Hope Lost And Found

I am long overdue for some sort of reflection on intern year after having officially worked my last day as an intern a few months ago. Here's a small piece of what it was like for me:


At the beginning of this year I bought a ukulele. I started intern year at a sprint, like anyone does, arms full of hope which was quickly extinguished, lost in an atmosphere so devoid of hope that all of it flew out of my arms to settle into places so far in between it might as well have been floating in the vacuum of space.

I was alone in a new city and alone in a new role I didn’t know how to wear for a lot of reasons. The cloak of physicianship burdens upon you suddenly not just the obvious – the responsibility for human lives – but also darker, sinister things that are similarly heavy – a power over people nobody shows you how to soften, the shame of a tradition of institutional oppression that’s now officially dirtied your own hands by vocation, the towering knowledge that much of the time medicine is hurting people. Adjusting to the new responsibility of being a doctor felt really impossible.

There’s something special about going to work in a hospital – where there is no luxury of the mundane to fill in the gaps between flashes of drama. Most people working in a hospital recalibrate in some way, but my own response to intensity has always been intensity. And this first year of doctoring was one winning an intensity contest. My father had just died, my husband was living 2000 miles away in the city that felt like home, and going to work every day was a new jack-in-the-box of horrors, each one a stab at the raw place in me that bleeds for people but progressively softened my cringe reflex into something that was like having the chills almost all of the time, hair on perpetual end.

So for a while, I got home every day and played the ukulele. I sucked at it and had learned my first song, poorly, drinking bourbon in the rented house prior to my best friend’s wedding so I could play them a love song, just a few weeks before. I knew that song* – Can’t Help Falling In Love With You – and maybe four more.

But playing those songs would pull out the tears from my eyes that I had suppressed all day and massage that raw place a little and put a little dressing on my wounds. Playing the ukulele every night meant the hard places in me from medicine didn’t become as hard. It was a balm that helped replace bitterness, which is so tempting to tack on to yourself when you’re in medicine. Bitterness is all around, because of tragedy, because of overworked healthcare providers, because of disparity, because it’s hard to help sometimes – it’s a sticky plethoric tar that protects you if you paint yourself with it but hardens in layers until before you know it the only touch that can mark you is a scratch.

Intern year loped along and by the end of it I was thin and ragged, gasping for air and just hoping I’d make it to the finish line. Hope felt long gone. I was well aware it was a perspective problem – the patients that did well left the hospital, and so I didn’t get to hear from them, and the ones that did poorly bloomed in my awareness, taking over my thoughts and ideas about how medicine works and what’s likely to happen to people. Pessimism was joined by sacrifice – in my last month I’d become uncomfortably accustomed to losing the things I wanted to be as a doctor:

me, tired, part of the way through a 30 hour shift

me, tired, part of the way through a 30 hour shift

  • Spending an extra minute with a patient that has more questions
  • Standing up for a patient in pain that’s been labeled as drug-seeking
  • Swallowing snarky comments in favor of well-crafted criticisms
  • Trying to teach med students to think better

For the sake of:

  • Getting to the next admit they give me on the rotation with no cap
  • Eating my first meal of the day
  • Working my 85th hour in a week
  • Writing more billable notes at the insistence of hospital administrators

It sucks when these are the sacrifices. It sucks when you’re used to that sting. It sucks when getting a win – maybe by doing something on the first list – is the only thing that’s gonna inject some hope into the situation, but you can’t. It sucks when hope is so thin on the ground.

I didn’t enter medicine because I thought it was easy but I did go into it thinking I could do it proudly. At the end of intern year, I was very seriously doubting that. I was very seriously wondering two things: 1) Would I ever be able to find a way to do this so that I’m proud of myself, and think I’m doing more good than harm? 2) Is there a way to tolerate all the tragedy without becoming a monster?

I still don’t know the answers to those questions. (They’re really hard ones to answer in the field I’ve chosen. Spoiler: not being an intern anymore helps.) Sometimes I would get home from work and I’d get my ukulele out and I’d claw for hope by playing sad songs fast and fiercely, feeling something besides sorrow, reminding myself of all the people in the world that have made it through hard times and the practices and traditions that help to share the burden of hardship and the balm of joy (music). I’d do this at 1am when my alarm was set for five the next morning. I’d do this after really hard days when patient courses were long and arduous. I’d do this when I was thinking of my dad. It was a balm when hope was thin.

And then – on my very last day of intern year, and I still can’t believe it went down like this, I taught one of my patients how to play the ukulele.

I had entered this patient’s room in order to clarify a few things and give a few updates before I sat down for the afternoon to pound out my notes so I could – I hoped – leave a little early on my last day (I had a plane to catch). But instead I saw that little plastic four-stringed piece of magic labeled “OCCUPATIONAL THERAPY, 7TH FLOOR” (we were on the 5th; this is how it always goes in hospitals – nothing and no one is where they belong). I saw my patient struggling to finger a G chord (I had struggled too, at first). I saw a person clawing hard at hope in a hard situation. I saw my humanity rushing back at me during all those late nights playing sad songs fast and fiercely, thinking of patients that did poorly and situations that were fucked up and all the ways bodies and minds and medicine failed us. So I sat down on that hospital bed and spent several hours teaching chords and sharing my favorite tab sites and practicing sing alongs. One of the songs we played goes like this:

Don’t let us get sick
Don’t let us get old
Don’t let us get stupid, alright
Just make us be brave
And make us play nice
And let us be together tonight

It’s the song** I’d been playing and singing to myself all year, the one I chanted like a prayer hoping to ward off black clouds and bad omens, hoping to make the hospital feel more like a team room than a battleground. I sang this, finally, with this patient, who was sick but getting better, who was brave.

Ultimately, this tool I had been cultivating for my own sanity over the course of the year was one I got to share with a patient as I crossed the threshold from intern to resident. We almost missed our flight but didn’t.


 

So here’s my intern year survival tip: go to the place where hope seems thinnest.

I don’t know why. It’s something I felt compelled to do.

Go to the place where the darkness is thickest, go with all your hope gathered in your arms and into the vacuum it will disperse until you’re gasping, breathless, from the thinness of it, from the scarcity of hope in the sparse and lonely atmosphere, reaching in the darkness with hands wet with its thickness, its beefy angry sopping heaviness, drowning in the horror, hope lacking.

There, find it again. Reach and reach. Dig and dig. Fight harder for hope than you ever thought was possible, than you ever imagined, than you ever thought you would. Pile it back into your arms and get ready to plunge again.

Matilda

*This is, of course, Can't Help Falling In Love With You by Elvis Presley: link here.
**The song is Don't Let Us Get Sick by Warren Zevon: link here.
***Please note my posts are always HIPAA compliant -- I always change details and I never include PHI.

Dear New Intern: Remember That You're Brave

It took me until the end of my intern year to fully understand and internalize this message, so I’m going to say it loud and clear here:

BEING A DOCTOR IS BRAVE!

I spent most of the first part of my first year as a physician climbing the giant mountain of fear and anxiety and paperwork that is intern year, and it’s hard to scrape together perspective when you’re doing that. Especially when you have very little time for reflection. And especially when everything is terrifying all the time, so you feel like a scared mouse.

Being a doctor is terrifying, and so what you’re doing is brave.

Not many people go to work and prescribe treatments that could help or hurt people.

Not many people talk to a million different strangers all the time.

Not many people sign up to answer the plan of care questions from nurses that have been working in the hospital longer than you’ve been alive.

Not many people take on the risk of using your own damn judgment when it comes to what to do for a patient.

Not many people have ever run to a code blue. Not many people have to try to think of what to do when a person is really sick.

Not many people wake up in the morning to take over responsibility for people’s lives.

Most people aren’t brave enough to be a doctor.  You are.

Give yourself some credit for that.

You're a doctor! Yep, you! (Intern Survival Tips)

A year ago I couldn’t believe people were talking to me when they said doctor. Now I can’t believe I only have 3 days left until I’ve officially made it through my intern year. (Thank goodness.)

This year has been a really big challenge – and I’ve learned so much. I know I have a long ways to go, but looking back on the person I was a year ago makes me really proud of how much I’ve grown. But there are a multitude of things I wish someone had told me (and I'm sure I would have had to learn the hard way anyway).

Here's me on my first day of orientation. I think I wore this white coat less than a dozen times this year.

Here's me on my first day of orientation. I think I wore this white coat less than a dozen times this year.

This post is about one specific thing – how to keep your head when you get a page or a call you don’t know what to do with. It was the first thing I freaked out about on my first day, because getting a page is the first freaky thing that happens, since that's the life of an intern -- answering pages.

I’m a pretty anxious person. These tips might not be relevant to you if you’re not like me, so feel free to ignore them. At the beginning of this year I couldn’t believe that I was the one expected to answer pages, that when something happened a nurse had to tell a doctor about, I was the first person that would find out. It was unbelievably nerve-wracking until I hammered home the lessons below and realized I was up for it.

Here are three things to remember when you get a page you don’t know what to do with.

  1. You have time. You always have time to think, I promise, so take a deep breath. The only instance in which you don’t have time is if the patient is coding, and if that’s the case nurses know exactly how to start a code without you and your senior will be running it. in every other case, you have a second to take a deep breath and gather your thoughts. If you take this step, everyone will be better off because you’ll have your wits about you.
  2. You went to medical school. You learned some things, and they’re still in your brain. After you take a deep breath, take a second to come up with one relevant or semi-relevant piece of medical information you know. Remind yourself you know things. And that’ll get the ball rolling and soon you’ll be listing out your differential.
  3. You’re not alone. One thing about feeling like the dumbest person in the hospital is that it means you can’t throw a Foley kit without hitting three people you can ask for help. ASK! Know your senior’s phone number. Call consults liberally. Ask the nurse paging you, “What have other doctors done in this scenario?”

No offense, but you’re an intern. Everyone in the hospital knows you’re inexperienced – that’s kind of the point. This is your very first year as a training doctor and you’re here to learn. The most important thing isn’t that you remember everything and know exactly what to do in every possible scenario, it’s that you keep your head and enlist the people you need to learn from and get the job done. That’s how safe patient care works, how learning works, and how you succeed as an intern!