(When I first started this blog, I was going to call it “The Slacker’s Guide to Medical School” because as you, my long-suffering readers know, I didn’t exactly cover myself in academic glory.  I decided against calling it “The Slacker’s Guide” for the simple reason that I am not, in fact, a slacker.  I like to work and have worked hard my whole life.  It’s just that much of medical training is so utterly pointless that anybody who has ever worked at a real job could not help but take whatever opportunity presents itself to gain some relief.  I decided on “Panda Bear, MD” instead as we all need a nom de guerre in the blogosphere to protect us from overzealous and vindictive bureaucrats who have still not realized that, to paraphrase the ancient wisdom, God made men but the blog made them equal.  I’m not that anonymous, as a matter of fact, but these kind of things are traditional. Panda Bear, by the way, was my radio call-sign as a young Marine Infantry Squad leader.  Everybody gets bestowed a nickname of some kind or another and I got off light, at least compared to my good buddies “Cat Pussy” and “Sasquatch.”-PB)

Architecture

One of the first things a medical student needs to learn is how to make a clean getaway.  As hard as it for some people to imagine, laden as they are with the guilt of abandoning their patients to the cruel devices of the nurses and residents, there comes a point when it is time to go home.   Identifying this point is the challenge as it is rarely going to be obvious.  Not only will you rotate on countless services over the course of third and fourth year, each with it’s own schedule, but it is an unwritten rule that to merely ask about leaving is considered a sign of weakness.  In fact, to ask will challenge the philosophical underpinnings of much of medical training where the simple question, “When’s quitting time?” is viewed as a thorny philosophical puzzle on the order of “What is the sound of one hand clapping” or “Will Whoopie Goldberg ever make a funny movie?”

It is a mystery.  Nobody really knows except that it will happen at some imaginary point when everything that needs to be done is done, a very unsatisfying answer to a medical student who has ever worked at a real job.  Unfortunately, this imaginary point is often after afternoon rounds with your attending and, because in academic medical centers there is no penalty for being insufferably rude to your subordinates, you may find yourself waiting for hours with no idea of your schedule for the evening because your attending, even though unavoidably and understandably detained, lacked the courtesy that is common among pimps to let his biaches know when he may be expected back on the block.

Not to mention that technically there is always something that needs to be done.  A medical student, if he had no self-respect whatsoever, could ask for and receive scut work enough to keep him occupied until in a sign of incredible weakness, he collapsed from exhaustion four days later.

So you will need to look after yourself.  Rounding, like death, taxes, the latest news on Anna Nicole Smith, and other unpleasantries is unavoidable and you will need to stay to the bitter end as you pretend to manage your resident’s patients.  But often there are no afternoon rounds and you may, like Oliver Twist, screw up your courage to ask your resident, “Please Sir, may I go home?”  As most residents are fairly decent people and realize that you need to study, eat, sleep, or do the hundreds of other things that they used to do before they were sucked into the black hole of residency training, they may say, “Okay, see you tommorrow.”

If they do you need to leave, and quickly.

Sound, at sea level, travels at approximately 750 miles per hour.  An “Oh, by the way” can make it from one end of the ward to the other in less than a millisecond which is a lot faster than you can manage.  You need to quickly put some architecture between you and your resident lest he change his mind or remember some scutty task that is still undone.  I suggest taking the first door, stairwell, or exit even if it is not the shortest way out of the hospital. They give you a map of the place at orientation.  Learn it.  Hell, don’t learn it.  I’d rather be free and  lost for a minute of two than called back for a half hour of scut.

It goes without saying that you need to learn how to turn your pager off faster than someone can pick up a phone and dial your number.  I typically turned mine off at the first hint that we were going to bust out of there.  There is no reason for a medical student to ever answer a page once he has been formally dismissed for the day.  Turning the pager off removes the temptation to return the page and be sucked into writing one more HPI on a patient that just showed up.  Alas, when you are a resident you cannot escape so easily as you are actually responsible for patients.  Even post call I usually keep my pager on me, for a while anyways, because I have a great deal of respect for nurses and I know it makes their jobs easier if they can talk to the guy who admitted or is following the patient on whom they have a question.

Never Look Back

Like Lot’s wife who looked behind her and was turned into a pillar of salt, bad things can happen to the medical student who looks back.  I advocate working hard during the day but I advocate even harder leaving when you are done.  If you are leaving, then leave motherfucker.  There is nothing in that Sodom and Gommorah know as your hospital that should concern you.  Do not turn around to ask your resident if there’s anything else you can do.  Are you crazy? Of course there is.  Asking a resident if you can help him with his never-ending ration of scut is like asking a sailor if he’d like his ashes hauled.

By the same token, once you get moving never retrace your steps to retrieve a forgotten item.  First of all, when you start smelling the barn you need to start planning your escape by collecting all of your gear and stowing it in the pockets of your short white coat.  This is why I don’t advocate bringing a book bag or a “day pack” to the hospital, namely because retrieving it can signal your intentions and give your residents time to think about how nice it would be if you took care of some of their scut work.   I suppose if I had left an expensive gold pen or my PDA where it could be stolen I’d probably suck it up and go back for it.  But I would be a surrepititious bastard and go as ninja as I could.

But the stinking remains of your lunch?  Dude.  Leave it.  First of all, if anybody really wants to steal your Hello Kitty lunch box with the half-eaten tofu sanwich than they should be welcome to it.  Same with your ratty sweater.  You shouldn’t bring anything of value to the hospital anyways unless you carry it on your person.  Just ask yourself this very important question: “It’s four o’oclock.  Miraculously, I have the weekend off and even more miraculously, I am out of here before seven PM.  Is that sweater that my grandma knit for me with her own hands before she died really that important, especially considering that grandma had the palsy and only a blind man would ever even think of stealing it?”

Is it worth an “Oh, I thought you were gone…hey, there’s an interesing chest pain in the ED….”