trials

i have so much to catch up - life as a surgeon, characters, peds, delivering babies later.
for now i just can't help but feel like a kid. Its fourth year, you're supposed to know stuff, right? I feel like I'm just a scribe who takes notes, reports, and has no idea what they're doing unless you tell them. its hard to take charge when you don't even feel like an adult outside the hospital.
my patient came into today with acute on chronic kidney failure, full out uremia, possibly secondary to infection - now what? or my frail bedridden patient with chronic RA that has pretty much incapacitated her and left her hooked on morphine tablets that just give her constipation and a bowel that doesn't want to move. at times you just don't want to deal with those types, they whine, they plead, they demand, they do more ordering than the doctor, and you get irritated and say wait a minute, who's the doctor? how do you know what pain meds you should get and when and how. So many times we encounter these people that we cant stand - but we have to take care of. and its so hard to not be annoyed by them. nothing is unbias, even an umpire.
after i finished the hand p on my patient my resident went over the case with me - line by line. you shoudlna written this, you should write this. why do you think that is? why is that? secondary to what? how do you calculate this? what does it mean? what are the different causes of that? what else do you want to do? and on and on. each question caused by whole body to get a giant heat wave, sweat, and just feel so on edge. and its a completely no pressure situation. there is just such a pressure to be smart, to know the answer, to not look dumb in front of others. i feel like i won't ever know any of the answers. i just know that intern year is going to be a HUGE learning curve. there is so much information, not enough ttime to sift thru it and make all the right decisions for every patient. that is scary.