Shoulder to the Wall

One week down, forty-seven more weeks to go. In the past seven days, I have worked 90.5 hours, admitted nine patients, and provided cross-coverage for many more for my team and others. These numbers are not meant to impress: there are many others who have worked longer and cared for more patients. I am very much of the sentiment that there is no need for one-upsmanship or overzealousness: there is no shame in sleeping on your call night, not capping your admission quota, or needing that third cup of coffee.

The intern year has begun and has already left me weary, frustrated, and at times outright enraged. Perhaps most frustrating has been my reflection on my own performance: abysmal, by my prior standards. Starting this year is quite reminiscent of my early days as a third year medical student: inefficient, inexperienced, easily fatigued, and baffled by the idiosyncrasies of this hospital system. Even though my fourth year respite from clinical duty was much shorter than that of many of my classmates, my last true wards rotation was back in September, and my factual recall is despairingly rusty. I have one pristine skill – my ability to develop a strong rapport with my patients – which remains largely intact and has helped provide me with one anchor against the constantly raging storm.

My first day of work was an overnight call day. My job was to admit patients from 6 PM to 6 AM. Typically, the overnight intern gets to sleep during the afternoon when the workflow has diminished, but last Friday was about as quiet as the day the Red Sox advanced to the World Series. I capped within the first hour I was on call and was also cross-covering for other teams at the time. Owing to an unexpected page about an angry mother who wanted her daughter (cared for by another team) out of the hospital that night, I wasn’t able to get anything done in the first hour, and I had little sense for how to approach the numerous tasks I needed to accomplish to admit a patient. Despite several quick and clear explanations from my resident earlier in the day, it was nearly impossible for me to retain any detail without actually going through each step (which my co-intern had the opportunity to do). By the time I was able to get in all of the orders simply to initiate comprehensive care for the five new patients, it was already past midnight and I still had five History & Physical notes to write. My last one was written between the hours of 4 AM and 6 AM when I was floridly encephalopathic and almost prepared to use words such as “penultimate.” Nonetheless, several residents, co-interns and my attending commented that I looked surprisingly awake and put-together.

That, perhaps, is the beginning of the great lie. I have grown fond of most members of my intern class, and the only time I see them is in the brief moments when we are sitting at adjacent computers or passing in the hallways. When I ask “How are you doing?”, I get a variety of answers, the only genuine ones ranging from numb indifference to tired but thankful commiseration. Amazingly, I have overheard chief residents and others kindly asking my fellow interns the same question with the inevitable response being, “Good! Alright! Fine!” My program, from the attendings to the chief residents to the supervising residents and program coordinators, have been showing overwhelming displays of support, much more than I would have expected. However, in these brief and benign exchanges, I have seen a completely different story being told to me: we are all going through the same experience together, and no one else really knows what it feels like. The unifying sentiment: our more senior physicians have forgotten what it was like, and those who will never experience the intern year will never know what it means. This may not be true, but as I write this on my first day off, my day to finally recover from the disorientation of the first week, I think of a man who frequently dislocated his shoulder and would reset it himself by ramming it against a wall. Shoulder to the wall.

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