A Letter to the New Interns

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They can always hurt you more, but they can’t stop the clock

-Revised Law of the House of God (AKA probably plagiarism by me)

(Image above is me stuck in a chair in our workroom. Residency is hard)

To the graduates of medical schools across the nation, you wonderful newly minted doctors…on behalf of physicians everywhere, I’d like to congratulate you on joining the fraternity of medicine. Through blood, sweat, and incredible amounts of (sometimes unknown) body fluids, you have made it through medical school. You have earned every bit (all two of them) of those letters after your name. You are now part of a prestigious, elite group, with a steep entry fee of selling your whole life. I hope you have thoroughly celebrated with your friends, family, and colleagues in medicine. You should have a great sense of pride in your accomplishments. You should also stop reading this until you are ready to think about intern year. As of today I know most of you are gearing up for orientation, but I would encourage you to stay in the mode of partying and celebrating as long as possible. However, the dull, pounding knock of your intern life is only going to get louder from here on out.

 

WARNING, Read on only at your own risk

 

Your life will never be the same. You cannot undo becoming a doctor. I cannot overstate this point. You will never be the person you were before. I want you to take this statement with no underlying meanings or motives, as it is not intrinsically good or bad. It means…a lot of things. One of them is you’re going to be the person that your family members ask about their medical problems (especially if you are now the only physician in your family). It means that you get to change your drop-down prefix to “Dr.” when you’re putting in your shipping address. It also means that (most of) you have signed a life-altering contract to begin your residency. You cannot go back. If you went into this for the right reasons, being brutal honesty with yourself, you won’t want to go back. That and the crushing amount of debt makes it so going back isn’t an option, but let’s focus on the feel-good right nwo.

The same amount of time until you become interns is the same amount of time until I complete my intern year. Yes, I still love medicine. Yes, I would go into medicine again, and yes I would choose surgery again. I’d say that even in the throes of the worst moments of this year. Yes, I am happy with my life and the decisions that got me here. And yes, I still manage to have fun. It is possible to make it through residency without hating your existence (Hating the existence of others will happen, however). That’s a very real fear, one that I wrestled with before and during my first few months. The range of emotions you will feel over the coming weeks will be wide. It is excitement at finally being “a real doctor”, at being able to “actually do things”. It is also fear at the first time you put in an order for Tylenol and realize that it does not have to be co-signed by anyone; subsequently you have crippling fear of putting your patient into liver failure, despite them being a very healthy 26 year old.

Most of you are wondering what you can do to prepare for your new life. I’m going to stop you right now and say that reading the entirety of a medicine textbook is not the answer unless you’re the person who has a mental breakdown without reading a textbook for more than 24 hours (in which case, go ahead and read for your mental health. Also, learn to relax a little bit). Take a deep breath. Most of you will be moving (or have already moved) to an entirely new place. Even if you aren’t, there’s still more than enough change to be had. I’m going to give a few concrete tips that I think are useful, then quickly wrap things up after.

Do everything you can to have your life in order outside of residency before you start. I cannot emphasize this enough. The last thing you want to be worrying about when you get home at 10 pm your first week (because you’re wildly inefficient) is trying to find a time for the cable company to set up your internet, assembling your new bookshelf, or getting your check engine light looked at. The key to this is often moving in a few days early and making a concerted effort to have your ducks in a row. For me, that included a half dozen trips to IKEA (IKEA rules, by the way), ordering online supplies, and visiting stores like Target. While not everyone is going to want/need to go out and buy things, moving to a new city will inevitably create some new needs. It was also my first time living by myself, which added a layer of complexity despite most of the essentials from my last apartment being mine (RIP to my wonderful roommateship with my former roommate of 5 years). Make sure before your first day of orientation that you have a well-stocked fridge and pantry, have plans for where you are going to buy groceries, figured out how to get to the hospital, and found a gym/whatever unique thing you need.

This will make your life so much easier. I had to dump a few hundred dollars into car repairs to meet St. Louis standards in order to register my car here (If able, it’s probably easier and less expensive to keep your car registered at your home/parent’s address. I’m fairly certain it is technically required to change your registration to your new state of residence, but not like the registration police go door to door or anything), but had to do it during my first month while I was trying to figure out where the bathroom was, much less figure out how to be a doctor. That was a pain while my car was out for a few days.

Fill out all your new residency paperwork immediately. There will be forms for your license, getting paid (OMG, actually making money!11!1!1!!!), and many, many other things. May Science have mercy on your soul if you have to register to work at the VA, because I’m pretty sure they need a rectal biopsy to verify your identity. There will be so much paperwork you wont know what to do with yourself. Save copies of your NPI and DEA number in your phone, you’ll frequently need to refer to them. This point goes with the point above as to having your life in order. You don’t want to be the person who starts off on the wrong foot by not getting things done.

Be early. Yes, not on time, EARLY. You’d be surprised at how many people don’t get this right, even at this stage. I’m the first to admit I was one of them. I will never forget my second week of orientation, the first day of my true general surgery orientation, when a few of us walked in 30 seconds late. I’ll leave it at the fact that our program director made the expectations crystal clear from day 1 that not being late was unacceptable, adn neither was being on time. It’s something I’m still working on, and while I am very rarely late, I cut things way too close. I’ve improved a lot this year. There is no easier way to piss off your senior residents than by being late. Everybody has a morning they oversleep or where the world is working against you to get to work on time, but you want to be known as the resident who is always reliable. One day of sleeping through your alarm is much more understandable when it’s the only time it’s happened over 3 months, than being the second time it has happened that week. I was gifted a second alarm clock by a co-resident before we started because I knew I needed extra help getting up before 4am.

Buy a textbook. Read it (starting on day 1 of residency). Read something. ANYTHING. As one of my fellow interns put it,

“I think of all the things I need to read and how overwhelming the amount is, then I get paralyzed and read nothing.”

– Alaska, the Resident

This is all too true, and happened to me too. Make it a manageable goal. I tried 10 pages a day out of a 2000 page surgery textbook. With tiny print, that wasn’t reasonable. Even 5 pages a day, or even 3, is better than nothing. 5 pages a day is 1825, which would have let me finish the book in nearly a year. I’d still finish it in under two years by 3 pages a day. Instead, I’m busy trying to crush the book in big chunks now. I wish I would have stuck to a simple goal. Don’t have regrets like me. What also helps is reading on your patients. Pick one thing a day that you want to read about and spend 10 minutes reading about it. It adds up quick. And will also help with your inevitable in-service exam (surprise, exams aren’t over yet. And the ABSITE for surgery is heavily looked at. Your mileage may vary based on your specialty and program).

Find a hobby outside of residency, or continue one you have. I cannot overstate this: you NEED to have a life outside of residency. Granted, it might not be much of a life when you’re spending 80 hours a week at the hospital, but it has to be something. If that means you need to find a climbing gym, a shooting range, running routes, a local theater, or a hockey rink, do that before you start! It is a necessity in maintaining your sanity. Understand that there will be days in which your job (I should stop saying job and use the word “life”) as a resident will be prohibitive to doing these things (i.e. on a 24 hour in-house call, you won’t be making it to spin class), but you need to continue doing the things that make you…you. For me, that was figuring out where the gym was (that we so graciously get free access to as residents. One of the few perks….), and joining a local Brazilian jiu-jitsu gym. I found a good park nearby for running too. If your life is only work, sleep, and eating, that makes for a miserable resident. Besides, if you ever want a chance of interacting with someone outside of medicine, you better have something else to talk about besides your daily hospital life.

Put every resident’s contact info in your phone ASAP. I had the phone numbers of every resident in my program in my phone on day 1, and that made it so I didn’t have to try to dig for someone’s number at any point during the year. Especially in surgery, your cell phone becomes the most crucial piece of equipment you bring to work. Near constant contact is required in a busy surgical environment, and it was how I called my chiefs about consults in the middle of the night, stayed updated with my team, or even texted my attendings when needed. Making sure your phone works in your hospital is also a crucial step. A not so subtle advertisement, but I’m on Google’s Project Fi, which means all my calls/texts go through Wifi, so even in the deepest parts of the hospital, my phone always works, which is a huge plus.

A few other small things:

  • Wearing a watch is useful. I started wearing one on a daily basis back in college, and I find it incredibly useful in the hospital. I can’t leave home without one anymore.
  • Plan for food. I find it easier to make my own breakfast/dinner and always eat lunch from the hospital cafeteria (even when “lunch” is a meal at midnight on night float rotations). It’s not the greatest food, but calories are calories.
  • Eating is good, do it when you can. I never thought I’d be the one to skip meals because I so, so dearly love food. I had multiple nights my first month where I went the entire 12+ hours only eating peanut butter/crackers I found at nurse’s stations.
  • Carry some essential medications with you. I always have ibuprofen, throat lozenges, and cold medicine in my backpack. Things like chapstick, toothpaste, an extra toothbrush, etc., are also useful.
  • Buy a few dozen extra pens or pick a good one that you like and don’t lose it. I’ve now gone the latter route. It actually has my name on it so that people ideally shouldn’t steal it. My pen probably gets more use than my cell phone.
  • Comfy shoes are a must. A lot of people wear Danskos. I wear Nike Free’s and love them. Change your shoes fairly often (I aim for Q6 months) andyour feet will thank you.
  • Sleep. It’s also good for you. Do it when you can.
  • Don’t forget to drink water. You’d be surprised how easy that is to forget. I’m pretty sure half the residents in the hospital have an AKI by the time they leave. On busy nights, I used to yell “FIGHT AKI” while passing by water fountains to remind my students to drink water.
  • Learn to use a pager before you start. You don’t want to be the person who has no idea how to work one.
  • Keep a change of “nice” clothes in your car or at work somewhere. This is something I still need to do, but it’s good for when you forget you have clinic that day, need them to look professional for grand rounds, etc.
  • Blackout curtains are a must. Mine don’t work the greatest, but they are a necessity for sleeping during the day on night float, post-call, etc.
  • Candy. Have some. Starburst and lollipops worked great for me when I needed a pick-up in the middle of a long day/night.
  • Dress sharply. This is pertinent for surgeons, where there can be a bit of an “old school” mentality and many surgeons frequently wear suits. When I’m in scrubs, I’m fully committed to being comfy. Like, I want to be covered in puppies kind of comfy. When I’m in clinic or another professional function, I’m fully committed to looking nice. If I’m in professional clothes, I will be in no less than slacks, a button down, tie, and tie clip with my white coat over it. Again, that’s just me, and your specialty may vary (pediatricians, for instance, almost never wear their white coats). Regardless, when you need to look good, look good. There’s some Deion Sanders quote about looking good means playing good that applies here.
  • If your program gets some kind of pullover/jacket, get it. It will become your de facto everyday wear. We got nice Patagonia zip ups that I wear nearly every day. They go great over scrubs.
  • Bring an extra phone charger/portable battery charger with you or to have at the hospital. There will be times when you dearly need it.
  • Ditch some of the crap you carried in your white coat as a medical student. You don’t want to be the person with 1000 things in your pockets. I think the mentality of “less is more” comes with experience and training. I still carry my stethoscope (most surgery residents ditch theirs at some point), but otherwise carry few things in my white coat pockets. I have 2-3 pens, my Maxwell’s (always useful – EDIT, I just removed this from my white coat. It wasn’t seeing enough use. Sad that it became outdated in the week or two that I began writing this post until now), a hemostat and pair of scissors, whatever patient list I need, and little things like a pack of gum. I currently have a bouncy ball because why not. I used to carry a “Pocket Medicine” book when I first started. That quickly went out the window cause man that thing is heavy for a small book.
  • Check your residency email often. Unfortunately ours switched to a type that is very annoying to put on smartphones (Thanks, Microsoft), so I have to check it fairly often.
  • Benefits! Have them! Make sure things like your health/dental insurance are sorted out.
  • Lastly, don’t lose track of human things. Stuff like oil changes, haircuts, dentist appointments, and all of that are very easy to lose track of. Residency is hard enough when you don’t take care of yourself.

 

 

Okay, I’m done with the concrete tips. Very briefly, I want to go into the not so concrete things. Your residency is your family. Actually, calling them “family” is an understatement. You will spend more time with your co-residents than your friends, family, and everyone else in your life combined. Go to the official and not-so-official hangouts of your residency as much as you can. I alternate between being extroverted and introverted. This, combined with being utterly exhausted most of the time, I’ve occasionally had to force myself to go to social things. That being said, I’ve never regretted going. The times I’ve skipped out on things, I’ve regretted it. However, sometimes you’ve gotta sleep. My co-residents have become my lifeline, my family, and my fellow soldiers in the trenches of surgery. They are a hilarious, diverse, and utterly insane (in the best way, I love them so much) group of people. They are my people. Make your co-residents your people. Our intern class, while being 5 categorical and 5 prelim residents, stuck together with the rest of the surgical interns (such as neurosurgery, plastics, etc.), and the 20-something of us are a close group. While it can be hard to branch out to other specialties, do your best to. We didn’t interact with many of the other specialties (i.e. non-surgical) during orientation, which made it difficult to meet those from the non-surgical realms. That being said, do it if you can, but the people within your own field will be the closest no matter what.

 

The last thing I’m going to leave you with is how to be a good intern. A great intern, even. The best intern. Honest to Science, it’s simple. So simple, a slightly above-average caveman (Like me) or a trained mongoose could do it. It can all be summarized in one phrase. One of the residents in my program recently hung up a sign in the workroom that says “Figure it out”. It’s that simple. Figure. It. Out. Trying to find a way to pre-op 4 patients, see all your patients, round with your chief, then attending, write 15 notes, get all the consults called and orders done, then somehow be prepared for your one surgery that you have no idea how to do? Oh, and see 4 new consults? Figure. It. Out. You need to bring a no-holds-barred type of dedication, persistence, and resilience to residency. If your senior tells you to do something, figure it out. If you’re overwhelmed and don’t know how you’re going to do it all, figure it out. If that means asking for help, asking nurses where to find the supply room, or even a medical student where to find some forgotten wing of the hospital: do it. You want to smash through all barriers to getting your patients taken care of. Assume that everyone is trying to kill your patients and that all that stands between that is you. At the end of the day, everything is for your patients.

To reassure you a little bit…a lot of the times, your mistakes will not hurt your patients. They may make your attendings or senior residents mad, or may cause a patient to not get the optimal timing on a medication, or may make a nurse yell at you…but they ultimately won’t affect your patients. Those mistakes still sting because you want to appear competent and for your senior residents and attending physicians to trust you. You’re going to feel like a failure. And sometimes, your mistakes will have the potential to hurt patients, but won’t. Then, there will be mistakes that do hurt patients. There aren’t enough words in the English language to describe how soul-crushing those mistakes are. You feel bad for about yourself, but more importantly you will hurt because you caused another human being unnecessary pain.

All of these mistakes will happen to you. All of them will happen during your intern year. And all of them are a necessary part of learning to become a doctor. They will keep you awake at night, cause you to wake up with your mind racing, and will make you better. I’m going to tell you the single best piece of advice (The second best piece of advice was in the paragraph above: figure it out) that I can: Don’t make the same mistake twice. Period. When you make a mistake, all you should say to your superior is this: “I’m sorry, I made a mistake. It won’t happen again.” Don’t make excuses. Don’t lie. Own it. It shows you understand your error, have taken responsibility, and that you will fix it. The learning has been done. The interns that grumble and grovel and make excuses find themselves quickly despised. Don’t be one of them.

Play nice with others, treat everyone with respect even if they don’t show you that same respect, and do your best at all times. Learning to work well with people you are stuck in a pressure cooker with 14 hours a day is hard. Personal conflicts will happen, but do your best to avoid them at all times. Follow the law of Bill and Ted: be excellent to each other. Residency is likely going to be the hardest thing you have ever done. It has every emotion wrapped up in a big, greasy burrito of life. While maybe I am looking back at the past 11 months with rose-colored glasses, there have been a lot of good times and plenty of bad ones. I wouldn’t trade the opportunity to be a surgical resident for anything. This was far and away the most formative year of my life. Buckle up.

For those you coming to SLU, welcome. Buckle up, it’s going to be a wild ride.

– Brandon

Here’s the song of this post, “Worry No More by Diplo feat. Lil Yachty and Santigold. Don’t be worried.

Here’s a few more – Machine Gun Kelly – Habits

And a banger to be your theme song for the first month: Logic and Marshmello – Everyday

Everyday – the Lyric Video (condensed from the music video)

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