Lessons Learned From An Intern Year – Finished

Intern Year: 0. Elana Miller: 1.

Last Thursday at 8am I emerged from the hospital after a 24 hour call. It was like any other post-call day, except this day I was leaving the hospital as an intern for the last time.

The intern year is feared by all. It’s the subject of countless books, including the infamous and still relevant House Of God (although I don’t think my experience was as bizarre as that book). Everyone talks about it. And now I’m done with it.

Looking back, I’ve learned a lot more than I realized I had. Toward the end of the year things started to come together. I felt comfortable making decisions, managing acute crises, and teaching and guiding medical students a year or two behind me on the path. Instead of feeling completely incompetent and ineffective, I now feel capable of doing some good, and knowing that I’m doing things right.

It’s When Things Are the Hardest That You Learn the Most

On reflection, it was actually the hardest rotations that made me want to run into a closet and scream (or cry) that taught me the most. I remember there was one call night when 7 psychiatric patients who needed to be evaluated and admitted presented to the ER. I know this doesn’t sound like a lot, but at UCLA it can take over 2 hours to evaluate a patient, present to the attending, and write admission orders.

So when 2-3 patients come in at once, not only do you have a guaranteed 4-6 hours of work ahead of you (bye bye any chance for sleep), but you have the fear of not being able to handle the workload and getting backlogged when even more patients come in during those few hours.

That was probably the worst call of my entire year, but I came out of it thinking, “Wow, if I can handle that, I can handle anything.”

Similarly, my inpatient medicine and ER rotations were also brutal and painful, but gave me the most confidence in managing acute medical problems. Now if a patient on the psychiatric floor starts to have chest pain, I don’t worry about what to do – I KNOW exactly what to do. Oxygen, aspirin, nitro, EKG, troponins, cardiac monitor, call medicine. ST elevation or depression on EKG or elevated troponin? Admit to telemetry. It’s reflexive now.

I Don’t Hate This Medicine Thing As Much As I Thought I Did

I know I’ve written a lot about how discouraging and painful this year had been. I’ve wanted to quit many a time. Now that I’ve finished and have a little time and space to reflect, I don’t feel that way anymore. I feel lucky to have the knowledge and training I’ve worked so hard to develop.

I have the capacity to be a good physician and treat people who are sick so that they are better.  I can communicate diagnoses and treatment information to patients and families who are scared or confused and give them some reassurance and peace of mind. I have skills that allow me to have a positive and profound impact on someone’s life. Not everyone has this gift, but I do, and I appreciate it.

When Times Are Hard, Sometimes It’s Better To Roll With The Punches That Struggle Against Things You Can’t Change

There were so many times I struggled during the last year, and so much of this was unnecessary. Instead of riding the wave, I would fight against the current. When something unexpected would come up that would create extra work or keep me at the hospital late, I would get frustrated. When a call was busy with a ton of consults and floor calls – especially if they were inappropriate calls – I would get mad that I had been bothered and wouldn’t be able to get any sleep. Instead of accepting that while in residency I would have a certain lack of control over my life, I fought it.

I’m not saying you should never fight against things you don’t agree with. Sometimes a little fight helps you feel alive. But you have to pay attention to when the fight strengthens you and when it weakens you. I know there were times I fought and it weakened me.

All Bad Things Come To An End

No matter how much a certain period of your life sucks, it’s not going to last forever. All bad things come to an end. While you’re in the moment it feels like it will last forever – but it won’t. If you’ve made a decision to do something difficult, or something bad happens that is out of your control, find comfort in the fact that the difficult times are only temporary. And sometimes you need some bad times to appreciate the good. When it ends, you will likely have a new perspective on what happened that will give you strength to handle things better in the future. Even though I just finished the year, I already feel appreciative for what it taught me, and feel renewed and inspired to be a kick-ass resident for the next 3 years.

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Hey readers, any other interns out there stoked to be done with the year? Or anyone else finishing up something big and looking forward to moving onwards and upwards? Share it in the comments!