Next Generation is a Brigham Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email us. This month’s column is written by Tracy Makuvire, MD, of the Internal Medicine Residency Program.

Tracy Makuvire

It was my first day on a twilight shift (starting at 4 p.m. and ending at 2 a.m.) for my Cardiology rotation. I was cross-covering up to 16 patients at one time. It was early on in my intern year rotations and I was energized and excited.

The pages from my colleagues were coming in — questions about repletion of electrolytes, details about dosing diuretics and updates on the progress of patients.

“I can do this,” I told myself.

And then I received the page:

“A RAPID RESPONSE HAS BEEN CALLED TO YOUR PATIENT IN ROOM X. PLEASE COME ASSESS.” 7:31 p.m.

The adrenaline immediately set in. With my heart pounding, I quickly grabbed my list of patients to briefly read pertinent information for this patient. He was a male in his 60s who had advanced heart failure and was awaiting a transplant.

I called my senior resident as I ran to my patient’s room. With my slightly oversized white coat trailing behind me and my stethoscope hanging asymmetrically around my neck, I dashed to my patient’s room. My senior resident, who was seeing a new admission, was in the Emergency Department. He would meet me shortly.

“Thank God, the doctor has arrived,” I overhead someone saying.

“Check your own pulse,” I remember thinking as I tried to remain calm while I put on my contact precaution gown and gloves. I could see that my patient’s room was a bustle of activity with yellow gowns surrounding his bed.

I entered his room.

“I’m Dr. Makuvire,” I said. “Can someone please tell me what’s going on?”

“The patient is acutely hypotensive to the 60s,” someone quickly responded.

“Doctor, will I be OK?” Mr. X asked me as I leaned over to obtain a manual blood pressure. I used my stethoscope to listen, confirming that his systolic blood pressure was indeed low. With my senior resident at bedside, the fellow on call, and the nursing team, we quickly discussed a plan of action. I kneeled at his bedside to update Mr. X. He was scared. We appropriately triaged him to the Cardiac Care Unit (CCU) for escalated levels of care. He was my first patient to have a rapid response — I will always remember his concerns, priming my new doctor ears to not only listen to his heart sounds, but to listen to the patient and his care team.

This critical moment, and many to follow during my intern year, reminded me of why I chose to train at the Brigham. I was part of a beautiful fabric woven with teamwork, support, empathy and kindness towards our patients, as we work together to take care of their acute needs. As I near the end of my intern year, I would like to share with incoming interns the top three pearls that have shaped my training as a physician and continue to fuel my passion for medicine.

1. Never forget to listen
   From calling on colleagues for a consult, to performing procedures and discharging patients, your daily tasks may feel like a mountain you have to scale each day. While overwhelming at first, I found that the balance to this feat was at the bedside, talking to my patients and listening to their stories. I believe the most important task that you can perform and do well from the moment you arrive is to listen to your patients. As the intern on the team, make it a priority that your patients can identify you as their doctor — someone who can answer their concerns, update them on their health and talk to concerned family members. As the year progresses, the mountain of tasks will become easier to climb, even second nature. However, never forget to listen to your patient as the diagnosis, however complex, can sometimes be found in the minute details of his or her story.
2. Connect with the nurses
   Learn to connect well with your nurses and address their concerns for patients. I found that I could rely on many nurses at the turning points of my patients’ care, from asking questions about how to manage common conditions to when to worry about a patient. They are the best resource you have about how things and procedures work on each floor.
3. Never worry alone
   “Never worry alone,” is something that you will hear often from the beginning of your training at the Brigham. I did not understand it until I was on the ground, working daily to help our patients. You will find an incredible resource and team in your co-interns, residents, fellows, chief residents and your attending physicians. I often relied on my fellow interns and residents to discuss difficult cases, to obtain advice on challenging admissions and diagnoses, and they were always there for me when times were difficult. Your co-residents become your family. I learned so much from reaching out and always knowing that there is someone to rely on. Do not be afraid to reach out to any of us.

As I sit here with about two weeks of my intern year left, I think about the fact that while some things have changed (becoming comfortable with daily tasks, for example) the impact of my patients’ stories continues to build my passion for medicine. I am still enriched by the stories that bring my patients to the hospital, and, even more so, by the stories when they leave the Brigham to resume their lives. Listen to those stories and hold them close to your heart.

It is with joy and pride that I welcome you, the new doctors, to the experiences you will have this year, lessons that will last a lifetime and to the stories from patients that will forever shape your physician-hood.

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