Ask anyone who knows me well how I feel about intern year overall, and they’ll tell you I love it. But there are undeniably some really remarkably shitty days and nights. Ranging from 12 to 25-hour stretches, there are some shifts where my pager won’t stop alarming with either relatively unimportant notifications (which is just annoying) or with critical alerts that my patients are sick (which is terrifying). There are shifts where I feel utterly incompetent, incapable, and either fully fired up on adrenaline or unable to keep my eyes open. Sometimes I’ll be 8 hours into a workday without having gone to the bathroom or having eaten a single meal. Interns are almost always expected to be in three places at once, and our focus is split, which makes my brain feel like an egg being cracked open, scrambled, and discarded by the end of the day (or night).
In the past 6 months, I’ve come to accept that chaos is endemic to hospitals (although it certainly could be better!), and the feeling of drowning is part of the gig as an intern. The chaos isn’t going to resolve itself at any point, but the goal of this year – and seemingly every year that follows – is to learn how to tread calmly and move forward.
My first day as an intern set the precedent for what a Bad Shift looks like. I started on a Saturday on the Trauma and Acute Care Surgery service. On weekends, we have a third of the usual staff. So I, a brand-spanking-new doctor, was responsible for the care of nearly 40 patients. Of course, I had a “chief,” a calm, supportive senior resident, who dictated care plans for the day and, when she wasn’t in the operating room, fielded my many panicked text messages. Still, I felt pretty alone and disturbingly unprepared.
Although I had spent the day before reading through the patients’ charts, I couldn’t keep their stories straight. There were multiple people who had been in car crashes, victims of shootings and stabbings, or some with acute surgical problems like bowel perforations and blockages, appendicitis, or inflammation of their gallbladders. From the moment I took over the pager at 5:30 AM till I left at 11:00 PM that night, I couldn’t catch a break. I was getting paged relentlessly: “The patient’s potassium is low. Please replete.” “The patient is anxious, please treat.” “The patient is shallow breathing, come assess STAT.” By the time I pulled that patient’s chart up to review their labs and vitals, a new page was coming through at full volume. One hour in, I was twenty pages behind, and I already wanted to throw that noisy little Tamagotchi-like device down the 16 flights of stairs that I was running up and down all day.
Looking back on that day, the volume of pages – issues I needed to respond to, act on, or selectively ignore – would still overburden me today, but they wouldn’t overwhelm me as much now. Back then, I had no idea where to begin. Med school tried but fell so short in preparing me for the practicalities of life as an intern, in large part because the surgical intern’s job requires medical knowledge, but ultimately isn’t really about medicine. For example, one of our main tasks is to discharge patients – coordinating their follow-up visits, at-home nursing care, and prescription pick-ups. I don’t remember a pharmacology lecture on “How to Find the Only CVS Pharmacy Open after 11 PM So That Your Patient Gets Their Pain Pills.”
Another example: A critical part of being a surgical intern, possibly more than for interns in other specialties, is speaking to families. Because our senior residents are in the operating room during the day with the attendings (the Real Surgeons), we are often the only ones available to respond to nursing pages that say “Family is at bedside, and they’re ANGRY. Come ASAP.” As a new intern, I found myself being yelled at by a patient’s brother-in-law for not knowing his brother’s full medical history. He generously called me a “stupid f***ing intern,” which was completely inappropriate, but nailed exactly how I felt at the time. Later that same week, I sat in front of a family, telling them that their husband/father had cancer. I did my best to field and deflect their million questions that I couldn’t possibly begin to answer. Not surprisingly at all, the sessions we had on communication in med school didn't prepare me to be the one sitting in front of family members, absorbing their anger and sorrow.
I wasn’t remotely ready for these things and so day one hit me like a brick. At 5 PM, I shed a quick tear in the stairwell when a nurse, right in front of me snarkily joked with my patient saying, “This is the young intern’s first day, she’ll figure it out eventually.” At 9 PM, I completely broke down. I hadn’t yet written a single note, documenting the day’s events and plans for each patient, usually a task expected to be completed by noon. I cried my eyes out in the workroom with my co-interns who were there for 24-hour shifts. One co-intern, then basically a stranger, held my head against her shoulder and reassured me it would be alright. I felt both mortified and soothed, and picked my head up and started writing notes.
While I’ve struggled to describe and document intern year coherently, I have kept a private journal of mostly audio recordings I’ve mumbled to myself while walking out of the hospital or getting ready for bed. On the night after my first shift, the recording is time-stamped 11:48 - 11:51 PM. I’m eating carrots, hard-boiled eggs, and grapes (I know because I remark on the contents of my plate) – the sound of my munching doesn’t do much to mask the fatigue in my voice. “I had no f#&*$^g idea what I was doing all day,” I say to myself. In a perhaps regrettably dramatic statement, I went on: “I think this is the most stressed I've ever been in my entire life, and the worst part is it's not a satisfying kind of stress where I walk away feeling like it was hard but I took good care of patients or I accomplished a goal…I think I took bad care of people today.”
Listening to this recording 6 months later, I wish I could tell myself , “Yeah, it feels like that sometimes. It’s the worst, but you’ll get used to it.” Knowing myself, I would’ve turned back around and said, “I don’t want to get used to it. That wasn’t okay.” And the truth is, sometimes it isn’t okay – some shifts just suck, and you don’t provide the high quality, patient-centric care you aspire to – not because you don’t want to but because you really can’t. But those shitty shifts will start to diminish in frequency and, when they do occur, you’re no longer in shock. Eventually, the tasks are no longer daunting; the barrage of pages becomes manageable items to triage; you know how to treat the sort of sick patients and you know who to call for help for the very sick patients. Eventually you know which pharmacy is open late, and you quickly learn who to turn to when you need a shoulder to cry on.
And then, between the less-frequent shi*ty shifts, are incredibly good days. Days where I learn, where I excel, where I pat myself on the back for applying the knowledge I've spent years accumulating toward the care of a real human – whether on the floor or in the operating room. Those days are like the floaties of residency, leaving me buoyant and reminding me that although the job of an intern can suck, it can also be incredibly fun and exciting. Although I started off with no idea what I was doing, eventually I'll look back and realize I've managed to keep my head above water the whole time.
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