Tuesday, July 01, 2008

Limping Towards the Finish Line

Yesterday was the last day of clinical fellowship for the Brigham-Mass General combined Nephrology training program for the 2007-2008 academic year. It marks a change: after a grueling year of 100% clinical work, being on-call every third night, being required to go in to the hospital to deliver emergent dialysis, etc etc, fellows transition to a lifestyle of lab or clinical research, during which their schedules are largely made by themselves, and involves a real minimum of clinical obligations (next year for instance I will be required to work a half-day of clinic a week plus one Saturday a month for about 5 hours). The individuals in the photo above are those who have undergone this ordeal of clinical fellowship with me this year as well as our department heads and program director.

Before I start celebrating my good fortunate for finishing clinical fellowship just yet, however, it turns out I still have one month more to go than all the other fellows. Why? Fortunately, not because I'm a slow learner, but rather because I started my fellowship a month late due to Sophie's birth in a foreign country. So I still am limping through my final month before the end of the clinical year.

Here are some of my thoughts after such an emotionally taxing year:
1. My tolerance for sleep deprivation and inhumane work hours is decreasing as I grow older. I think I would have fared better had I done this when I was younger. Some of this is perhaps because I now have a family and feel pressure to make it home at a reasonable hour before my daughter's bedtime.
2. The kidney is a complex, complex organ and our therapies, while certainly representing a major medical achievement (we have a machine that can kind of replace kidney function!), are woefully inadequate and there is major room for improvement.
3. Despite my occasional complaints that clinical work is too demanding, I am certain that I will miss it! There is something about the urgency and importance of patient care that I really like, and I will make sure to always keep one foot in the clinical arena. It will be a fine line to walk such that I do enough clinical work to keep me up-to-date, but not so much that I get burnt out with it.
4. I'm not sure how I would have made it through the year without my wife Claire and daughter Sophie--who was always happy to see me when I walked through the door at the end of the day, regardless of whether I was wearing a smile or a frown. Thanks!

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