一夜

早上七点，漫长的夜班终于结束了，人们陆陆续续来了，用新鲜的笑脸和精神接替了疲惫的忙碌了一夜的人。ER因为医生，护士，技术员都在交班，熙熙攘攘地非常热闹。

这个班上的病人特别重，所有我手上的病人全都收进病房了，还有一个去了ICU。而这次带我一起值班的attending，是个笃悠悠慢吞吞的中年医生，几乎不怎么说应该做什么，我大多数时候要自己去捉摸，特别紧张。

在收病人的时候，要和病人的主治医生打交道，这个是我最怕的，半夜三更打电话那些医生脾气就不太好了，再加上如果汇报得不清楚，没有说到要点，就会听到一些不爽的语气。这个attending坚持要我打所有的电话，其中有一个是大家都知道对intern非常不友好的T医生，以前的attending都直接打电话沟通的。在page T医生后等电话的时候，我紧张地察看病人所有的纪录，实验报告，生怕有所遗漏。还好T医生这次没有给我难堪。顺利把病人交出去了，真是长吁一口气。

然后一个病人突然不好了，我做了初步治疗，紧张地想着还有什么没做，那个慢吞吞attending说，我们给点利尿剂好不好，我猛然醒悟。心里不由得很感激，虽然他看上去不太管我，其实还是放了一只眼睛在我身上的，呵呵，这样想心里就觉得踏实多了。

跟attending汇报病例的时候，看着他写字的手忽然不动了，再看他，原来合着眼睛竟然睡着了！这时候是早晨4点多，人最困的时候，我已经喝了三杯咖啡了。看着他头上冒出来的白发，和疲倦的神情，我心里忽然觉得酸酸的，就默默地写着病史让他难得眯一会儿。不过没几分钟护士过来汇报就把他惊醒了。

在这里想多嘴一句，看到很多40岁以上的中国留学生在报考医生执照准备从医，希望大家要做好思想准备，体力上的付出是很大的，这不是年龄歧视，是自然的过程，在准备走这条路之前，一定要谨慎地把握好自己的位置，强弱，确定自己有能力去应付这样的强度。

在ER里，我记得有一集说医学生卡特为陪着一个临终病人说话，为他读书，我当时还觉得这个很不现实，今天自己也亲身经历了相似的场景。一个60多岁的妇女，多年前的癌症复发并且广泛转移了，因为呼吸困难来急诊，胸片里肺转移得到处都是，只留下很少的可以呼吸的组织了。我把结果告诉她，她很平静，有几次我停下来为我没说清楚地几个英文单词而抱歉，她还拍拍我的手说，that's ok honey.我忍不住说你真坚强阿，她笑着说，just take one thing at a time, cry won't do any good. 我走出房间的时候，她说，能不能不要把帘子拉起来，我回头看着她瘦小的被床单包裹着的身躯，似乎能理解她不希望与死神独处。就这样帘子敞开着，我忙进忙出的时候，都看见她坐在那里静静地看着我们，终于空下来的时候，我不忍心她这样孤单，就过去和她说话，她告诉我她生了癌症以后冒着危险怀孕了，现在儿子在芝加哥读书，义务在医院里做社工，还有她的先生，他们浪漫热烈的持续了45年的爱情，还有她在佛罗里达的房子，和狗。我默默地听着，微笑着，心里有一种说不出的感觉。后来她被转到楼上病房去了，我说take care，她用力地握了握我的手。

快下班的时候，attending心情才好起来，笑眯眯地跟我说，抱歉我让你自己跟所有的医生打交道，我难为情地说这也是对我必要的锻炼，他说是阿，多说了你就不会害怕了，这次你和T医生说话就不错啊，以后你就是对付T医生的专家，我们要和T医生说话就都找你了，我吓得急忙摇手说不行不行，他哈哈大笑。

走出昼夜灯火通明的ER，外面是雨雾迷蒙的清晨，刚刚下过小雨，空气中散发着草木的芬芳，让人不由得深吸一口气。ER自动门在我身后合上，把所有的喧闹都留在了身后。

[breakfastclub]

Hey,
R u doing residency in ER or IM residency?
Try to get used to it.
It's a the only way heading maturity.
I, too, am a resident in Beth-Isreal Hospital.
It's really nice to see chinese here.
Hope u everything fine, friend.

[sylinna]

Hi, Falling Flower,
Thank you for sharing your life here. It encourages me all the time.
sylinna

[寒枝]

加油！

[黄大皇]

多睡一会儿吧！

[happyljx]

嗯。其实，那个病人已经接受这个事实了，其实相信，她觉得自己已经很幸福。真的。有时候，如果改变不了事实，可以改变心态。我又说多了。

继续努力。补祝生日阿！　你算的是农历啊？

[feifeibei]

To wuximm,

I send you a qiaoqiaohua. please check. thanks a lot!

To luohua, sorry for using your place to leave message.

[feifeibei]

Thanks tabby! I appreciate your encouragement.

[feifeibei]

wuximm:
Thanks for the information and encouragement. I am going t my application very soon. Actually I did not take the graduate years into too much consideration because if I do, I have only few choises. I guess I would have to apply more to increase the chances. Good day!

[tabby]

feifeifei,Don't restrict yourself with those "rules" when you apply for residency. When I applied I was 7yrs post grad. I disregarded those restrictions and got invited anyway. You have to be assertive and speak for yourself. If you don't hear anything from certain programs, don't assume you are too old/not good enough/whatever for the program. Call PD and tell him/her you think you qualify for their program and want to get interviewed.Being assertive is something you need to do consistently down the road. Good luck!

[wuximm]

To Feifeibei: sorry if I made you disappointed. I contacted our residency office, they state that we "prefer" candidates who are within 5 yrs of graduation plus minimal 12 months US clinical experiences ( either observe-ship or externship). Of course, it would not write down on the website for legal reasons.
The other bright side is the fact that less and less AMG's want to be a PCP in recent years ( such as IM, FM, Peds), so more slots should be available for FMGs. People will take your clinical experiences in China into considerations. Don't be discouraged by my generalized opinion, and good luck.

[Angelboy]

谢谢，写得很好，特别真实，有身临其境的感觉。
不知道其他Intern （尤其AMG）对T医生是否有类似看法，或仅局限于少数IMG。假如是前一种情况，那不必介意。另外，美国病人的教育程度较高，不少具有医学信息的获取与分析能力，这些信息包括一切公开发表的书籍与文献报告，还有一个额外的信息来源，就是通过参加全国甚至世界性的病患组织及其专门的网路，经常与其他病患讨论与比较其他医生的治疗方案与效果，也就是说，他们得到的信息比医生还快。这类knowledgeable病人在诊室里可能会提出一些对低年资医生来说比较challenging的问题，但是，其中有不乏重要的信息，应引起高度重视。做一个让病人百分之百满意，让所有同事尊重的医生，确实不是一件容易的事情。

[feifeibei]

wuximm, What a disappointing fact. I graduated more than 5 years ago although I did 3 years clinic back in China. Do you know if your program website states that you won't consider old graduates? Because some programs do not say that although they do that way. Thanks!

[大理茶花]

首先我想说，一定有很多人象我一样，喜欢默默关注你的博客，读你的文章。但是这次因为你要过生日了，所以一定要说一声：生日快乐。很欣赏你的乐观、坚强却平和善良的心，还有你的率真和坦诚的风格。（不肉麻了 :-))。
同样的话也可以用来说这篇文章。（不好意思的说，我已经三次被你接连的三篇文章弄红了眼睛了）。希望你一直都作一个好医生，真诚、善良。我你骄傲。

[wuximm]

Give a little bit negative insight. In our program, we only give interview to FMGs who are within 5 yrs of graduation, usually are those US citizens ( born here and received education here up to college, except medical school). It is harder for a person graduated many yrs ago especially those never had pt contact (most of them have advanced degrees here for Master or PhD for research). I had a couple classmates either never be able to match a position-cause family break-up, or unable to renew contracts for second yr position. Residency programs sign contracts every yr, usually 1-2/12 in our program will not get renewed each yr and usually they will have hard time to find another position.
Please no harsh feeling, I just would like to add some facts. So, you can be prepared when you choose to get on this long journey and face the challenges without regret.

[de1007]

人都是被逼出来的，熬过去就好了！加油阿！
师傅现在也上班了，不过是在妇产科。每天工作10小时。鬼子的钱不好赚阿！
我实习只在外科急诊呆过1周，道行还浅。那里也是看尽人生百态阿
谢谢关心！当年突然半条胳膊动不了了，关节痛，查来查去也没查出来什么毛病。曾经以为是Borreliose, 所以做了骨穿。