Moving On

I received the page: “Your patient is short of breath with a heart rate in the 120’s. Please come.”  At this point in internship, I am able to distinguish benign pages from those that set off warning bells.  This one sent me running down the hall. The patient was an 80 year-old woman being cared for by my medical student.  As house officers, part of our job is to supervise students, while we are in training ourselves.  I told her to come join me, and decided to grab my resident on the way. 

“What are her vitals?” I asked, taking a look at the patient.  She was becoming increasingly short of breath.  I laid my stethoscope on her chest.  Her heart was in an irregular rhythm, and her breathing was labored. Her neck muscles stood out against her gaunt frame, as she struggled to breath. This was my moment to shine. When the resident joined our team, he told me he would let me run most of the show since I was a few months shy of taking his place. It was time to prove myself. I would show the medical student how to manage a patient in rapid atrial fibrillation, and reassure both the resident and myself I was capable of it.

I asked for the EKG and confirmed that she was in atrial fibrillation.  “So what do you want to do?” my resident asked.  The medical student hovered by, waiting for my word. The nurse asked which medication to give. I looked down at the patient. She was clearly tiring, and becoming increasingly disoriented. I took a deep breath. Right, so here we go. 

In medicine we live on the edge of our expertise. As soon as we are comfortable in our position, it is time to move on. For the past few weeks, I have been feeling an increasing mix of emotions about finishing my internship. Almost daily, my attendings ask: “Are you excited to be a resident?” My response is always the same, “I am ready to finish internship.”  There is a notable absence of input about my moving forward. I am both excited and full of dread. “Am I ready?” I ask myself.

I think back to my third year of medical school. I remember walking in the door of the hospital in San Francisco to start my first rotation, Obstetrics and Gynecology. I thought to myself: "Now everything rests on my shoulders, and I am responsible for all these patients." Only later did I realize how many layers of supervision sat above me. I suppose I am overestimating the solo nature of my role as a resident with the same mix of fear and naivete. Medicine is, after all, a team endeavor. But, I will still need to be the one who knows the answers much of the time, and this fills me with great fear. I have started to look at my residents in a new light, and wonder whether I will ever know as much as they do.  

In the end, however, I will need to move on. We are one week away from the match, where the names of the new interns will be unveiled. My replacement has already been hand picked, and my fate is sealed. Come July 1st, there will be someone ready to step into my intern shoes and assume the responsibilities that I have undertaken for the past year. It will be my job to help teach and guide, while learning my new role as the resident.

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