intern year: reflections and advice

Intern year is finally and officially over. For those unfamiliar, intern year is the first year of residency training, or post-graduate (from medical school) training. It's the first time many trainees go from being "just a medical student" to being addressed as doctor. So naturally, it's simultaneously thrilling and terrifying. Many of us have been waiting for this day for years. If the often-used analogy for transitioning from college to medical school is "like drinking from a fire hydrant", I'd describe the transition from medical school to residency like being thrown into water when you don't know how to swim. That brief moment when you're treading water and you feel like you may be staying afloat, only to be drowning seconds later is how a good part of most days that first year feel. But! As hopeless as the days may feel and as stupid as you may feel multiple times a day everyday, the hours and days and weeks and months do pass. And then it's on to the second year.

Psychiatry residency training is 4 years long, so I'm 25% of the way there. A measly percentage, but I'll take it. This year has been the most consistently challenging, tiring, and difficult-to-adjust-to year of my training thus far. By far. And definitely top 3 most difficult things I've gone through. That said, alhamdulilah (praise God), I survived. Somehow, to my amazement and confusion, I survived. For anyone out there starting intern year tomorrow (July 1st is the official first day of the new academic year), I have noted reflections and advice about the year that I am sharing in this post. It is absolutely an exhausting year filled with some incredible highs (successfully treating someone all on your own for the first time, a patient thanking you and really meaning it, a patient giving you a handmade gift) and devastating lows (losing patients, making mistakes, feeling like maybe you weren't meant to do this). I genuinely hope this post is able to offer insight and inspiration to survive intern year. 

Without further ado, here is a list of things I learned throughout my intern year in Psychiatry, in no particular order.

1. Recognize the system is broken. I read about a hilarious difference between July and June interns: July interns question their choice to become physicians, and June interns question humanity. This may happen more often in Psychiatry than other specialties, but I guarantee it'll happen regardless of specialty. Patients will tell you about unfair social circumstances that you will need to realize are beyond your control. It's humbling and depressing. You'll hit a roadblock in a patient's care plan that you can't get past, whether it's because the patient doesn't have insurance, or is homeless and unable to get certain resources, or because they don't have any family or friends you can reach for help. As a result, they won't be able to get the optimal care they deserve, and you won't have a good answer for when they ask "what do I do?". As a provider, you will learn the system is flawed and broken, and lets people fall through the cracks. You will realize there aren't enough resources to help your patients. You will learn  prisons have essentially become state hospitals. Regardless of specialty, you will definitely learn how severely limited access to healthcare is about to become. As depressing as this realization is, let this be an opportunity to learn where the system fails people (even if it causes you to question humanity) so you can help your patients and truly advocate for them.

2. Forgive yourself for not knowing and not being the best resident ever. As you can gather from the above post, learning about the inadequacies of medicine and the healthcare system is not encouraging. Add sick patients, being overwhelmed with how to put in (the correct) medication orders, writing notes, pre-rounding, rounding, rounding again, discharging people, admitting people, transferring people, returning pages, and everything else in between, and you will have days the only thing you look forward to from the moment you wake up is when you can get back in bed. This will make you less enthusiastic and happy obviously. It's ok to not be the best resident ever. Sometimes it'll just be about making it through the day. You won't know things, make mistakes, say the wrong thing, act the wrong way, do the wrong thing. Forgive yourself.

3. Practice self care. Obviously a priority for someone in the mental health field, but equally important for everyone. Practice self care. Your job will become even more miserable if you feel perpetually ill (although you will feel perpetually tired, but that's a different story). Try to eat well. Step outside once in a while. Call family and friends. Read something enjoyable. Watch a movie. Go out to eat. Do whatever helps you relax, but do take breaks and treat yoself. My self care involves going out of the way to get better coffee. So worth it.

4. Be kind. To patients, nurses, social workers, other residents, medical students, anyone and everyone. You lose nothing by being nice.

5. Advocate for those who can't help themselves. See point 1. You're the "expert" now (yikes) and very often someone's last resort. If you don't have the answers to their questions or can't provide the services they need, direct them to someone who can help. Be empathetic and helpful, even when the other person is being a jerk, rude, and is showing evidence of being in the hospital for secondary gain. Let the power and authority you have be for the betterment of patients' lives. Fight for them.

6. You'll feel like an MS5 for atleast 6 months, and this is completely normal. Especially if you don't stay at your home program, you will be lost and confused for atleast the first half of each and every rotation. You will have moments where you feel like a fraud, a fake, and will wonder a) how you even got into medical school, b) why anyone ever thought you were competent enough to graduate from medical school, c) how any residency program accepted you, and d) why your family didn't stop you from becoming a doctor because you clearly weren't meant to be one. You will have no idea what's going on at times, will be caught off guard by patients, and will sometimes feel less competent than the medical students when they're more familiar with the EMR than you are. It's ok. It finally started getting better and more comfortable for me around February (8 months in).

7. Get help when you need it. Everyone has gone through intern year and everyone has felt, at some point, the same as you (see point 6). Ask for help when you need it. One of the best parts of residency is no one is grading your performance. You get evaluated, but that's so your program can ensure you aren't largely deficient in something (like making sure you show up for work). Don't know an answer to your attending's question? Who cares. Don't know how to put in an order for Tylenol? Ask. Get lost on your way to the first day of a new rotation? It's ok. Feel depressed and overwhelmed to the point where it's affecting your work and well being? Ask for help. There is never any shame in asking for help and support. Again, intern year is hard. Ask for help.

8. Push through it. Just when you hit a block and feel like you literally can't make it, keep going. When you feel tired beyond belief, have been at work for 16 hours, are so hungry you're positive your stomach is auto-digesting but you can't take a break just yet, keep going. There have been so many times that I was convinced I wouldn't make it through. Your strength, grit, resilience, and commitment will shock you. When you do make it through your first day, first night, first call alone, first _____, recognize you survived and applaud yourself. What you're doing is far from easy. Recognize your perseverance. The only exception to this: don't hold your pee.

9. Get used to never getting enough sleep and always feeling tired. One of my attendings recently told me this doesn't go away even when you graduate from residency. Oh well. The sooner you get over never feeling fully rested, the less upset you'll be that you're never not tired. One caveat- make sure you're not anemic or something. Also, never underestimate the restorative power of a good nap and going to bed at 8pm.

10. Cry when you need to cry. I've gone to the bathroom to cry more than once this year. It happens. You'll feel better after a good cry, so just go do it for like 5 minutes, and then come back to your work and push through it.