Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Being a good intern (PGY-1)

I was reading a post on one of my favorite blogs , Missionary  Doc in The Making  http://doctajay.com/?p=1489 , where a young orthopedic resident describes some of his experiences in striving to be the best intern that he can be.  I am reminded of my first months as an intern in General Surgery. I remember that my first chief resident chewed me out daily for the first week because of the things that I had missed in caring for the floor patients. By the end of that week, I was a better intern because of those “daily chewings” and my experience working under this chief resident. I learned how not to “miss” anything and how to become efficient enough to get into the operating room to scrub a case or two during the day. If I had not had a very demanding chief resident during my first rotation, I would not have learned as much as I did. It was an awesome experience and I am thankful for the heavy workload that helped in my early training. In short, I learned to “think on my feet” and to make detailed observations in a short period of time. I also learned to provide the very best care of the patients on my service that I could.

Yes, I was bone tired when I arrived home each day. I usually arrived at the hospital at 4:30AM and didn’t leave until after 7pm each day. By the time I arrived home, I took a shower and hit the bed so that I could get some rest to start the day over again the next day. If I was on call, the other interns would sign out to me around 6pm and I would generally make quick rounds on the sign-out patients so that I could see if there would be any issues. I was also a compulsive list-maker so that I could check off things that just needed to be done. I would try not to eat a heavy dinner because I found that the night would drag on. I kept myself well hydrated with iced tea (avoided coffee in the evenings) and generally used my call time (if I wasn’t busy) to dictate discharge summaries and get things ready for my patients who would be going home the next day. During the night, I would read and then nap (couldn’t really sleep soundly in the noisy call room) and rest as much as possible. At 4:45 AM, I started my post call day, did my morning notes and usually left the hospital around 12 noon after all notes were done. If there were many things to be done in the morning, I would help the on call intern and then leave when things started to slow down for him.  I learned quickly that teamwork was the best thing that we could do for each other to get the work completed as efficiently as possible.

On my very first rotation, my fellow intern on service was not much of a colleague. He left many things undone and generally refused to do work that needed to be done such as discharge summaries. I simply took over his paperwork and mine too. I knew that work had to be done for the service and I picked up the slack rather than complain. Again, it was good that I just pitched in and worked for the team and the patients. I wasn’t doing the other intern’s work for him, I was doing the work that was needed for excellent patient care. All of the patients on the service were mine as much as his. Again, the more work I did, the better I became at getting things done. I wasn’t long before my residency director figured out that I was keeping the service humming along and that I was always one for taking up the slack. I also earned the respect of every one of the chief residents who always wanted me on their services and were ready to teach me things that I was eager to learn.

The thing about being a good intern is that you learn to prioritize your life. You learn to appreciate how important your home life is to your work life. You appreciate just spending time with the people who you love. You also start to be come thankful for all of those hundreds of little victories that you get during the day. You learn to forgive yourself for missing things and you learn to not forget those same things the next day. The fortunate thing about medicine is that every day is a new opportunity to learn and grow as a physician if you take the time to do so. Medicine is a joy to practice and a daily reminder of those who are less fortunate than myself. In only a second, I can be the patient lying in that bed who is worried about recovery and how their life has changed by illness. One has to take good care of one’s life at home, one’s spiritual life and one’s health in order to be able to give our patients that best that we can.

I have written other posts about staying awake and keeping myself committed to the thousands of patient care tasks that residency will demand. Most of the things that I learned about patient care and keeping up with things, I learned as an intern. It took about two weeks into my first rotation as a new intern, to not be panicked with those “calls” from the nurses in the middle of the night. I learned that I actually know how to take care of patients and that I was confident in getting the best for the patients that were under my care. I learned to have a good relationship with the folks in the allied health care professions because they helped me take care of my patients. Medicine today is a team and not just one person doing everything.  Yes, the physician is at the head of the team but having good people around me who can do their jobs professionally, is worth gold. I am thankful that I am generally an easy-going person but can be pretty decisive when I need to make decisions.

If medicine becomes drudgery, then you have chosen the wrong profession. If you can’t keep your mind interested in the care of your patients, then you are likely not going to be a very good or very competent physician. Your patients teach you and your colleagues help you every day. Medicine is truly magical when every one and everything is in that zone where you start to appreciate the magic. Medicine is and never was a “job” for me but something that I feel blessed in order to do. When I read my friend’s blog about going through internship and all of the great learning that he has in front of him, I see myself and I see how far I have come.

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16 October, 2011 - Posted by | general surgery residency, intern, on-call

3 Comments »

  1. I just found your blog and I love it! I hope it’s okay if I link your blog on mine. It’s easier for me to keep up on your posts. I’m really enjoying your writing and your anecdotes. It’s helpful, especially as I’ll be restarting my m1 year next year (medical leave).

    Comment by a | 17 October, 2011 | Reply

  2. Thank you for your helpful thoughts! I appreciate them and entirely agree with them. I’m all for working hard. I love patient care. I enjoy spending hours in practice because I feel like I’m perfecting my craft and just as importantly being helpful to patients. I think surgery is truly being the most well-rounded doctor. I agree ‘daily chewings’ make you a better physician too!

    At the same time, now that I’m getting older, it’s harder on my body. Although I’m perfectly happy where I am, I sometimes wish I had picked a different surgical specialty. One that’s more conducive to being able to ‘take good care of one’s life at home, one’s spiritual life and one’s health in order to be able to give our patients that best that we can’ after completion of training.

    Could I ask you, would you say General Surgery is where you belong? Or would you say you would’ve preferred another surgical specialty like Orthopaedic Surgery instead?

    Comment by Beks | 17 October, 2011 | Reply

    • To Beks:
      I am a Vascular Surgeon but I did a full residency in General before fellowship. I loved every aspect of my General Surgery training but Vascular was my first love and my first residency rotation. It turns out that Vascular surgery patients are often the sickest patients on the surgical service with multiple co-morbidities (diabetes, renal insufficiency etc). I found that I wasn’t as interested in the laproscopic work and didn’t want to spend the rest of my career doing primarily choles and hernia repairs. I preferred a well-constructed amputation any day and love the creative aspect of vascular surgery. The patients are a challenge but good work oftens lends itself to making a difference in the patient’s life. Considered ENT as a third-year medical student (elegant cases ) but preferred General Surgery to ENT. After doing several turns on the Trauma service, ortho is more interesting that it was when I was a medical student. Make no mistake, ortho has long hours.

      Comment by drnjbmd | 17 October, 2011 | Reply


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