December 26, 2021 monicarose

The First Six Months

Residency

Not surprisingly, the first half of my intern year has gone by incredibly fast. Although I’ve been writing down brief thoughts along the way, I haven’t kept up with my initial goal of posting here each month, and that’s okay. It’s just a reflection of resident life, being flexible, and taking advantage of pieces of time wherever you can. 

The last six months have been incredible, and I know I’ve learned so much, even though I am still plenty intimidated at how much more there is to learn. 

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Working as a Resident

As I’m sitting down with some time off to write this post, I decided to start by reading my post from over 2 years ago when I reflected on the first five months of clinical rotations as a medical student. It’s funny reading words that I wrote as a new third-year medical student and realizing that I’m still repeating many of the same reassurances to myself even now as an intern.

Some of the common themes are:

• Balancing personal and professional life 
• Frustration and anxiety as I was “learning a new language” of medicine then, and still now as I’m learning the practice of Emergency Medicine 
• Excitement for the future, for being more competent and helpful for my patients 
• Truly enjoying the parts of my day where I’m talking with my patients and their families 
• Reminding myself that this journey is a privilege every step of the way

Despite these common themes, there is also so much that has changed now that I’ve made the jump from medical student to resident, as I touched on in my last post. 

In these first six months, I have gotten much more comfortable with my role as a resident, as a doctor, and I attribute a lot of that to the culture at my program.  The most recent example that comes to mind that demonstrates this culture was actually from block 6, in the Medical ICU (MICU).  I had a very sick patient who was having seizures after having multiple episodes of cardiac arrest, and my attending and I were examining the patient alongside the ICU nurses. Both myself and the nurses were turning to the attending to determine the next steps, and then my attending pulled me out of the room to talk.  He was allowing me to be the one to lead my patient’s care, to go back into the room with my nursing team, and tell them the plan, “my” plan.  Small gestures like this go so far in building my confidence, my leadership skills, and allow me to learn more with each encounter.  Being immediately treated like an equal, like a doctor, like a leader, by everyone on the patient care team, is allowing me to step up to this role so much faster and with so much more support than I could have imagined.  I am grateful to my senior residents and attendings for their guidance and mentorship, and to our nurses/respiratory therapists/techs for their confidence in me even though they know I am new and have so much still to learn. 

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The Struggles

Although as a whole these first six months have been great, I would be misrepresenting myself and this journey if I didn’t continue to share some of the hard times. 

In block 3, when I did a month of night shifts in the Emergency Department, I had one week that was particularly tough, and I wrote down some of my thoughts at that time.  I think the reason for this struggle was multifactorial, as most ups and downs are, and included the fact that I was having a lot of trouble sleeping during the day.  I was being extremely hard on myself internally, so much so that one attending noticed I was too scared to confidently “pick my plan” for my patients.  The attending probed a little and asked why I was scared to present a plan.  Having him point out that the worst thing that will happen is the attending will say “no let’s do this instead”, was helpful in getting me out of this anxiety loop I was stuck in. I went home from that conversation and realized that I was developing internal dialog with myself that is a little too harsh for being at this stage.  There are still so many firsts to experience, I am here to learn, and it’s normal for me not to know exactly what the next steps are in every situation.  

I honestly still have to make a conscious effort to be kinder to myself internally, but having this first realization during block 3 was an important first step.  Talking with my co-residents about this has also been helpful, and confirmed that this is not a unique struggle, it is something that most residents face along the way.  We worked our entire lives to be here, of course we want to be completely confident as soon as possible; but, growth requires discomfort and uncertainty, and that’s just part of this journey. 

During block 6 in the MICU, I felt more emotionally drained as I was seeing patients and their families more than just in the emergency department.  As I had repeated interactions with patients and their families, I over-empathized at times, and had a couple of instances where my emotions got the better of me and I cried while I was at work.  Again, talking with co-residents and attendings helped so much, and they normalized this experience.  I don’t regret that I feel the “human side” and the emotional side of what my patient’s families are experiencing, and I am grateful to be in a field where we’re not told to suppress this side. Instead, I just know I’ll continue getting used to this exposure, and continue finding my own ways of grieving for my patients while still taking care of myself. 

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The Highlights 

Whenever someone asks me, “how is residency going?”, my immediate and natural response is “it is so amazing … and terrifying … but mostly amazing”.  I absolutely love being a resident, and I just can’t get over the quality of my training here in Corpus.  I constantly look at my senior residents with admiration and a goal to be as good as they are someday.  Even after six months, the fact that I get to do this as a job continues to feel surreal. 

As with most emergency medicine residents, I do love the procedures.  The moments when I’m performing procedures are definitely some in which I actually feel like “a doctor”, even though I know I need a lot more repetition. (For emergency medicine residents, the most common procedures include intubations, central line placements, arterial line placements, laceration repairs, and many others.) 

That being said, simply talking with my patients and their families continues to be one of my favorite parts of this job.  The more conversations I have, the better my communication skills become and the more confident I feel as I discuss results and plans with my next patient. 

I also want to recognize the importance and the highlight of leaning on my co-residents.  Whenever I have the opportunity to talk with my co-interns, to share our struggles and our highlights, I come out of the conversation feeling one-thousand times better, and so proud to be working with them. 

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Looking towards the next 6 months

My senior residents kept reminding me this last month that I am half-way towards being a senior resident myself.  This is terrifying and exciting, the usual combination of feelings in residency.  A lot of senior residents say that the first 6 months is a different type of growth and struggle than the second 6 months as an intern.  I am hopeful that getting more repetitions in, increasing my study habits, and continuing to work on being kinder to myself, will all make for a great second half of intern year.