Between Expectations: Lessons from a Pediatric Residency [Hardcover]

Meghan Weir (Author)

Book Description

Release date: March 1, 2011

When Dr. Meghan Weir first dons her scrubs and steps onto the floor of Children’s Hospital Boston as a newly minted resident, her head is packed with medical-school-textbook learning. She knows the ins and outs of the human body, has memorized the correct way to perform hundreds of complicated procedures, and can recite the symptoms of any number of diseases by rote. But none of that has truly prepared her for what she is about to experience.

From the premature infants Dr. Weir is expected to care for on her very first day of residency to the frustrating teenagers who visit the ER at three in the morning for head colds, each day brings with it new challenges and new lessons. Dr. Weir learns that messiness, fear, and uncertainty live beneath the professional exterior of the doctor’s white coat. Yet, in addition to the hardships, the practice of medicine comes with enormous rewards of joy, camaraderie, and the triumph of healing.

The three years of residency—when young doctors who have just graduated from medical school take on their own patients for the first time—are grueling in any specialty. But there is a unique challenge to dealing with patients too young to describe where it hurts, and it is not just having to handle their parents. In Between Expectations: Lessons from a Pediatric Residency, Dr. Weir takes readers into the nurseries, ICUs, and inpatient rooms of one of the country’s busiest hospitals for children, revealing a world many of us never get to see. With candor and humility, she explores the many humbling lessons that all residents must learn: that restraint is sometimes the right treatment option, no matter how much you want to act; that some patients, even young teenagers, aren’t interested in listening to the good advice that will make their lives easier; that parents ultimately know their own children far better than their doctors ever will.

Dr. Weir’s thoughtful prose reveals how exhaustion and doubt define the residency experience just as much as confidence and action do. Yet the most important lesson that she learns through the months and years of residency is that having a good day on the floor does not always mean that a patient goes home miraculously healed—more often than not, success is about a steady, gradual discovery of strength. By observing the children, the parents, and other hospital staff who painstakingly provide care each day, Dr. Weir finds herself finally developing into the physician (and the parent) she hopes to become. These stories—sometimes funny, sometimes haunting—expose the humanity that is so often obscured by the doctor’s white coat.

Editorial Reviews

From Publishers Weekly

It's a given that doctors-in-training will suffer through sleep deprivation and stress, but pediatrician Weir brings something more heartfelt—and joyful—to this achingly personal chronicle of her residency at Children's Hospital Boston and Boston Medical Center. Weir's grim introduction to Connor, a fragile preemie, forces her to wonder whether "the ends will justif even the most agonizing means." There is her anger at baby Myranda's drug-addicted mother, her panic over blue-baby Briony, her struggles to tell 19-year-old Harry's father that his son has a brain tumor, and her realization that when you don't know what to do, you should know whom to call. The most memorable parts of Weir's grueling training are the complicated kids and families, the hope she inspires in them—and the hope they give her in turn. Yet, she shows, doctors working with very sick children must know when they're offering families too much hope, or not enough, and that there's a cost to everything they do. Here's a white coat insider's account with better writing and more soul than most medical dramas. (Mar.)
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From Booklist

Among the lessons Weir recounts in this somewhat uneven memoir of her residency at Boston Children�s Hospital is the fact that sometimes parents of seriously ill children are more resilient than one might expect and that, as a physician, one can only do what one can do. When she needed to take a break early in her internship due to job-related stress, Weir fretted over the decision but took it nonetheless. Upon her return, she realized it was the best thing she could do, both for herself and for the children in her care. Additionally, a brief stint at a disastrously underequipped and understaffed hospital in Monrovia, Liberia, revealed that medical priorities must be adapted to the reality of one�s situation. Finally, by following her early patients and their families over the span of her residency, she discovered that sometimes the advice she might have given parents as a new intern was best left unsaid. Aside from its unusual pediatric perspective, Weir�s medical residency memoir is a consistently modest addition to the physician-in-training genre. --Donna Chavez

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Product Details

• Hardcover: 288 pages
• Publisher: Free Press; 1 edition (March 1, 2011)
• Language: English
• ISBN-10: 1439189072
• ISBN-13: 978-1439189078
• Product Dimensions: 9 x 6.1 x 1.1 inches
• Shipping Weight: 14.9 ounces (View shipping rates and policies)
• Average Customer Review: 4.3 out of 5 stars  See all reviews (16 customer reviews)
• Amazon Best Sellers Rank: #386,840 in Books (See Top 100 in Books)

Most Helpful Customer Reviews

10 of 10 people found the following review helpful

5.0 out of 5 stars A wonderful glimpse inside the life of a hospital and a resident March 3, 2011

By Brent Ragar

Format:Hardcover

I will admit up front that I am biased - I remember first hearing about this book years ago on call over subsidized cafeteria food when Dr. Weir was an intern and I was finishing residency. But just because I like Meghan and have enjoyed her updates as she submitted her manuscript and chose titles and covers doesn't mean that the book will be good. That's why I'm relieved that I really loved her accounts of her experiences as she grows to be a better doctor.

There is a lot to love here. First and foremost are the patients - even though she claims not to tell their stories, she does so quite well. Her blend of compassion, rectitude, and practicality make sure that we realize that we are seeing patients through her eyes and not necessarily as others would see them. However, I think that many patients, families, and doctors would benefit from such an honest assessment of the patient-doctor relationship -- especially when it pertains to students, residents, and fellows who are still learning the art of medicine. She is to be commended for putting forth her own insecurities and for constantly seeking to improve herself by revisiting old encounters and examining them in the light of subsequent events. Such a view of the human nature of doctors can only improve the shared decision-making needed between doctors and patients.

Another aspect of the book which I found special was the juxtaposition of her time in various hospitals - from Children's Hospital to Boston Medical Center to JFK in Liberia. Realizing what it would take to give everyone the kind of care they need and deserve is a central part of the narrative and the depressing effects of war, poverty, and rampant disease are important reminders that it's easy to lose sight of how much is needed in this world. Whether it's education or basic human rights there is much work to be done.

4 of 4 people found the following review helpful

4.0 out of 5 stars heartfelt March 7, 2011

By Leady

Format:Hardcover|Amazon Verified Purchase

I will admit to being a sucker for the medical trainee memoir. From my first encounters with Perri Klass, I've been hooked. And with the proliferation of the genre since Klass' "A Not Entirely Benign Procedure," there has been no shortage of fuel for my addiction. I've been waiting to read Meghan Weir's "Between Expectations" for some time now - and it's a nice addition to this collection of writing about medical training. But what does she add to the genre?

Her writing has some insightful moments for sure. She bears witness to the painful suffering of children and their families that goes on in our hospitals all over the country. She gives voice to the trainee who too often just plugs away at the machine that is medical training without the space for self-reflection that she fought for in her own training program. But she did fight for this opportunity to write about her training, and I wonder, by the end of the book, what she accomplished beyond catharsis by writing this collection of stories. Many times by the end of a chapter I found myself wishing that I were able to ask her "OK, THEN what?" Not about what happened to the patient, or what she did next, necessarily, but who cares? Why did you write this? What did this change about who you decided to be as a pediatrician? How did this experience affect what you decided to do with your next patient? Or did it?

But while I find myself wanting more, my medical memoir fix has definitely been met by this book. It's very readable; the framing of the collection with her first patient in the NICU and the "NICU grad" at the end adds a nice structure; and maybe that's enough. Maybe it's enough to just bear witness to a child's story, a family's loss, a moment that passed by at 3 AM on a hospital ward where there was only a bleary-eyed intern (or senior resident) to notice. Or maybe if Weir pushes herself a little more she might find something more overaching to say about medical training, pediatrics, parenting, childhood, and loss.

5 of 6 people found the following review helpful

5.0 out of 5 stars The doctor we'd all want February 23, 2011

By sunshine

Format:Hardcover

This books provides the reader with rare insights into the making of the kind of doctor we'd all like to have-smart, knowledgeable, highly-trained, compassionate, funny, humble and immensely human. Meghan Weir has done an outstanding job of allowing us to experience the extraordinary difficulties and daily decisions required to practice medicine today.