The First Breath of Autumn

I love mornings like this, early fall maple muffin mornings, with fog as thick as a cloud bank hovering over the hayfield. Freddie the Freeloading porcupine sneaking breakfast under the apple tree, unaware I'm watching. Dew on the grass that will be frost soon enough and air already cool enough to faintly see your breath. It won't last long, the mid-morning sun will see to that.

The first breath of autumn always goes fast.

Kind of like third year rotations. When you're in the starting gate, gazing down the track toward the clubhouse turn (the first curve in horse racing), six weeks appears endless. Before you know it, you're in the home stretch and the written exam lies ahead at the finish line and you're wondering what madness possessed you to think you were too weary to study after a day on the wards. Surely, you didn't need sleep that badly, did you? Yet, somehow, like Seabiscuit, you dig deep, pulling a passing grade or better out of your hat like a magician's rabbit. A weekend of freedom passes like a thief in the night and the process starts all over again

But not this time. At least not with internal medicine. IM is a twelve week test of endurance, though broken into several subgroups you get a wide glimpse at the field. Thus far, I've been on the residents' teaching service, spent eight days with a hospitalist, and Monday heralds rehab medicine. Two weeks later comes two weeks of night float and assuming I'm still afloat after that, my final two with the residents. It's not as long as it sounds, like the first breath of autumn, it goes fast.

At first, the twelve hour days are exhausting and you wonder how the residents do it, how you'll do it when you're one of them. A week and they're familiar, another and they're commonplace while you're hustling to get all your patients seen, clinical notes written and patients seen once more before evening report. If you've had an admission or accompanied a patient to a procedure, you realize this is what cranberries feel like when they're tossed into a blender at Thanksgiving and the switch clicked on.

The good thing is, it's only week six. Instead of feeling like you've just gotten accustomed to finding your way before it's time to move on, you have a chance to actually practice what you've been learning. The context in which you'll see patients will change, but it's still internal medicine. It's not as though you've been doing well-child visits, diagnosing colds, ear aches, and strep throat, and suddenly have to distinguish between major depression and an acute grief reaction. Racing to a code blue cardiac emergency is a bit different from rushing to intervene with a telephone wielding patient who checked self-control at the door to the locked psych unit.

You get used to it, we all do, but it's nice once in a while when you don't have to. When you can to get close to a patient without having say goodbye before hello has barely passed your lips. When you've grown confident walking into a hospital room without a resident holding your hand because you've done it thirty or forty or fifty times and lived to tell the tale. When you can step into the doctors' dictation room, sit down at a computer and do your business because you have business to conduct, just like the other doctors. Don't get too comfortable, though, because it won't last, it can't -- you have other things to learn, other patients to see, and like the first breath of autumn, it all goes fast.

It always does.

(Creative Commons image of autumn colors by franzikus garten via Flickr)