New surgery intern reflects on first month: ‘The hardest 31 days of my life’

My first day as a surgery intern scared me half to death. I walked out of the hospital wondering how I would survive a year, let alone care for my patients.

I arrived at 6 a.m., ready to shadow the intern I was going to replace. He was in the trauma bay helping resuscitate a patient who had been stabbed in the neck. By the time I got there, the patient had died.

Welcome to trauma.

Trauma surgery, my first rotation, is known to be the hardest of the residency. In my new workplace, a hospital in a rough area of New York City, patients with gunshot and stab wounds are routine. In July, when I started, these patients flood the ER. Hot weather equals violence.

I was anxious for a number of reasons. Back in medical school, my third-year surgery rotation took place in a large upper-middle-class suburban hospital. So I had never worked with patients who had taken a machete to the face, been pushed in front of a subway train or been beaten up with baseball bats.

And besides being 18 months removed from my last surgery rotation, I do not have the hardcore, type A surgery personality. I matched into anesthesiology. I’m here to complete my preliminary year.

Making it

My hospital was short on staff, and with July’s extra patients coming in, we were stretched even thinner. On my shadowing day, the trauma list contained 47 patients, and the intern I was following had no time to speak to me, let alone answer my questions or alleviate my anxiety about the upcoming week. In the meantime, I saw a list of the types of injuries I’d be facing for the next month. The fourth-year chief resident noticed how nervous I was, shrugged, and said, “At least you’ll have plenty of interesting stories to tell.”

I compare my early experience at the hospital to being thrown into an ice-cold pool with all my clothes on. The first two weeks I worked nights, when the staff and residents are even more short-handed. I was on my own. The other trauma intern worked days. The second-year resident was doing consults. The physician assistants were off-duty. The chief was busy with the sickest patients coming into the ER.

So some things I had to learn on my own. For instance, I had never prescribed pain medication. “You will learn during your residency,” I was always told. Well, I learned quickly because many of my patients required narcotics around the clock. The first time I put in an order for morphine, I was so nervous I ordered half of a dose. I learned how to dose correctly by researching it on the Internet.

During nights, I had to report to the ER every time a Level 1 or a Level 2 trauma was called. I dreaded the sound of my pager—it felt like a ticking time bomb in my pocket. I had always made it a point to return pages and respond to nurses in a timely manner. But when I was helping with traumas, I couldn’t answer my messages—sometimes for hours. The delays did not help me win any popularity contests. I learned to be very apologetic.

During that first month, a friend asked me if I ever had time to nap during my shift. I had to laugh. On top of helping patients, I also wrote 30-plus notes and updated the surgery team’s patient log for the morning. I was zipping around the hospital all night.

Eventually, I got the hang of it. The nurses warmed up to me. I could write for narcotics. I completed my notes in a timely manner. Injuries I once found emotionally and intellectually overwhelming became less so. When I made it through the month to the end of the rotation—the hardest 31 days of my life—my chief told me I learned fast and did great work. “I was nervous for you because you were so anxious at the beginning,” she said.

I couldn’t help but feel proud of myself for making it through, especially considering I had so often wanted to quit. I also feel lucky for the opportunity to learn how to manage surgery patients and and work side-by-side with their physicians. This year is going to be a long one, but it will make me stronger and better in every way.

When I was well into my second rotation, bariatric surgery, I learned that another preliminary-year surgery resident like me had quit the previous year after three days. During evening rounds, he turned in his pager and said, “I just can’t do this.”

“Wow,” I said to the colleague who told me. “What rotation was he on?”


Original article – The DO – October 25, 2013

Filed Under: FeaturedGeneralPremed Corner

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