Reflections of a Graduating Intern

Today is the first day of my PGY2 year. I am writing this at midnight, just as the final hours of my life as an intern have evaporated. My main emotion, which I am sure is not unique to me alone, is a feeling of relief. However, as I reflect on the actual experiences that I have had over the past 12 months, I am mesmerized by how freaking cool my job is. The internship, no matter your specialty, is one of the most demanding professional experiences in the entire world. Yet, it is also one of the most rewarding experiences that can be found in any profession.  I would like to reflect on a few of the overriding feelings I have had over the past week.

Dear medical students and new interns:

Your job rocks

You change lives every day Every Single Day. You will know the basic treatment of nearly every single patient that could walk through a hospital door. You are a DOCTOR!  You are not an orthopod, an ophthalmologist, a dermatologist, or an internist [yet]…you are simple a well-rounded DOCTOR! You get to be part of some of the most important situations and conversations that your patients will ever experience. You will provide live saving service to hundreds of the coolest people you will ever meet. It is hard to grasp the reality of your job as a student or a resident. But take a small step back and think about it.

Do not allow yourself to be jaded

You are an intern, these things are a given: awful work hours, negativity from your colleagues, difficult patients, even more difficult families, intolerable work load, mistakes. These issues are inevitable and to allow them to bring you down is a sign of weakness. Recognize that no matter what you do, where you do it, or who you do it with, you will encounter each of these things. Rise Above! Don’t forget #1 above: you actually have a great job.  [Note: I am not a rockstar. I was frequently jaded, I was occasionally the negative colleague, and I did not always have the best bedside manner. But I can tell you, when I decided to get over that stuff, my job was great and patient care improved]

Work hard in medical school

Work hard, not for yourself, not for the grade, not for the board score or to check off another box on your CV. Work your tail off for your future patients. Remember, you came to medical school for them, not for yourself. If you were doing this for yourself you would be getting an MBA and working on Wall Street. As you sit there studying biochem, embryology, PreTest for the Pediatric Shelf Exam, and First Aid for the USMLE Step 2 you will not realize what is actually happening. You are acquiring information that at some point in the near future will be lifesaving to another person. DO NOT take your studying lightly. As I learned in my first days as an intern, your knowledge WILL be relied on very soon to save someone’s life. Let me provide you with just a few examples over the past 12 months to drive this point home. I recount these stories not to boast, as I am sure every intern in my class would have done exactly the same; I share them only to reiterate that you can NOT take your studying lightly.

NOTE: Stories have been altered to mask any identifiers but are otherwise true.

Exhibit A:  Early in my internship I was called to the emergency department to admit an older woman who was complaining of right hand weakness. She was unable to open and close one hand at all and the other was not much stronger. She said she had a vaccination about 4 weeks earlier.  Walking had become more difficult and she felt like her shoulders were now weak.  My ears began to perk up, the words and phrases from my countless hours of studying flashed in my head, as they will in yours. She then said, “you know, I am having some trouble swallowing right now.” BINGO! At this point a light must go off in your head. [GBS! GBS!]. Her weakness is above the neck and she has minutes to hours before her respiratory muscles will fail.  I immediately called my senior resident (something you should always feel comfortable doing, especially early on). We intubated her within minutes and she made a slow but great recovery.  I was the only one there. I was one month out of med school. DON’T TAKE STUDYING LIGHTLY.

Exhibit B: Towards the end of internship I was in the basement of a friend’s house when a three year old boy who I know very well was playing with a marble and inhaled it. He made the universal sign with his hands up to his neck. He coughed twice, and then stopped coughing and breathing all together. I immediately grabbed the boy, flipped him upside down and gave him a whack on his back (ACLS/BLS Protocol). After the first whack there was no change, only the same choking boy. I then gave him a second and viscous whack. A large marble erupted out of his trachea and onto the basement floor.  I am sure the toy was completely blocking off his airway because he had stopped making any noise at all.  DON’T TAKE YOUR TRAINING LIGHTLY (BLS/ACLS ESPECIALLY)

Exhibit C: Early in the year I was speaking with a patient when the nurse next door screamed for help. I walked in the room and the nurse pointed to the patient (not my patient) who was staring blankly into space. She said that the patient was conversing normally minutes ago and had been recovering well from a small GI bleed.  All of the sudden the patient turned towards me, opened her eyes wide, and then spewed out nearly a liter of blood from her mouth.  Any clot overlying her bleed was now obviously gone and she was acutely loosing incredible amounts of blood via hematemesis.  If you are not yet aware, such an episode is can lead to death within minutes. I was the only doctor on the floor. My reading, rounding, and studying of GI bleed was the only thing available.  DON’T TAKE STUDYING LIGHTLY.

Call your resident

It is not weakness. If you have a question, call. If you ever think about calling your resident, call.  In the grand scheme of things, is it better to be irritating or to harm a patient for fear of being irritating?

Smile!

You knew this was going to be hard. You knew you would work more than everyone in your family and all of your friends. You knew you would have little free time. You knew there would be crummy nurses and egomaniac residents and attendings. Don’t act surprised. Don't be weak and let these things change you. These things exist in every profession. The difference is, you get to have a profound and positive impact on your patients that could change their lives forever.  And you get to do this EVERY SINGLE DAY!

You will make mistakes.

Get over it. Don't flatter yourself: you, just like every other intern that has ever lived, will make mistakes. Learn from them and teach students and other residents about them so that they never happen again.

Choose to be happy

Yes, it is a choice. Find a time to stop and reflect on what you are actually doing. You will certainly be overburdened by progress notes, H&Ps, nursing calls, terrible call nights, and trying to keep the rest of your life from disappearing.  Set aside a time where you can think about the great experiences you are having and the hundreds of lives that you are improving. If you find a way to smile and be happy, you will not only love your job, you will also become a world class physician and your patients will love you.  Attitude is everything.

You Job Rocks!

No, really, I am serious. It rocks.