people at their best or -usually- worst. Weekly, most of us encounter a patient who may never make it out of the hospital alive, or much more frequently, who is clinging to the edge of society -or sanity- or who has already fallen off into the amorphous abyss of homelessness, severe drug addiction and/or mental illness. We poke and prode them frequently, question them incessantly, drop in for 5 seconds anytime between 5am and 10pm, and sometimes hold them against their will.

The most extreme moments of life unfold around us everyday -- sterilely, methodically, and imperfectly. Yet, ironically, we are also going through one of the most significant transitions of our lives. We feel inadequate, scared, misunderstood or ignored, we struggle to prove ourselves without being needy, and of course, we want to have a good impact on our patients.

In this remarkably incongruent fashion, we can at times find ourselves stressing about writing a perfect patient note, or memorizing that patient's lab values before the attending comes around, while ten feet from us, that patient is clinging onto life or suffering in severe pain. We're doing exactly what we're supposed to be doing but it feels shallow and nasty. As we're going through the process of learning to provide patient care, the care of the patient is the last thing we are actually doing.

Though I'm on psych consult and therefore not directly treating patients, there are days when I feel myself pulled in these very different directions. During the first week of rotations, I would spend my free time rewriting my notes so that they would be just a bit better, or trying to prepare for presenting them at conference. I never went back to see how my patient was doing after I did what I was supposed to, and I could barely remember why they were in the hospital in the first place. Fortunately, this changed. I've now gotten better at gathering the data I need to evaluate my patients, but I have also again opened my mind to the possibility that they are human beings as well. I visit them if I have time, even if our consult team has already "signed off" on them, and I try to take interest in both their illnesses and their lives. At the same time, I'm still struggling with figuring out what boundaries I "should" set for myself. One patient asked me yesterday how she could get in touch with me once she left the hospital, and after a long and uncomfortable pause, I asked her to repeat her question again, and then mumbled something about her being able to reach me through the hospital operator. I think this will take a while to figure out, but for now, while I have the time, I think I might as well continue to err on the side of being 'that nice medical student with the awkward name and cheap pen'.