After 2 months of easier rotations, I finally got thrown into the real work of internship – a month on the hospital floors. For those in the field of medicine, there’s no need to explain the stress and anxiety in that first month, and for those lucky enough to not be in health care, just think about the first day on a new job, when you have no idea who everyone is, no idea where you are going, and yet at all times you must make decisions like you are competent. Or if you are into watching TV, just think about the first episode of Scrubs, when just minutes after entering the hospital, you literally feel like a deer who’s about to be hit head on by an on-coming tractor trailer, who then has to get up and keep working.
Now of course there’s upper level residents, as well as the “boss” – your attending – for the month or week, who are quietly or not so quietly in the background, reading the patient’s charts, seeing your patients, basically to make sure that you don’t royally screw something up and hurt someone. Despite this, there wasn’t one moment in any of the 24/28 days that I worked that wasn’t filled with some sort of unpleasant feeling – like not knowing what to do, or not having enough time to get something done, or trying to explain a complicated medical condition to a family member, or getting a stern talk from a consultant doctor who was bothered by your rookie questions…the list could go on and on.
The amount that I learned in that one month far surpasses any amount of studying I have ever done thus far in this process, because it’s in real time. It’s not as simple as answering a question on a test such as “What is the treatment for a patient with a deep vein thrombosis,” and you answer “why Heparin of course.” No, the execution of all that knowledge is much more complicated than a single multiple choice answer. There’s the dosage to consider – how much do I give? The monitoring of treatment – What labs tests do I order? The potential side effects – What should I be prepared for, and if the complication occurs, what do I do then? The length of treatment – How long do they stay on this drug? And what if they can’t afford it when they leave the hospital? And where are they going when they leave? Back home? To a nursing facility? What if they refuse to go to a nursing facility? What if they want to leave the hospital against medical advice?
The how to and what if questions just go on and on and on, all day long. Luckily, over the weeks I learned where to find the answers to most of my questions, and when in doubt, there’s the book in my pocket, and google. Yes, google. When a patient of mine was bleeding out her rectum after a surgical procedure and I needed to give her some fresh frozen plasma (that has proteins involved in the clotting process) I had no idea how much to give her. I asked my resident. He didn’t know. I called the blood bank. They didn’t know. I asked my fellow intern, nope. I looked in my little green book in my pocket. Nope. Finally, google saved the day. Found a medical website that had the calculations.
There is just too much to know in medicine, way too many details in the management of patients to learn all of this prior to this intern year. The learning is in the doing, I know that now. And I have never worked so hard before in my life. Not raising a child, or running my own business, or moving across the country. Yet there were pearls amidst the rough in that month. Times when I really bonded with a patient, when I really felt I made a difference by explaining what was happening to them and their bodies, times when I had a “ah-hah” moment, times when I (believe it or not) knew how to do something because I had just done it the day before. Now more than ever I am so thankful for the patients, and their willingness to allow us interns into their lives, into their bodies. If they knew how scared I was, or how incompetent I felt, I wonder if they would have trusted me less? What I do know, is how essential this internship year is, no matter the hours, no matter the stress and acid in my belly, no matter the nights I wake up worrying about a patient, wondering if they made it through the night. It’s essential, this year of being a medical workhorse, because it solidifies all that book learning I did for the last 4 years. It is the necessary training to become a competent physician, and even if it isn’t necessary to learn this way, I may as well embrace the long hours, knowing others before and after me will not just survive, but thrive. Cheers!