LAUSR

One year ago, I was terrified. I was in the neonatal intensive care unit with 3 co-interns for a brief orientation on the day before we started the first rotation of our residency. I remember the envy I felt while meeting with the previous team of interns, from whom we received sign-out on our patients—our first-ever patients. One sat with feet up on the sofa in the workroom; another efficiently put in an order the nurse had just requested; the upper-level intern peeled a tangerine in the corner. These residents showed no signs of the nervousness, trepidation, and self-doubt that were suffocating my thoughts. Posted on the walls of the workroom were facts that every resident surely knew—literal signs of my inadequacy: neonatal vital signs (wait, 160 is a normal heart rate?!), Apgar scores (what does the g stand for?), infant formula choices (more than one option exists?). “I cannot wait,” I remember thinking before my first day, “for this year to be over, and to be a confident and knowledgeable resident.” Like so many times during intern year, my thinking turned out to be completely wrong. First, I was misguided to project total confidence on the residents. I do not know how many years of training it will take before I can walk into the hospital without a twinge of unease at not knowing a diagnosis or self-doubt about a management plan. But it is certainly more than one. Intern year has been an irreplaceable learning experience; my knowledge has increased exponentially and I feel confident in many of my medical decisions. But I still get nervous every morning during my bike ride to work, when I think about mismanaging a patient, making an incorrect diagnosis, or looking like a fool during rounds. In fact, it is common, especially early in training, to misdiagnose and feel overwhelmed on rounds; interns are often unenviably described as being at the bottom of the totem pole for this reason. What often goes unsaid, however, are the benefits, responsibilities and joys that come with this position. As an intern, I was almost always the first physician to see my patients in the morning and often the last to see them at night. This presence caused patients to view me as their primary physician. Of the many physicians on the team, it is often the intern’s name the patient remembers. After discussing treatment options with the entire team, patients would regularly ask for me to come explain the plan again, to answer their questions, or to ask if they were making the right decision. It wasn’t because my explanations were the clearest, and it certainly was not because I was the most knowledgeable. Rather, it was because I had gained their trust and confidence. As one climbs the proverbial totem pole, patient responsibility increases. Upper-level residents, fellows, and attending physicians have more patients and fewer clinical hours than interns, which can translate to less downtime. Sure, these breaks are good for grabbing food, checking ESPN, and responding to email. But less downtime means losing perfect opportunities for getting to know the patients. It is a complete cliché to say that patients are the best part of being a physician, but it’s a cliché for a reason; patients are funny, interesting, and have stories to tell beyond their history of present illness. Time passes the fastest in the hospital while listening to a teenager bashfully yet vividly recount her arrest for jealously keying an ex-boyfriend’s car (he had been cheating on her), or guessing the answer to an 8-year-old’s joke about the type of cheese that is always in the gym (shredded). Most residency application essays include some meaningful patient story; there is no reason these interactions should stop after graduating medical school. Research has demonstrated that shared, stressful activities catalyze group cohesiveness.1 This theory helps explain why certain groups of people quickly form strong, lasting friendships, such as military units, fraternity/sorority pledges, and intern classes. A typical team is one attending physician, one fellow, one upper-level intern, and several interns. A week of nights might be exhausting and disorienting, but there was always a co-intern with whom to enjoy midnight hot fudge sundaes. Interns rolling their eyes in the background while an onerous fellow scolds you for presenting too few laboratory values can make that fellow bearable. Being with classmates daily has been a brilliant aspect of this year. In case my program director is reading, this essay is not a plea to repeat the year. It was often grinding and stressful, and I know I’ve had enough note writing, second guessing, plan changing, and 3 AM diet orders for a lifetime. But I also know that there will be many times in the coming years when I prop up my feet, enjoy a tangerine, and reminisce about my wonderful patients, how much I learned, the midnight ice cream, and being an intern.