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!

Books I hope you read: The Neapolitan Novels

My Brilliant Friend by Elena Ferrante

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Have you heard about these books yet? They are a series of four novels following the lives of two Italian girls (Lila and Elena) in Naples for six decades. I finished the last one weeks ago and am still processing them, still finding words and feelings they left me.

These books celebrate womanhood while lifting up an alternative to traditional femininity in Lila, a character so sharply singular you feel her cutting through each page. To Lila, compromise is like a sulfur flame, and she’ll never allow herself to be burned. But this character being unlike anything or anyone else also becomes its own magic, because also in her agony I think all women can see some of their own experiences. The end result is that by knowing two women, you get an image of the whole world, you know all of humanity. And possibly the best marker of this book’s impact and Ferrante’s skill: I still can’t believe it’s not real. I’ve read all sorts of questionably-sourced materials searching for evidence that this is the true story of a woman reaching out in love and longing for her lifelong friend. I’m almost certainly wrong, but that’s how captivating it is. I hope everyone reads these.

Books I hope you read (or not): A Little Life

A Little Life by Hanya Yanagihara

Disclaimer: I don't think reading this review would ruin the book for you, but please note that it is not spoiler-free, and I am a person for whom spoilers don't ruin books.

Content warning: suicide, abuse.

It ended how it always was going to. I am frustrated by it, and deeply saddened, of course. And also, somehow, essentially unaffected and I think this is because I feel this story is one I’ve played out before in my own head. Its prose even felt like how I talk (or at least how my thoughts feel to me) – so many words and adjectives spooling and spilling, rambling and yet with such a vibrant steel thread within it, all sewn through with meaning, each word imbued and glowing with it – essentially, rich. It was a book about in some ways the intimacies of life, between people, and so this vacation week with Lumberjack has not only been blanketed with languor but also all those small comforts between us have been stained by the pain of thinking of Jude and Willem and JB and Malcolm. And I’ve woken every night the past few nights soaking wet from their world, clutching my husband and feeling the sadness of A Little Life. It was a truly beautiful book, and an expansive and extraordinary one.

(I think one of the knives in the back by this book is that I know I am JB. Self-involved and essentially insecure and a hardship poser. I like to hope I am also a bit of Willem.)

(Digression: for the medicine people, note that there’s a really fun surgeon character in this book that I really appreciated.)

I was uncomfortable with how comfortable with the topic of suicide I have become. Line of work casualty, I guess, as a psychiatrist. Suicide looms early and colossal in the story and I knew it was there even though I hoped it would slunk away somewhere along the line. It feels sometimes inevitable, both in real life and in the book. After a major tragic blow in the novel, I was dejected but not sobbing, not surprised. Ultimately I guess my feelings about these things was resignation. I’m at a point in my life and career where resignation takes up too much space in me and indignation not enough and I hated that this book reinforced that with its litany of terrors. (Early in my intern year I took care of a patient about whom my attending, on her discharge day, said, “She’ll suicide one day. There’s just no way around it.”) I felt, resigned, like the grainy grey of the cover, staticky - the pain from this book was like sandpaper rubbing over an old lingering open wound and not like a hand plunged Indiana Jones-style into my chest to take out my heart. (Though that’s not to say there weren’t times when, sitting next to my husband, I gasped in horror, I clapped my hand over my mouth, I squeezed my eyes shut against sudden tears and felt the deep sadness.)

This book has been criticized for almost fetishizing abuse, for overdoing it. Not for describing a life with too much of it, but for describing the details too liberally – at a certain point it becomes fascination with the abomination, it becomes voyeuristic, sensationalist. And I think, but I’m not sure, but I think I agree with this. I’m reluctant to say that there was too much terror for my poor privileged heart, and so I’m careful with this criticism. Especially because maybe too many privileged hearts spend too little time considering the terrors that this world – and the people in it, and privileged people especially – put humans through.

But there’s something to this criticism. Because I wanted to know Jude better. I think we were meant by the author to understand that Jude was wrong in his understanding that he was made up just of his sufferings, but the book showed clearly and best the peripheral indications and only murkily and in small servings the direct evidence of Jude’s personhood-beyond-suffering. I just wish that the proportions were different. I wish I had read less about the exact details of Jude’s abuses and more about Jude making Willem laugh, Jude intimidating associates at the firm, Jude’s way of thinking about math. We got to know so much about the personhoods of Jude’s posse through the stories of how they cared for (and didn’t) Jude, and in this we knew them better than Jude, because not only did this clarify their characters but it also obscured Jude’s by reinforcing the archetype of the long-suffering, the cared-for, the lost soul. And this was the archetype Jude was fighting his whole life, so in this way this obfuscation by the novel is meta – and a mistake, in my opinion. I wanted to know Jude.

And through Jude weren’t we supposed to know better the rest of the lost souls in the world? Weren’t we meant to have better aching hearts like Willem did? And for this reason I resented not just the obfuscation of Jude’s character but also the caricature of it – he was remarkable, written somehow to be loved. He was brilliant and pliant and loving and extraordinary, with hurting hands turned only towards himself. I resented him and the author for this, for how deliberately lovable he was when that’s not often the characters a long-suffering life creates (but my patients still deserve love).

And then the book ended, and not only that but it ended with Jude apologizing, with him not having learned he was loved. With Jude not at his core moved by Willem and Harold and Andy and etc, etc, etc. How awful. What an awful rebuke of my career. He was a great steel ball we hoped to melt into warmth and yet we only got the outer few layers, coming off onto our hands, pretty, sweet and beautiful, we fooled ourselves, where he stood cold and unhappy still.

And actually I realize that I got that last feeling/image from my own experience with rewarming cold balls of pie dough. Pie dough is finicky, so finicky. It can be really good, just perfect, a few days after you’ve made it and put it in the fridge. But the tricky thing is that it can never get too warm before you shut the oven door on it, because you want the butter to be rubbed into the flour but never really married to it, and that’s what gives you those glorious flakes interwoven with lovely flavors. So there’s this moment when you’ve taken the dough ball out of the fridge and you have to warm it enough to roll it out but not too much to ruin it. So you roll it in your hands. And if your dough ball got too cold in the fridge, you’ll find that the outer half inch or so will get nice and soft and probably too warm far before the center of that dough ball isn’t a rock. You might think you’ve got it just about warmed and ready because the outer layers are squishy and pliable in your palms. But you’d be fooling yourself.

Ultimately, I realized that the story this book told was one I had learned to stop telling myself years ago. So I spent all the week I was reading this book under a dark cloud, yes – but I think I will come out from under it easily. Because I’ve been coming out from under that cloud my whole life, and I’ve succeeded.

I think the real triumph of the story was that nobody else ever turned away from him. To the very end, Harold and Andy and presumably Willem and JB and Malcolm were still there figuring out how to love Jude.

And you know what? If you work that ball of pie dough just right, it’ll soften and stretch and come together into itself so you can roll it out. You can even ruin the outside by getting it too warm and still make something work. There’s never an irrevocably frozen center.

I don’t know what to say about how A Little Life should have ended. It was an incredibly beautiful book. It was aching and the prose rolled the narrative out bleeding all the way. Its characters – Jude as mentioned above aside – grew life-size before me in perfectly described moments, in many small imagined acts witnessed by the others. It really shows us that humans are found in the spaces between us – we hold each other. And so the book was excellent and I know that it was never going to be written to end any other way than the way it did, and also it was awful. I don’t think it wasn’t true to the story or the characters. But I think the story itself as it was conceived was inherently flawed. St. Jude is the patron saint of lost causes. What does it mean to have a saint of lost causes? What has the Catholic church decided is a lost cause? Because fuck that. We have to reject that narrative. That’s not a way to live in this world, so fuck it.

(My patient, by the way, is still alive. And I think she can find some love for herself in this world. I really think that’s possible.)

Books I hope you read: Bad Feminist

Bad Feminist by Roxane Gay

Roxane Gay is an inspiration, and a really good example of how heroification isn't necessary to feel in awe of a person. Her book talks about tough, often academic feminist issues while never forgetting that feminism is personal. This means she schools on intersectionality, brings pop culture into it, and makes hard questions accessible. Above all, though, she never leaves out humor and never leaves out the profound. It's a hopeful beacon in a conversation that's way too often cynical. I cried on the bus...twice. I can't wait for what it might do for humans, i.e. you. Read it!

Books I hope you read: When Breath Becomes Air

When Breath Becomes Air, by Paul Kalanithi

Whether we like it or not, and whether we are aware of it or not, when we decide to become doctors we choose to ask the problem of death into our lives more bodily, more substantially, than most people. Paul Kalanithi took that to the extreme when he decided to become a neurosurgeon, and he wrestled with the problem of death – helping to guide patients across the landscape of health and disease which brings us so close to it – just as he wrestled with the problem of human meaning by choosing to become a physician after studying literature. His openness and vulnerability in discussing these problems in his book reflects not just a remarkable wisdom but also a rare and clear-eyed bravery, especially as the problem of death became personal for him.

Dr. Kalanithi talks in several places about the struggle at humanity’s very basis, and then he reinforces this foundational idea throughout the book when he talks about his own struggle. This constant striving really is essential to being human, and it reflects the conflict between life and death that we are all perpetually trapped within, and which he himself must face more readily than most of us ever will.

Living life means a constant balance between grasping and acceptance. We all must find our values – find the right way to spend our lives reaching while facing the knowledge that eventually, at some unknown time, everything we’ve reached will be taken away. Accepting death but knowing that the answer isn’t to stop the struggle – that’s life’s great challenge.

And Dr. Kalanithi faced it, and demonstrated it, beautifully. He takes the reader on our own, heartbreaking version of it. We get to know him, we grow to admire and appreciate him and his life, and this all the time knowing that his days are limited. I think knowing that Dr. Kalanithi died before he could see his book finished, but also having this version in my hands here in front of me, played out that never-ending challenge like Sesame Street teaches you how to tie your shoes.

This book was, ultimately and fundamentally, enough. I wish that Paul Kalanithi could have lived years and years longer to have written many more words for us, and I also accept that he didn’t. I am so grateful to him for baring himself open, for helping me figure out what it means to be a doctor, and for teaching me this really important lesson.