Welcome New Residents, Watch Where You Step!



Today is the day that new resident physicians begin their training all across the United States.  Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.  Extraordinarily well educated, driven, disciplined, anxiety-filled and debt-ridden, they will embark on four to seven (or even more) years of training to make them into practicing, life-saving, life improving physicians.

I will occasionally wax poetic and philosophical for their benefit.  But not today.  Today there are practical matters.  Today I want to give them a few pointers, to ease their transition into the maelstrom of post-graduate medical training.

1)  Any flat surface that holds still, is free of gross body fluids and not used as a walk-way or cook-top will serve for a quick nap.  Practice sleeping in odd positions:  sitting upright, reclining at various angles, lying sideways, lying next to your untouched food or with your head cradled in your hands.

2)  In my day (always wanted to say that!) we filled our fresh, white lab-coat pockets with review books, algorithms, reference manuals, scissors and calculators.  And candy bars.  You, doubtless, have a smart-phone of some incarnation, which contains all that we had, as well as the Web.  Which means, where we had to play video games in the lounge and find answers in giant, antiquated things called attending physicians and books, you can look up fun facts on hyponatremia, clotting cascades and NG tube sizes and then instantly check your Instagram account, whether you’re on rounds, in the cafeteria or hiding in the call-room, pretending you didn’t hear ‘code blue.’

3)  Eventually, you may decide the lab-coat isn’t worth it.  Don’t be surprised.  Your kids will eventually wear it for Halloween.

4)  If you keep the lab coat, what with the extra space in your pockets, carry extra candy bars.  Or protein bars, or whatever it is you crazy kids snack on these days.

5)  Watch where you step.  Trauma patients and cardiac arrests are exciting!   But there’s almost always some body fluid on the floor when the shouting is over.  Try not to get too covered in blood early in your call night.  It’s sticky and gross.

6)  You know so much.  You don’t know anything.  Keep those two ideas in constant tension.  Odds are, your command of modern evidence-based medical research is extremely impressive.  28 years after residency, I can still leave you in the dust when it comes to making decisions and knowing who is sick and who isn’t.  And I do it all while holding a donut and being bitter about politics.  (Attendings are people who have seen and done a lot, and are able to tamp down their own inner rage and still treat patients, teach you and be professional.)

7)   Learn, as quickly as you can, who is sick and who isn’t.  Medical school helped but you just need to see more.  If you know this simple thing, you will know when to go for help, when to panic (or not) and what to tell your upper level residents and attending physicians on rounds.  And you will become that greatest of commodities:  useful.

8)  Look professional, develop your own style.  Be comfortable.  My friend Sherri used to wear pearls on call, with her green scrubs.  They always made her appear elegant, no matter how much pediatric vomit had been hurled her direction.  As an ER doc I’m duty bound to wear a polo shirt under a scrub shirt, with cargo pants.  (The ER equivalent of a lab coat.)  Some call it the ER Mullet.  You’ll find your own look.

9)  Patients can be frightening.  But remember what they told you at camp, about bears, raccoons and snakes.   ‘Don’t worry, they’re just as afraid of you.’  This is kind of true.  Except patients really aren’t afraid to ask for pain medicine or call attorneys, whereas you are afraid to do anything since you can’t believe you know anything yet. Even though you really, truly do know a lot.

10)  You may be more frightened of physicians than patients.  But remember, the people assigned to train you are smart, capable and experienced.  And they put their tentacles in their pants just like everyone else.  Ask them questions, listen and watch.  And remember what I said above:  be useful.  My surgery resident was fond of saying, ‘Help me, don’t hurt me!’  Of course, he also said ‘call me if you need me, need me if you call me, to call me after midnight is a sign of weakness.’  He hated me.

11)  You will soon have a thing called a paycheck.  It will have a stub that shows how much the government is taking from you.  Do not be surprised.  This happens to everyone.  It’s just that you owe a lot more money than most people.   Cheer up!  Everyone expects you to be rich someday, so they can complain about the fact that your rich.  (Whether you will be or not remains to be seen.)  Remember that no matter how little or much you make, never tell a building contractor or car-dealer you’re a physician.  Tell them you work in customer satisfaction, or something nebulous like that.

12)  Crazy people, even really crazy people, are sometimes terribly ill.  Pay attention.

13)  Ill people, really ill people, are sometimes very crazy.  Pay attention.

14)  Medicine is inexact.  I promise you will make mistakes. Don’t live in fear, and don’t let error define you.  No one in medicine, or law, is capable of perfection.  Except for being perfectly insufferable, of course.  In the end, you will have helped far more people than you harmed.  This will be true much sooner than you think.

15)  If you poke things that look like they are filled with blood or pus, they will explode into your face; if you tend to hold your mouth open when you focus, well you know what will happen.

16)  Scalpels really are sharp.  Pneumonia, HIV, TB and Hepatitis really are communicable.  Psychotic patients really will sometimes try to choke you.  Medicine is dangerous.  Be careful out there!

17) Some of the nicest people you meet will be in handcuffs and orange jump-suits.  Some of the worst will be professionals in business attire. With clip-boards.

18)  Human beings are really frail, vulnerable and hurting.  Be gentle and kind whenever possible.

19)  Have fun!  Don’t think of it as residency, think of it as a chance to spend most of your waking and many of your sleeping hours in a huge, cold-building where people are dying.  And where sometimes you help them to escape without dying.

20)  Everyone is proud of you.  I know I am.  Well, that kid you went to school with who called you a giant nerd? He still hates you.  But that’s OK.  He plays video games and smokes weed all day, so….

21)  Pay attention to what the nurses say.  They have useful insights.  But learn in due course to see past what they say and make your own decisions. Nurses are as human as everyone else and can be influenced by fatigue, hunger and burnout. And many of them have not been nurses all that long. They’re still learning also.

22)  Do NOT let physician be your entire identity.  You are far more than a doctor and doctor is a far smaller thing than ‘human being.’  Find solace in more than your work.  Find love, find connection, have a hobby whenever you have time.  Some weeks sleep will be your hobby.

23) Figure out how to address the suffering you will see.  My faith helps me here.  But even if you do not follow any faith, consider ways to cope with and comprehend pain and loss.  Philosophy, art, psychology, nature and other things can help you process the hurtful things you will see.

24)  If you despair, if you consider hurting yourself, if you find yourself turning to drugs, alcohol or unhealthy sexual practices in order to cope, then please ask for help.  And if you just can’t take it, then quit.  Move on.  It may be that the world needs you somewhere else.  Better you’re still with us than gone from us, doctor or not.

25)  Laugh whenever you can.  And cry whenever you need to.

26) When your supervising physician tells you to go home and get some rest, do not argue.  Say thank you, turn and run.  And enjoy your time away.

27) Nobody, and I mean nobody, has sex at the hospital as much as they do on television dramas.  Sorry to burst your bubble.  Most of the time you’ll be too tired anyway.  And you need a shower!  What’s that on your scrubs?

28)  Jokes on you!  Internship and residency are really training programs in computer data entry.  Sucka.

29)  Only three to seven years to go!  Hang in there.  Remember, it’s no different from Boot Camp.  It just lasts much, much longer.

30)  About COVID.  Be careful.  It’s a dangerous thing, but not the worst thing.  And remember, infectious diseases are kind of part of the job.  Don’t start wearing your ‘hero’ shirt in public quite yet.

Have a great year!


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