Rite of Passage

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"Making mistakes humbles you and allows you to learn," Dr. Patricia Rekawek advises the residents as she addresses the Mount Sinai Department of Obstetrics, Gynecology and Reproductive Science on graduation night. As an incoming wave of newly-minted doctors arrives to enter the grueling grind of residency, this group of seven trained physicians is departing to begin their careers.

Brought together by a shared passion for women's health, through 24-hour shifts and late-night takeout, Dr. Rekawek, Dr. Whitney Booker, Dr. Rachel Carroll, Dr. Sara Farag, Dr. Alicia Robbins, Dr. Ann Tran, and Dr. Shannon Wallace hail from the four corners of the globe - from South Africa and Libya to California and Queens. They have made New York City their home for the past four years as they learned the art of obstetrics and gynecology. Beyond patient care, one of their most important duties as chief residents was the training of junior residents, and I have been a grateful beneficiary of their mentorship throughout my intern year.

"Scalpel." Dr. Wallace calls for the instrument and the nurse presents me with a knife. I take it and, for the first time, I press the blade against the patient's taut skin. The edges part with ease and reveal a network of blood vessels, membranes, and fat. We work meticulously through the layers of the abdomen, finally approaching the uterus - the shelter to the new life about to emerge. My hands are shaky and inexperienced and my mind is untrained. Yet Dr. Wallace guides me through each step, patiently waiting for my needle to pierce the muscle in the right place, for my forceps to grasp the right tissue. Anticipating my next move, using two hands simultaneously to retract tissue and cut suture, suctioning fluid and tying knots to make it look easy for me - this is the mark of a good surgeon. Dr. Wallace started in my position and now, four years later, she is a confident surgeon, a master of her craft.

Two months later I'm fighting fatigue at 3 o'clock in the morning when I hear hysterical crying from a woman rapidly approaching my door. "I'm losing my baby!" she screams, and I jump up to assess her. "How many weeks pregnant are you? What number pregnancy is this? Are you bleeding?" I quickly ask as I put on gloves to examine her. My heart sinks after I learn she is 16 weeks along in her first pregnancy and I feel a tiny head protruding from her dilated cervix.

I call Dr. Robbins to let her know the patient is having a miscarriage as we wheel her down the hall. The labor floor erupts in chaotic chatter as the nurses quickly work to obtain vital signs, draw blood, and place an IV, and I reflexively raise my own volume to comfort the patient through her desperate sobs. Dr. Robbins walks calmly into the room and, within minutes, establishes a comforting, compassionate rapport with our anguishing mother. Her sobs subside and her breathing evens. With intelligent responses in understandable language, Dr. Robbins provides reassurance and hope for the young woman, as she answers the inevitable question, "Why is this happening to me?" I'm impressed with the genuine concern and the compassionate bedside manner she has developed despite the challenging hours and workload of the past four years.

This is the process of residency: through diligent work and repetitive practice we hone our skills to become competent physicians. Residents are the first doctors to see each patient in the emergency department, and we assess whether they are healthy or sick. Residents read CT scans and MRIs to determine whether cancer has spread. We perform surgeries and deliver babies.

Chief residents are the key mediators of patient care. Leading each specialty team, they make decisions for each patient in collaboration with the attending doctors, and they train the junior residents to think critically and perform the physical tasks of our profession. The chiefs leave their mark not only on the patients whose lives they personally touch, but also on generations of patients who receive care from the junior residents whom they teach. The seven women who depart Mount Sinai this month for fellowship and private practice have been exemplars of excellence in obstetrics and gynecology not only to their patients, but perhaps more importantly to those of us who have trained under them. As my fellow interns and I transition to our second year of residency and beyond, we aspire to pass on their legacy to the next class of interns and to generations of physicians to come.

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