What I got wrong in residency

Residency is a machine designed to produce a specific kind of confidence. Not competence — that comes later, if you are lucky. Confidence. The kind you can wear into a room at 3 a.m. and not have the family clock it as fear.

I have three regrets from those years. None of them are clinical. All of them were, at the time, invisible to me.

1. I mistook loudness for care.

There was an attending I admired who ran the loudest codes. He was, in retrospect, a mediocre resuscitationist. But he knew the effect of loudness on a team that had never been in the room before. For a year I copied him. I have quiet hands now. I am better at both codes and conversations for it.

2. I did not learn to say I don't know.

In pulmonology fellowship I finally did. It felt, the first time, like taking off armor at the door. The room did not fall apart. The patient's daughter looked at me and said, thank you for saying that.

3. I told a family what I would do if it were my mother.

I meant it kindly. I know now it was a way of putting my thumb on the scale, which is not what they needed. What they needed was for me to slow down enough to let them find their own thumb.

The reason to write these down is not confession. It is inventory. Every year the number of things I got wrong that I now have language for goes up, which is either progress or aging, and honestly at this point I do not care which.