The following manuscript was submitted to the March 2017 s/p The Match — One Year Later Themed Writing Contest.

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Chief Complaint:

“Intern year”

History of Present Illness:

This is a 30-year-old female with past medical history of anxiety. She is otherwise healthy.

The chief complaint has been ongoing for the past nine months. She describes the following precipitating events:

“My early idea of what it meant to be a intern came from a combination of pop culture physician idols (i.e. ER) and a handful of actual medical experiences. A dive headfirst from a shopping cart at young age earned me my first trip to the emergency room. I remember the good news delivered by a young female intern in a white coat. I still have the x-ray of my head. My little head with its little unconfirmed suture lines.”

“This occurred in the setting of growing up in Trinidad, Colorado. It is a small town in southern Colorado that was formerly known as ‘The Sex Change Capital of The World.’ It was not uncommon to know transgender individuals. Growing up, I was exposed to the idea of living happily as one’s true self. I saw that medicine had a role in that.”

She describes her present state of person and mind:

“Intern year — it is my first real exposure to the realities, strengths and limitations of our current medical system. It is also the first time that I have worked 80-plus hours in one week. It leaves me feeling simultaneously exhausted, disappointed, exhilarated and hopeful.”

The chief complaints are aggravated by the following factors:

Regarding the current medical system:

“Homelessness, young veterans with PTSD, the fallout from the most recent election — the reality that not all are living happily as one’s true self. The systemic racism. The systemic sexism. The systemic injustice. At first I tried hard to ignore the effect this was having on me. I found it difficult to know where to fit into the conversation when I have experienced very little of it myself.”

Regarding the long hours:

“Making time to do things I enjoy outside of residency has been difficult, in particular, keeping up with friends and family. I have a stack of greeting cards filled out but not addressed and a pile of clothing for my friends’ children’s birthdays that will be soon be outgrown. The stack and pile torment me daily.”

The chief complaint is alleviated by the following factors:

“My husband, family, friends and teachers, who despite the absence of snail mail and tiny outfits, love me anyway.”

She lists the following associated signs and symptoms:

“Extreme emotional highs and lows. Sleep deprivation. A thirst for apple juice in four-ounce quantities and a hunger for strangely textured hospital graham crackers.”

Past Medical History:

As stated in HPI.

Past Surgical History:

“Thankfully, none. However, I did toy with the idea of being a surgeon for a long time. I did a transplant surgery elective in my fourth year of medical school. It was such a rush procuring donor organs and watching them come to life in the recipient. Then one day, I found myself holding a retractor in the thorax of an eight-year-old girl who had been in a car accident with a drunk driver. As the transplant surgeons carefully and respectfully gutted her body, I found my free hand reaching up to settle her fibrillating heart. I decided in that moment, that I wanted to take care of hearts. Not in the cardiology sense, but in the ‘maybe I can prevent a few drunk driving accidents’ sense.”

Family History:

Maternal: vocal, a preserver of human dignity, an innate ability to see people’s true needs and meet them

Paternal: silent, an innate trust in the intentions and abilities of others

Social History:

Past work experiences:

• Wendy’s: “I keep my old name tag on my nightstand. It keeps me on the ground.”
• veterinary technician: “I have a scar on my wrist from a cat named Psycho to prove it.”
• Planned Parenthood Health Center Assistant: “My head and heart aligned.”

Relationship status: married

Sex, tobacco, drugs and alcohol: responsibly

Birth control: My body. My choice. My future.      

Vital Signs: 

Temperature: 97.1
Heart rate: 90
Blood pressure: 116/70
Respiratory rate: 12
Oxygen saturation: 99%

Physical Exam:

General: no acute distress
HEENT: pupils equal and reactive, nose is distinguished and loved
Cardio: borderline tachycardia, normal rhythm, no murmurs
Pulmonary: clear with intentional prolonged expiratory phase
Abdomen: soft, non-tender
Skin: going through a rough patch
Neuro: awake, orientation to the adult world pending
Psych: affect appropriate to situation

Assessment:

In summary, this is a 30-year-old female, with a remote history of head injury, who endeavors to be equal parts her mother and father, who is status-post The Match nearly one year.

She reflects on her active issues below:

On being an intern:

“Intern year is hard, no matter what anyone says. Beyond the physical exhaustion of the long hours, it is just downright emotionally painful at times. A few days ago, I told a young woman that her young husband was brain dead. A few weeks ago, I watched the color drain from a man’s body as he bled to death. A few months ago, I took care of a unvaccinated homeless boy who was hospitalized for pneumonia. Nearly a year ago now, I sat with a young veteran who told me about the horrors of his tour in Afghanistan. The list goes on and on. I often wonder, is medicine always this emotionally charged? Am I just too sensitive? Why is there so much suffering in the world?

Intern year is also difficult because it often feels isolating. It is difficult to come clean about how you really feel when anyone asks you, “How are you?” because being honest takes effort and leaves you at risk, leaves you vulnerable. Even in my residency program where I am surrounded by colleagues who are extremely caring, I find it difficult to speak openly on the topic.

This isn’t to say that I haven’t had amazing and happy experiences. A few days ago, I placed two central lines back to back emergently like a boss. A few weeks ago I received a letter from a patient thanking me for reminding her that not all is lost. A few months ago, on my thirtieth birthday, I delivered three babies, one of whom sprayed me straight in the chest with amniotic fluid as he came into this world. And nearly a year ago, I met my first patient, to whom for the first time in my life, I said, ‘Yo soy su doctora.’”    

Plan:

Get (or stay) involved in a social cause:

It will keep you energized and will give you something to fight for when intern year leaves you wondering why you went to medical school in the first place. Your voice matters. Find a way into the conversation.

Reach out:

When you are feeling sad, tell someone. The traditional culture of medical training is to show no weakness. Sadness is not weakness. Sadness is essential to navigating the human experience.

Make time:

Make time to send those greeting cards, mail those presents, and thank those who helped you along the way. Tell your family and friends you love them.  

Celebrate, acknowledge, and practice:

Celebrate your strengths. Acknowledge the gaps in your training. Show up to practice every single day.

Enjoy intern year:

Every minute you spent doubting that this is exactly what you wanted to do with your life, remember this: You studied hard for this. You fought for this. You sacrificed for this. You earned this. Show up. Work hard. Take care of yourself. Enjoy being exactly who you are in this moment. You are an intern.

Image credit: Stethoscope by Rosmarie Voegtli licensed under CC BY 2.0.