Paging the Resident

In the world of medical research, PhDs and MDs must often work together toward some common goal. I think I’ve done a decent job of interacting with clinical staff, but sometimes it’s slightly challenging.

I completely appreciate what it took to get a PhD. Shared experiences provide some camaraderie. I read some blogs, and I remember how awful revising the thesis felt – to feel done, only to find that the writing experience wasn’t close to being over. I’ve been mind-numbingly bored in seminars, seriously contemplating throwing my strappy sandal at the idiot who would dare ask yet another question, further drawing out the torturous experience of learning about some obscure facet of useless knowledge. I’ve crammed for a qualifier, experiencing the only nervous breakdown of my life 2 days before the exam. I’ve taken in treats to my prelim so I could persuade my committee that I was able to tackle the research project I planned. I also partially hid behind a chair during the question portion of the oral exam, not realizing until after it was over that I was peeking over a conference room chair while sitting completely behind it. I postponed my final defense date twice, neither by choice, and I’m still trying to rebuild my confidence after the spectacular failure that marked the end of my graduate career. My point? I meet people or read blogs, and I identify with some of the experiences. And whether from empathy or friendship, I’m motivated to help people who have gone through similar experiences.

But medical school…wow. I found graduate coursework to be competitive, but I could barely breathe through the fog of superiority that encompassed some of the classes I took with medical students. Those folks are ambitious, bright and a little bit scary in their focus. They can balance it with a general trend toward being kind, interesting and funny, in my experience. But I don’t know much about how med school goes, so I feel we’re in pretty different worlds.

Now that I’m more firmly in the research world, having escaped being a student only to become a trainee, I continue to see differences. My priorities are more strictly focused than ever. Though I understand many post-doctoral positions involve a fair amount of teaching, that’s always been something I’d rather avoid. I did my share of skipping classes and reading on my own as I found it to be more efficient. Honestly, I haven’t seen many professors who are inspiring as teachers. Actually, I was reading a NYTimes article about teaching in elementary schools. If we, as a nation, can’t figure out how to do that well, then higher education, in my opinion, is a lost cause. (How many commas can I put in one sentence? LOTS – stay tuned.) My point? I do research, and since I’m still getting my projects up and running, I’m doing less teaching and mentoring now than I did in grad school. I’m not serving on any committees or participating in volunteer work yet, so I just need to figure out what I want to know and how I want to know it. Nice, right?

Well, part of what I want to figure out requires a patient population, and I’ve never dealt with getting approval on human subjects and designing a study. That was all done for me before. You know how you answer essay questions? So you’re given a bunch of starting information, you need to have some idea of how to understand it and put it together with what’s in your head. I feel like that’s much of what doing research is about. Getting a sense of who knows what, determining the correct question, and finding a way to coordinate various efforts (hopefully many of which will be personal) to come up with a novel solution. It’s this coordination that I pride myself on – judging people’s strengths and personalities in a way to maximize my benefit to working with them. But I’ve never had to write my own questions before. Honestly, I’m not loving it.

For me, working with MDs has been pleasure. They tend to know a lot about their specific areas, and have ideas on a lot of medical topics that they may not deal with regularly. Also, at the large teaching hospitals where I work, the doctors tend to balance patient care with teaching and research responsibilities. While they do have their own post-docs on occasion, they also consult on a number of projects – providing patients for studies, guiding the study design, addressing problems and confounds as they arise, giving immeasurable insight and edits on drafts of manuscripts. In my short career so far, I’ve decided that if you’re doing research that requires patients, having an MD on board (and excited about your work if you can possibly pull that off) is critical. If the doctors don’t care, you’re screwed for a couple reasons. First, you’re missing all those advantages that I just mentioned, which makes life hard. Second, if they don’t care about your work, it’s likely you’re asking the wrong question or working in an irrelevant area. And whether you’re trying to publish or just finish a thesis, that’s not what you want.

I deal with these people with a mixture of respect, understanding of their hectic schedules, appreciation for the help, and enough confidence to gain their respect. That’s what works for me, and I don’t like to alter a plan. I’ve lived here for almost 6 months, and I know one freaking way to get to work, for goodness sake. So when I needed something from a surgeon, I sent email, made an appointment, and arrived at his office, armed with a list of questions and comments, efficiently made my points and got the relevant information, shook hands, expressed my appreciation, and left. And that’s the way it’s done.

So when I needed a protocol from a resident, I sent my polite email. And waited. Then I was out of town for awhile. I came back, then waited some more. I let 2 weeks pass before sending another email, still very polite. And that was 3 weeks ago (more traveling time in there – I haven’t been sitting at my desk waiting for email all this time). Running out of excuses on why the planning is stalled, I paged him today and I hated to do it. First, my pager startles me when it goes off and that’s unpleasant. And I haven’t gotten a single page that hasn’t immediately triggered the thought of send me an email! I’ll respond as quickly as I can! So I assumed Resident would have a similar response to my paging him, and dreaded it. But I sent email already, so I buckled down and called his pager. Then waited, staring at the phone.

He called me back, but was in a meeting (so I felt badly for disturbing him when he was busy with something else). So we talked later that afternoon and agreed to meet tomorrow so I could get the file I needed. I’m supposed to page him when I have free time. Apparently his pager isn’t the beeping minion of evil that I have to carry around with me. Who knew? The lesson, and my original concept in writing this, is that it’s fine to bother people. For someone like me (don’t interrupt, don’t get in the way, be quiet and polite, show appreciation when people help you out, never make a negative impression), that’s difficult. It’s probably part of the reason I took a post-doc rather than one of the industry jobs I interviewed for. I need to gain more confidence. That wraps it up pretty neatly – I need to feel better about my skills, ideas and qualifications to be truly effective in a field in or out of academia.

Sciencewoman made a comment that made me consider the issue more carefully though. I tend to be self-deprecating, both in writing and in person. I underestimate and understate the importance of what I do and say, my performance in grad school and so far in this position, my manuscript-writing skills (as I’m still struggling to get some graduate work published), and even what I’ve written here so far. If I say it’s not great, then it preempts anyone else’s criticism. And if by chance someone thinks it’s decent, maybe they’ll try to boost my confidence somehow. So it’s win-win. The problem is that I’ve seen many women in science do this – somehow present themselves as something less that what they truly are.

So if this is just a personal characteristic, that’s fine. I can try to be more aware of it and not be so hard on myself. But if I’m working in an environment that tends to make women feel self-conscious and inferior, then that’s a big deal. I was infuriatingly confident in my intelligence and ability when I was younger. I calmed down so people wouldn’t hate me, but the real feeling of being somehow lacking started in grad school. So now I’m trying to remember certain situations, and determine whether this is internal or somehow inflicted through the graduate environment. I guess my feeling is that if there is some external negativity, I was more likely to pick it up and let it affect how I felt about myself.

So I’ll conclude with what I should have done, and what I hope I do now. It’s important to be aware of your environment. I served on committees in order to change some of the graduate training culture, but on a day-to-day level, it escaped my notice on any real level. I didn’t make time to notice how it felt if someone was talking about how I was near the lower end of the grade scale on an exam, or how it felt to be the only person in the group not attending a conference, or what message it sent when we were told that only students who received invitations to talk would go to another annual meeting and everyone ended up going, though I obtained the only oral presentation. Looking back, it eroded my confidence to have everything I wrote criticized so heavily, though I knew the comments were mostly constructive. But when someone you respect places exclamation points after some comments, it’s degrading and unnecessary. And rather than saying what a dick, and moving on, I decided that my work quality was low enough to deserve such treatment. I think if I’d been more aware, asked for more support, let people know that certain behavior was counterproductive, and consciously checked myself when I started being too negative, that I would have emerged from grad school more effective and confident.

So now I’m aware. I’m going to page people when they don’t answer email after a couple of days. I’ll work within my comfort zone – be pleasant, polite and grateful, but I’m bothering people when they ignore me. I think there’s a good place between being nice but useless and effective but annoying. And I will find that place. I need to seek out other women in the field. I talk to W once a week, and we share many of the same irritations and problems, acknowledge that we should do more to support each other, but let opportunities to do so slip by. When I review papers, I’ll continue to look for, and compliment, good points as well as suggesting changes for weak areas. And I’m going to try to make this space something I’m proud of. It’s going to take some time, and I’ll probably be a bit embarrassed as I’m paging through my visitor statistics pages (which has become my new favorite hobby, second only to sleep) because things aren’t quite as good as I want yet. But so far, it’s been good for me. And that’s the point.