A veteran offers advice for those just starting residency.
Dear Intern,
I love potassium. And allow me to tell you why you, too, will possibly come to love it by this time next year.
You see, on June 24, 2013, I was the intern. And 31 minutes into my internship I encountered my first “real doctor” moment. I vividly remember making my way out of my patient’s room after prerounding on her when I was suddenly halted by a yellow sheet of paper and a nurse’s alarmed face very close to mine.
“Here.” My gaze went up from the paper to her face. I am certain she viewed my expression as a big question mark.
She waved the paper again and said, “Um, it’s a critical value; her K is real low, it’s 2.1. What do you want me to do, Dr. Sayyeeeed?”
My mind was racing, faintly aware of the fact that she did not pronounce my name right and more conscious of the fact that perhaps, for the first time in my life, someone had addressed me as a doctor and expected me to tell them to do something.
“I think we need to give her potassium then, right?” I managed to respond after an awkward, what-seemed-like-forever, nine-second pause.
“Okkaaaayyyyy, so can you write for it then?” Clearly she was getting annoyed with me.
“Sure.” I pretended to turn around to the chart and concentrate on writing for potassium. In reality, my mind was a blur and I was standing there with my pen ready to put my thoughts in ink and my PGY1 stamp in my pocket.
“HOW ON EARTH DO YOU GIVE POTASSIUM? Give her BANANAS?”
My mind struggled to bring back images from the one week of orientation we had prior to starting the floors as interns. Could I recall a time someone had repleted potassium in front of me? I found nothing there.
The intern handbook! I reached into my white coat pocket and realized there was no book there because my copy was still not printed yet.
With my inherent inability to multitask, I scrolled down my phone’s call list. I had to ask for help. They said ask for help.
“This is so dumb, you don’t even have the intern handbook. The nurse is still looking at you. Wow,” my inner voice said.
Finally I scrolled past my resident’s name: Amrita John. Ohmygosh, the relief.
“Well, do you want me to get an EKG at least?” the nurse said.
“Yes, of course. Thank you.” I smiled. A smile can do wonders usually, but I was sure that this nurse smirked in response. At me.
And off she went.
Amrita’s voice came to life on my phone and I felt safe again.
“Um, hi, Amrita. I think I need to ask you a question …”
The Ride of Your Life
Needless to say, since then I have learned (among several other things) to write “10 meQ of KCl in 100 cc of sterile water” with ease.
When people say internship is like a roller coaster ride, they are lying. It is a roller coaster. In terms of the ups and downs of your emotions, knowledge, competency, physical strength, and sanity, it is inflexible; you deal with it, mold yourself around it.
For now I know appropriately filling out an insulin sheet, or wondering how to cycle troponins, or trying to helplessly gauge out a plan of action for your patient while juggling all of the paperwork, or getting the hang around a delta wave when you really see one on an EKG are all gigantic and overwhelming. But you will move on from these small (yes, small) hurdles and soon be taking steps to get the feel of the big things, like learning to deal with (hold your breath) BiPaps and ventilators and becoming comfortable with the idea of putting in central lines and a variety of other milestones.
There will be times where you feel anger and frustration while you are put on hold at the primary care physician’s office in an attempt to make a follow-up appointment; there will be times when someone else will easily outshine you and you may not get credit for the long hours you put in; there will be times when you will want to question your resident who is making you write the respiratory sheet the third time over. It is expected of you to feel slightly insecure and wonder why others can do the same task in half the amount of time it takes you to do it. It may also dawn upon you during intern year (and several times that is) that maybe, just maybe, you’re not doing the right thing with your life.
But the day you see that you closed an anion gap in the right time frame, the day you realize you were able to predict and save a patient from going into avid delirium tremens, and the day when you are able to start the sepsis protocol in time and hit the right bug and see your patient turn around … you will be so satisfied. Your faith in what you do and how you do it will be restored that day. And there will be several of those days, I promise.
For now, take pleasure in this year you have kick-started. You are an intelligent young physician, starting to live out your dream. You worked incredibly hard to get this far. And just like everything great we have achieved in our lives, this year will not be easy. You are adequately equipped to deal with what may come—and if you’re not, then you will pick up the gear along the way. Seek help when you need it, and don’t be ashamed; we all need help! Be kind and compassionate; try, even if it doesn’t come to you naturally. Be true to your patient’s care. Often you will find relief in your patient’s comfort. Read, make friends, take meaningful walks, talk to your loved ones, and take good coffee breaks. You will need solace wherever you can find it during the next few months. You see, intern year is unbreakable … but then again, so are you.
With love,
An Ex-Intern
