Compassion

I used to say, “Love your patients”.

But that’s open to misinterpretation. And it’s sometimes difficult, because some patients are downright nasty.

So instead, better advice is to be compassionate towards all patients.

Let’s turn to our favorite dictionary again for the meaning – “pity and concern for the sufferings or misfortunes of others.”

Surely we can feel that… even for the worst among our patients?

In the course of your medical career, you will treat all kinds of people. I’ve had convicted rapists, undertrial murderers, and long-time gangsters as patients.

To a doctor, everyone is the same.

My favorite professor, whose patient list included a literal ‘Who’s Who’ of famous celebrities, once made noted violinist Kunnakudi Vaidyanathan wait for almost an hour in his clinic, while he examined other patients who had arrived earlier.

Later, over tea, he explained. “In a doctor’s clinic, everyone is a patient first. And anything else only after that.”

In other words, a patient is a patient – regardless of who she might be as a person.

And so what your patient does, how famous or otherwise he is, how wealthy or influential or wicked… all of that doesn’t matter.

You should be able to feel compassion towards each one.

That is definitely NOT easy.

When you hear of the cruel and terrible things a patient has done, your first instinct may be to serve as an instrument of justice or retribution – and make the criminal suffer for those crimes.

As a medical doctor, that is not your role.

Your Hippocratic oath is to preserve and cherish life – not based on what kind of life it is, or whether you believe it is worthy of saving.

That is why compassion is so vital to a doctor.

When you can feel pity or concern for another, irrespective of their status in life or their activities during it, you can transcend them and focus on what you’re meant to do –

Treat disease, relieve pain, heal patients.

Leave justice to the judges.

Leave punishment to the policemen.

And play your role as a doctor, to your best ability.

Compassion is a powerful emotion.

Not a strong one like passion or rage… but a quieter one, like determination or faith.

It requires that you envision the whole of humanity as being somehow connected to you. Deserving your affection. Worthy of your concern and attention.

Adopt that mindset, and it will have a transformational impact on how you serve and act as a doctor.

Treating patients becomes more than simply a mechanical act of prescribing pills or performing procedures.

It becomes an act of love!

And then, you won’t feel tired or frustrated or exhausted by having to do it for long hours. At extreme personal discomfort. Or under suboptimal conditions.

Because what you do now becomes an expression of compassion for fellow human beings in pain and suffering.

Your every action as a doctor takes on a magical character. Becomes an act of worship or divine service. Is a fulfilment of your life’s purpose.

You stop counting the cost.

You don’t focus on the difficulties.

And you become obsessed with the joy and satisfaction that comes from doing whatever you can… to heal those who deserve your care.

So…

Open your heart. Feel compassion for your patients.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Empathy

As always, empathy comes highest on any list of desirable traits for doctors.

That’s because empathy for our patients lies at the very heart of our profession.

Without it, nothing makes as much sense.

With it, everything does!

A dictionary defines empathy as “the ability to understand and share the feelings of another”.

The unwary young intern might interpret this (incorrectly!) to mean that you should suffer and hurt along with your patient.

No.

That isn’t what empathy means.

Empathy is being able to appreciate the other’s feelings – without necessarily succumbing to them yourself.

That’s a tricky distinction.

Take, for example, a patient with advanced, infiltrating cancer. She’s in crippling, constant pain. Depressed and suffering, irritable and restless. All the time.

Your empathy for her does not require that you feel a similar pain.

It does mean, though, that you can IMAGINE how it is to be in her place – and then deal with her, while keeping that in mind.

So if she’s curt and rude with you, don’t get upset. Empathize with her condition.

If you see her always crying, moaning and complaining, don’t brush her away. Empathize with her situation.

And then, you will naturally be driven to do all that you can to help her.

Or your other patients.

It is the human state to want to reach out and help those we feel empathy for.

So developing empathy is the first step. The rest will follow naturally.

Once you can understand and share another’s feelings, you can take the necessary steps to help. Your actions in this direction will be guided by the right motives and purpose.

But there’s a fine line to be aware of – and not cross.

It is easy, in the name of empathy, to imagine that you and your patient are the same… with the same problems and circumstances, pain and suffering.

That will be counter-productive to your role as a doctor.

It’s okay to have that degree of intense empathy for a loved one – your family, friends or anyone else.

But if your empathy interferes with patient care, it will mess with your objectivity, judgment and professionalism.

That is highly undesirable.

Because it will prevent you from doing your best for your patient – as a doctor!

Empathy, like everything else, is good in moderation.

Cross the limit, though, and empathy can be really bad.

However, feelings aren’t always easy to manage or control.

There will be times, if you’re truly empathetic, when you’ll be overwhelmed by a patient’s suffering.

This is more likely if the patient is your favorite.

Or if you’ve been caring for him a long while.

Or when it’s somebody in a special group (like kids, or the mentally challenged, or folks with disabilities).

In these instances, you must paradoxically work hard – to prevent feeling too much empathy.

And shift instead to sympathy.

This lets you indulge your sense of sorrowing and hurting for somebody else… without impairing your own balance, judgment or confidence.

It’s a tricky shift that you’ll have to master – and make repeatedly, over the course of a long, productive medical career.

Remember Lord Tennyson’s “’tis better to have loved and lost than never to have loved at all”?

By and large, for an intern it is better to feel empathy than to never have any at all!

Because the lack of empathy removes most of your motivation to become a good doctor.

Just don’t let it overwhelm you.

Be empathic, within reason.


Have you read Dr.Sivasubramanian’s books on the making of a surgeon yet?

Read the other ‘Desirable Traits for Interns‘ here.

Dear Medical Intern…

Dear Medical Intern…

Congratulations!

You’ve finished a rigorous 5-year training process. Taken a tough exam. And stand ready to enter a new phase in your growth as a doctor.

I’ve been there – 30 years ago. And I’d like to share something with you.

To help you. To guide you. To reassure you.

And to convince you that what lies ahead is…

Your Most Important Year Of All!

In the immortal words of Mark Twain, “I didn’t have time to write you a short letter, so I wrote you a long one!”

Maybe you’re one of those who have attended my classes (in person, or lately, online) and learned about specific topics in medicine, surgery and pediatrics.

Here’s a perspective.

If these other lessons were 3 to 4 on a scale of 10, then this one is a…

10.5

Yes. That’s how much it matters.

In their book “The Fourth Turning“, William Strauss and Neil Howe talk briefly about roles of citizens in older cultures and ancient civilizations.

  • The first turning lasts until age 20. Children play – and also learn the dual arts of fighting and how to grow (or hunt for) food.
  • Between ages 20 and 40, a young man practices his craft – and provides for his family and people, while keeping them safe.
  • In the third turning, around age 40, he switches gears. Now grown slower and weaker, his role is to offer strategic advise – and guide younger members of the tribe to do their job better, more efficiently.
  • Finally, in the fourth turning, at age 60 and above, his role changes again – into one of sharing hard-earned wisdom and philosophy. Rather than telling his tribe how to fight better to win the war, he shows them it’s wiser to avoid war itself!

I’m now somewhere between the last two turnings.

So this will be a mix of both strategic advice and philosophical wisdom!

It reminds me of this man…

He’s my father, Dr.N.Sivarajan. A pioneer cardiologist, among the first 3 qualified heart specialists in Chennai, and the person who established a Department of Cardiology at Govt.Stanley Hospital.

Although he was widely acclaimed as a great teacher, over all my years of medical college there were fewer than a handful of occasions when he formally taught me something.

One of them was just as I started my medical internship. He sat me down to talk about what the year ahead meant. To me, as a person. To my career, as a doctor. To my life, as a human being.

What I’m about to share with you draws upon his ageless wisdom, layered with whatever I’ve picked up myself over the last three decades.

In other words, this is the distilled experience of two collective generations of medical practice… to inspire, encourage and comfort you in the challenging year ahead.

Your Most Important Year Of All.

In school, we once went on a class excursion to the railway factory at ICF.

One vivid memory from that trip is how a straight, stiff iron rod entered a furnace. It slowly glowed, a bright red. And then, powerful machines molded it. Twisted the thick bar into a spiral.

What had been a rather useless straight rod now became a functional shock absorber for a railway carriage. It would cushion millions of passengers over journeys of thousands of miles.

It’s the perfect metaphor for your medical internship year!

Over the next twelve months, you too will be forged in the furnace.

You will be shaped and twisted into a rather different person… one better equipped to serve, cure and comfort thousands, if not millions, of patients over your lifetime as a doctor.

No. It’s not going to be easy!

Transformation rarely is.

This is a picture of me, taken in the middle of the night, at 3 a.m. on an emergency day during our General Surgery posting towards the end of my internship year.

You, too, will work hard in the year to come. Over that time, if you do the right things for the right reasons, you will discover that it has been the best year of your life and career.

  • What are the right things?
  • Which reasons are the right ones?
  • How will you even know if they are?

That’s what the rest of this letter is about. Let’s get on with it.

FOUR THINGS – AND AN ATTITUDE

That’s all you have to pick up during your medical internship.

The four things are what will make you a better technical specialist, and a good practitioner of your profession.

The one attitude that drives them all will make you a better doctor, and a better human being. I call this the GOLDEN RULE. It gives everything else more impact. And it begins to become established during internship.

There are also other things. They matter, too. But maybe not so much as the Top Four.

And while you’ll want to get them all right, it may not matter if you mess up the lesser ones. But if you fail at the important learning experiences, your vital year as a medical intern will have been squandered away.

So what are these Big Four things?

1. COMMITMENT

There’s a reason I mention this first. Without commitment, everything else means less.

In that long, long ago conversation with my father before starting my medical internship, he told me this:

“If you’re in bed with your wife, preparing to make love, and you get a call from a patient to attend an emergency, you should be ready to go – immediately!”

The message couldn’t be any clearer.

Even the most primal, pleasurable activity should be prioritized below your patient’s well being. That’s what comes first and foremost. Always.

No wonder it’s said: “Medicine is a jealous mistress”!

Over the years, I’ve had several interesting conversations with young doctors who question this kind of priority-setting. Their arguments are cogent and convincing. One might easily be tempted to buy into them.

But here’s the thing.

If you, or someone you love, needs urgent medical attention and rushes to a doctor – who places YOU on a lower priority than his or her own pleasure, convenience or comfort, how would you feel about it?

You wouldn’t want that kind of doctor for your loved one, right?

So don’t ever be that kind of doctor… to someone else’s loved one!

I know, I know… that sounds kind of naive and simplistic. And maybe it is – because right now, we’re talking about a critical phase in your training to become a full-fledged DOCTOR.

Your internship year.

During the coming 12 months (or 365 days), your highest priority – bar none! – should be your profession.

This is your acid test, your baptism by fire. A time to pit you against the world of medical practice, and see if you’re fitor fail the test.

If at this stage in your career, without many other conflicting distractions to worry about, you cannot – or will not – show a firm, unyielding commitment to medicine, then it’s fair to say you won’t later on. Not when so many other things will compete for your attention and interest.

That’s why, in comparison to the year that lies ahead, all your earlier medical university examinations, internal assessment tests, and informal evaluations are nothing.

This right here is THE test of your mettle and determination to become a doctor.

And it’s the answer to a deeper question that has driven you to this point:

“Why did I want to become a doctor?”

Even if you’ve never quite asked yourself this over the last 5 years, you’ll likely ask it several times over your internship year. And I’m delighted for you… because every time you answer it in a convincing and confident manner, you’re taking another step towards living your destiny.

Being a doctor isn’t a job.

It isn’t a profession.

It’s a CALLING.

You are called upon to serve. To cure and heal. To comfort and relieve suffering, to your best ability.

To learn, grow, and stay humble. To get better and better at your work, so that more and more people will benefit from your care.

That begins with feeling – and demonstrating – your unwavering COMMITMENT to the task you have chosen to embrace.

The career you picked isn’t an easy one. Not always.

It isn’t fun. Not always.

But in the timeless words of Lord Lister in his graduation address delivered in Edinburgh in 1876:

“… and truly if we have nothing but pecuniary rewards and worldly honors to look to, our profession would not be one to be desired, but in fact you will find it is attended by peculiar privileges second to none in intense interest and pure pleasures.”

Yes, it is a privilege to be a doctor.

You’ll discover that when you make your firm and full commitment to its practice and pursuit. And unless you make that commitment, you will never experience the magic and beauty of a life devoted towards caring for sick people.

How can you tell if you’re committed as a medical intern?

By observing yourself.

Seeing what you do… How you think… What you feel… about events in the year to come.

You’ll be called to see a patient – just a few minutes after you get back to your room, after spending hours right there in the ward, when you’re so tired you could just sleep for a week!

What will you do?

You’ll have the hard work of hours destroyed in a moment of carelessness. A difficult i.v. line – yanked out. A carefully done wound dressing – ripped off. A painstakingly sutured laceration – accidentally scratched.

How will you feel?

You’re irritable, cranky and tired. (By the way, that’s often the ‘default setting’ for a medical intern!) A patient in distress wants you to comfort or reassure him.

Can you do it?

With commitment, you can. And will.

But without it? Maybe not.

That’s how you can tell.

And it’s how you can recalibrate your behavior over the critical year ahead. So that, by the end of it, you’ll be able to confidently answer all those questions:

“Of course, I will. I have done it!”

2. HARD WORK

A quote I read somewhere goes: “There’s enough time to rest when you’re in your grave.”

Now, a counterpoint to this may be that not resting enough will put you there sooner. But the message is this.

Hard work is an essential part of being a doctor.

Not all work is physical labor. So it isn’t fair to compare what an intern does with a manual laborer who hauls bricks or sand all day long. Much of your work as a doctor is physical. But there’s also mental and emotional work.

Caring for the sick and suffering doesn’t come without a heavy burden of heartbreak and emotional pain! Bearing that involves effort. To carry on treating your patients as they sink and don’t respond to treatment can be horrifying and hard to watch.

So know and accept that hard work is inevitable during medical internship.

Broadly speaking, there are 2 kinds of people – workers and shirkers.

Describing them is easy. Workers work. Shirkers don’t.

That’s all!

You’ll come across both kinds as an intern. You’ll find one dumping their work burden on the other. You’ll get angry at this, frustrated at how nobody seems to care, upset at how unfair it all is.

Here’s a viewpoint that will help.

The more you do, the more you learn.

There are no exceptions to this rule. When you do more things, you’ll get better at them. See more variations. Understand nuances better. And eventually become expert at them.

If your learning comes at the cost of a shirker, don’t complain. It’s your gain – and their loss! (If you’re a shirker, this should worry you!)

An even more important benefit to working hard during internship is that it builds the right attitude towards work in your mind. Just as regular exercise builds muscle, your attitude towards hard work grows strong with practice.

I cannot think of any branch of medicine where hard work is a disadvantage or drawback. Not even one.

True, some specialties involve more work than others. But even in ‘light’ specialties, working harder brings you (and your patients) more benefits.

Attitudes toward hard work begin in internship. They are shaped during the internship year. And at the end of it, you’ll feel this is the year you’ve worked the hardest in your life – and that it has been worth it!

So, we’ve discussed two of the Big Four:

  • Commitment
  • Hard Work
  • Skills
  • Knowledge

Let’s move on to the third…

3. SKILLS

Nobody is born perfect. We all work towards it.

As a heart surgeon, my hero and role model is Dr.Denton Cooley.

But I wasn’t a Cooley when I began training! Not even close.

Years and years later, after acquiring skills as a surgeon and then a heart surgeon, I am closer to his level of competence than at the beginning.

This takes incremental, intentional improvement which is sustained over many years. A process that starts as a medical intern.

Simple things will be frustratingly difficult when you begin. Starting an i.v. line may take an hour – or two! My first time doing this in the medical ward as an intern took an entire morning!

But that’s okay. Because you’ll learn and improve over time.

Soon, I was able to set up an i.v. infusion within 5 minutes – even in difficult cases. That comes from following a process:

  • Do
  • Observe
  • Think
  • Improve

Do stuff. Rush to follow instructions. Volunteer to do it. Even if you’re not good at it. Know that only practice makes perfect.

Observe others. Watch what they do, what they get right, what mistakes they make. See an expert do it. What do they do differently?

Think about what you did and saw. What mistakes are you making? How can you change? What should you correct or adapt?

Improve over time. Keep track of whatever you do. Conduct a personal audit. Look at how many tries you need to get it right. See how long the same procedure takes after some practice. Count how many errors or mistakes you make. Compare it against your past record.

Are you getting better? Good. No? How can you?

It’s an ongoing exercise. Even ten years later, you’ll pick up a new trick or technique to improve what you already do very well.

And this attitude, this focus on intentional practice, the self-correcting approach of auditing your own performance… it all begins as a medical intern.

Start laying the foundation for your constant growth and improvement right now.

4. KNOWLEDGE

Immerse yourself into a learning habit this year.

The morning after I finished my M.Ch. exam in cardiothoracic surgery, I met one of my professors. Dr.Joseph Draviaraj gave me this nugget of advice:

My boy, make it a habit to read for at least 1 hour a day… for the rest of your life!

I have tried my best to follow this ever since.

No matter how busy you are, no matter how tired, or how bored… learn something new every day.

There’s no end to studying. Exams aren’t the end, just the beginning. There’s always more to learn. And new things are being discovered every day.

By making it your core practice to acquire knowledge, right from your internship year, you’ll stay in front of the pack all through your medical career. Learning more makes you a better doctor for your patients.

This matters especially during times like a crisis, when knowledge evolves rapidly – and misinformation runs rampant. Knowing the right things can help save lives and avoid suffering.

If you try to establish a learning habit only at such times, you’ll struggle. But when your quest for knowledge is already a practiced routine, you’ll easily scale it to meet the needs of the hour.

Equally important is to…

Apply what you learn; and study what you apply.

What do I mean?

This is your chance to put to work all that you’ve painstakingly learned over your five years of medical college. To translate ‘sterile knowledge‘ into ‘fertile treatment’.

When you see a patient with symptoms and signs you’ve read about in a textbook, start drawing connections – between theory and practice.

When you make a diagnosis based on your examination and investigations, connect it up to therapies you’ve learned about – and bridge the gap between what you’ve read and what you prescribe.

This gradual process is your transformation – from medical student to doctor!

And it works the other way, too. As a medical intern working under supervision and guidance of senior doctors, you’ll often be told to do something you don’t know about or understand.

Go back and study what you applied. Do it right away. Not a week later, when your memory of what happened is weaker.

Immediately reinforcing your practical application with the theoretical knowledge of why you were asked to do it will soon make you a better clinician. You’ll have a wider database of experiences to draw upon in the future, when you’ll independently treat patients on your own.

Knowledge scales infinitely. The sooner you begin acquiring it, and the more regularly you continue to add to it, the better you become as a doctor.

And that, again, is a habit that’s formed while you’re an intern.

Finally, here it comes…

THE GOLDEN RULE

Now that we’ve talked about the Big Four things, it’s time for the Golden Rule.

Why do I call it the Golden Rule?

Because it’s so important that without it, all the other 4 are practically worthless! (Or at least significantly less valuable.)

Listen, we all agree that these four aspects of your medical internship are precious. No question about it. These are definitely the BIG four.

  • Commitment
  • Hard Work
  • Skills
  • Knowledge

But there’s one element of being a doctor that stands apart from all these four – and still infuses all of them with incredible power and energy.

  • It can make them wildly effective at helping you care for your patients.
  • It can drive you to heights of effort, tolerance and patience, ones that you’ve never believed possible.
  • It can give you enormous confidence, determination and satisfaction when you develop it.

What’s this near-magical force, then?

It’s a word that you’re probably familiar with – but it has a meaning that takes some time to truly understand, appreciate and internalize.

COMPASSION

For your patients. For their suffering. For their loved ones.

I’ve often said that I can teach anyone with reasonable motor skills how to operate on the heart. But I can’t teach anyone how to be compassionate.

That is something that wells up from within you. It’s internal. And integral to your personality.

Compassion for patients is what drives doctors to sublime heights of effort and endurance.

Without compassion for your patient, it is incredibly difficult to motivate yourself to do so many things that you’d do naturally and without hesitation when you feel it.

And compassion doesn’t spring up suddenly in an instant. It grows over time, as you engage more deeply and personally with patients. That begins usually in your internship year.

Before this year began, your encounters with patients are limited to ‘taking a history’ before you present a case to your professor in a classroom or clinic.

But as an intern, you get closer to your patients.

You’ll see them every day. You’ll watch them interact with family and friends. You’ll observe the progress of their disease or condition, see it improve or worsen.

And you’ll feel their pain.

As a medical student, you were insulated and protected by distance. You could walk away. As an intern, you cannot. You must stay – and suffer.

This can be heartbreaking. The thought of Jayaraman still brings tears to my eyes.

He was around my age, dying of an untreatable condition (primary pulmonary hypertension). No family to stay with him. Scared to die all alone. He wanted me to hold his hand as the end neared.

I was afraid too. And angry. That I couldn’t help him. All my medical knowledge, skill and commitment weren’t enough to save him.

When he died, I cried.

You, too, will cry as an intern. And that’s nothing to be ashamed of. Because it means that you feel compassion for your patient.

Channeled correctly, that emotion will help with your work.

Because there are times when patients can appear to be thankless, ungrateful, even hostile – and you must still love them!

In her essay applying to medical school, Anjali writes:

“Medicine is about so much more than science. It is human connection in its most vulnerable form.

This should be burned in words of fire into every medical intern’s mind. You are dealing with human beings at their most vulnerable.

Afraid and anxious. Nervous and needy. Upset and unsure.

You must find it in your heart to understand and accept their state of mind. Empathize with it. Feel compassion for their suffering.

But do it without becoming paralyzed by emotion to the point that you are non-functional in treating them professionally.

That’s the tricky line you’ll learn to navigate as an intern. And when you learn the Golden Rule, it will make each element of the Big Four infinitely more powerful.

  • Commitment grows stronger when you truly care for your patient.
  • Hard Work comes more willingly when its purpose is noble.
  • Skills are acquired with more meaning when applied for a good cause.
  • Knowledge is sought as you’ll make an impact on people you care about.

Each nurtures the other.

It’s a virtuous positive feedback loop that makes you a stronger, better, more deeply caring doctor.

One who is moved to do the right things, for the right reasons, with the right attitude.

That is the essence of your medical internship year.

To transform you from a sincere, serious medical student – into a caring, compassionate doctor.

Read on for Part 2: Your Internship Year – Other Issues That Also Matter

Your Internship Year

In the earlier article about your medical internship year, I mentioned the Big Four and The Golden Rule (if you haven’t read it yet, go here first).

At the end of it, I said there were also other things that matter.

Smaller, maybe, as compared to the Big Four. But no less important to you, in a real sense, during your internship year.

Here’s a list of them:

  • Security
  • Safety
  • Sleep
  • Nutrition
  • Discipline
  • Time Management

Let’s talk about each of them in more detail.

SECURITY

It’s sad that this has to be listed high among things a medical intern must be aware of. Yet it’s very practical in the charged environment doctors operate in today.

Violence against doctors, including medical interns, is an unfortunate reality.

Reports aren’t widely circulated. Public outrage against it is sporadic, at best. But for an individual doctor, as well as collectively to the fraternity, this practice is a serious dampener.

All doctors are painfully aware that at least a part of their focus should be on avoiding ‘problem situations‘, ones which may make them targets of a mob’s ire.

So as a medical intern who will often be on the front line of patient care, you should be aware of this constant danger – and take due precautions to avert flare ups and potentially explosive situations.

SAFETY

It’s just as sad that your personal safety has to be prominently addressed in any internship checklist. Yet it is true that interns are often placed in risky, even dangerous situations that could leave you vulnerable.

Do not make the mistake of assuming that a hospital is as safe as a medical college. It is not!

Apart from work-related safety measures – like wearing protective clothing and gloves/masks, handling sharp instruments carefully, being aware of the health hazards of contagious material and such like – there are also safety measures you must take against assault (sexual or otherwise) inside the hospital.

Being sleep-deprived and under stress leaves your judgment unreliable at times. The emotional trauma of treating ill patients can make you edgy or anxious, sad or angry. And this leaves you vulnerable to predatory elements that exist in any unusual ecosystem – like a hospital.

Risks may come from colleagues and co-workers. They may come from patients and their attenders. And they could even come from authority figures.

Every medical intern is just as much at risk as any other.

It is critical that you

  • establish safety precautions,
  • build your own networks of trusted people,
  • inform yourself about the geography of the workplace,
  • evaluate how safe and secure a given location or position will be,
  • avoid getting stuck in places where you may be at risk, and
  • take all necessary steps to stay safe while you work.

SLEEP

A rested mind and body is infinitely more productive. Yet rest and internship rarely go hand in hand.

Yes, you can complain about it… or you can choose to see it differently, as essential practice for rare occasions where you may be called upon to perform without rest in a professional context, when only your skill and action can save lives.

With that being said, try and get as much sleep as possible – without compromising on your patient-care duties.

There’s an old wartime adage for soldiers, that serves interns and residents well.

“Don’t walk if you can stand; don’t stand if you can sit; don’t sit if you can lie; and don’t lie if you can sleep!”

Bedbugs and unfamiliar surroundings, interruptions and worries about your responsibility, emotional stress connected to patients, and unfamiliarity with your daily routine can combine to make it hard to sleep. But getting used to this is part of your training to become a doctor.

So try your best to sleep well.

NUTRITION

Eating is another casualty of a medical internship.

On a busy stint, you may not have time to grab even a quick meal. So it has to rank high on your list of priorities to nourish yourself as best as possible.

Lacking energy, low on immunity, weak from hunger is a horrible frame of mind to deal with an intern’s slog. Prepare and plan to get your calories and nutrients right.

If you lose too much weight, you’ll be susceptible to infections which could quickly become life threatening. Take care.

All these issues collectively bring up another important element of being an intern.

You need to develop discipline.

DISCIPLINE

It isn’t everyone’s favorite word. Yet to an intern, it must become a rule of life.

Being disciplined in how you eat, sleep, work, study and handle your patient care tasks is the only thing that can keep you healthy, safe and happy during these busy days over the year ahead.

Over most of your time as a medical student, the lack of discipline might have been a minor nuisance, with few consequences if any. During a hectic internship, it can mean the difference between efficiency… and complete chaos.

More importantly, if you don’t care to develop a disciplined approach during this early phase of your medical career, it gets infinitely harder as your life grows more complicated and multi-faceted beyond this point.

As you progress in your career, your professional tasks will remain just as intense – or even grow more demanding. And you’ll have to juggle them with others, such as managing a relationship, getting married, raising a family, caring for aged parents, and advancing your career.

As this complexity grows and becomes more tangled, your lack of discipline will have increasingly serious negative consequences.

All of this can be avoided by laying the foundation of a disciplined approach – right during your medical internship.

TIME MANAGEMENT

Time Management is a vital skill to acquire during your internship.

You’re often called upon to handle several tasks as an intern. Each takes time and effort. Your list of things to do will seem formidable. And you need a systematic approach to finish your duties every day.

You could muddle along through it all, rushing from one crisis or urgent situation to another, stressed and anxious all the time.

Or you could devise a system to prioritize correctly, assign time for each task, and work your way through the list in a calm, collected way.

Which approach you choose to adopt as an intern will very likely signal how your future as a doctor unfolds. There are both kinds in the world. You’ll easily be able to tell… by how irritable, short-tempered, rushed, stressed and ineffective they are – or not.

Now until this point, I’ve addressed general areas for growth during your internship year. They apply equally to EVERY intern today – and even those who’ll begin their internships in the future.

What follows is more of a personal reflection on an intern’s role.

It states opinions I hold, and that you may well disagree with. Take it or leave it, as you will. But these are also areas that an intern may choose to focus on with advantage, to become a better physician.

TOLERANCE

No, I’m not talking in the socio-political sense here – but of personal tolerance.

Tolerating your own self.

Because if there’s anything constant about internship, it’s this.

You Will Make Mistakes

Often, many of them. It is inevitable. Because you are still learning. There’s a trite aphorism in Tamil: “He who has killed a thousand is half a doctor!”

Well, don’t take that too literally. But also be accepting and forgiving of yourself.

Don’t blame yourself or feel guilty about your mistakes. Just make a promise to yourself – that you’ll never repeat them again.

Also, don’t forget or ignore them. If you brush them aside, or make excuses for why/how they happened, chances are you will end up repeating them in the future.

  • Learn lessons from every experience.
  • Spend time to review what happened.
  • Determine what went wrong, and why.

To not do this adds insult to injury. A patient (usually) suffers the consequences of your mistake… and if your introspection protects other patients from the same kind of suffering, then at least something good has ensued.

On the day I joined my training program in heart surgery, our professor met the new candidates. Among other things, he told us:

“There are no new mistakes under the sun. Any complication you create here, someone else has already done before. So don’t worry about making mistakes. Just learn from them.”

Those wise words went a long way in lowering the stress of entering a new specialty – where even tiny mistakes could be punished by the loss of a patient’s life.

Also, the realization that everyone makes mistakes at this early learning phase of their career should encourage you be be kind, gentle and forgiving – with yourself.

Don’t become overwhelmed by guilt or anxiety.

That way, you’ll do your job better – and save many more lives over your career as a doctor than you ever harmed through your newbie mistakes.

DEATH

For many like you, internship will be the first intimate acquaintance with death.

Maybe you’ve experienced the loss of a loved one before. But with very rare exceptions, the internship year will be the first time when your own actions and decisions become related to death, when death is felt to be the consequence of something you did – or did not do.

That can be traumatic and tough to deal with.

French surgeon René Leriche said:

“Every surgeon carries within himself a small cemetery, where from time to time he goes to pray.”

I have mine. Maybe, over time, you’ll have yours, too.

It’s a way to keep us grounded, remind us of the terrible cost of becoming over-confident, arrogant or careless. It makes us better doctors, watchful and wary about what we do.

But there’s no point wallowing in guilt over a patient’s death. Almost never is your (in)action the sole cause for the loss of a life. It’s not usually in your hands.

A disease’s severity. A patient’s overall health. A procedure’s effectiveness. A medicine’s efficacy. Other unknown variables.

All of them determine the outcome.

Too much guilt and self-criticism is a luxury you cannot afford as a healthcare professional. You must move on to help others, using lessons learned from the experience around a patient’s death.

Guilt won’t help. Careful and critical introspection will.

And in time, you’ll evolve your own relationship with the idea of losing some patients.

Be patient with yourself. And don’t let it overwhelm you.

This is especially important for interns who are beginning their tenure in the middle of the COVID pandemic.

Seeing death all around you can be disconcerting and depressing. You need to be strong, mentally and emotionally, to deal with it – and carry on with your important, life saving work.

Remember – almost always, it’s not your fault.

In the Bhagavad Gita: Chapter 11, Verse 33, Lord Krishna tells Arjuna:

“These warriors stand already slain by me, and you will only be an instrument of my work, O expert archer.”

YOUR PERSONAL PHILOSOPHY

Right at the start of this long essay, I called the internship year…

Your Most Important Year Of All!

If I had instead called it your toughest, hardest, most challenging year of all, it wouldn’t be too wrong.

Most doctors will agree that their own year of medical internship is when they changed, grew and evolved as doctors – more than any other comparable period of their life, before or afterwards.

It’s also usually a time of personal turmoil.

You’re thrown out of the warm, secure womb of medical college, right into the roiling waters of a hospital-based healthcare system.

You’re forced to recall stuff you learned from textbooks and classrooms, and use it to treat disease and save lives.

And meanwhile, other important things are happening in your life.

  • Maybe you’re in a relationship, and wondering how it’ll go.
  • Or maybe you’ll soon be married, and worry about that aspect of your life.
  • Or you might have made plans which get derailed by circumstances beyond your control.
  • Maybe ailing grandparents are unwell.
  • Parents might be entering a phase of poor health.
  • Siblings may need guidance or encouragement.
  • Financial needs may have to be met from your earnings.
  • Your own career has to be plotted and planned.
  • Post graduate entrance exams loom in the distance.

In the midst of it all, here you are… struggling to find your feet in a new environment – where the price for careless, ignorant or uncaring action is a human life!

Not easy. Nope.

And that’s often when you seek a guiding philosophy that helps you make sense of your life.

It may be religious or rational, social or something else.

You’ll seek explanations and try to find meaning. And in the tumult and confusion of all that’s happening during the internship year, that philosophy will itself evolve.

To fit changes you see. To match experiences you’ll have. To offer credible explanations for new events and observations you’ll now be a part of.

It sounds difficult.

And maybe it is. But here’s the good news.

At the end of this year, you will be a new person.

A tougher person. A stronger person. Wiser, calmer and more caring.

Yes, you’ll be a DOCTOR.

Anything worth getting and keeping is worth a fight and struggle.

Becoming a doctor is worth it all.

At the end of the coming year, you’ll agree.

Come back then and tell me all about it.

Here’s wishing you all the very best – in your career, and in your life.

Onwards…