I’m 2 months into my 2nd year as a pediatric resident (which means I survived my month in the pediatric intensive care unit… heehee!!!), and as I sit here incredulous about time’s ability to fly past me, I can’t help but muse over how I managed to make it through my intern year. Besides taking a quick, pertinent patient history, and getting pretty good at looking in kids’ ears as they actively fight me and my otoscope, I picked up on a few things that ensured my year was, for the most part, a smooth sail.
So after much thought, here it goes… my Ten Commandments for surviving a medical internship:
1) Know how to introduce yourself.
If you walk into the neonatal intensive care unit on your first day of your rotation, and you tell the nurse that’s been working there for 30 years, “Hi, my name is Dr. Blah-blah-blah,” they will not be fooled. They are FULLY aware that you are a glorified 4th year medical student with two new letters after your last name, and that you have NO IDEA what you are talking about. Instead, drop the title, offer your first name with a friendly handshake, and DO WHAT THEY TELL YOU. On the other hand, if the lab is taking forever to process blood tests you sent off on a patient two hours ago, pick up the phone, politely but firmly introduce your Dr. Blah-blah-blah self, and you’ll realize that somehow, magically, things get done.
hi, I’m new here! will you be my friend??!
2) Accept that you don’t know anything.
In elementary school, you were in the A-Honor-Roll. In high-school, you were in the National Honor Society. In college, your GPA got you into medical school. In medical school, you somehow survived. In intern year, you don’t know anything. You are at the bottom of the totem pole of life. Realize it. Embrace it. And do something about it! Ask the nurses lots of questions (who, after doing #1 above, and after you’ve demonstrated respect for their experience and knowledge, will be on your side), take note of how the upper-level residents gracefully waltz their way between patients, and be open to feedback and constructive criticism.
first day of first grade. completely unnecessary photo, but awwwww….
3) Don’t ever imply that people are not doing their job.
Unless of course, you want to die. Sure, you sometimes write an order to discontinue a patient’s IV fluids and 4 hours later you realize they are still running. Bring it to the respective person’s attention, apologize that you didn’t make yourself clear earlier, and move on.
4) Quit complaining.
OH MY GAWD. Were you really expecting to have a fantastic schedule, weekends off, and a high salary? Please. You FINALLY arrived at the point in your life towards which you have been working for as long as you can remember. You chose this and you are fortunate enough to have achieved it. You work 80 hours a week, get 4 days off a month, and have a broken circadian rhythm… and you knew it would be this way. And now you are surprised that you are stuck in the hospital on a Friday night? Quit being a baby.
booyah! champagned it.
5) Have a positive attitude.
#4 nicely leads to #5. While a negative attitude weighs you down and brings out the worst in you, a positive attitude lifts you up, puts you in the appropriate mindset, and brings out your best. If you HAVE to spend New Year’s Eve covering the hematology and oncology floor, why not allow yourself to be ok with it? Decide every day to open your mind and heart to this profession you chose, and give it your best.
being silly facetiming with my dad at 3 am. we were both on call, me in Boston and he in Mexico… and we were wearing matching scrubs!
6) Expect the worst.
If you are starting a week of nights, expect a very high patient load, lots of notes to write, patients that suddenly need to be resuscitated, and absolutely no time for sleep. This way, if you only admit a few patients, patients behave themselves, and you are able to sneak in a 2 hour nap at 4 am, you will feel like the luckiest person alive!
7) Dress the part.
It takes just as much work to throw on black pants and an old sweater as it does to look a little fabulous. And when you look good, you feel good. And when you feel good, you work good. And when you work good, people are happy with you. And when people are happy with you, you love your day more. Get it?
8) Stay organized.
If you are going to be admitting patients, always keep admission materials on hand (for example, at my hospital this means a history and physical form, and medication reconciliation form, and a doctor’s medication order sheet). If you are in the neonatal intensive care unit, stuff your bag with materials on how to adjust ventilator settings, how to make a blue baby that’s not breathing alive again, etc. And get some sort of small notebook that fits in your white coat or scrub pocket where you can slowly collect pearls of information regarding patient care. My choice was MGH’s Pocket Pediatrics, because it has rings and I can add important things to it. It also has pockets inside the front and back covers, where I keep my PALS card, list of hospital phone numbers, table with normal vitals signs for every pediatric age group, brochure of different IV fluid and electrolyte solutions available at my hospital’s pharmacy, etc.
my Pocket Pediatrics = my security blanket
9) Don’t beat yourself up.
I used to sit at morning and noon conference (the equivalent of our short, daily “classes” during residency) agonizing about everything they were talking about that I wasn’t understanding. The more I agonized, the more my mind shut down. Now, I pay as much attention as possible. If I don’t understand something, I try my best to make a mental note to look it up or ask someone about it afterwards, and move on. I have also fully given in to the theory that we residents learn by osmosis: the idea that we learn without being aware of it, through our daily exposures. It’s true. And you don’t actually believe it until the new wave of interns arrives and you think “Wow! I actually know more than they do!”
juggling 3 pagers
10) Treat yourself.
Have fun. Allow yourself to catch up with old friends. Talk to your mom. If you have a weekend off, make pancakes for breakfast! If you have a balcony, sit outside with a good book. Check your free weekends ahead of time, and plan what you want to do with each one so that your precious days off don’t go wasted (camping weekend, skiing trip, etc.). And DON’T FORGET YOUR HOBBIES! If you are happy outside of work, you’ll be happy inside of work.
amazing day at the beach with my residency friends and some of our significant others
So there you have it. What do you think? If you too have gone through this, please share YOUR advice in the comments below. We’d all love to know about your experience!
Good night to all of you, and happy medical training!
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