Crash and Burn.

There is no way to prepare for this moment. When the patient is lying there, oxygen mask on, an aspirin, a nitroglycerin, and 20 milligrams of morphine later, eyes wide with fear and in irretractable pain, when all the cardiac workup has been negative, when all eyes are on you and you don't know what the hell is wrong with her, and what the hell can raise her pulse from 70 to 140, her systolic pressures rise from 110 to 150 in a matter of minutes -- it is like a train about to crash, with you driving, and you suddenly realizing you didn't know how to drive, all this time.

When all you want is to curl up and cry, this same sick panic you've been feeling everyday for the last week, when you're feeling like you really don't belong here, and that you're no good for this. This feeling of incompetance. Wanting people to know that you're only (for God's sake) a student who can spew out the molecular mechanism of coumadin without knowing why the hell someone with an INR of 3.96 could still extend her pulmonary embolism and suddenly be in respiratory distress. And even if you did, not knowing what the hell you can do about it, short of holding her cold, shaking hands, looking into her tearful eyes, and apologizing for her pain, her suffering, her terror, and your helplessness.

This feeling. Of not being ready. I don't think I have ever questioned my career choice as much as I am now.