Divide and conquer

The thing with being an intern isn't just that the work is hard and demanding. Or that the hours or so long and we're always so tired. The main thing is this overwhelming sense of disconnect. You spend so much time at the hospital and the hours that you aren't there are reserved for sleep, eat, shower and repeat that you have no time for your family or your friends. Maybe this is different if you actually live with someone. But I come home to an empty apartment every night after working anywhere from 10 to 15 hours a day and I just don't have the energy to talk to my parents or even my best friends. Some of whom are actually in the medical field and might be able to relate.

Maybe it's just that I work in such a big university program but I feel the same disconnect amongst my fellow interns. The 20+ of us are split amongst 13 different services and another at an entirely different hospital. If you are lucky you might have one other intern on your service, in addition to a chief or a mid-level resident. You spend a lot of time with your nose to the grind-stone just trying to get everything done without screwing things up too badly. Everyone talks about how your intern class is your support group. Which would be great if I ever saw them. But we just don't see each other that often. And when we do it's not like we have time to sit down for a chat. Even when we sign out to each other (ie, when the on-call intern gets the low-down on all the patients on a particular service from the covering intern) one of us always has an eye on the clock. Either because we're the one that wants to leave and get home or because we're the one covering 4 services and already have so much shit to do it's not even funny.

The uppers tell us that we should take a second during sign out to relay a funny story or two. But there are some days/nights at the end of a shift when you feel so run-down, beaten and just incompetent that you can't bring yourself to make a joke or laugh at one of theirs. And often times you are so wrapped up in your own perceived failures you don't see the same dejection written all over them. Logically we all know that no one is expecting perfection out of any of us. Attendings will be the first to tell us that there is a reason residency is so long. But, we're surgeons for a reason. We hold ourselves to exactingly high standards that have nothing to do with what others expect of us.

I can't speak for all of my fellow interns. But I'm fairly certain that what I'm saying is true to varying degrees for each of them. When I make a mistake, when I ask a stupid question, when I don't know an answer, when I forget to put an order in or any of the hundreds of other tiny mistakes I can make I always feel like I'm letting someone down. Usually the person I've let down is myself as opposed to one of my superiors. I've actually been really lucky in that while most of my chiefs have been exacting they have also been understanding. But that doesn't mean I haven't had my fair share of cries in supplies closets.

For weeks I thought I was the only one with these feelings. But, then a miraculous thing happened. I went for drinks with a couple of the interns in my call pool. The ortho intern walked into the Burn Unit to sign out to me looking like someone had punched her in the gut. And one of the ENT interns who is always so smiley looked like she was about to spit nails. And me, well my chief had to fix all the orders I'd put in on my patients cause I still couldn't figure out the damn order system so I wasn't feeling too great about myself either.

So we get to this bar and order a highball each and a giant plate of french fries. 10 minutes later we're swapping stories about which chief yelled at us. Which attending terrifies us. Which nursing stations drive us crazy. Which patients are the scariest. And somehow all that self-loathing I'd been feeling for days started slipping away. I felt like a new person. It didn't matter that I was screwing up, because these girls were too. Even though all of us that the other was a model intern we were all suffering through the same insecurities.

The funniest thing was that this whole thing only lasted about an hour. We ate, drink, laughed and even got a little teary in over-drive. We were manic in our thrill at having found an outlet for our self-recriminations. Anyone looking at the three of us in our green surgeon's scrubs, with our beepers sitting on the table, would have seen something like a cross between a psychotic episode and an intense cocaine high. There was intensity and desperation in our eyes. We were trying to live out ten different meals filled with gossip and drinks in one evening. We didn't have the time to do this leisurely. All of us had to be up 4 the next morning and it was already nudging closer and closer to 9. None of us wanted to relinquish our precious sleep. But that night I slept like a baby. The recurring nightmares of me screwing up so badly that I got kicked out or someone died didn't wake me up that night. I felt good about myself.

I took this experience from a weeks back to heart and decided to start a weekly intern drinks conference. It's an outlet for all of us. We can get together and share our stories. We can bitch to the only other people who will truly understand what we are going through. And even though that same desperation and mania lingers around us while we do it. It's still the best outlet I can imagine. We've managed to bring the crew together twice in the past few weeks. And of course it's never all of us because there are always those of us on-call. But I genuinely think it's the best thing we can do for ourselves. It's something for us to look forward to. It's a way for us all to feel connected. And most importantly it's a way for us to form a relationship that will go even deeper than just co-interns.

I know that my program doesn't have some nefarious plot to divide and conquer the interns. And I know that we're split throughout all these different services because otherwise their would be no way for the surgery department to function. But, a tiny, tiny part of all of us do feel that this is their master plan. But, our little weekly "intern conference" is the perfect act of civil disobedience.

I know that in ten months when we are all no longer interns we'll look back on all of this fondly. And these people I've worked with all year long will be like family. And in the 5-8 years it takes us to get through our residency together we're going to get even closer and it makes me glad that I have such great people to do it with.

Anecdotally, I recently overheard one of my attendings consulting another attending in another state who had been an intern with him decades ago. I heard his raucous laughter as they aped a chief they had both despised. I heard them discuss another one of their co-interns who had recently fallen ill in hushed and reverent tones. And I heard them pass the care of this particular patient from one to the other the same way the had done all those years ago when they cross-covered for each other as interns.

That little bit of eavesdropping gives me hope.