A Medical Intern Writes to His Future Self

Dear future Pranay,

By the time you read this, time will have passed with the same explosive inevitability that C diff diarrhea passes from unfortunate rectums. I'm not sure where life has taken you--you might be a serious senior resident physician, frazzled fellow, or -- maybe -- living your dream of being an eccentric train conductor with an affinity for shoe polish and writing novels. Wherever life has brought you, take five minutes, sit back, put your feet up, stop being distracted by the passing scenery on the Northeast regional, and think about your intern year.

How far you have come from the fresh-faced, bow-tie-wearing, revoltingly cheerful fellow who stumbled anytime he had to introduce himself! The first few days in the hospital were so gruesome that they'd have been conducted off-stage in any respectable Greek tragedy. People actually expected you to KNOW stuff. What a notion! Sure you had gained vague ideas of what PTs and PTTs were in med school, but what were you to do when gimlet-eyed nurses asked you to adjust heparin drips? Need I remind you of your frequent urge to dive into a corner and impersonate a HIPAA compliant dustbin until people left you alone?

And why, in the name of all that is digital, did we have to pre-round and present every patient every morning? Was there a celestial curse upon our attendings and residents that blinded them to readily available information on the very computers they pushed around? The only thing worse than supervisors ignoring the information before them was supervisors entranced by it. When around supervisors thus transfixed, presentations sometimes felt like ancient rituals necessary to stave off famine. The amount of pimping you experienced was fortunately minimal, but occasionally it did feel like a form of advanced interrogation that Dick Cheney would support. What on earth is Throck-Morton sign anyway? Even on the rare occasion when you actually did know a thing or two, the IQ -depleting gaze of some inscrutable attendings reduced your intellect to that of a salamander who had had a difficult birth.

And then came the notes -- the scourge of every intern. We all developed a dreaded condition called hypernotemia. Does every patient really need Shakespearean prose written about them daily? You probably spent more time doctoring your notes than your patients. Mind you, the notes often parted company with reality. Lungs: CTAB? Heart: RRR no m/r/g? Thyroid: Midline? Yeah, right!

The cacophony of pagers, so integral to the intern experience, gradually ingrained itself into your nervous tissue like some insidious toxin. By the middle of the year, your acoustic nerve began to conduct paging sounds to your brain without any stimulus at all--kind of like a pager fibromyalgia. Your best friends developed the dreaded pager-traumatic stress disorder, with dreadful flares during backup rotations. Symptoms included jumping at small sounds, checking the pager obsessively for missed pages, and waking up screaming at nights. Each page filled you with a nameless dread, especially at first, and you asked deep existential questions about why you got yourself into this mess in the first place? You had fleeting regrets about passing up on a graduate degree in Gender studies or English literature where nobody would ask you to fix broken human bodies.

Most dangerous, of course, was the ever-present threat of crippling cynicism. Inappropriate ICU care, overly optimistic code statuses, ridiculous ROMIs, helplessness before cancer, and unprecedented exhaustion eroded your spirit. You became the gruff bar curmudgeon given to slurred soliloquies about life, the universe, and the medical-industrial complex.

There is probably no escaping the malaise associated with internship. Doctors, like Rome, are not built in a day. But slowly and imperceptibly, over the course of the year, you and your friends became competent physicians. Before you knew it, notes were done before rounds, pages lost their terror, and you learned to make even the most solemn attendings and nurses snort with laughter. Managing chest pain, shortness of breath, and electrolyte problems became surprisingly ordinary. With increasing competence, your initial wretchedness and inadequacy gave way to renewed joy in medicine. Most importantly, your humanism, ethics, and general sense of optimism survived.

You couldn't have done it without compassionate co-interns who listened to the aforementioned soliloquies and salved your wounds with kind words or the occasional frozen yogurt. Almost every day, you were rescued by residents and attendings in shining armor well...bleached white coats at any rate. They taught you to manage sick patients, listened to your rants, took annoying tasks off your hands, and respected you. They spared you from "paying" most of your supposed "dues" because they remembered their own struggles with heparin drips, "hypernotemia," and pager-traumatic stress disorder.

I write to you now, at the end of my intern year, to refresh your memory and dispel recall bias. If you are currently supervising interns, remember your humble origins and cut them slack. Do the things that made you adore your favorite residents and attendings. Take a genuine interest in your interns as human beings and trainees- fake curiosity is cloying. When you teach, do so to improve their knowledge, not to showcase yours. Respect their intellect and don't be embarrassed to learn from them. Remember that interns prefer to work with human beings, not demigods. Pay attention on rounds and make eye contact. The occasional encouraging smile or wink goes a long way. Make them feel like valuable members of the team, not chroniclers of events that they weren't part of. If you see them struggling with something you also struggled with, share your experience candidly to remind them that they aren't alone and that there is hope. Oh...also, donuts and coffee don't hurt on the weekends. If, however, you ended up becoming a train conductor, enjoy the scenery, polish your shoes, and write a good novel.

Yours truly,
Pranay Sinha, MD (Intern)

This is a cross-post. The essay was originally posted on the extraordinary kevinmd.com