My First Day By Daniel Rosas, MD

My First Day

By Daniel Rosas, MD

Finally, July 1st: I’m starting my internal medicine residency in the medical ICU service, on night shifts. Imagine starting a new dream job in a brand-new place, in the middle of a global pandemic, and with a new electronic health records system. This was going to be fun.

The local surge of COVID-19 cases in the city, as well as in the hospital where I was going to start, made me nervous about this great learning opportunity; but finally, the opportunity to help! Until now, I had only experienced the pandemic on a television screen. Now, at 10:00 pm, there I was, fueled with coffee, stethoscope and pens ready, pager on, looking professional with scrubs and badge, ready for anything … or so it appeared.

Upon arriving at the ICU and introducing myself to the resident, he asked me why I was there so early. The answer came with a nervous and shaky voice tone; it was my first day so “early meant on time”. The resident was very kind and took me to the workroom to review the patients to be assigned. They assigned me a total of six patients; four of them were diagnosed with respiratory failure due to COVID-19. That is scary. Immediately the images of healthcare workers seen on the news for the past months were a reality. From that moment on, I was one of the healthcare workers, and although scared, eager to help and learn.

The resident instructed me to chart-check my patients; so, the attempt at navigating the new electronic health record system began. Tutorials used during orientation had not prepared me for this. With no idea what I was doing, after some struggle I found out how to read previous notes; they were filled with more abbreviations than everyday text conversations with friends. Not being sure about what details to pay attention to, almost everything was written down. I googled most of the unknown abbreviations, wrote the word “medicine” after the abbreviation, and Google almost always had the answer. The computer next to me showed that someone had searched “what does I/O mean?” Good to know I wasn’t the only one feeling lost.

Six hours later (that’s right, one hour per patient), it became clear why during orientation they had told us so many times “do not worry, you will get efficient reviewing charts with time”. This made so much sense now. When reading patients' charts, most of the patients with COVID-19 were in their 40s and 50s and were very sick. It was while checking the chart of my 4th patient with COVID-19 that I saw something that I will never forget. The patient was only 18 years old! This shook me to my core. Although the scientific data shows that older patients and those with comorbidities are at a higher risk of a severe infection, there isn’t an age range that is immune to the virus. It has also been shown that in the current surge, the higher number of cases have been in a younger population than it was during the first wave of infection. One reason is the reopening phase, which puts the younger population at risk of infection when going outdoors more-so than with the older population.

Continuing to evaluate the patients, I wrote down my findings and started getting ready for rounds. When the attending entered the room, we all introduced ourselves and then we went on to start rounding. Three pages of notes per patient contained random facts and lab values written all over the pieces of paper; there weren’t enough pockets on my scrubs to fit all those paper sheets. Each time upon presentation, the resident and fellow corrected me on lab values, medication doses and 24-hour events, among many other details I either had not found or presented the wrong number. After reporting the wrong “I/Os” on my first four patients, on the 5th one I told the attending I was sorry but now knew where to look for that information the next time. The attending said it was alright and, since it was July, everybody understood that we were just starting and getting used to everything. This was so encouraging to hear, and it was said with such a positive attitude that I wanted to show up the next day and be ready and more efficient than the day before. What an example she was being for everybody there. It’s hoped that the fellows, residents and interns from that moment on will follow this approach with their future interns on their first day. If it hadn’t been for this amazing group of co-interns, sensational residents, a mind-blowing fellow, and a one-in-a-million type of attending, I don’t know what would have happened to me.

Maybe it was just luck having those types of people around me the first day, but I could not help but think about other interns on their first day who had a superior that was demeaning and treated their interns/residents/fellows with aggressiveness and shame. That kind of behavior and medical education philosophy makes people feel bad about themselves when they do not know the answer to a question. I believe this type of educational philosophy must change.

Every physician should remember their first day as an intern when they read this and, regardless of how that day was, be willing to help people on their first day on the job. This not only gives an example to follow but encourages us to do better every day. I hope that every healthcare worker remembers and sees how far they have come and how strong they have become along the way to face challenges like the one we have been facing for months, and probably will face for months to come. Thank you to the teachers that gave us good examples to follow but thank you also to the teachers that show us how we are not supposed to behave. Inevitably, the student becomes the teacher.

Daniel Rosas, MD is a PGY-1 in the Internal Medicine Residency Program at UT Health San Antonio.