As every EM resident, I LOVE outside rotations…..and by love, I mean we absolutely dread spending time out of the ER. It’s almost a constant reminder of why we picked the speciality that we did; I don’t want to manage high blood pressure long term, I don’t want to be in the OR where I have to worry about what I can and cannot touch, and I for sure don’t want to spend all day in clinic. However, some outside rotations are better than others. In surgery, I got to see and participate in the surgeries that I daily tell people they need in the ER. In cardio, I got to read EKGs until they became less scary and more routine. In anesthesia, I got to tube and tube and tube until I felt like I could take on any crashing patient. But then…..there are some rotations that just kill.

My program’s second year is very EM heavy and outside rotation light. I spent the beginning of my year in the ICU and then spent one month in a pediatric ER (so still very homey). Both of which were informative, useful, and full of valuable teaching moments. My predecessors have complained about the rotations that didn’t seem to fit those standards and our curriculum has been changed a lot to make sure that we spend time in ways that is beneficial to our education. Except for this one. And I’m just finishing week 1 out of 4 of this dreaded, spiteful rotation. And I’m about ready to jump ship and forget about being a doctor!

Let me preface that I had been warned about this physician by every single one of my co-residents. I have had experiences with him myself with phone calls in the middle of the night discussing a case in the ER. I have even seen patients cry after he has walked out of their room. I was prepared for this to be a tense month. I was prepared for his hearing impairment and need for me to shout (when he deems it appropriate for me to speak). Hell, I was even prepared to have to be silent for a month and just look pretty (which, happily, I have been told that I am a lot in the last few months). But I wasn’t prepared for what this rotation is actually like.

First, and the most bizarre thing that I have ever experienced, is how he is referred by all of his staff (clinic and surgery). He is referred to as “Doctor”. Not “Dr. [insert last name]”, “the doctor”, or even by his name. As in, “Let me see what Doctor wants”, “You can’t have certain foods here because Doctor is sensitive”, “Don’t speak when Doctor is speaking”. It’s like he’s this weird god-like figure in the people that surround him. They cater towards him like he can do no wrong. They contort themselves to make sure that he is happy at all times. Even hearing this behavior, witnessing it, I feel like I am some outsider that was allowed into a cult for a brief visit. I am as foreign to them as they are to me. I can answer their smiles with a smile of my own, but we both know they are as fake as the pedestal upon which he stands. As a physician, I cannot even fathom trying to make this kind of environment for myself. I am not a crazy god-like creature just because I went to school and learned some advanced biology. I am not a person to be tip toed around just because of some initials behind my name. ER is a team sport full of doctors, nurses, respiratory therapists, and emergency medicine technicians. We each have a skill and knowledge that is needed to make sure our patients get the best care. And that is the kind of environment that I want to practice medicine in. I don’t want to balance on a slippery pedestal built from my ego and hubris.

Secondly, he is just an asshole. I could try to sugarcoat it and talk about how he is just very blunt and rude. But let’s be straight, he’s just an asshat. He does not allow others to speak while he is speaking, thinking, or performing surgery. He does not call people by their names. He does not attempt to teach – he just boasts. In fact, I have been handed laminated newspaper articles praising him to read while he sees a patient. I have been asked, in front of patients who are there for a pre-op visit for the same procedure, to confirm that it was the best surgery I have ever seen. I have been prey to his endless rants about how incompetent our ER and the physicians who have welcomed me, loved me, taught me, and praised me, are. So with a silent mouth and a fake smile, I have nodded my head and felt a little piece of me die inside.

And I think that is the part that is bothering me the most – this requirement to be silent but still dying inside. Anyone who knows me can tell you that being quiet or being silent when I feel like injustices are being done are not my strong suit. As a child, most of my report cards had “exceeds expectations but could learn when it is appropriate to talk”. And my mother probably would have been happier if I hadn’t learned about feminism and social justice in 5th grade. I have always been the girl that is not afraid to speak or afraid to stand up for someone who cannot. Part of why I picked medicine as a career and emergency medicine as a specialty was because of that fact — I wanted to be a voice for people who do not have ready access to medicine. And in this rotation, I am expected to nail another board of praise to his pedestal. I am not expected to learn, to grow as a physician. I am expected to contort myself into this weird cult member for a month. I am not expected to see a patient or make a single clinical decision. I am expected to be a quiet smile in the back of the room.

Well, we’ll just see about that.