On the last day of intern year, ready to take the next step

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When you are a week out from finishing your intern year, you start to feel pretty confident. When you are a week out from finishing your intern year, and you spent the last four months of it on a COVID floor in a major New York City hospital, you start to feel particularly confident. Whether you’re about to become a senior resident, with interns of your own, or about to start your categorical program after a prelim year like me, you’ve achieved a lot this year. You survived a grueling year of waking up early, pre-rounding, seeing your patients, getting grilled on rounds, and cranking out notes until there’s no tomorrow. You rolled with the changes and kept calm in the chaos when COVID first erupted, and all the procedures had to change. On the first day of the intern year, you arrived worried, even afraid that you would not know what to do. The patient is hyperkalemic, do you give K-Dur or Kayexalte? Both of them have a K, right? Now those decisions are second nature. Now, you’re ready.

At least that’s what I thought until last night. While on the night shift, we had a patient who was awaiting a small procedure the following morning and had been stable for several days. Around 3 a.m. the patient called me into the room because she “just wasn’t feeling right.”  After a thorough assessment, physical exam, EKG, labs, and another exam, I figured that it was anxiety, so I was standing with her, holding her hand, and reassuring her. Then, around 3:15 a.m., everything changed. She became bradycardic and unresponsive. The nurse who was with me turned to me and said, “Doctor, what should we do?” I froze. My first thought, “Where’s my senior?” The nurse snapped me out of it by asking if there was a pulse. I felt a faint, but present pulse and we called a rapid response. Things quickly escalated from there, and my responses were more fluid and practiced, but I distinctly remember breathing a deep sigh of relief when my senior arrived. By 4 a.m., she had coded, twice, and ultimately passed.

Besides the grief of losing a patient, one feeling stood out to me: disappointment. “After all these months and all this practice,” I kept thinking to myself, “I’m not ready.” I froze when a patient needed me the most. One of the fellows noticed I was standing off to the side and asked what was wrong. I explained what was going through my mind, and he told me what I least expected, “You are ready. I still freeze for a moment when something goes wrong, and you’re still just an intern. You will continue to get better with these scenarios, and moving forward, you will always remember this moment to remind you what needs to be done.” I still felt disappointed, but his words certainly helped and reminded me of something — If we were expected to be ready after one year, then residency wouldn’t be multiple years. There is still plenty of learning and growing to do.

So, to those of you who are wrapping up the year and feeling worried, feeling confident, or feeling anything in between, remember that we might not be “ready” yet, but we are ready to take the next step.

Shane Stone is a resident physician.

Image credit: Shutterstock.com

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