Hi Everyone,
I began internship in the summer of 1988, on an oncology unit without residents. If I paged a resident, they’d come, but they were floors away and my paging threshold was high. Like most interns, I trusted the system. I learned from nurses and looked things up. If nurses wanted orders, I obliged. If I had questions, I scoured my Washington Manual.
I learned two lessons that July. First, you can’t give too much potassium to patients on ampho. Second, if you tell a resident that your patient has “tombstones” on their EKG, they’ll come immediately, and teach you how to recognize a left bundle branch block.
My second rotation was in the VA MICU, where one of my patients had a massive GI bleed. It didn’t occur to me to call the resident for help, let alone the attending. Instead, I called my brother Myron, a pediatrician in Buffalo. My co-interns and I believed we “owned” our patients, and that we were ultimately responsible for their lives. Back then, common wisdom held that you should try to avoid hospitalization in July, when the new interns started. Which was good advice.
In 2024, July is as safe a month as any to be hospitalized, maybe safer. We monitor our interns like hawks. They have potential, but they’re not ready to fly. Not yet.
We believe in graduated autonomy. At the start of internship, residents teach non-stop: how to place orders, how to stay organized, how to call consults, how to give sign out, and how to perform basic procedures. Our seniors are the best teachers I know.
So, what do we expect from the interns on Day 1? We expect them to show up, ready to learn. We expect them to ask questions and get used to saying “I don’t know.” We expect them to respond when nurses call and to console patients who need reassurance. Finally, we expect interns to embrace the most important lessons- that medicine is hard, the work humbling, and the rewards incomparable.
Summer passes quickly, and before we know it, the interns will soar. But this Friday, on the first day of internship, we’ll be standing beside them, as we begin another year of profound professional and personal growth.
Happy Father’s Day, everyone. Heide and the girls are taking me to the 23rd Annual Egg Rolls, Egg Creams, and Empanadas Street Festival today in New York City. My triennial is done and I officially return to work tomorrow.
Yours,
Mark
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