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					                      Reflections over twelve months as an intern:
        My thoughts, realizations, and developments in the first year of residency
Ani Saryan, MD University of Wisconsin Fox Valley Family Medicine Residency Program

July – OB. Three weeks of orientation prepared me for this? I’m now in charge, directing
actions, writing orders on my own. Waiting for that first delivery, waiting as the clock ticks on.
Working with the mother to push harder. After possibly hours, the brief moment arrives. A cry
from the newborn, two clamps are placed, and cries from the parents as the cord is freed. A new
year ahead, full of hope…

August – Orthopedics. My attending keeps introducing me to the patients as the joint expert. I
laugh to myself, because I’ve never even casted or splinted a broken bone (something my brother
assumes is taught early on in medical school). By the end of the month, patients tell me my joint
injections didn’t hurt a bit.

September – Medicine. This rotation month is five weeks long, and I’m not even sure I’ll get
through my first night on call alone. After sleepless nights and 28 hour days, I think I was
counting down the days to October. My first patient died this month, as I was having a
conference with her family. It was expected, but I was mad, feeling as if I had done something
wrong. Something I have to learn is that part of being a good doctor is preparing patients for the

October – Family Medicine Center. An entire month to recover from September’s multiple
demands. I started to become more comfortable with the process of seeing patients in clinic; by
now I know which button in the room to press when I’m seeing the patients. I also got to tour
the homeless shelters in the area – they are remarkably warm inside.

November – Medicine. Back for more. The hospital has been changing, so we have to change
with it. That demand for flexibility and adaptation will hold true for the rest of my life. I’m
starting to figure out the “collaborative care” process, slowly though as all the kinks are worked
out. Thanksgiving day and night were spent at the hospital; thanksgiving lunch and dinner were
the same plates of cafeteria turkey.

December – Pediatrics Nursery and NICU. Halfway through the year, it seems the months are
starting to go by faster. I am quite immune to crying babies at this point, especially when
performing a circumcision. I attend a delivery of premature twins and need to run backwards
down the hall at the end of an incubator, somehow not letting go of the baby’s mask. One
particularly snowy Saturday on call, I just sit in the warmth of the NICU, feeling alone but
surrounded by tiny babies pushing to survive.

January – OB night service. I decide to completely switch my sleep/wake cycle this month. I
stay up all night, ready for the next crowning grand multip to rush up the elevator. That only
happens a few times, but I was always ready to catch. The other catching I did this month was
catching up on that growing mountain of unread journals. If you’re going to stay up all night, I
learned, you might as well get some reading done in between cases.

February – Medicine night service. Another month to continue being a night owl. I discovered
the many ways to make meals out of toast and jam found in the doctor’s lounge. My main task is
to do admissions at night, so I try not to tempt fate too often and look at the census in the
Emergency Room. On the night that the Packers won the super bowl, the ER was strangely
quiet. Only after the game ended did the rooms fill with people experiencing chest pain (for

March – Pediatrics inpatient. It seems like RSV season never wants to end. Some days are
longer than others, some days don’t end until 2 am. By now, the match results have told us that
there is a new group of interns coming to our program in a few months… which means it will
soon be the end of intern year.

April – Surgery. I think I have always liked being in surgeries; it’s like a choreographed dance of
moving scalpels, suctions, sutures. I put my hand in the chest next to a beating heart, and next to
a solid adrenal tumor. In one day, we told three patients that they had cancer – that we would
work with oncology to find the best treatment, and that it was okay to feel overwhelmed.

May – Medicine. Seems sooner than I expected, but already it’s the final month of medicine
service for the year. I feel more efficient with admissions; I can tell a consulting physician
succinctly why we’re requesting their help. Even though there are still logistical issues with
collaborative care, I am able to see 5 or 6 patients, take a few admissions, pre-round, round, and
still have time for lunch and dinner. I feel more confident when I’m presenting my patients to
the attending. And every day this month, one of my patients has told me “thank you for taking
care of me” or “I appreciate the work you’ve done.” I think the patients have been saying those
things all year long, but I wasn’t listening for it.

June – ER. Being in the ER is a completely different jungle than clinic, even though some
people use it as their primary doctor’s office. One room has chest pain, the next room smoked
too much “green dragon” and the next room just wants her rash from yesterday rechecked. I
think to myself, how different things could be if everyone saw their family doctor routinely. One
morning, the incoming class of interns walks through the ER as part of their hospital tour. As
I’m sitting in the dictation booth I overhear their guide say “…and this is where the doctors do
their work.” Turning to see our new class of residents, and remembering when I was on the
same tour one year ago, it finally starts to settle in… the twelve months of intern year are coming
to a close.

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