Happy July 1st

 

PEM Fellow Graduation 2022

Today I was talking with a physician friend about everyone's nostalgic posts on residency, July 1st, finishing graduations, etc. It occurred to me without realizing it previously that this July 1st is PGY-10 for me. Post-(medical school)-Graduation-Year-10, for those of you confused by all our ridiculous acronyms in this career. Clearly I have taken the road less traveled, and parts of it did hurt, as the Kid President says. It has been an uphill battle a lot of the time, through hurricanes, snowstorms, blackouts, polar vortexes, disaster medicine, bouts with mortality-defining illnesses, births and deaths...and, most recently, being on the frontlines of a global pandemic. I was feeling quite nostalgic saying good-bye this June to the first group of residents that I as faculty had the pleasure of mentoring towards PEM fellowship. It's crazy to look back and see myself in their shoes. They are excited and worried, and most of what I wanted to say to them is to be excited about the journey before you. 

PEM IG Graduating Residents

In honor of ten years of post-graduate training, it seems fitting to look back on what I learned since residency. I hope that some of you will enjoy this post, no matter on what part of the journey you find yourselves. Remember, you have mentors, and you have co-residents and co-interns who will be family for the next 3 to 10 to 20 to forever years, you never know. Even better, the people outside of medicine that stick with you on this journey, that put up with the sleep-deprived and over-worked version of yourself, those are your people. Hold onto them. 

Violet & Curtis visiting me on a 28-hour call
(because I left the hospital too late the night before
to get to see her before bedtime and wouldn't see
her for three days...)

For what it's worth, here are 

7 Residency Truths:

Residency Truth #1: Naps and Strategic Caffeine. 

Dr. Burks at PGY-1 Trip to the Bronx Zoo

My program director, Auxford Burks taught me that residency is all about naps and strategic caffeine. As a shift worker, as a frontliner during this pandemic, and as a nocturnist of the last two years (stay tuned for a blog about how sleep is the ultimate self-care), this advice has served me very well. One of my favorite night nurses and I always joke about how we look forward to our evening pre-work coffee. For me, it often comes after a nap or after getting the kids to bed, even though I already had coffee in the morning. If you don't do coffee, do exercise when possible, even if it's just a walk. Endorphins are endorphins, friends.

 

Residency Truth #2: Hold or feed a baby. 

The best part of NICU was the feeder-growers
and my co-intern, Rushita Mehta, M.D.

Another Auxford Burks original. This may be a bit Peds specific, but it’s hard to feel like life’s problems can’t be fixed, or at least overcome, when you have new life in your hands. If you are lucky enough to have specialized in Peds or OB, you know where the nursery is, and they usually don’t mind if you offer to sit and feed a baby. During the hardest days, our PD said he would just go by the nursery and offer to feed a baby. Endorphins. Cute little life form that you are cuddling. An instant sense of hope for that baby and for you to make the world better for it by continuing to do what motivated you to start this journey.

Residency Truth #3:

Intern Dream Team with Huma & Carly

 Do Something for You.

Maybe holding babies isn’t for you. That’s cool. I learned from my co-resident, Huma Mirza that sometimes self-care and doing something that you are passionate about outside of work is more important than going straight to bed when you get home from the hospital. She said that she would often sleep less so that she could do what she needed to do to be a better doctor when she was in the hospital, even if that was lounging on the couch watching TV. It was her way of not losing herself in all of the sacrifices that this journey requires. When you don't know who you are anymore and have nothing left outside of the hospital, you have no real energy or optimism left for your patients. Never truer words. 

We are altruistic people by nature, but when we give up so much to serve others, we get lost in the process and forget how to be good for our patients. It starts with being good for yourself first. In a similar manner, it is important for parents to take care of themselves, so that they can take care of their kids. No one understands this more than doc-moms and doc-dads; we push the limits every day, trying to fit more in and do more and be more. 

All the Residency Babies

Sometimes it is important just to be there for yourself. As a resident, I was constantly training for triathlons and marathons or going for post-call runs or swims or getting up for a kettle bell workout before a 28-hour call. I was a nutjob. But, I will say, now that I'm older, while I do value those workouts, I never underestimate Truth #1 followed or preceded by a nice long walk. Everything is easier and clearer after a nice long walk. 

Orchard Beach Picnic, PGY-3

Residency Truth #4: Remember where you started. 

Write it down now. Remember why you're in this. It will be December 21st, the darkest day of the year, the longest day of the year as an intern, and you will be wondering. Wondering. You will need a note from your former self... and probably a resident holiday party wouldn't hurt either.

PGY-1 Skit & Holiday Party

 

Residency Truth #5: See the Beauty.

Travel and do Global Health and get out of town or see your town when you can, but there may be a lot of days where seeing the sun out of the hospital isn’t a thing... So, find a window, find a courtyard, find a retreat on a long call. Seek out your own silver linings, even if it’s just bonding with your team doing the silly stuff that gets you through it, ordering on-call food, teaching each other, believing in each other, playing practical jokes. 

This NICU window was a great reading spot in between deliveries and the viewpoint for many sunsets and sunrises. I can remember it fondly, as well as my team and my seniors that got us through it all.

Residency Truth #6: Expect and accept failure. 

You are going to mess up so much. That's why you have supervising physicians, upper-level residents, nurses, 

pharmacists, and many other people in the hospital to help you and guide you. This is hard for Type A people, but failing is learning. It is the Practice of medicine. It is an art. You did not learn it all in medical school, but you learned some things, so go forth believing in yourself and knowing that it is okay to fail.

<---This tire is a crazy blow-out I had on the way to work one morning. My co-intern said, “Wow, you really don’t do anything halfway, do you?” Nope. Fail big, learn big, folks. You have people to help you.

 

Hermann's Finest

Residency Truth #7: Listen to the people that know it all.

In case anyone is wondering, it's the nurses. They will pull you to the bedside, they will address their concerns with you, they will catch the majority of your sleep-deprived wrong orders that you have placed in the computer. They'll teach you so much about compassion in medicine and about procedures and how teams work. Approach them with grace and thank them for what they do for you in your training and what they do for our patients.

Alright, friends. Congratulations. It's July 1st. Good luck on your journey, wherever you may be.