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 Amin Aalipour, MD, PhD, a resident-physician in Internal Medicine.
It’s hard to believe that a year ago, I was reading this Clinical & Research News column in search of inspiration and reassurance as I nervously started intern year. A San Diego native who had never lived outside of California, I was a medical student who hadn’t properly seen a patient since February—a fledgling doctor who was to start residency caring for the sickest patients in the intensive care unit (ICU). No words will fully quell the anxious excitement of a new intern, and no amount of sage advice can fully prepare you for the intellectual and emotional whirlwind that lies ahead. In those early moments of uncertainty, I found some clarity in The Conference of the Birds, a poem about the Simurgh, a mythical bird in Persian mythology. I hope you find the same.
As the story goes, the birds of the world gather to determine who shall be their leader, and they decide upon the Simurgh, a virtuous bird thought to possess the knowledge of all ages. To reach the Simurgh, the birds must pass through seven Valleys: Quest, Love, Knowledge, Independence, Unity, Wonder and Deprivation. In the Valley of Quest, they pass hundreds of trials; in Love and Knowledge they learn the limits of pure reason; in Independence and Unity they learn the interconnectedness of self and universe; and in Wonder and Deprivation they stand in awe of the divine and lose any notion of self.
Only 30 birds make it through the final Valley, and upon arrival all they see is each other and their own reflections in a lake. You see, in Farsi, Simurgh translates to 30 (si) birds (murgh). The legendary Simurgh was simply the birds reaching a more perfect version of themselves.
Intern year, too, has Valleys of its own. You learn to practice with both heart and mind, to seek knowledge and have the humility of knowing the limits of the medicines we offer, to build individual endurance and confidence while also working as a team and lifting your peers. But just as the Simurgh resided in the birds themselves, so too is that potential already within each of you. As you start this process of self-realization, here are a few tips that helped me make the most of the year.
Learn From Every Patient
How do you learn what can appear to be an infinite amount of medicine from a finite number of patients in residency? Maximize learning from each patient by thinking deeply, even beyond the presenting complaint. Early in intern year, I would think through a differential and an approach to every abnormal symptom, lab value, or imaging finding, regardless of its relevance to the presenting complaint. Of course, removing fluid is key in a hypertensive patient presenting with decompensated heart failure, but giving thought to their anemia or taking a moment to review the causes for secondary hypertension will help reinforce your mental frameworks and multiply your fund of knowledge. The eyes do not see what the mind does not know.
The 110% Rule
A senior resident once told me that medicine only works if everyone gives 110%. Giving 110% means picking up your co-interns’ shifts so they can make that family wedding, staying a little later to write a helpful admission note for the day team, and stopping by on your way home to see that patient who you sensed still had questions after rounds. There will be days where even giving 100% will be hard, and you can and should prioritize your well-being and time outside the hospital. But I often remind myself that the people we take care of have trusted their well-being in a stranger’s hands. I hope we can all reward that trust.
Health care delivery revolves around effective communication. As the intern, you are the hub of all information between a patient, their families, nurses and consultants. Communication is also key among your peers, both within your team and during transitions of care. Make effective communication a learning goal and ask for feedback. When in doubt, always pick up the phone to loop in nurses and families.
Practice with Purpose
Amidst a year of pages (the most I fielded was 67 in a 9-hour span), paperwork and phone calls, it can sometimes feel like intern year is happening to you rather than by you. In those moments especially, I found it helpful to build time for active reflection on the “why” behind the daily mechanics of being an intern. The reasons and how you choose to reflect on them are highly personal, but taking the time to define them will allow you to train with intention and purpose. Your personal statement for residency is a good place to start.
It’s an honor to welcome you all to the Brigham, a place that will help transform you into the doctor and person you wish to be. What a blessing to train amongst brilliant clinical minds and in a culture of kindness, humility, and comradery—a philosophy built top-down by visionaries like Joel Katz and Marshall Wolf before him, and sustained by all of you. It is, after all, your decision to train here that gives the Brigham its magic. I can’t wait to see you all on the wards. Your Simurgh awaits.