Honest reflections on my first 3 months of Intern Year

I initially planned to write this blog post after my first week. It’s been 3 months now, and I am1 day away from my c-section and the birth of our little boy! I wanted to put this out there before I have a new story to tell 🙂

On The work

I started intern year in the last week of July. Due to visa delays I started 6 weeks later than the rest of my cohort who started in mid June. Starting to work as a physician felt like going from 0 to 100, or perhaps I should say 0-90 because that’s how many hours I worked in my second week (Note: I don’t think that’s the norm – our limit is 80 hours a week, I’m just very slow, gah!)

It was overwhelming. I graduated medical school in 2016 – that’s 5 years ago. And while I have had some clinical experiences in the meantime, it has mostly been in an outpatient clinical setting or in the calm world of research. I was certainly not prepared for on service hospital medicine, especially in the US.

My first two weeks were intense, and I felt like I was drowning. I felt like I couldn’t keep up no matter how hard I tried to. Everything felt hard and out of my comfort zone – even basic tasks took a lot of me to learn how to do with some level of competency.

There were various aspects of it; the first, learning how to take medical knowledge and putting it into practice. To understand the pathophysiology of a disease and knowing how it works in real life and to the patient in front of you. Bringing a textbook in life. Knowing medications and doses. Knowing all about your patients and making the connections and understanding. To knowing what to do when someone is sick. To knowing treatment plans and actually administering them.

Then, there was the administrative aspect of it all: Like how to get things done in the hospital. It’s one thing to say “I would do a chest-x-ray” or “this patient should go to the ICU” but now you have to actually make those things happen, and that involves a lot of steps – making calls, talking to people, placing orders on the computer, coordinating care, and ultimately advocating for your patient. And learning how to use the EMR; how to write notes on patient encounters, how to place orders (even the most simplest orders felt scary to do the first time because it’s so REAL. What if I make a mistake and order something I’m not supposed to? And what if it hurts my patient?)

And finally, the structure of it. We have a 6+2 schedule which means we spend 6 weeks on service in the hospital, and then 2 weeks of clinic. The 6 weeks are intense, and we work 6 days a week. The days are long. I leave my house at 4:30am. We alternate between long call (where we work till we sign out to the night team which starts officially at 7:30, but depending on how busy the teams are and how many teams there are to sign out, it can mean you don’t sign out till 8:30). On short call days, we attend rounds, complete our notes and patient related tasks, and can leave between 3pm-6pm. In the beginning there was no difference between long and short call days because I was/am inexperienced to the system and everything took so long, so I would leave whenever the work gets done. These days I am being more intentional about preserving my short call days and it has made a significant difference in my fatigue/burn out.

It’s easy to focus on the hard parts of my work, because it’s so abundant, but ultimately, I love the work I get to do! You know when something feels hard in a good way? In a “this sucks right now, but I want to get really good at this, because it aligns with what matters to me” kind of way?

I think my favourite thing about working as a physician is the variety of my day to day work. I love seeing my patients every day, and talking to them, getting to know them and updating them on what we are doing for them. I LOVE seeing patients get better. I love that I get to work with some really great doctors, learning from them, their experience, their teaching and their practice. Working with fun and supportive co-residents is such a treat. I enjoy talking about difficult topics at family meetings, and advocating for my patient. Even though calling consults and talking to people from other specialities can feel daunting at times, I like being exposed to specialized knowledge. Time to write my notes gives me time to process my thoughts and really understand my patients story. Then, we have our daily didactics where we get to expand our knowledge base, and everything we learn feels so highly relevant that I really try to soak it all up. And of course, dealing with emergencies or unstable patients requires a completely different skillset and presence of mind. I love the variety of it all. I find it really enriching – never a dull moment!

On overwhelm and fatigue

I think burn-out is almost inevitable; with the long hours and being constantly stretched out of your comfort zone. It’s a full immersion into an ocean of important things that you don’t know, while you cling desperately to small islands of what you do know. It takes a toll on a person. I am always at the hospital – most of my waking hours are spent here. That’s why they call us “residents” because we reside at the hospital. Sometimes I feel like I come home only to take a quick nap before waking up and doing it all over again. On long days I come home, shower, eat, and sleep. On short days, I come home, shower, eat, maybe get an extra half an hour of time, and more often than not, opt to go to bed early because sleep feels so essential right now.

I prioritize sleep a lot these days. It makes me feel stable. But it doesn’t make me feel joyful. Right now there isn’t a lot of time or space in my day to fit in extra cup-filling activities. The solution to that is to find as many pockets of peace, and joy while at work. That might be laughing with my co-intern over our misadventures, or a coffee before I sit down to write my notes, or simply just protecting my time off by making sure I get off on time on my short call days so that I can create a pleasant hospital-free memory that stops my days from blurring together. I think rest is also really important – just having time to do absolutely nothing in particular. And I’m still working on finding space for nourishing joy-filling activities. But writing this blog post is a start.

On growing & learning

I’ve never experienced a learning curve like this in my life. You have the opportunity to change and grow in just 24 hours.

And growth is not linear. There are days when it feels like things might be coming together, and then days when I feel like nothing makes sense and I’m right back where I started. Maybe even worse off. Here are a few things that have helped;

🌱 Focus on getting just 1 percent better every day. Everything feels urgent and important and feels like it’s demanding something of you, but just focus on one thing. At the end of my day I ask myself what was one tiny thing I did better today than I did yesterday. These little things build up over time.

🌱 Keep changing how you do things until something works. For my first three weeks, I was never prepared for rounds (for various reasons; not knowing what to focus on, sometimes missing the point entirely, scattered information, unanswered question, poor time management). I tried new methods every single day for 3 weeks until one day I found one thing that worked. That also means I failed 18 times before I succeeded once in a very minor way. But it also means I successfully found 18 things that do not work haha.

🌱 Share with your peers what works for you and listen to what works for them. What works for them might not necessarily work for you, and you may have to find your own method of doing things, but sometimes it can prevent you from starting at 0 each time.

🌱 Remember that a day falls on a spectrum; there are so many shades of bad days and shades of good days. Instead of classifying a day as good or bad, notice that it can be, and almost always is, a blend of both.

🌱 The bad days are more important than the good days. I read that on a bad day and it changed something in me, it changed how I process my bad days – and I have a lot of them. How you think on a bad day and what you do on a bad day has extra impact. Surrender to the day. Accept it, vocalize it, share it. “I’m having a bad day” and then try to create a little pocket of goodness by doing something that moves you forward in a tiny, small way. Dwell in that. Continuing to create goodness in the midst of a bad day is one of the most powerful things you can do.

🌱 Learn from everyone; from your patients, to your attendings, to everyone on your team.

🌱 Growth is not linear, but trust in the natural and gradual upward trajectory of it, despite the daily dips and plateaus. Some days I feel like I’m making no progress. Some days I feel like I’m doing worse than ever before, or that I somehow know less than I did yesterday. It’s disheartening. I try not to focus on the progress I make, and instead focus on the actions I take. Even if it feels like you are walking on a treadmill, keep putting one step in front of the other.

🌱 Try to enjoy the process instead of suffering through it. Accept that it is supposed to be hard – it was designed that way. Accept that competency takes time, and mastery takes deliberate practice. Accept your failures for the growth lessons they are. Have fun along the way!

🌱 Get comfortable with failing wildly. Don’t worry about looking stupid, as long as you learn something.

On time with family

Starting residency has completely restructured my every day life, including the things I really cherish – like spending time with my husband and daughter. I get so much less of it. It hasn’t necessarily been a bad thing, in-fact it gives me an opportunity to make up for what I miss out in quantity, in quality

Some evenings, especially after being on long call, I have only minutes to spend with Reya. I aim to engage in one “high quality” activity with her every night. It could be a one-on-one, uninterrupted conversation about her day, painting our nails together, sitting with her as she eats, bathing her, drawing with her – anything. It doesn’t have to take very long. Sometimes 15 minutes are all I have to spend. But those 15 minutes are so potent, and really ground us in our relationship.

I wish I could convey the same level of commitment with my husband, but it is one thing that has fallen to the wayside. But I will say this – he has been the glue that kept everything together over the last couple of months. He held everything up. He cleans, he cooks (I’ve basically retired from cooking at this point), he plans special days for him and Reya on weekends when I am working. He supports me when I go to bed at 7:30pm on a short call day because I just don’t have it in me to stay up any more. He listens to me when I share about my day, especially the hard ones. He has just been this wonderful comforting and stable presence in my life, and I want to give more of myself to him.

The times when our relationship feels strained is on my ONE precious day off a week. Naturally, after having a week of basically solo-parenting and solo-husbanding, he looks forward to my day off so that we can go out and do a fun family activity together. I, on the other hand, just feel so spent, and an afternoon nap/a morning sleep-in feels absolutely necessary. Then, I usually have a number of things/administrative tasks on my to-do list that I haven’t had a chance to look at during the week that require my attention so I don’t fall behind on life. And then there are all the things that need to be done to set up for the week ahead – laundry, grocery shopping, meal planning, weekly planning, cleaning the house. One day feels far too little to achieve all these things: rest, keeping on top of life admin, preparing for the week ahead. A lot of the times, our fun, connection-building activity gets put aside and it’s been hard on everyone. My husband feels frustrated and I feel depleted. We need to find a way to make our time off together more nourishing.

On Pregnancy in intern year

I was 26 weeks pregnant when I started my intern year, and have worked until 35 weeks with my c-section coming up in a couple of days. Overall, things have been great! Working gave me a sense of purpose and focus, and perhaps contributed to experiencing less anxiety in this pregnancy. My morning sickness subsided (with the help of medication) and I generally felt great! Somehow I haven’t felt overwhelmingly tired or as though I was pushing my body too much during my working hours – maybe because I don’t really get a moment to think about how tired I am! I do get hungry a lot though and eating lunch is one of the highlights of my day haha. The exhaustion really sets in when I am home from work in the evening or on my day off. It is in those free moments that my back feels achey, or I get those horrible leg cramps, and all the other wonderful side effects of pregnancy.

I get so many comments from my peers “I don’t know how you are working like this while pregnant!” and I just think – this is the easy part! It’s about to get a lot harder when I have a newborn in tow and the already very little sleep I get before a long shift, is further fragmented and disturbed. I don’t know how I will handle a lot of those challenges. I don’t know how it will feel like to leave my son at just 6 weeks old to return to work. I don’t know what my night shift blocks will look like when my husband will be caring for both our babies by himself all night. I just don’t have a lot of answers to how the next few months will be. But I do know we will figure it out.

As always, thank you for reading.

Malavika