What’s the biggest lesson of intern year?

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Even during medical school, there was always the running joke about getting kidney stones. With the frenetic pace of many rotations, it was always difficult to squeeze in bathroom time, and I suspect many of us adopted the same solution – drink less water. That is certainly how I survived my month on vascular surgery. After a nine-hour case, I was told by one of the residents that everyone was impressed that I had stayed scrubbed in, standing the entire time, and that I didn’t even need to leave for the bathroom. Even then, it seemed like an odd thing to be impressed by. There was a rumor floating around that one of the surgery residents had restricted water to the point of developing a kidney stone, but we all laughed, sure that was not going to become us.

Fast forward to my second month of residency. I was on an inpatient rotation, where there were so many patients (and consequently so much documentation) that it didn’t feel like there was enough time to go to the bathroom. We held it for hours, waiting for a good moment to slip away from the mountain of work, but that moment didn’t always come, so we stopped drinking water to prevent the eventual consequence.

Near the end of my first week on this rotation, I felt a sharp pain in my side associated with waves of intense nausea. I took some Motrin and Zofran and kept chugging away on rounds. Then the nausea/pain combo got worse, and I had to lean against the wall for support. When I told my team of my suspicion, they immediately told me to leave and go to the emergency room.

I was right. I had a kidney stone.

The fact that my diagnosis had been correct was a small consolation. After the stone had passed, I was discharged from the ED. After making sure that no one expected me to return to work that day, I trudged home and spent the rest of the day lying in bed, recovering. I was back at work the next morning.

Intern year is hard. There is an overwhelming volume of patients to take care of, endless documentation, and the perpetual fear that we might accidentally hurt a patient because of our cluelessness. We are all warned about these things.

But the part we don’t always remember, amongst the innumerable tasks on our to-do lists, is to take care of our own basic needs. We need to drink water, eat food, and go to the bathroom, just like any other human on this planet. And that’s something that is too often overlooked.

After leaving the ED, I did make one pit stop, which was to buy a massive 64-ounce water bottle to lug around with me. It’s heavy (so I can kid myself into believing I’m getting my arm workout done at the same time) and likes to clang at inconvenient times whenever it gets bumped. I don’t always finish the whole bottle, but progress is being made. As for increased need for bathroom breaks, well, nature calls. It’s not always convenient for me to duck out to the restroom, but it’s something that has to happen.

Why is it so accepted, almost expected, that we deny our basic needs in the name of patient care?

It’s easy to say that it’s the system. Too many patients, too many expectations. It’s the way it’s always been done, and nothing seems to be changing any time soon. And that’s probably true, but that also takes the solution out of our own hands.

During the three (and a half) days on the rotation prior to my kidney stone, I would have told you it was just not possible for me to find time to go to the bathroom. After the kidney stone, I had no choice but to drink water. Which led to its inevitable consequence, and it was okay. It was not great, because of course, I was still struggling with the massively steep learning curve and all, but it worked. The world stayed on its axis, and everything still got done.

I was still overwhelmed and confused and perilously close to a mental breakdown. But I was drinking water, and, slowly, I figured out what was going on with my patients and got better at handling the workflow. And I kept drinking water.

Some days are better than others. I’m still not drinking quite as much water as I should. But I’m getting there. Baby steps, right?

I am an intern who, still at times, has no clue what I’m doing. But I’m doing my best to take care of my patients, and I’m working to get better at taking care of myself too. Because, if I’m in the ED on a stretcher being pumped full of IV fluids and Zofran, it helps no one. So, that’s my biggest lesson of intern year: Put your own mask on before helping others.

Sara Walker is a family medicine resident. This article originally appeared in Family Medicine Vital Signs.

Image credit: Shutterstock.com

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