Next Generation is a Brigham Clinical & Research News 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 Charlotte Story, MD, a resident in Internal Medicine.
July has arrived, and with it, comes the next class of newly graduated doctors. A year ago, I was in their shoes, equal parts excited and terrified, and counting down the days until, pager in hand and badge clipped to my coat, I would walk into the Tower at Brigham and Women’s Hospital.
I’ve emerged a year later with extra crow’s feet and bags under my eyes, and with lessons to share for the incredible doctors that are getting ready to start the most memorable and transformative year of their training.
Ask for Help Early
Ask the nurses for help. Ask your residents for help. When you’re nervous about a decision, speak up. Being a good intern isn’t about knowing the most esoterica. It’s more valuable to recognize when having more support is best — for you, for your team, for the nurses, and, ultimately, for the patient. Even in scenarios that are less well-defined, check in with those around you. I have definitely asked my resident to look at patient because, “I am not really sure how to describe it… she just seems sicker.”
Learn the Lingo
Like every hospital, there are certain phrases that are unique to the Brigham. Learning them and using them will help you begin to feel like you are part of the Brigham family.
- The Brigham: instead of Brigham and Women’s, you’ll notice insiders just say “The Brigham” to refer to our institution.
- LENI: Lower extremity ultrasound. Pronounced “Lennie.”
- Upper LENI: upper extremity ultrasound. Pronounced “Upper Lennie.”
- RUQUS: Right upper quadrant ultrasound. Pronounced “ruckus.”
- The Phys: a supervising Internal Medicine resident who mysteriously appears during medical emergencies to whisper advice and support into your ear. Possesses a magical ability to facilitate transfers to the Intensive Care Units. Pronounced “the Fizz.”
- Brigham Cocktail: the combination of ice, ginger ale, and cranberry juice that can be found at every nurse’s station. Delightful.
- Cardiac MRI: a screening test for chest pain.
Not everything needs to happen right now.
As an early intern, I felt an urgency to immediately complete the ever-mounting stack of to-dos. Pages from “Your patient has a weird toenail” to “BP 74/41 please assess,” 7 progress notes, 2 discharge summaries, melatonin requests, STAT diet order demands, records that the attending wants yesterday, and wait…. Another page about a nosebleed that just won’t quite stop its slow, stubborn ooze.
This inundation can be truly overwhelming. Focus on the most important tasks first and don’t stress about low priority items until the high priority ones are wrapped. No diet order is really STAT when you’re working on an unstable patient. Let yourself focus on the most important and time-sensitive task first (your hypotensive patient) before moving on to the next task. Over time you’ll get better at multitasking, but learning to triage will help manage stress in the meantime.
Name that thing that gives your heart peace and keep doing it. I’ve never been a hardcore runner, but getting out on the Esplanade for any period of time lifts my mood, my energy, and my kindness. For you, that source of humanity may be reading, gaming, day trading, biking, talking in weird voices to your dog, I don’t care. Figure out what it is, carve out protected time, and commit to engaging in that activity every week. I am running more at the end of intern year than when I started, and I am so much happier for it.
Take care of your co-workers as well as your patients. First- and second-hand trauma from working in healthcare is real. Sleep deprivation is hard. The responsibility is heavy. So, stop and tell the new nurse he did a good job recognizing early signs of a deep vein thromboembolism. Thank the attending whose rounding efficiency helped you get to noon conference. Tell your resident that you really admire it when she takes over the phone to redirect a crabby consultant. One night in the Medical Intensive Care Unit when I was too tired to remember my own name, a nurse came by and told me I was doing a good job, and that meant more to me than any formal feedback session.
Tell Others When You’re Struggling
Vulnerability. Let’s say it again for the people in the back.
Tell people around you when you’re having a hard time and need extra support. There was a day last year when the Cardiac ICU was so hectic, I couldn’t leave for a ten-minute trip downstairs to collect my takeout from Giggling Rice. Rachel, a nurse who barely knew me, came to my rescue before I could go hungry. She left the unit for me- and for that I will remember her forever. On general medicine, when I was overwhelmed with admissions, my co-interns took work off my plate so I could go home at a reasonable time. A medical school classmate turned urologist once walked me through paraphimosis reduction over the phone at 11 p.m.
This is all to say: don’t do it alone. There’s no reason to. Those around you, your friends, your coworkers, and your Brigham family, will be there to support you through this incredible year. There are going to be tough moments, but with your friends at your back, you’ll learn more and you’ll provide better care than you can alone.