August 08, 2020, was when a chartered flight from Nepal landed at JFK. I wish the experience were as fancy as it may make you imagine. COVID-19 played a special role in our batch of interns; first, we did not get the ”I Matched” party, and then many of us were delayed in getting visas, which meant we were starting residency off-cycle. If you know anything about starting residency, the "off-cycle" part should add a few beats to your already racing heart. It certainly did to mine.
“You will get there!” My senior patted me on the back. No amount of reassurance is too much at the beginning of residency. I started PGY-1 year with Dr. G as my PGY-2. Anyone who knows Dr. G can tell you how lucky I am. Starting in August meant most of my batch-mates, who started in July, were already acquainted with the hospital and the day-to-day workflow.
At the end of my intern year, my wife recorded a mortifying video of me sticking my tongue out when my name was announced from the stage. I was selected as the best intern of the year. I am not sure why the people who did thought I was doing great, but I did not feel like I was. This is my attempt at thinking on paper to figure out what potentially worked for me. At the risk of being self-congratulatory at times and stating some cliche, let me think out loud here in the hopes that I might inspire one starting intern.
For questions like “How do I get to MRI?”, the answers I got more often than not were in the line of, “Here, let me go with you and show!” Be it writing my first AMA note, finding a colonoscopy report in Epic, choosing an easier-to-use butterfly needle, or that one specific vending machine that always had cold coffee available, I had many friends guiding me everywhere. Arriving late at Metro proved to be a blessing in disguise for me.
“Understood, thank you for trying!” I said. The echo tech looked at me in utter disbelief. Upon my senior's request, I went to the seventh floor to expedite an echocardiogram for a patient. We were ruling out ACS; he was our only potential discharge for the day. The poor echo tech told me that she had done a bunch of echos in the morning and needed to go for lunch. She would try to squeeze my patient in sometime in the evening. I reported that to my senior, who speculated that the disbelief I witnessed on the echo tech’s face was probably because I did not fight to get the echo done ASAP. As a second-year resident, I told all my interns they were part of a system designed to help patients. If they don't do their part (probably calling the MRI tech that the order is placed once a day until it happens), the system does not work. But if they try to do much more than their part, the system collapses because its parts will wear and tear. Understanding that a system is working to make things happen took a lot of load off my shoulders.
I would start my notes early in the morning, pend them, and see my patients at the bedside. Every time a patient complained of something that I did not know how to help them with, I’d ask, “How can I help?” Many times, I have had replies from the patients that I could absolutely do, and it was wrong on my part to assume that I could not help them in that particular matter.
“What is something you wish internal medicine people understood about psychiatry?” I asked a psych rotator in our team once. “Many things! Haha, but mostly the fact that you don’t need me to assess a patient’s capacity!” Dr. S replied. That made me wonder if we don’t ask others what they expect from us. Because if we do, they usually expect things that we are very willing to do and things that would make our lives easier. I tried to apply the principle of asking what I am expected of in most of my rotations early on, which helped me a lot.
“You really don’t ever complain of anything,” complained one of my batch mates. I read somewhere that complaining, at least in some part, assumes that you and no one else have realized the problem's existence. Which, more likely than not, is incorrect. It is one thing to offer a solution after careful examination of a problem humbly, but reiterating that a problem exists does no good to anyone. Having read and tried to apply that has helped my spiritual side the most.
Recognizing that my biggest assets were my friends helped me the most. Alarmed that the patient with heart failure received 2L fluid already? The nooks and corners of Epic are easier to explore if you have a friend pointing out you are in the wrong patient's chart. Dreading Dr. L's age-old questions in the rounds? It turns into an epic laughing adventure in the sign-out room later during lunch. Of everything that went right for me, I think the most important ones still don't fail to celebrate my wins in a WhatsApp group, not at all ironically named "Accountability." As I approached the second year of residency, I asked myself some interesting questions. Who did I want to be like? How would I help my interns learn while I needed much learning myself? Would I even be able to endure the stress of being the responsible leader of a team? Next year, Dr. K.G. came up to the ICU and joked, “They should just give you a lifetime achievement award at this point!” I was selected for the best PGY-2 that year. I was doing my first MICU night float ever. PGY-3s, including Dr. KG, were graduating that day. They called my name from the stage. I remembered not to stick my tongue out this time around. The adventures of the second year...