In the final stretch, residents look back on what’s changed

   BROCKTON — Just when Dr. Justin Routhier thought he had gotten a break from admitting patients to the emergency department, his pager rumbled.
   The elderly woman who had been having trouble breathing all day had died. Her heart had stopped overnight. Routhier was exhausted and alone. It was last summer, when he was starting his days before sunrise while completing his rotation in surgery.
   That night, he was completing his turn on the overnight shift — an evening that had been nonstop since it began — with little backup. But Routhier hadn’t had time to feel sorry for himself that night.
   Instead, he finally felt like a doctor.
   Just 11 weeks remain until the interns at Signature Healthcare Brockton Hospital complete their first-year residency there and move on to other hospitals where they will pursue their preferred specialties.
   They are well past the halfway point of this year and feel more like the trusted, encyclopedic and even-keeled physicians they are training to become.
   “You know that it has to happen,” said Dr. James Knutson. “I remember (thinking) in August and July and September, ‘Eventually, I’m going to have to be good at this. I don’t know when or how it’s going to happen,’ but eventually, it just does happen.”
   For his first time as an intern, Routhier had to pronounce a death that summer night the elderly woman died. It was the final bit of chaos to a “totally preposterous” night, he said.
   “I didn’t realize it at the time, but I look back on it and I think if anyone’s going to be broken, it’s going to be during one of those nights,” he said last week.
   But Routhier realized later he wasn’t broken. He called the time of death. He learned how to fill out a death certificate. He called the woman’s family and tenderly told them she had passed.
   “You just feel like it can’t even get any worse — and it does — and then you look back and realize, ‘All right, well, I’m still alive,’ ” he said.
   These days in the hospital feel like a long way from their first day last June, the residents said.
   Basic tasks, like writing orders and admitting patients, no longer overwhelm Routhier.
   “I’ve learned how to be pretty efficient at my day-to-day activities, which is great, as opposed to the first day when everything’s new — you don’t know where the cafeteria or the bathroom is, never mind reminding yourself how to do a history and physical,” he said.
   “You only learn by doing,” Routhier added. “Medical school doesn’t prepare you for that. Textbooks don’t prepare you for that.”
   Knutson doesn’t flinch — well, as much as he used to — when he has a line of patients to admit to the emergency department, three pages from nurses on other floors for consults and a mound of paperwork to complete.
   But he, like the others, are ready to move on.
   “It’s been a very affirming year. I’m very glad that I won’t have to do this forever,” Knutson said. “That sounds bad, but patient care and general medicine takes a special kind of patience, and I realize I didn’t go to medical school or go into medicine to do this kind of job.”
   A little hardened by their experiences, the doctors said some of their naivete about the job has worn off.
   “Sometimes my job is not inspirational. Sometimes my job is not intellectually taxing. Sometimes it’s more emotionally taxing and psychologically, and I think I really gravitate more toward the specialties where it’s purely thinking, purely intellectual and analytical,” Knutson said.
   “This isn’t to say that, you know, I don’t ever want to see patients again, or I don’t ever want to have to use my heart or soul or spirit,” he added. “But at the same time, it takes a lot out of you.”