It will be the best of times and it will be the worst of times.
And what a special time this will be. This will be a time of learning. You will learn the details and nuances of clinical medicine — the diagnostic features of sarcoidosis and the second, third, and fourth line treatments for community acquired pneumonia. You will learn how to learn, and you will forget what you learned, only to learn it again. You will sometimes wonder if your brain can possibly store any more information. And often it can’t. But sometimes it will.
In the beginning of the year, you will find that although internship is about learning the secrets of disease, it is equally about learning the secrets of yourself. When an insurance company refuses to cover an important MRI, you will witness the intensity of your anger. When your hearing-impaired patient misses her appointment because she cannot find transportation, you will feel the depths of her sadness. And on the eleventh day of a twelve-day call block, you will wonder why anyone would choose to do this work under his own volition. Why would you attach your life to the suffering of others, why would you hide yourself in the shadows of illness? But then while cleaning your desk on a quiet October night, you will come across your medical school application essay. You will be struck by the curiosity in your voice and the excitement in your thoughts. But you will be saddened upon realizing that in your relentless pursuit of tomorrow, you have forgotten that today contains everything you have desired.
In these moments of insight, you will realize that happiness is a choice, and that medicine like anything else is a mix of awe and awful. You can choose awful. You can choose to hear the screams of suffering patients, mock the outdated technology, and avoid the rooms filled with the scent of staleness. But you can also choose awe. You can choose to remember the stories that make you tremble with emotion, like Mr. J the thirty-two year-old singer who you will admit to the ICU for a life-threatening abdominal infection. His parents will tell you that he was supposed to get married that week, and the sadness in their voice will make it difficult for you to sleep. You will look for someone or something to blame, but instead you must find someone or something to believe in, because good things can happen to good people. Four weeks later, you will stand by his hospital bedside with a beaming smile as you watch him, the handsome groom, be married to her, his beautiful bride.
During the harsh winter, you will sometimes resent your friends in other professions. You will see pictures of their new homes and weekend getaways, and you will want to get away. After a tiring day at work, you will propose that your team go out for dinner. But the entire conversation will be about the very job that you came to dinner to get away from. In moments like these, you will realize that you never really wanted to get away, that you may have chosen this profession, but by now, it has also chosen you.
By March, you will have learned to never underestimate the recovery of the human body or the resilience of the human mind. You will have repeatedly observed that the best predictor of a sick patient is a worried nurse. And you will have found that when you are tired, anger comes easy and kindness takes effort – especially kindness toward people who are not kind toward you.
As the sun returns in April, you will begin to feel burdened by the looming expectations of a new year and a new role. Some mornings, you will walk into the hospital feeling like an imposter – as if you stole your badge, stethoscope, and medical degree from someone else. You will inevitably make mistakes, some of which may harm patients. And when this happens, you will hate every cell in your body. You will promise to never see a patient again. But hopefully you will remember that time as a medical student, when Ms. G, the homemaker from Santa Rosa California, told you that you will make a kind and thoughtful doctor one day. You truly it believed it then, and it is important that you believe it now.
As the year comes to a close, you will begin to accept that this job is unfathomably difficult, although your attendings will make it look remarkably simple. You will envy their intuition about patient care and their ability to manage difficult conversations. You will envy their schedule. They will arrive at nine in the morning with a bag of bagels and cream cheese, and you will want nothing more than to one day be an attending yourself. But perhaps, when that day comes, you will arrive to the workroom and see your team, surrounded by unfinished notes and finished cups of coffee, and you will want nothing more than to be a resident again — when it was ok to not know, when every diagnosis felt new and every emotion felt raw.
Finally, I would like to congratulate you. From now until forever, the letters M.D. will follow your name. But I would also like to caution you. Please remember that medicine is not who you are, it is simply a thing you do. You are a brother, a Hindu, a Rockets fan, a best friend, a tennis player, and for some days of the week, a physician. So do not let these letters get too close. For if the M.D. erases the name that precedes it, you will become indistinguishable from many others who practice this profession. And you are too young and it is too early to let that happen.
Muthu Alagappan, MD
*Published in a slightly different form on KevinMD.com at http://www.kevinmd.com/blog/2017/07/dear-intern-advice-first-year.html