Problem list starting Internship:
1- The newness
2- Being alone
3- Having to interact with patients in a context they understand
4- Being hard on yourself, and overwhelming-ness
5- Not knowing what to do
6- Failed expectations
(PS: this is an outline that will guide through a two-piece article).
Finishing medical school was cathartic in a way. After many many years of studying, of late nights, early mornings, long lectures, sitting in college feeling trapped static in one point of place, and arguably time, you’re free.
Despite the fear of what lays ahead and the stress of the long way to go still you will feel a sweet release, that gradually builds up to anxiety as the first day of your internship approaches. And suddenly it is like the first day of school, you’re somewhere you don’t know surrounded by a lot of people with vivid very contrasting personalities.
Weird place, very odd people, and absolutely zero ideas on what the hell are you supposed to be doing here. Your support system of friends you spent the past few years building is spread out, for the first time you’re standing at a hospital door alone.
I remember how confused, shy, stressed and absolutely verbally dyslexic I felt that day. How everything was so different. How everything I studied seemed irrelevant.
It was so humbling that I, super friendly loud outgoing talkative confident twenty-six years old person, turned into a silent creature who blushed every time someone spoke to me or I was expected to speak.
I’d walk in to assess a patient and turn around myself in circles a few times (Yes!! totally in front of the patient!) before I’d realize that I need to sit down and introduce myself.
Adjusting to all of that was overwhelming, especially that I started my rotations with Emergency Medicine where everything kept moving way too fast for me to keep up. I could not catch my breath until one of my attending physicians seated me and said: “I am sure that outside of here you have a fully grown personality but right now you are still a baby clinician who is still taking the first steps to develop who you will be here with your patients and it is okay to be confused about it now.” Hearing that, as an overachieving perfectionist, from someone I greatly respected felt like finally grasping air after a very long time underwater. It was okay that I did not feel myself, nor did I feel that I belonged.
The more time I spent in the hospital the less lonely and out of place I felt. For starters, I learned where I can stash my snacks at every ward so I sneak a bite when a round took too long and I started to get hungry. What bench to sit on to have my breakfast to get a perfect view of the sunrise after an Oncall. The clean toilets. The comfier beds. The cute pediatric patients I liked to tap their little noses before I start my days.
As for the loneliness, I started realizing that everyone is just as bored as I am so I just started smiling and saying good morning to everyone I saw. I got out of my comfort zone and my childish feeling of “omg I want to finish work and get to my best friend’s house already” and started sharing my food -and life- with the other interns and learned that if we don’t stick together the next 12 months of my life would be miserable. I helped my seniors as much as I could and reminded them that they needed to eat. A few months into my internship I had so many friends at work that the walk from the hospital door to the morning meeting every morning had too many “Good morning”s and “Have a nice day”s that actually my day was already made by 8 am.
I learned how to communicate with my colleagues, but it was harder to learn how to communicate with my patients. Initially I just felt shy, judged and totally clueless to how to use a language my patients would understand despite everyone’s contrasting backgrounds. I couldn’t control my terrified thoughtful expression nor my eyes popping out every time something was going on with the patient. And the truth is dealing with someone who’s super vulnerable and handing you full control over what you want to do with them, opens a very intimate connection between the two of you that whatever you feel will be transferred to your patients and vice versa. I realized that I wasn’t being judged but I was looked up to and how terrified or frustrated I felt would only attract the same feelings to a patient. I learned to feel genuine pleasantness approaching a patient, to smile and utilize touch whether by shaking hands, holding hands or tapping a shoulder to really open that channel for human connection. And then simply listen to what they have to say. Establishing that trust will not use up more than a minute and you cannot imagine how much you will be appreciated and how many things you will be excused for just by doing that. With time you will start developing a vocabulary that seems to be better comprehended by your patients, and you will start experimenting with a lot of social forms of interaction until you reach one that does not feel too awkward for you but is liked by your patients. You will notice yourself getting more confident, and way better with communication even in your personal life. It is a blessing really to see a patient lighten up every time they see you. Work for it, because that’s what makes a good doctor.
I was never a huge fan of Grey’s Anatomy but I always go back to Christina Yang shouting on an intern and saying “On the evolutionary scale of doctoring you’re an Amoeba” and that’s particularly true. However, it still does not mean that you shouldn’t take yourself seriously to some extent. I wish I could write down a list of your job description as an intern but I can’t, mostly because it depends on what institute you work in, the center load and the trust your seniors have in you.
A few general rules for patient’s safety -and your own safety-:
– NEVER make a clinical decision, no matter how insignificant it is, without verifying with your senior first.
– ALWAYS make sure that your senior will follow-up on your work no matter how much confidence you have in yourself.
– Don’t shy out from asking as many questions as you need to ask until you clearly understand what’s being asked from you, even if the person in front of you was impatient or angry.
– NEVER do anything until you understand why you are doing it, because if you ever tried to send a medical consultation just because your senior asked you to without knowing exactly why you’d totally understand the importance of this point. Plus, you are a doctor and not a secretary.
– Examine your patients EVERYDAY. Review their medications EVERYDAY. Even if they had a long uneventful stay in the hospital.
– If you are not eager to learn do what you have to do and get out of the way.
– Documentation and all the tricks utilizing the computer system is your craft, own it.
– If you are left in a situation you are overwhelmed with ask for help and demand your senior to be present.
– To be respected you need to respect first.
Once the above things were figured out, I felt at greater ease to go by my internship. Of course, there was the excruciating anxiety about the SMLE, the match, the interviews and the entire prospect of life after this year. But once my day to day stressors at the hospital were managed even being oncall did not give me the sense of impending doom it used to give at the beginning and instead became this opportunity to learn and practice really really cool things (I mean during my surgery rotation oncalls felt like an amusement park and I got a chance to feel the inside of every hollow viscus in the human body!!).
Just remember to always be you, yet push yourself gradually out of your comfort zone. Learn so you don’t leave your internship as the same person who started it. And most importantly always seek negative feedback because that’s just room for growth. No one is out to get you and mostly nobody cares about “the intern” and nothing is really personal, so instead of hating the people you work with for some of their unpleasant traits learn not to grow into them. And look up to the ones who inspire you to be a way better version of yourself.