The twilight of spring brings graduation season, our ritual of milestone celebration towards a still to be defined professional and life goal. I distinctly recall the evaporation of this vagueness for my medical school graduation. It felt more concrete, more substantial in its singularity than the accumulated individual graduations preceding, and necessarily prerequisite. However, possessing an MD and being a doctor are not one in the same. Fortunately for physicians, we have a highly regimented and ostensibly replicable apprenticeship program in our various disciplines, across the country. The graduated responsibility granted during the process of learning embedded in working is quintessential to our professional maturation. As the current iteration of graduates begins their intern year (you!), they’ll undoubtedly receive sage advice from august physicians, which will undoubtedly be drowned in the incessancy of pager beeps during the first overnight call.
And that’s okay! I know for a fact I received excellent guidance on managing the rigors of residency while sorting through the disorienting process of identifying career path. I also know for a fact that while I heeded some, I regretfully forgot most. However, what is now keenly manifest with lens of hindsight, is that that this advice only buttressed lessons learned only through invaluable experience. The camaraderie of your instant colleagues and friends, witnessed and experienced emotions across the human condition, the asymptote like learning curve, and the gradual sense of craft via implementation of painstakingly acquired knowledge, often under duress, is without substitute. As I reflect on my intern year and residency, I can say I thoroughly enjoyed it and suspect at the end of my career I’ll view it as one my favorite professional experiences. Admittedly, there is no better assuager of the difficulty, sleep deprivation, and loneliness experienced during residency than time away from residency. Moreover, my views are shaped by the luxury of being single and without children at that time, whereas some of my colleagues had to balance considerable family responsibilities as well. Even with these concessions, I still loved my training and I suspect you will as well.
So what did I learn during my intern year and training in general that is transferable? I struggle with this, because my most impactful personal lessons allayed my most irrepressible personal flaws. As such, what was necessary for me may not be applicable to the current generation of physicians are who are hopefully more evolved and, well, woke. I was incorrigibly arrogant, impetuous in wanting to be heard rather than hearing others, and guilty of ingrained preconceptions resulting in uninformed assumptions on staff, nurses, patients, and colleagues in other disciplines. To be fair, these are seemingly axiomatic to physicians, facilitating rapid self-acceptance, particularly during the inevitable periods of self-pity invoked by 80 plus hour weeks, nights and weekends spent in a drab, cold call room. To paraphrase Yoda, it took years to unlearn what I had learned.
Through public and private humiliations, thousands of patient interactions, a gently critical wife, and identification of my personal role models, I arrived at the two skills which have helped me the most professionally and personally: patience and a genuine ability and interest in listening to others. These may seem trite, and superficially simplistic, but I’ve found to be incredibly challenging but most rewarding when to implemented into practice. I recognized within the first few months of internship that if I were to achieve any degree of professional satisfaction, it would be a career built upon these pillars.
Patience is multifaceted, silently contorting to be of utility in nearly all situations. You will rarely get credit when you exercise it, but it’s absence will palpably disheartening to those in your charge. I was praised for my patience growing up, but that was an untested version. The residency workload is intense and compounded by your still maturing clinical acumen. As a consequence, I found myself impatient with patients when they were elaborating on their histories in a manner I found tangential, or when it didn’t align with my assumed diagnosis; with nursing staff or techs when I had comically naive expectation of instantaneous execution of my orders rained down from the Mt. Olympus of call room computers; out of myself for not knowing as much as a 3rd year resident or a board certified attending with two decades of experience. I was impatient with my status of my life compared to my non physician peers, my paycheck, and the seemingly interminable training. Residency goes at light speed, but the end of it always seems to be on the opposite end of the universe.
This crystallized rather quickly in my second month of training, on the afternoon end of a particularly brutal 30-hour ICU call. My patient, a new paraplegic from a motor vehicle accident and suffering through the relentless medical complications thereof with astounding positivity, kindly asked me to be less curt with his wife when she was asking questions about his progress. I was crushed, but it still took a while to morph a self-absorbed notion of personal failure into a tangible lesson.
I suppose this episode straddles the nebulous boundary between patience and listening, and perhaps they’re poles of the same thing. Too often though I found myself speaking (and interrupting) first, thinking second, and breezily listening third; perhaps it was a misplaced attempt to broadcast my sense of my own intelligence. Perhaps I felt that only after certain conditions were met, would someone merit my undivided attention. With time a few things stood out: There are many, many people far smarter than me. If they’re not smarter than me they’re more experienced than me, which inexorably makes them smarter than me. Perhaps most importantly, I recognized the large swaths of knowledge, insight, skilled judgment I was leaving by the wayside. When I didn’t focus on the person in front of me, I undervalued them and my own education
So patience and listening. If it seems anticlimactic, it’s because it is. The grander themes on the role of medicine and the human condition have been more eloquently elaborated upon by many talented physician writers. They are worthy reads and will supplement your own experience as you sculpt your career into what you want. There are other pieces on self-preservation and combating the loneliness that can seem enveloping, also worth your time. My general advice is purposefully vague, but hopefully holds small value in recollection during trying patient and professional encounters. They are hard skills to master and implement, particularly when time seems perpetually unavailable and the work demands are ever increasing. However you will get better at your craft, your acumen and decision making will speed up exponentially, and all of a sudden you will have more time even in small ten minute encounters to experience why you went into medicine in the first place. Residency, and internship in particular, is hard; but I loved it and hope you have as rewarding of an experience as I did.
Mitul Gandhi M.D. is Board-Certified in Medical Oncology, Hematology, and Internal Medicine and works at Virginia Cancer Specialists
