Reflections on Intern Year as a Family Medicine Resident

Hello and welcome to another Medical Mondays! From randomly coming to NJ between rotations before interview season really went under way to Match Day (aka one of the happiest days of my life), it was a whirlwind of a journey leading up to starting my residency here at RWJ (orientation feels like such a long, long time ago!).

Getting here for my actual interview two(?!) years ago was an adventure all on its own (for future reference, try to never schedule 4 interviews across 3 days in 3 different states!), but it was obviously worth it, given that I ended up matching to this program, and some rather awesome things the faculty told me during my interview still stick with me to this day!

Reflections On Intern Year As A Family Medicine Resident

I’ve officially finished all my rotations for intern year, and there are lots in store for this upcoming year that I’m super excited about, so I figured I’d share with you some reflections on intern year before second year really gets rolling!

They say intern year is the toughest of them all–I was in in a new place with an entirely new EMR. I knew 2 people in this state (one that has since moved away). I’d never worked in a hospital with over 500 people before (RWJ has almost 1000 beds), and since most of my experiences were in small community hospitals, I’d had very limited experience with programs where there was actually more than one residency program there.

One of the reasons why you want to make your rank list based on your gut/how well you felt you’d fit into the program is because they become your family, due in part to the inordinate amounts of time you spend with each other–there’s little time to spend elsewhere (although I managed to gouge out time ;P ).

“You’re the fastest intern east of the mighty Mississippi. Your ability to finish it quickly means nothing to me.” / “I’m so glad I’m working with you for my last two weeks of service ever–you would’ve ruined everyone else for me.”

Favorite Medical-Related Extra-Curriculars:

• Volunteering as a a medical consultant with my advisor for Tzu Chi
• Covering the Big Ten Women’s Gymnastics Meet

Favorite Rotation: Not an actual rotation, but I liked seeing patients in the office (outpatient clinic) the most. I’m looking forward to next year’s rotations more than anything! Night service was actually pretty fun (but only because I wasn’t alone), and radiology gave me some really glorious hours!

Most Memorable Moments:

• I’m still super proud of my diagnosis of a BJJ injury for one of my patients–my hunch was a lateral collateral ligament sprain, which is pretty rare to see isolated (it’d almost always come with some other injury elsewhere) but I was right! :P
• I ended up being dragged into a lot of patient cases involving courts and investigations–from trying to avoid taking sides in custody battles to speaking with the state detective about potential abuse.
• We had a super sweet patient who found out she had cancer and had really severe anxiety so on a day where we were a little less busy, I went up there to talk with her and go through different deep breathing exercises with her. She had an amazing support system and always had at least one family member or friend there with her. <3

Most Interesting Cases:

• A patient who came in with a stroke (middle cerebral artery) that we put on anticoagulation as per protocol…but who then ended up with a gastrointestinal bleed, so we had to stop the anticoagulation. It was a mess in terms of trying to balance it out since the risk of a repeat stroke was definitely more devastating than a repeat GI bleed (which could be much more “easily” managed than the potential repercussions of a stroke).
• A patient who was on service at the same time as the case above who technically “died” for a few seconds, then ended up in Torsades and an unstable arrhythmia who was seen by cardiology and recommended to the cardiac care unit but was rejected by both the CCU and the ICU…so we started an amiodarone drip on her on the floor and I got held hostage on the floor because they weren’t allowed to run that medication without someone on the floor to monitor. Twas not a fun time (my senior was at clinic while all this was happening).

“All of us had great things to say about you, but Kyle especially. You’re the most efficient intern we’ve had.” / “You have great insight on the things you need to improve on.”

My mottos for the year:

• Fake it til you make it. (Imposter syndrome is very real. I’m still working on my confidence/learning not to doubt myself.)
• For the harder times: This too shall pass. No matter how bad it got, I knew I could get past it.

Least Favorite Rotation: Hands down, inpatient pediatrics. (I’m so glad that’s over. >_> )

Worst Mistake: Starting an albumin infusion in the wrong patient. Granted, I caught this super quickly and had it stopped + went over to apologize and let the patient know what happened. She was (thankfully) completely fine with it and said it actually made her feel better.

Most Annoying Case: We had a patient who stayed for basically the entirety of my first month on service. He was rude, abrasive, insulting, dishonest, and completely uncooperative with any of the treatment modalities we offered…but we took it for the team, and after he almost assaulted our night resident, he was [finally] discharged from our practice.

We also had a “dump” case where the Neurosurgery team was taking care of our patient for 1.5 weeks but neglected to ever mention this to us that he was even in the hospital until the day of his intended discharge, where they [barely] signed him out to me so they wouldn’t have to do any of the discharge paperwork or write his discharge summary.

…

Things I’ll Miss The Least: Writing discharge summaries and having to click 3248072394 times before putting an order in. Having to cancel an order and rewrite it entirely instead of being able to modify it was also a pain.

• What’s something you’ve learned this year?
• What’s something you want to work on improving this year?