The following manuscript was published as part of the March 2018 s/p The Match — One Year Later theme issue.
At the beginning of my intern year, I bought a ukulele. I started intern year at a sprint, like anyone does, arms full of hope. This was quickly extinguished, lost in an atmosphere so devoid of hope that it all flew out of my arms to settle into places so far apart, it might as well have been floating in the vacuum of space.
The cloak of physicianship was a sudden burden that I wasn’t sure how to carry. Beyond the obvious responsibility for human lives, I was troubled by darker, sinister uncertainties that were similarly heavy. Medicine was wrought by evils executed by disparity, ignorance, scarce resources and tradition. I wrestled with a newfound power over people that no one had taught me how to soften. I felt a sense of shame in joining by vocation a tradition of institutionalized racial and socioeconomic oppression that now had officially dirtied my own hands. Going to work felt like a daily jack-in-the-box of horrors. Unlike other jobs, there was no luxury of the mundane to fill in the gaps between flashes of drama. Every bad outcome felt like a stab in the raw place in me that bled for people. Over time, it progressively softened my cringe reflex into what felt like having the chills almost all of the time, hair on perpetual end. Adjusting to the new reality of being a doctor felt really impossible.
So, for a while, I came home every day and played the ukulele. I was horrible at it, but playing those songs would pull out the tears from my eyes that I had suppressed all day, massage that raw place a little, and put a little dressing on my wounds. Playing the ukulele every night meant the hard places in me from medicine didn’t become as hard. It was a balm that helped soothe the default path of bitterness. The bitterness that dominates medicine comes from many places — from seeing tragedy over and over, from feeling overworked, from feeling helpless in the face of disparity, from being unable to help. It’s a sticky, plethoric tar that protects you if you paint yourself with it but hardens in layers until, before you know it, the only touch that can mark you uses a knife.
Intern year loped along and, by the end of it, I was thin and ragged, gasping for air, and focusing on just getting through. Hope felt long gone. Patients that did poorly bloomed in my awareness, taking over my thoughts and ideas about how medicine worked and what could happen to people. Pessimism was joined by sacrifice; in my last month, I had become uncomfortably accustomed to losing who I wanted to be as a doctor for the sake of getting to the next admit, writing more billable notes, or working my 85th hour in the week. Hope was thin on the ground. I didn’t enter medicine because I thought it was easy, but I did go into it thinking I could do it proudly. Towards the end of intern year, I was having very serious doubts about that. Would I ever be able to find a way to do this so that I was proud of myself and think I was doing more good than harm? Was there a way to tolerate all the tragedy without becoming a monster?
I still don’t know the answers to those questions. (Spoiler: not being an intern anymore helps.) Sometimes I would get home from work and get my ukulele out and I would claw for hope by playing sad songs fast and fiercely, feeling something besides sorrow, reminding myself of all the people in the world that have made it through hard times with this balm of joy — music. I would do this at 1 a.m. when my alarm was set for five the same morning. I would do this after really hard days when patient courses were long and arduous. It was a balm when hope was thin.
And then, on my very last day of intern year, and I still can’t believe it happened this way, I taught one of my patients how to play the ukulele.
I had entered this patient’s room in order to clarify a few things and give some updates before I sat down for the afternoon to pound out my notes so I could — I hoped — leave a little early on my last day (I had a plane to catch). But instead, I saw that little plastic four-stringed piece of magic labeled “OCCUPATIONAL THERAPY, 7TH FLOOR” (we were on the fifth; this is how it always goes in hospitals — nothing and no one is where they belong). I saw my patient struggling to finger a G-chord — I had struggled too, at first. I saw a person clawing hard at hope in a hard situation. I saw my humanity rushing back at me during all those late nights playing sad songs fast and fiercely, thinking of patients that did poorly and situations that were deranged and all the ways bodies and minds and medicine had failed us. So I sat down on that hospital bed and spent several hours teaching chords, sharing my favorite tab sites, and practicing sing-alongs. One of the songs we played, Don’t Let Us Get Sick by Warren Zevon, goes like this:
Don’t let us get sick
Don’t let us get old
Don’t let us get stupid, alright
Just make us be brave
And make us play nice
And let us be together tonight
It was the song I had been playing and singing to myself all year, the one I had chanted like a prayer hoping to ward off black clouds and bad omens, hoping to make the hospital feel more like a team room than a battleground. I sang this, finally, with this patient, who was sick but getting better, who was brave.
Ultimately, this tool I had been cultivating for my own sanity over the course of the year was one I got to share with a patient as I crossed the threshold from intern to resident. We almost missed our flight.
So here is my intern year survival tip: go to the place where hope seems thinnest. I don’t know why. It was something I felt compelled to do. Go to the place where the darkness is thickest. Go with all your hope gathered in your arms and into the vacuum it will disperse until you are gasping, breathless from the scarcity of the sparse and lonely atmosphere, reaching blindly in the darkness, hands wet with its thickness, its beefy angry sopping heaviness, eyes drowning in the horror, lacking all hope.
There, find it again. Reach and reach. Dig and dig. Fight harder for hope than you ever thought was possible, than you ever imagined, than you ever thought you would. Pile it back into your arms and get ready to plunge again.
Image credit: Ukulele by Phil Hawksworth licensed under CC BY 2.0.
Resident Physician Contributing Writer
University of Washington School of Medicine
Monica is a second year psychiatry resident at University of Washington and graduated medical school from University of Illinois at Chicago. She has long been a writer -- winning contests as an undergrad, contributing to the lit mag in medical school, and now leading the narrative medicine group in residency. She is guided by the principles of grit, thoughtfulness, and intensity, and hopes to live these values by working as a child psychiatrist working towards social change. She writes at www.monicasamelson.com.