To all the fourth-year medical students out there, CONGRATULATIONS! I know Match Day was not exactly how you pictured in this COVID-19 world, but it is still a huge accomplishment. You should be so proud! While the world is a little different right now than we thought it would be, I know that you all are both excited and anxious to begin your residency. Whether you’re a newly minted Family Med doc, OBGYN or general surgeon, July 1 is going to come with a lot of unknowns. In light of that, I thought I would provide you all with some of the things I wish I had known before starting my intern year.

1. Please, for the love of God, do NOT take any extra electives in critical care or pulmonology to “give yourself an edge.”

I hate to break it to you, but no matter what you do, no matter how many books you read or rotations you take on, you’re going to feel lost during intern year. Intern year is not about being the most proficient at ventilator management or a wiz at chest tubes, it is about learning how to work at a hospital. Your days will be spent learning how to replace a patient’s potassium or how many calls it actually takes to get an IR procedure done, and nothing can prepare you for that. Very soon your free time, weekends and holidays will be ripped away from you. Use these last few months to enjoy generally deciding what you get to do with your time.

2. No matter what you do, something will go wrong.

When I was an intern on the transplant surgery service, fumbling over how to dose Cellcept and making sure every patient’s Prograf level was drawn at the exact same time each morning, inevitably one thing slipped through the cracks. No matter how many times I called to make sure that creatinine had been drawn, the lab would skip the patient. And as an intern, when your worth is directly correlated to how many administrative tasks you can successfully execute in a day, I felt like a failure. But when that lab draw was missed or a medication wasn’t given, my fellow would just say “working in a hospital is hard.” And he is right. When you have humans taking care of other humans, it is an imperfect system and no matter what you do, things will go wrong. 

3. You will forget what it is like to be a medical student.

This is one I was sure that I would be immune to. I remember being an eager third-year med student and an even more ambitious sub-intern, frustrated with my inability to be any kind of useful. I vowed that when I was an intern, I would always be the kindest person and make sure to fully utilize my medical students. Spoiler alert — that did not happen. This one is the equivalent of your parents saying, “You’ll understand when you’re older.” Once you transition from the coddled med student life (I know, you don’t feel coddled) to the sharp world of residency, you will understand that the external pressures on your residents are what sometimes prevents them from being the best teacher. Dear med students, you aren’t being ignored or forcibly kept past 5 p.m. for our enjoyment; your resident is just trying to finish the interdisciplinary orders before the case manager leaves at 4 p.m.

4. There are not a lot of “thank you”s.

This is a sad one to write, but it is the truth. There will come a point when you become “super intern.” You can get numbers for a 15-patient service in 30 minutes, you have the CT reading room extension memorized, you and Liz the pharmacist are best buds and TPN is re-ordered before 1 p.m. without missing a beat. You will get to the end of a day where you successfully discharged a patient to skilled nursing facility on a Friday, and literally no one will acknowledge your hard work. And part of writing this is to remind seniors to thank your juniors, but also to all the interns out there — remember to thank and be kind to yourselves. Acknowledge your own hard work, and if you’re ever feeling taken for granted, go talk to a patient — they will always say thank you.

5. It gets better. 

Maybe everything I wrote thus far makes internship sound kind of awful, and it kind of is! But it is also kind of amazing. I don’t think any person grows as much as they do during their intern year. No one knows the hospital and the patients as well as the interns on every service, and that is when you really start to feel like a doctor and that’s why you went through this whole process in the first place! Like I said, you will trip and fumble around for months, but you do get up and dust yourself off, coming out stronger on the other side. The friends you make during your intern year are some of the best because you’re the ones in the trenches together, fighting the good fight. Misery loves company. Take the time to get to know your co-interns, vent about your bad days and remember that you are not alone in this crazy world of medical training.

I know there is no substitute for knowing EXACTLY what interning will be like, and as we are all textbook Type A personalities, we want to be as prepared as possible. But just trust me on this one — there is no way to prepare, and I absolve you of the responsibility of trying. Use these last few precious months of freedom to spend time with your family and friends (at an appropriate social distance…), pick up a new hobby, check things off your bucket list, sleep for hours on end uninterrupted. Because come July 1, the hospital owns you, and you will learn how to be an intern. 😉

Contact Auriel T. August M.D. at ataugust ‘at’ stanford.edu.