I remember the first days of nephrology fellowship. It was exhilarating. It was terrifying. All through residency, when you came across a patient that had you stumped you could just call the consultant. Now I was the last line of defense. I was on the receiving end of that phone call and I did not feel up to the task. I remember those months as being among the most stressful of my career. I started carrying around a small bottle of Pesto-Bismol to fight the stress induced gastritis.
I felt like a drunk, walking out of the ICU to take little nips from “my little helper.” It’s a lot of self induced pressure to battle the imposter syndrome inherent in being a new fellow, especially one coming from an outside institution.
One of my first consults was a transplant patient. The patient had acute kidney injury (AKI) and hyponatremia. She had recently received IVIG and I was so excited that I figured out that her hyponatremia was due to pseudohyponatremia from the IVIG. (See
this letter to the NEJM). So it was particularly disheartening when the transplant surgeon was not impressed pseudohyponatremia diagnosis especially since I had not been able to make any heads or tails regarding the AKI. He made his displeasure quit clear. I felt pertty humbled going to my attending, Patrick Cunningham, but he said, “Let’s walk through the case” and quickly, and humanely, pointed out the possibility of osmotic nephrosis from the same IVIG I had already blamed for the hyponatremia.
Fellowship is hard. Be humble. Try hard. Read as much as you can. Ask for help. Every person we graduate is a competent nephrologist. You will be one too. Trust the system. Together we’ll get you there.
