intern year is over!

The most difficult year of my life is about to be over.

Intern Year, Generally Speaking

A whole year of stress, anxiety, being pushed around by senior residents and attendings, being ignored and not taught while being pushed to my physical and emotional limits.

Working under intense time constraints with unstable patients, giving bad news and poor prognoses, soothing crying family members and patients, seeing some patients actually make it off pressors and out of the ICU, being thanked by patients and family during rounds, patients and their family giving me blessing after blessing for just doing my daily job.

Calling the shots to initiate pressors and call the code when I had done neither before.  Being called to bedside to get ready to pronounce someone dead soon and watching the final changes in their vital signs.  Getting cornered and pressure to make decisions without time for help because I have "MD" after my name.

Seeing way too many people die uncomfortably and unresponsive on a ventilator on pressors and seeing far too few people take the option of comfort care.

I hardly saw my friends, even the ones I started residency together with.  A year further in my training, a year spent becoming more separated from the people I love.

It took me 3 months to renew my driver's license because I had no time to do it.  I've seen hundreds of patients over the course of this year but I haven't been to a doctor myself.

I've seen a lot of the people I started residency with gain 20 pounds or more.  I've seen one person quit and two people switch residencies.

This year's been a blur for me, but when I really look at it, it felt like a long march, often stressful and joyless.  I call it joyless because after a while, the amount of clerical things you need to do and time spent at the computer wears away at you.  So does having to study for your specialty while trying to pass Step 3 in one go (which I did!  that was awesome!).

Clerical Woes
Medicine reconciliation is one thing and absolutely good for the patient, but having to constantly tell administration why this central line is indicated is ridiculous and sends the message to us that doctors aren't to be trusted.   Yes the patient is in the ICU and they are unstable and/or need central TPN, why do you need me to tick these boxes?

The Burn Out
Being a doctor is something you're excited about since childhood, often times.  Then there comes the classic intern burn out you hear about all the time.  For most, it happens in January.  For me, it didn't hit until this June.  I didn't feel the same satisfaction I had at the beginning.  Mostly because so much of medicine is done through a computer clicking this box, and typing in this order, being rushed and gradually eroded by volleys of non-critical calls from nursing.  Often you're trying to stabilize a patient and then you get hammer get paged/called about the decision to start diet orders or maintenance IV fluids on someone.  Day in, day out.

Also, being made to do some activities like consent patients for things while your superiors play on facebook or do nothing wears on you because on top of that, you have to do all your internly duties of H&Ps, progress notes, and fielding all kinds of calls your superiors don't have to do.  You're taking care of something every minute of the day until sign out is over.

Futile care is something that you'll learn about and will erode you.  I've been so direct and compassionate with families and patients who end up not choosing comfort care and see their family member die unresponsive on a ventilator instead of choosing comfort care.  I know they're not doctors and they don't get how medicine works, but I'm constantly pushed to "do everything possible" even though I explain they're going to die unresponsive on a vent.

Hospice or comfort care is viewed too much as a defeat..but when you're not going to win the battle regardless, why not die comfortably surrounded by your loved ones instead of the middle of the night after undergoing a dozen procedures we recommend against including surgically placed equipment/devices?  I think aggressive family-led care in the moribund uses up a lot of resources, but most importantly, means less time a patient spends comfortable with their family before they die.

Break Time
A year of driving to work at 530AM or in the middle of the night to work 10-14 days in a row without a day off.  Telling myself my weekend was "6 hours long" so I could convince myself I actually did have some semblance of time for relaxation.

I've become more aggressive about my time off.   I'm disappointed I have to make a timetable for all my activities, but it helps me get to everything fun I want to do.  The earliest I've started drinking and enjoying my time off is 0841, lol.  Whisky in particular is my drink of choice.

The Comrades

I've been able to make friends from different specialties.  I've become closer with the medicine interns most of all, but had the deepest bonds formed with the pediatrics interns.  A lot of off-service interns/prelims like ophtho, derm, and neurology bonded with me, mostly over the trying times we shared together and how badly we wanted to move onto our specialized training.