My first act as a physician was pronouncing a patient dead

I was so scared. It was the first day of intern year. I was starting on nights, and I hadn’t been able to sleep the evening before. My significant other took a picture that morning even though I asked him not to because I felt like a wreck.

He looked at me and said, “You are going to be Dr. Richards today. You will want to remember this forever.” He was right.

After arriving for that first shift, I haphazardly walked in circles, trying to find the MICU. Two emergency medicine residents gave sign-out first. They seemed so proficient—in, what, one day?–and I felt so incompetent. Turns out, they were second year EM residents, soon to be third years. Nonetheless, I felt inadequate and the night hadn’t even started.

‘Please, don’t die tonight’

During sign-out, the residents noted that one patient had been made comfort measures only earlier that afternoon. They anticipated the patient wouldn’t make it through the night. I remember thinking, “Please, don’t die tonight. Just let me get through this first night.”

About an hour later, a nurse came and got me. The patient had passed. I had reviewed how to formally pronounce a patient, so I went in to do it. The family thanked me for making the patient as comfortable as possible the last few hours.

Deep inside, I was thinking, “Dear Lord, this is the first physical exam I am doing as a doctor and it is to pronounce a patient.” I wanted to break down. I asked the charge nurse for the death certificate and paperwork. She looked at me, said “go ahead,” and I cried.

I stayed up all night and felt like I didn’t have time to blink. After sign-out, I biked home. It took 15 minutes but it felt like an eternity.

The importance of self-care

A brief aside on personal health: In the throes of intense focus on others’ physical and mental well-being, It can be easy to lose track of your own. It is critically important to make time for exercise and meditative thought during residency. I found that biking to and from work provided ample opportunity to partially satisfy both of these needs.

After a week of night float, I thought it would get better. But it didn’t.

I remember admitting a patient with an increased oxygen requirement, which meant she had to come to the MICU because she couldn’t stay on the floors. She was not septic and did not have a complex medical history other than breast cancer.

As the day progressed, she required more and more oxygen. I asked if there was anyone I could call for her. She said her husband was with her children, but he would be in later.

The more we talked, the more it became very clear she wanted everything done. In her words, she knew she was dying and when the time came, she wanted her children to know she did everything she could to stay alive and that the disease chose otherwise.

One morning when I went to preround, she was creating a book of pictures, descriptions, and memories for her children. I sat with her for 30 minutes working on a caption until it was just right. I left her room, closed her door, and completely lost it.

With a box of tissues in hand, I went into the stairwell. It became my place to go when it all became too much.

Noncompliance

A few months later, I was on medicine floors when I admitted a patient with endocarditis. The patient was an IV drug user who last used hours before being admitted. It was a struggle. Every. Day.

He would tell me daily that I wasn’t controlling his pain and would threaten to leave against medical advice. Everyday I would convince him to stay another day for antibiotics. It was a vicious, exhausting cycle. The amount of time I was putting in to keep him in the hospital was absurd.

In the end, he left in the middle of the night. I knew that he would have left no matter what intern was following him, but somehow I couldn’t shake the feeling that this was my fault.

My attending pulled me aside and said, “I’m surprised he stayed this long. You did everything you could.” In the end, it was his prerogative to choose. That was my takeaway from this situation.

All of this seemed rough. Then came my second round of night float.

Night float as an intern is hard. You’re covering a ton of patients you don’t know much about for six nights in a row for two weeks. Despite sleeping regularly and eating well, by the end of the second week, I felt terrible. It was like the day after running a marathon, with exhaustion that continued on for days. Night float almost broke me.

‘It never always gets worse’

Residency is like that – when you think it’s too much to handle, it pushes you even further, and when you feel like you are about to break, it doesn’t ease up. But you are surrounded by people who care about you and are helping you develop into a physician. And eventually, things will get better.

A seasoned distance runner once said of the struggle, “It never always gets worse.” Remember that.

Intern year taught me so much– strength and patience, love and courage, dedication and will, perseverance and compassion.

Residency is challenging. You will have low lows and high highs. But always keep in mind that being a physician is a privilege. Patients and families confide in you, and you have the opportunity to help them in a way no one else can. And that is beautiful.

Related reading:

First year of residency: 5 things to expect as an intern

Advice for incoming residents: 8 tips on professionalism, work-life balance, and more