Just some insight that I had tried to overlook before this year: Internship is really, really hard.
First, it’s the time commitment. On wards months, you’re working 11 to 12 hour days, 6 days a week. I function well with a schedule, so I started my wards months getting up at 5am, running with Max and then walking with Piper or taking them both for a longer walk together. I’d get back, make lunch (sometimes I would do this the night before so Dan had lunch too), try and straighten up the house or edit someone’s personal statement for my part time job, run around getting my breakfast ready and the dogs fed, and then be off to the hospital. The days always go by in a blur- rounding in the morning, calling consults, answering pages, going to noon conference, writing notes, discharging patients, and admitting new faces. At 6 pm, the night person comes in (that’s a whole different story on nights- trust me) and you can sign out your patients. I would rush to get done for around 6pm so I could sign out my pager. Some interns choose to stay at the hospital after theyv’e signed out so all their work is done before going home. Usually those guys were leaving later. But for me, I was working 11 hour days and then going home to work on notes. I was adament that I wasn’t going to sit in the hospital for one minute more than absolutely vital. Instead, I would get home, greet my beautiful dogs and husband and plop down on the couch and start notes. Sometimes notes only took me 45 minutes to wrap up, othertimes I was working until 9 pm. Either way, the days felt REALLY long.
Then, it’s the fear. It’s a crazy thing realizing your mistakes could kill someone. Hospitals do a wonderful job of not letting interns get too sleep deprived (I can’t imagine life before duty hour restrictions!) and there are multiple checks in the system (pharmacy double checking orders, nurses questioning what you write, residents peeking over your shoulder) to ensure costly mistakes don’t get made, but they still happen. And that realization has woken me up from sleep a few times, panicking I didn’t order someone for a vital antibiotic or that I didn’t order them for a needed stress test. I haven’t been afraid of my attending doctors yet <knock on wood>, but the fear of hurting a patient is real and it’s powerful.
Then it’s the patients. Patients can drive you absolutely nuts. They can be needy, complaining, whiny aggrevations who seem like they’re just trying to make your day longer. They can complain about every little thing you do, but be in the hospital for conditions that they could have controlled. They can become delirious, really disoriented, and combative. They can suddenly stop breathing or their blood pressure can bottom out. They can ask you to explain their condition over and over and then make you call each of their children to explain. Or worse, they can lie to their spouses and ask you to lie to their spouses as well. They can keep you late, overwork you, and drive you to your wits end.
Or, you can see that they’re human. That they’re scared and alone, and just want someone to recognize that they’re a real person with a family and hobbies and a deep desire to be happy. They can make you realize the little old lady with anemia was actually a beloved former educator, or that the crotchety old man with liver disease is a veteran who put in time serving our country. Worse still, you can realize the patient with a new diagnosis of terminal cancer is about your father’s age. Or that the suddenly critically ill patient has eyes that look an awful lot like your grandmother’s.
And then that fear returns, only this time it’s different
. Because it’s not a nameless patient, it’s your friend in bed 314A who wants to go home and make sure their cat is okay. I will never forget the first time I saw a patient truly understand they were dying. I stood at the foot of the bed of this patient I had cared for for two weeks, listening to the attending dispassionately but slowly explain that the patient had untreatable cancer. We had warned the patient and the family about the possible diagnosis, but when the “C” word came out as a definite there was a palpable change in the room. I watched the patient’s spouse’s body sag. The patient looked bewildered until the spouse blurted out “You have cancner, and they can’t do anything about it”. At that point, the patient began to tremble and immediately teared up. I felt so wrong being there- not because I was uncomfortable with the emotion, but because I was in a white coat and was part of the unemotional, detached team delivering the bad news. Inside, I felt emotionally battered by the “is it cancer” “is it not cancer” dance I had been doing for the past two weeks. I had been rooting for a good outcome and had been praying for this patient (a topic that gets some in medicine heated) each night. I had to leave twice during the conversation, pretending to answer pages, because I knew I would emotionally lose it in the room. And as much as I wanted the patient to know I was upset for him, this wasn’t my pain…I didn’t want my grief to muddle the intense emotion the patient and the family were feeling. So I waited. After the attending physician left, I quietly told them just how much I wished there had been a different outcome, and that I would be outside the room, working on his paperwork since he was electing to go home. Before they left, I hugged the patient’s family and the patient, making eye contact and wishing them the very best. Still and all…it was a crummy day.
So this was longer than I thought it would be, but I think it’s cathartic. I think its good for others to hear what the ups and downs of internship can be, and how it’s possible to still keep your soul but sometimes it’s damn hard. It’s nice being on elective, as now I have a chance to reflect like this 🙂