Wednesday, February 2, 2011

The Chief Residency Thing.

 "Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood. . . ."

~ Robert Frost, The Road Not Taken

Last Friday, I was talking to one of my favorite Grady-slash-Emory doctors, Roy A. In addition to being, quite possibly and simultaneously, one of the overall smartest and nicest people I know, he is also one of our Internal Medicine chief residents this year. (Clearly he is brilliant--he reads my blog in between all of the medical journals that he memorizes each night!)

Anyways, Roy asked me why I hadn't posted about my experiences as a chief resident. I did remind him (which he acknowledged) that I had one post inspired by that year, but promised him that I would let the thought marinate.

And so.

Inspired by dear Roy, today I am reflecting on the year 2001.  The year that I served as a chief resident. I'm reflecting on the whole darn thing. . . . warning. . .rambling ahead. . . .

The "Chief Thing"

For the non-doctor folks reading this, every residency program designates one or a few of their high achieving resident physicians to spend either their final year or an additional year as the "Chief of Residents."  Universally, it is seen as an honor to anyone who has held the position, even if it doesn't always feel that way while you're doing the job.


It first starts with someone tapping you on the shoulder and looking from side to side during your second year of residency.  "Pssst!" they say.  "I need to talk to you in confidence."

Immediately you start wondering: a.) Did I kill somebody?  b.) Was I supervising somebody who killed somebody? c.) Am I behind on my dictations?  d.) Did somebody find out that the program coordinator accidentally gave me three extra meal tickets to the cafeteria?

You follow the person (usually the program director or chairman) down the hall. The same way people follow those handbag salesdudes down some murky corridor in New York City, only to get horribly disappointed by the "totally authentic" Chanel bag that you keep explaining to the salesdude isn't "totally authentic" since Chanel starts with a 'C' and not an 'S' and has only one 'N'.

Yeah. Kind of like that.

But instead of getting tortured with scary pleather handbags and polyester scarves, you sit in silence across from the biggest wig you know, wondering what the hell landed you there.  First they smile at you, kind of warm and goofy like. Then they make small talk about your rotation which you try to pretend doesn't suck even if it does. Next comes some ramblings about all of the times you managed not to be an assassin and (hush yo' mouth!) actually do something that resembled a good job. And finally they're out with it:

"How would you feel about spending an extra year with us as chief resident?"


Okay.  Maybe you think you are half way decent, but I'm telling you. No matter how rad you are as a resident, your second year is absolutely the point where you feel the most inadequate.  Something about that transition from being the intern data-miner to actually having to know what the hell is going on is terrifying.  And marks the climax of your fear of being an assassin.

I always say:

"Being an intern is the best possible role.  If you do well, you're awesome! If you screw up, you're just an intern.  But being a resident?  Now that's tough.  You nail the diagnosis, you were expected to, so no confetti gets thrown. You miss the diagnosis? You suck."

So somewhere in the midst of that, someone representing the powers-that-be says, "Not only do you not suck, we actually trust you enough to pay you to teach others."  And most times, unless your personal life prohibits you doing so, you are so caught off guard slash flattered slash gobsmacked that you say, "Yes."  Yes to the mess.

Interns and medical students: 
"All hail The Chief!"

Residents and faculty members:
"Awww, hell! The Chief!"

(Damn. That was kinda witty, if I do say so myself!)

Anyways, where was I? I'd say the first tricky part is taking boards while serving as the golden boy or girl of your residency program.  What do I mean? Let me explain.

You have been selected amongst a slew of others as one of the best the program has to offer. Your embroidered coat screams to all of the new interns during orientation that yes, you are kind of a big deal.


You just finished your residency.  And people who finish residencies need to take board examinations to render themselves sho' nuff and bonified. (Yes, I intentionally misspell bona fide.)  So anyways, for folks in internal medicine, that big ol' exam comes in August.  Right at the start of your reign as the chief of the whole nest.

Sure, you were picked to be chief so you're smart.  Of course. And just maybe (if you are scary smart like Roy A.) you don't even bat a lash at this.

But if you are like me, surely it crossed your mind that you would be the first chief in all of chiefdom history to be branded with a scarlet letter 'F' at the start of your year as "it girl" or "it boy"--forever known as the "suspect chief."  I recall breaking out in a cold sweat over that horrid thought.  And what's worse is that I did combined training in IM and Pediatrics--doubling my anxiety.  Medicine boards in August, Peds board in October.  A heinous little combination, I tell you.  Hallelujah, I lived to tell--and to become certified.


The parts that I loved were predictable.  Teaching the residents and medical students.  Serving as a liaison between the faculty and the house staff.  Running morning reports and conferences. Coming up with innovative ideas.  That part rocked.

There were also the stinky parts that I saw coming. Like making schedules before the invention of the excel spread sheet or shmancy programs.  Or listening to people whine about this and that and that and this. And calling folks in for jeopardy calls on Saturdays. That part stunk. But every chief sees that coming.

But then there's this one part that I can only describe as. . . . indescribable.  This unpredictable weird thing I would guess has affected many a chief, but certainly stands out as memorable to me. . . .

It was discovering that the faculty members to whom I most looked up were. . . .gasp!. . . . mere mortals.

Some imperfect.
Others, weak leaders.
At times, not so noble in their professional interactions.
Shockingly less than helpful.
And a few. . . just downright disappointing.

Umm, yeah. 

I hated seeing peoples' clay feet.  I loved my little Pollyanna world during residency. . . the one where several attendings and administration leaders walked on water.  In chief residency, you're in this wonky time warp between little guy and big guy.  It's like suddenly being moved from the kiddie table during Thanksgiving to the grown up table, where you discover that Aunt Clara actually drinks too much or Great Uncle Mike swears like a sailor and tells racist jokes.  I often found myself longing for the blissful view from the kiddie table . . . .where "grown-ups" are awesome and make only sound decisions worth emulating.

Fortunately, the flip of that is discovering all of the amazing folks that you may have overlooked during residency. . . .that quiet junior faculty member who is actually quite kick-ass, that tireless program coordinator that helps you put out the worst of fires, that short list of residents who always, always take one for the team without so much as a hint of complaining, that standoffish attending that seemed mean but is totally approachable, and that less-than-popular faculty member that you later learn is your strongest advocate and sounding board. Now that part? That part was pretty cool.

It's a year that's choc full of learning. And since only a tiny number of folks in training programs get the chance to do it. . .it's definitely a road less traveled.

Of it all, the best thing I gained was perspective on my future.  During my chief year, I slowed down and looked around. Instead of making a rushed decision at the divergence in the woods, your chief year forces you down several paths for a little while, at least, and that's majorly advantageous. On Monday, you might have to be a cardiologist, on Tuesday, a pulmonologist, and by Friday, an infectious disease maestro--all the while, constantly wearing your Dr. Phil  hat in the event of an unforeseen meltdown.

I paid attention to people and situations and my reactions to them all. And in that year, I had a ginormous ah hah moment.  All along, I though that I would work in an office somewhere seeing a combination of adults and children while welcoming residents and students to occasionally join me. I saw a practice with mostly insured people like my folks and their families. . . .and I imagined myself happy and fulfilled and everything else you can think of, too.

That is, until I became chief resident.

That year, I recall standing at the board each morning at 8:30 A.M. for Pediatrics morning report.  The post call teams would present patients, and we would teach straight from the hip. Bam! Turns out that all that frantic studying for boards paid off. Aaaaah. . . . it was exhilarating. I attended on the wards, and felt drunk with teaching excitement.  Rounding the way I had always wanted to round and finally discovering my own voice as a teacher.  On those months, I connected with patients, but especially the indigent ones.  I would go home thinking about them and hoping they were okay.  Remembering how their faces would light up when our team would come to see them and collectively envelope them in the kind of respect and empathy that had become a rarity in their lives. That's when I knew.

I knew for sure that I wanted--no, I needed--to teach. I mean teach teach. Not just sometimes or once per week, but all the time. And not only did I need to teach. . .  I needed to get to a sho' nuff and bonified public hospital to do it.  I felt drawn to the least of these. That year helped me to discover that I wanted a job that would never feel like one and that could somehow also feel a little like a ministry.  Instead of sending people away because they fail a wallet biopsy, those were the folks I wanted the most. The ones who consistently shook me to my core, taught me the most, and touched me the most.

Did this job even exist?

My chief year gave me time to realize that indeed it did. 

That job meant going to a sho' nuff and bonified public hospital. If you know anything about public hospitals, there aren't a lot of hospitals on that list.  So that meant Atlanta, New York, Miami, New Orleans, Chicago. . . .and only a few more places.  And interestingly, as a Med/Peds trained physician, I didn't care if I was teaching learners in the adult or pediatric setting. I just knew the environment I was looking for, and that part wasn't negotiable.  Lucky me, Grady was my only job interview that year, and the one that I continue to say "yes" to every single day. I definitely have my chief year to thank for that.

So, there you have it, Roy.  That's my take on the chief thing. :)

Final thoughts about chief residency:
  • You find great lessons about leadership there. Even if they hurt sometimes.
  • The best way to become one is to do a great job.
  • Campaigning to be chief resident generally guarantees you won't be.
  • The year is exactly what you make of it.
  • It is an outstanding year of discovery.
  • Best of all? The chief year is a great time to linger before choosing a path along the yellow wood.
  • It can make all the difference. It sure did for me.

 "Two roads diverged in a wood, and I--
I took the one less traveled by,
And that has made all the difference."

~ Robert Frost


  1. Soooo on the topic of teaching- do you ever accept visiting students on your service? I'm a 2nd year student in New Orleans- though our public hospital came to a close with Katrina only to never open again, I'm really drawn to the whole career/ministry as well. And Grady does seem to provide the best cases for both medical and life lessons!

  2. Thanks for sharing informative post.


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