Behind the Mask: Was I Really That Bad?

Near the entrance of the veteran’s hospital just a few feet past the coffee shop, there is a cashier window with a sign hanging above the counter that reads, in a serif font that takes itself very seriously, “We do not make change.”

How apropos. After 3 years of being away, I thought I traveled back in time when I entered the hospital again, only to be brought back to present day when I saw posters along the hallways celebrating the latest nurse of the year. And of course, on this day, I walked into the VA hospital as the chief resident.

Three years ago, my coresident and I started as the juniors at the VA with two of our graduating chiefs who are now attendings. The two of us did the best we could with our limited experience in patient management during that strange year, which was only further complicated by the pandemic. And it did not help that we were working within a health system that was not known for its user-friendly interface. And now, the two of us were now back as chiefs.

We have two junior residents of our own now, and they are still green. They make beginner mistakes. They forget orders. They sometimes mix up lateralities and misread radiographs. They are slow in the operating room. They ask a lot of questions in clinic, sometimes at inopportune times. Their self-confidence is as low as their anxiety is high.

To fill the silence as we were closing a total hip incision, my coresident and I reminisced on our time together at the VA in 2020. “We were never that bad, were we?” I asked him. I didn’t see myself in our junior residents at all. I wanted to believe that I was different when I was a junior resident.

“No way. I mean, we weren’t the best, but we were definitely better than our current juniors,” he replied. But there was a certain upward inflection in his voice that made me think that he was trying to convince himself, too.

I ran into my attending one morning while waiting in line for coffee. I asked him what the two of us were like 3 years ago. “About the same,” he said, with a sly smirk as he took a sip of his coffee and went about his day. In denial of his evaluation and a bit skeptical of his memory, I texted my old chief resident for a second opinion. He was one my favorite chiefs and was far more reasonable. Surely, he remembered us differently—we were wizards in the operating room and efficient with our patient care, or so I thought. He replied swiftly and without any doubt in his verdict: “Oh, you guys were awful.”

It’s natural to distort our perceptions of our past selves. I just didn’t realize how much I was doing it. Indeed, until my former chief resident and attending gave me some straight talk, I had placed younger me on a very high pedestal.

All this caused me to think back. Yes, I do remember missing pages from the ED only to be lambasted by my chief the morning after. I also mismanaged simple consults and malreduced bread-and-butter fractures. I also managed to only see a small fraction of patients in clinic and slowed down the clinic’s throughput. If only we had a camera following us during those early years so we could watch the replays—many stumbles, occasional successes.

But maybe self-deception and a little self-flattery are necessary in residency. I could not imagine progressing in training without a little bravado. Eventually, a certain level of confidence, well-deserved or not, is necessary to be able to take over a patient from the attending. And that transformation requires you to think highly of yourself—not just today’s version, but also yesterday’s and tomorrow’s.

So perhaps we should take some solace that the mistakes made by our juniors are not fatal and certainly not a sign that they are condemned to become bad doctors and surgeons. It helped me to realize that they are just facsimiles of us, perhaps even better than we once were, if we’re being honest with ourselves.