For all intents and purposes, I am 24 hours away from finishing my internship. For those of you lucky enough to have never done an internship, it can be succinctly described as this:
Imagine running through a forest fire, trying to save as many rabbits and deer as you can, through acrid black smoke, without any idea where the oft-rumoured safe meadow of competence is.
Maybe that is a wee bit dramatic. Since the end of August last year, I have been assigned to work as a junior doctor in various departments of various hospitals doing various tasks that I know next to nothing about. Now, it is true that I am a doctor, but I am not a specialist. It is true that I am experienced in emergency situations, but I am not much of a discharge planner. It is true that I am a good communicator, but I am no social worker. Yet, as an intern, I must be all of those things (at three o’clock in the morning).
Emergency residents rotate through various specialties in their first year of residency. We tell ourselves we do this because other specialties have important things to teach us that will prepare us for a life in the trenches that is an emergency department; we will see post-operative complications following bowel resections, overdoses of psychiatric medications, extraordinarily complicated airways, sick neonates weighed in grams (not kilograms), broken bones exposed to air, and women who may or may not be in labour but are certainly in a heck of a lot of pain.
But the second reason (or perhaps it’s the first, and all that other stuff is the second) we do this is to “staff” services. Hospitals rely on junior doctors to consult patients in the emergency department, care for patients on the wards, discharge patients to make space, and coordinate community care, follow ups, and tests. We also provide night coverage to a hospital otherwise desert of physicians. Working up to 80 hours a week (or, as my dear friend on the surgery recently confided in me, 140 hours), we often work 24, 26 or 30 hours in a row with little to no sleep, running from ward to ward putting out fires.
That sounds crazy. Placing someone who is not a surgeon in a surgery ward to assess sudden drops in hemoglobin, or someone who is not an internist adjusting electrolytes levels, sounds very crazy indeed. However, I must say, the last 8 months has been one of the most fun times of my life. Scary, also. And stressful. But so much fun.
Thanks to WIFI, iPhones and really smart nurses, the junior doctors I work with deliver exceptional, if not confident, care 24/7. We’re pretty crafty people, and unfamiliar with a disease or procedure or situation as we may be, we are trained to find the answer, consult each other, consult our bosses (who we wake up when we are really unsure of what to do) and figure it all out. And in doing that, we learn.
Now, I’m not saying this is the best way to teach me how to be an emergency physician, or the best way to provide care to hospitalized people, but it’s the system we have, and I think it works pretty well. We can, and must, do better, and I’ll write about how another time. But on this, the eve of my finishing internship, I just wanted to express how much fun it has been, and how much I have developed and matured as a physician.
Sure, there was that morning I was so tired I didn’t notice I put moisturizer in my hair until I had slathered my face with hair gel.
There was that time I’m 100% sure I was 99% responsible for someone dying. That time I was yelled at by a family member, and uncharacteristically yelled back. Times of gloom, sadness and tears.
But then, there were all of the other times. The time I picked up on an anastomotic leak at 3am. The time I influenced “flipping the plan” towards palliation for an elderly man who had the ultimate altered sensorium. The time I laughed so hard with a patient I snorted, and then they snorted at my snort, and then their neighbour, separated by a curtain, began snorting at snorts.
And then yesterday, when a nurse overheard I was heading back to the ER and offered me a make-shift going-away card.
Residency is hard. But when I look back on the last year where I played trauma team leader, paediatrician, obstetrician, anesthesiologist, internist, and general surgeon, I wouldn’t give it back for the world. There are many pejorative words we use to describe the first year of residency. But if I had to sum it up with just one, that would would be FUN.
In Part 2, I’ll discuss some of the ups and downs in more details, share a few stories I probably shouldn’t, and try to give you a good sense of the life of a resident doctor.
In Part 3, I’ll speak to the privilege of caring for people in a large, tertiary care hospital, and the wonderful people who make the monstrosity that is a Hospital function.
Thanks for reading. Have a beautiful week.