In Honor of July 1st: a Reprieve to Intern Year

Today is July 1st, a monumental day in academic centers around the country. It is the day when newly minted medical schools put their new M.D. to use as interns, when interns become junior residents, when junior residents become senior residents, and so on and so forth. In honor of today, I am reposting an article I wrote two years ago, at the end of my own intern year. This was initially published in AAEM's Common Sense magazine and on Medscape.

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“Excuse me… um… how exactly do I order the Tylenol?”

I look up. In front of me is a young man wearing a pressed shirt and striped tie. “I’m Ben,” he says, introducing himself to me as an intern on his very first day of residency. It’s not really statement that needed to be said; none of us would have mistaken him for anything but. How to order Tylenol is a seemingly self-explanatory action, but last year it was me asking that question. As I lead him through the order entry system, I reflect on the past year. How have I grown in this notoriously grueling yet life-changing internship year? What advice would I impart to the new cohort about to impart on this same journey?

Clinically, I am stronger than I was a year ago. Clinical training in a supervised setting is indeed the purpose of residency and why tens of thousands of young people in the prime of our lives devote many long hours to our hospital. Internship is all about becoming more comfortable with management of everything from routine urgent care presentations to medical resuscitation of very sick patients. Throughout this year, I’ve seen my classmates and I progress from asking “what next” to thinking through and acting on most treatment decisions ourselves. Part of that clinical development is knowing how much more there is to learn, and it remains daunting and inspiring to see that, as much knowledge and skills as we have gained, there is still a long way to go.

Professionally, I feel more comfortable in my role as clinician and resident physician. I remember on my first day of internship practicing my introduction in the mirror. “Hello, I’m Dr. Wen, your doctor,” didn’t seem quite right. Too curt, yet oddly redundant. “Hi, I’m Leana, your doctor.” Not right either. Too informal. “Nice to meet you, I’m Leana Wen, one of the doctors.” OK, but who are the other doctors? The struggle with something as basic as introducing myself is symbolic of my biggest challenge in intern year: feeling at home as a resident. Our training is at two main hospitals and two other affiliated sites. Not only were there dozens of residents and attendings and literally hundreds of ED nurses to meet, each month was a different rotation with more new people and new ways of doing things. It took me until the end of intern year to feel at ease with my colleagues. Being part of AAEM-RSA has been instrumental for me to feel at home in my specialty—now, not only do I know my 60 co-residents, I am connected with thousands of residents across the country.

Intellectually, this has been a year of alternating disappointment and growth. So much of medical school was about memorization and pattern recognition; I was afraid that residency would teach more of the same. I did not want to be an automaton who did nothing more than input data and run algorithms like a “Choose Your Own Adventure” book. EM, perhaps more so than other fields, has the potential to turn into an algorithmic exercise. However, there are plenty in our field who believe that EM is far more than figuring out a disposition. As my mentor, Dr. Josh Kosowsky, likes to say, EM is the modern home of diagnosis. What other field presents so many diagnostic puzzles in any given day? Checklists have their place, but algorithms should never replace the art of healing. One of my most valuable lessons this year, one that has kept me intellectually challenged and emotionally engaged, is to make sure to hear each patient’s story as their narrative, not just as a chief complaint followed by yes/no answers.

Personally, one of the battles each of my classmates has struggled with is finding balance. Internship is pretty far from a “normal” life: it throws off anyone to work under fluorescent lights for six days a week, to eat nothing but hospital food for three meals a day, and to not see family and friends for a day and a half. Our days are so long that by the end of a shift, it’s often hard to find energy to do the things that used to make us happy. Yet, as busy and as tired as we get, we shouldn’t make residency just about working, sleeping, and eating. I’ve watched each of our classmates emerge from survival mode to making time for the things that matter to us, from training for triathlons to watching sci-fi flicks to getting a scuba-diving certificate. As for me, I’m ballroom dancing and playing the piano again, and a much happier person for it.

Despite finding better personal balance, one of my classmates said during our end-of-the-year intern retreat that he wasn’t sure he liked the person he was becoming. This resonated with all of us. In intern year, each of us can recall instances when we’ve become more abrupt with family, short with sales clerks, perhaps impatient or even disdainful with patients. However, as difficult as our lives may be at times, as grueling as it may be to work night shift after night shift, we cannot lose track of our fundamental purpose of being healers and advocates for our patients. It’s a profound privilege that we have to take care of patients in the time of their greatest need. It’s a profound honor that families place care of their loved ones in our hands.

“That was an awesome day. Thanks for showing me around!”

I smile. It’s the end of Ben’s first shift. His hair, impeccably groomed ten hours ago, sticks out in the back and strands point towards the ceiling. His face bears the telltale imprints of mask and eyeshield. His blue tie is flecked with blood. (I feel sure that from now on, his attire will consist of scrubs.) I wonder what Ben’s reflections after intern year will be. I know that he, too, will develop clinically and grow into his professional role. I hope that he finds his intellectual pursuits rewarding and his personal balance satisfying. Above all, I hope he retains his humanism, his ideals for why he chose to enter this healing profession of medicine.