With the end of intern year less than three months away, my classmates and I are becoming restless. But most of us are apprehensive about becoming junior residents, and some are utterly terrified. One thing’s for sure, though: no one wants to be an intern forever.
“What I need is a year of vacation,” one member of my class said at happy hour last week.
The idea was so tantalizing that I couldn’t help but indulge for a moment. I’d have countless hours in which to accomplish … absolutely nothing. Thankless tasks like dictating discharge summaries and rewriting expired orders would become vague memories. I would watch as much TV as I wanted. Not that I actually like TV that much, but on principle, I’d watch it anyway. I could throw my pager into the Charles River while kayaking on a sunny day, and it wouldn’t make a bit of difference.
Yes, ’tis the season for burnout. I thought the intern class was the only one suffering until one of my attendings acknowledged that everyone is tired by April, no matter what their station in the food chain. Interns, residents, and fellows alike are a little more curt. Our medical students might not get as much attention as they did in July. And, as much as I hate to say it, we probably spend less time talking with our patients because we’re all hoping for some extra sleep.
“Why do I feel this way?” I’ve asked myself a few times. There’s a simple reason: I need a break. And this week, my wish will be fulfilled—I’m heading to the Caribbean for six blissful days. I’ll come back with a hint of sunburn and enough stamina to finish the year.
Yet, I’m not entirely satisfied with this diagnosis of my condition. (After all, I overanalyze everything). I know that I’ll feel refreshed after some time off, but I’ve been bothered by the thought that I don’t always love my job.
Undeniably, every day has its rewards. Completing a bedside procedure successfully is a small triumph. I feel gratified when I can reassure a patient or family member that things are improving. But amid the sheer volume of work we have to do, it’s easy to lose sight of these moments. For instance, I spend a great deal of my time adjusting medication orders—titrating insulin doses to optimize blood sugar control, retooling blood pressure regimens to provide maximal benefit with the fewest possible agents, changing antibiotics based on culture data. I have to explain many of these changes to the nurses, and when they feel that the changes aren’t practical, it’s back to the drawing board. I’ve become intimately familiar with the unpleasant but nondangerous side effects of various drugs, and I’ve learned how to counter them.
Then I read the attending notes, and they say things like, “treat infection” or “plan as per housestaff note.” If only I could get away with writing a two-sentence note, I think. It’s as if the plan were so obvious that anybody should be able to figure it out.
But if the best approach is obvious to me, it’s only because I’ve spent the whole year learning how to deal with these situations. Sometime in the winter, I had a patient who needed his insulin regimen adjusted, and I actually called my senior resident for help. It’s embarrassing to think that I couldn’t figure it out on my own—it was a straightforward case, and now, the task would be rote. Inpatient diabetes care is no longer a black box to me.
To put it differently, inpatient diabetes care is no longer as excitingly mysterious as it once was. This is good news for my patients, and I’m happy that I feel more confident. On the other hand, I’m starting to crave new knowledge. I want to reread the seminal papers that shape the management of diabetes in the acutely ill, and I want to apply the nuances to my cases. I want to move beyond “this is what we do” to “this is why we do what we do.” And overall, I want there to be less doing and more thinking.
Call it growing pains, spring fever, whatever—it’s time for a change. I’ve enjoyed the ride, but I think the real adventure lies ahead.
Just let me catch my breath first.
Nicole Martin, HMS ’06, is an intern in internal medicine at Massachusetts General Hospital
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
