New York City provides residency training like no other


As a fourth-year anesthesiology resident, I opened up my email eagerly, awaiting the results of the pain fellowship match. It was official; I was heading to a major academic program in New York City. First came excitement and relief immediately followed by a rush of all-encompassing fear. I had grown up in Arizona my entire life, and the idea of living and training in New York City was daunting, to say the least. Would I be able to thrive in a city of nine million hardnosed people? Would I figure out how the subways work? Am I going to be able to pay for this shoebox-sized apartment in Manhattan? For the time being, it didn’t matter. I decided to celebrate that night and worry about the move to New York City in a few months.

June came and went, and soon I was on a one-way flight to New York City’s JFK airport to start my fellowship training. Our furniture arrived a month late, so my wife and I lived in a hotel on the Upper East Side and made it work with some heavy use of the seamless app. The weeks were busy and hectic. There is simply no handholding in the New York medical training culture. Trainees stay until the work is done, no task is too menial, and ancillary staff is spread thin among the numerous academic medical centers. On rotations as a pain fellow, this meant your responsibility was to check the patient in from the holding area, set up the procedure suite and draw up medications, consent the patient for a procedure, bring the patient into the procedure suite and prep/position them, and then call in the attending once you were ready to start taking X-rays. The pace was much different than the West Coast, but the heightened responsibility led me to become involved in every single aspect of the patient’s clinical experience and prioritize efficiency. In a day, there can be no wasted steps or redundant movements if the clinic needs to finish on time. On top of this, I studied for the anesthesiology board exam. As a resident/fellow, the hospital relies on you to move the clinical work along, and you rely on your attendings to teach you how to best get this done.

On the weekends off, I felt just as motivated to explore New York City as I did to learn medicine during the week. The sheer number of things to do and see are overwhelming — especially when you have a finite stint in NYC for professional training. As I tried to get a grip on Manhattan, my mentors and colleagues at work drove me to venture to other boroughs like Queens and Brooklyn to grasp the full picture of New York. We pushed ourselves just as hard socially, making it to Saturday brunches, authentic Italian meals in Greenwich Village, nights on MacDougal Street at comedy cellar, summer rooftops watching the sunset, bike rides on the West Side Highway, and trying to see a few world-renowned Broadway plays, including Hamilton. Each museum in the city would take years to explore, and every time I wandered into Central Park, I walked through an area I had never seen the previous five times. When friends came to visit, we pretended to be locals and “show” them around like we knew what was up. Even in a city of so many people, my favorite weekends in New York were spent in the company of my best friends and family from Arizona, hauling it all over town to not skip a beat.

Twelve months came and went, and we had a decision to make, one that confronts people every year who don’t have set roots in the area. Should we stay longer, or was it time to leave the Big Apple and maybe go somewhere practical with affordable space?  My wife and I both felt as though we weren’t ready to pack it up just yet, so that led to me taking my first attending job in the Bronx. The first year out added stress beyond fellowship because now the buck starts and stops with you. I read more, cared more, and did more in my first year out of training than any of the preceding years where I always had a safety net. This sometimes meant showing up to work much earlier than expected to ensure that patients had preop lab draws, blood products available, and were medically optimized before going in for surgery. The financial boost from training to attending life did allow us to enjoy New York City even further by going on weekend road trips to Vermont and Maine and splurging on omakase and sake when the occasion called for it.

About two and a half years into the New York stint, we could no longer fight the itch to return home to the west coast, closer to our established social network. As we were getting ready to enjoy our last six months in New York, coronavirus happened. The experience I have had in the Bronx managing COVID patients has been nothing short of all-consuming. Three years after graduation from residency and having completed a pain fellowship, our department needed us to back up the intensive care unit, and I had to utilize concepts from intern year rotations. Before moving to Manhattan, I heard stories about the resilience, teamwork, and compassion exemplified by New Yorkers in times of difficulty. I witnessed these qualities first hand with my neighbors in midtown and healthcare colleagues managing the front lines. It is one of the hardest times possible to be in New York, and for as many times as I debated bailing, I felt compelled to stay and help.

As we wind down on our time in New York City, I never imagined opening that email three and a half years ago would have led me to this point. Don’t get me wrong; New York is a tough, gritty place to train. You have to be ready to push yourself harder and embrace scutwork to some degree. In the end, I am definitely a more complete doctor because I ended up here. Despite the hardships, I wouldn’t hesitate to do at least a portion of internship, residency, or fellowship training in New York or the northeast area. It was one heck of a ride. I will miss you, New York.

Sarang S. Koushik is an anesthesiologist.

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