a family medicine intern
When I started residency, my fiancé gave me a little green traveler’s notebook with my initials on it, along with a few "Field Notes" notebooks. They have pictures of national parks on the covers. He said they were to help me “forget I lived in a concrete jungle”, since I chose Fort Worth & John Peter Smith, instead of a few programs in Colorado. What follows is a collection of hastily scrawled notes from a family medicine intern. I myself find that my writings vacillate between childish, endearing and wise from month to month.
7/5/24 - 1st Week, PGY-1. (Newborn Nursery).
This week I definitely felt like a doctor. I had to make some decisions to escalate babies to the NICU, and that will make you feel like a doctor whether you want it or not. Patients that stick with me include the baby that withdraws, and the baby I started CPAP on.
I enjoy peds & newborn more than I thought I would. I have also realized I may be a calmer doctor than I think when I’m doing procedures. I am usually quite anxious, but during a procedure I realized I just lock in, and it comes naturally to me to ignore everyone except my attending and the patient.
7/14 (Newborn Nursery)
The adjustment has been hard to intern year. I feel OK, but honestly its hard trying to be a person during intern year. A patient interaction today though that I loved is watching the OB doctor speak to my Pashto patient’s mom about contraception. The patient asked how long the IUD was good for, and the doc showed eight fingers at the same time she said 8, but the mom clearly understood the message before the interpreter said it. They both looked at each other in that moment, smiled and gave each other a thumbs up. It was a moment that transcended any kind of language barrier, and I knew I had to write about it today.
7/18/24 (Newborn Nursery)
I am feeling better. Some cute moments.
the mom that was sleepy and not responding to us. But, then we stuck her baby in front of her, and she gave us the sleepiest smile
the feeling of privilege multiples times as I was the first doctor to examine a patient and to listen to their heartbeat
super happy as I bounced around on rounds
8/12/24 (Medical ICU)
I think I have cried less since the last time I wrote in here. I have enjoyed MICU, and I had a mild crisis about if I should have done critical care. I don’t want to do vent weans though. I like the true medicine MICU level patients, like a bad DKA or septic shock or even peri cardiac arrest patient. Anyways, I had a revelation today, and a good reason to pursue my wellness while in medicine. A jaded doctor ignores things. A tired doctor misses things. A sad doctor…probably is a good doctor because they care. A calm, empowered doctor is the best one for patients.
I know I’ll come back to teach interns specifically because they really are a vulnerable group. However, I would love to do IP/OP with OB/Peds. I want to be really damn good that, and maybe also be a geriatrician?
8/13/24 (Medical ICU)
I honestly can’t believe how difficult intern year is, even for an introspective, workaholic with a support system and a lens into the broader workings of organized medicine.
Patients I will not forget:
the lupus sister
the 35 y/o lady with lupus who died from acute liver failure and DIC. She had a provider who missed her lupus diagnosis & kept prescribing her antibiotics for her hematuria as she thought it was a UTI. She had referred to her dermatology for the rash, and she referred to rheumatology for a “positive ANA.” The patient died, and I couldn’t look at her sister as she screamed and sobbed asking why her sister had died. If I would have spoken, I may have said her death was preventable, by a better trained PCP, one who listened more deeply, or perhaps a PCP not overburdened by an insurmountable system giving them only 15 minutes with a patient. It’s hard to distinguish between the 3 sometimes.
he was fine 2 weeks ago
the patient with HIV who was off his meds for just two weeks, and he made my progress notes look like a chapter straight out of a book on opportunistic infections. I fought (respectfully) with my attending on if I thought he was volume up or volume down, and finally my attending gave up and let me give him a lil baby dose more Lasix. He died the next month, I heard through the grapevine.
was it me?
the lady with such a high Tylenol level that she arrested as soon as I finished putting in two central lines. She was my second patient that I saw die before my eyes.
the ones that got better
Takutsobos cardiomyopathy
septic shock and DKA lady
hypertriglyceridemia lady with pancreatitis
9/4/24 (Pediatric Clinic & Psych Consult Service)
I haven’t really written because I haven’t needed to process as much during peds and psych.
It’s hard to believe 3 months of intern year is about to pass by. I truly do not know where the time went.
my patients:
she’s a runner
the girl who kept running away after her dad died
bad depression
the new patient, a teenage girl with really bad depression that needed every resource I could give her in clinic.
dad before my eyes
the kid with very severe bipolar depression, and the moment she called her foster dad, “Dad.” for the first time. Dad smiled so wide.
a dove
the unhoused, pregnant woman with polysubstance abuse including fentanyl, who had an intrauterine fetal demise. i cried watching her cry. another provider said it was a blessing the baby died.
gotta catch ‘em all
is it possible to feel like a manic patient could be your friend? he came in overnight spitting tons of facts about pokemon and insisting he was a Pikachu. Can’t I say I’ve done the same?
12/3/24 (Surgery)
Now it’s been about 5 months since intern year. I am on Surgery, which I thought I would hate, but somehow, I don’t? It’s obviously not as interesting as OB. But OB was overstimulating honestly because I love it too much, and I get a little crazy about it.
I still feel as happy as an intern as when I started. I don’t necessarily jump out of bed to go into work when I wake up in the morning, but I definitely don’t dread it either. I take pride in a job well done when I come back. No matter what I try to stick to my systems, notes, checklists.
My mind is still bursting with what to do with my career, but definitely some level of FM-OB is one of them, working in Hillsboro or Sulphursville for ideally 3 years before coming back to teach at JPS. I could see myself working in the CMO organization after spending time in traditional community practice. I love business and finance, and our healthcare system definitely needs more doctors leading to make smart decisions.
1/4/25 (Medicine)
I had a tough clinic day yesterday, because I had so many patients and they were all kind of complicated honestly. I feel like I am not learning or studying enough, and that I am just doing. I make silly mistakes in clinic all the time.
1/15/25 (Medicine)
Sometimes it does feel frustrating that there is always another thing to learn & never a place I feel super confident. FM is hard. Also, I’m wondering how much guilt I’ll feel about working, and how much I’ll want to work later. I can see why being a woman, and a mom in medicine, feels hard.
1/26/25 (Medicine)
I realized I’m so focused on “getting it right” with the patients in clinic and elsewhere, meaning putting in all the orders & diagnoses, that sometimes I look back and realize I doubt the patient thought I was listening. Even though I was. I am going to improve my precharting so I can get better at this. They deserve to feel the presence, even though to me it’s obvious that I am there for them.
A home off the streets
the crotchety old, unhoused, COPD lady who had an admit almost every 3 days, who finally agreed to go to a nursing home
James
the story of my co-intern, James, who kept visiting his old patient on surgery months after the rotation ended
the light
in clinic, the cutest deaf kid, whose face lit up when he spoke with the video interpreter
anxious ladies
a lady’s first pap smear
my first continuity OB patient in my clinic, for their first pregnancy
the anxious mom who I had stolen from OB & put in my clinic
I am cool like that I guess
“I think it’s cool you actually listen.” - a patient with chronic vomiting, dizziness & migraines. A patient I eventually diagnosed with a hiatal hernia.
3.2.25 (while I am in the Emergency Room).
I did a thoracentesis and paracentesis that I was really proud of although they were actually quite procedurally easy. I have just come so far from what I thought I could do before intern year. It’s a testament to JPS and how much they support you. I still run from intubations though…I don’t want to do those.
Needs no title…
“My insurance said no. He said yes anyway.” - lady with pneumonia and a CHF exacerbation, referencing one of our cardiologists here who put her on her medication regimen.
Wife & Husband
“She’s real good. I remember her from my appointment.” - a wife who saw me in clinic, and then months later I ended up admitted her husband to the ICU from the ED.
Trust Fall to JPS
“I couldn’t afford it, so I quit paying my health insurance because I knew JPS would take care of me.” - a construction worker who came in with a slipped disc.
Old Wallet Pictures
mildly suicidal man who I had screened, reassured and given resources. he stopped me as I was walking by later to show me a picture of his kids that he had in his wallet.
Some Rest
the woman who I kept trying to loudly wake up to do a neurological exam, but my voice quieted when I saw the toothbrush, socks, and paste on the inside pocket of her jacket.
Undeserved Patience?
why didn’t I mind, at all, the super rude, mean, ornery old man that I did the paracentesis on?
A smile
Saw the super, depressed, bipolar, foster kid with some serious trauma from clinic again, and she was smiling this time.
5.3.24
I love how being competent in OB makes me feel, but I don’t really connect with the patients inpatient. I look back and see I have not written any patient stories here during my actual months on OB while on Labor and Delivery. Maybe it will feel different with my continuity deliveries, or after I have my own kid?
I will say with this last month on OB: it all clicked. I could coach women and myself through tough cervical checks, break bags of water, place internal monitors, deliver patients off epidural screaming in languages I don’t know, repair 2nd degree lacs, and still stay well through OB nights. My journey in OB probably deserves its own multi-page essay, to be honest. Holy heck that was probably the steepest and most gratifying learning curve that I am sure will continue.
Nexplanon Tales
the 19 y/o first visit to the OB, who wanted a Nexplanon, and I coached her through the whole procedure for 30 minutes as she kept crying, screaming, throwing up…the whole shebang.
Other Contraception Tales
contraception counseling another 19 y/o who kept getting really shy & embarrassed. I’m bringing her back in another two weeks after she’s “mentally manifested to talk about this.” :’).
Next Volume: field tales of a PGY-2 FM Resident. :). although, intern year isn’t quite over yet.