My program fired a resident last week.  Although we all knew he was having difficulties, the news surprised virtually all of us.  Our chief didn’t even know about the poised ax until it came down with a moist thud.

Your heart has to go out to anyone unfortunate enough to get fired in residency.  Doctors are highly trained…in medicine.  We don’t know nuthin’ about nuthin’ else.  I took a year off between med school and residency and the experience brought little else but angst and crumpled resumes to my life.  I couldn’t get a job anywhere.  Positions that paid well (still much less than doctors) required specific training that didn’t even remotely apply to my medical background.  Jobs that at least paid something and possibly provided some health insurance overlooked my resume because of concerns about “over-qualifications”.  After sanding floors for a bipolar gay house-flipper (his description) for 4 months, I managed to get a call back from…Target.

You know, the store.  With the…uh…red target logo.  And the possible job was for a cashier, not management. At risk of sounding arrogant, I will admit to a feeling of entitlement. I did figure that 4 solid years of intellectually-demanding graduate school would entitle a guy to at least middle-management at Target. But, based on my phone’s lonely message box after applications to Costco, Starbucks, Safeway and Pizza Hut, I don’t think they would have even called at all if I hadn’t “falsified” my resume…by omitting everything but my high school diploma.

At any given time, residencies around the countries find themselves with open slots (like we have now) for any number of reasons. Our erstwhile-resident may in fact end up employed in another residency if he can pull off the I’m-a-good-guy-but-it-just-didn’t-work-out-there routine with any sort of cogency.

I should add that the guy probably really did need to be fired. My first thought upon hearing the news was that our program would fare badly in an appeal process because there isn’t enough evidence against this resident to warrant actual termination. Then I realized that our program goes to great lengths to keep everyone’s struggles confidential and that I probably don’t know much about whatever he did to get himself into such a spot. I do know that it wasn’t anything huge, like molesting or assaulting someone. He was on his second probation at time of “El Chop”. So, yeah, I suppose he had it coming.

But I still feel for the guy. Residents live paycheck-to-paycheck. Remove even one pay cycle, and most of us are defaulted and nearly bankrupt. Then we get to try to find a job with the specter of recent termination hanging over our heads. I suppose the big problem for this resident was not so much that he made mistakes. We all do that. Especially me, it seems. For example,  I once got busted for passing notes to another resident during a – insanely boring, I must interject – lecture by one of our senior attendings. How juvenile is that?

So, it isn’t that the guy could be a tool, it’s that he had no capacity to clean up after himself.  He seemed incapable of recognizing the gravity of the mistakes he did make; never really able to ascertain exactly how to atone for them.  I would prefer to not need to ask forgiveness during these residency years.  But in fact I’m generally apologizing to someone for something stupid, or acknowledging that I contributed to a problem in some way, oh, probably every 2-3 days.

I suppose the difference between an employed idiot and an unemployed one comes down to an intangible ability to put Humpty Dumpty back together again.  If your genetic map just forces you to be a walking freak-show (like I feel most of the time), you better hope you also have it in you to know how to clean up your messes.