#181 July Stories 3.0

I am so excited to have NEJM's editorial fellowship program as a sponsor for this podcast. Hear from Dr. Harleen Marwa, an NE Jam editorial fellow, on her experiences.

I'm thinking about like what brought me to the fellowship and really it was I really wanted to like strengthen that muscle and being able to communicate science well. And so If that is a skill that folks are looking to strengthen, if folks want to get really strong at reading the scientific literature, interpreting it for themselves and then being able to communicate that effectively with their colleagues or their patients, then absolutely this is the experience for you.

Uh, I think if you're someone who also maybe like me was missing using the creative side of my brain during residency when we're so like grounded in illness scripts and clinical algorithms, then it's also like a nice breath of fresh air after your training or after a bit in clinical medicine to come up and think creatively about science and how we communicate it. And this is a one year full time paid editorial fellowship.

Check out the show notes from the link and learn more about the program and the application. It's that time of year again, dun dun dun July. And at Core IM we like to add some levity and realness with some heartfelt stories of all the mixed emotions and experiences this month can bring. I'm Dr. Shrey Trevetti. And I'm Doctor Marissa LaCastro, and to kick off our stories we would like to introduce Doctor Allie Trainer,

a pulmonary and critical care doc from Mount Auburn Hospital. You may know her voice from our Grey Matters series. Yes, and just for context, Allie is a rock star. The first time I heard of her, someone actually described her as perfect in every way. Um, so that context makes this story even more of a shocker. It actually happened on the first clinical day of my interneur. I'm rounding or doing my pre rounds on my patients and I have this one patient who was signed out to me as oh, you know.

This patient you don't need to worry too much about because she's a patient who was admitted by the IR team, and interventional radiology doesn't have their own service, so medicine takes care of those. And so she's post-procedure for a uterine artery embolization. So the, you know, resident signing her out says these procedures are painful, but she's just here for post-operative monitoring low on your.

So I see her plan to see her last, of course, and the nurse comes and grabs me and says, you know, misses X is asking to see you because she's really short of breath. So I go in to see her and she's crying and she's telling me that she's really uncomfortable and really short of breath. And I'm you're scared first in turn. So I take a listen to her lungs, you take a listen to her heart, press on her belly.

I don't find anything super abnormal. So I go to my resident and I'm I say, you know, I I don't know what to do. She seems really upset and concerned. So can you please just come look at her with?

My resident comes with me. We step out of the room after she does her evaluation, she explains, you know, she did have a uterine artery embolization. So essentially her s whole uterus is necrosing. It's incredibly painful and it's really hard to take deep breaths when you're having a lot of abdominal pain.

So we, you know, we together we reassure the patient, we tell her we're gonna give you some pain medications, this is expected, this is normal, it's uncomfortable, but you know, this is within the realm of what we do. Seems reasonable. I continue my pre-rounding. I get called to see the patient again. And she says the pain meds didn't work. I'm really concerned. And you're not addressing my concerns.

I take a listen again, everything sounds normal. I go talk to my resident. My resident says if the exam hasn't changed, just just do the same thing. Reassure her. I reassure her. go about my rounds and then a rapid response gets called on her. So we rush into the room, my attending, all the nurses on the floor, Other attendings who are nearby, like ev everyone on the entire medicine floor comes rushing into this patient's room.

And she now is hypoxic in her bed, tripoding, and she sees me come in and she points at me and goes, you This is your fault. You are the worst doctor ever. Screaming at me. I am mortified. Because you know every intern Maybe not every. Most interns have that dreaded imposter syndrome. And I was already thinking before this happened, I got here by mistake.

I snuck in and she's already figured out that I don't belong here. And now everyone else knows because I missed something and she has told everyone. So she gets transferred to the ICU, intubated, intubated for I think a week or so. I don't remember all the details. But so I... Hold it together in the room.

Step out into the workroom with my attending. She just looks at me and is like, Are you okay? And I started bawling. And I was so upset. And my attending was so kind and so reassuring. And she tells me all the things that in the moment I didn't believe but were true that I did the right thing. I asked my resident for help.

We evaluated her and her exam was normal at the time. It turns out in hindsight, you know, it it wasn't common. She had the interventional radiologists weren't exactly sure what happened to her either, but the theory was She set had some sort of reaction to the glue that they used to embolize her arteries and then developed ARDS as a result. So not an expected.

complication, but you know, in the moment when you're that devastated and been outed as the worst doctor ever, none of that reassurance hits home. So I make it through the rest of the day. I Go home mortified. Come back the next day, and as I'm pre-rounding, I get a page from the program director that says, Hey, can you come chat with me for a minute?

And I'm like immediately start sweating. I'm like, oh shoot, he heard that I'm the worst doctor ever. And now he knows and I'm getting fired. And I was So scared. And so I call him back and I'm like, yes, I'm free. And he's like, okay, I'm where are you? I'm gonna come meet you in person. And I'm like, that's it. Like you don't get fired over the phone. He's coming to fire me.

He comes, he pulls me into this like the family meeting room and shuts the door and I start crying even before he starts talking. And it was like No, it I mean, it was ridiculous. It was it was absurd.

I'm like bawling my eyes out and I'm like, you heard. Like and he's like, Yeah, I did. And I'm here to check in if you're okay. Like, And, you know, he said the same thing, you know, was very reassuring, was like, I heard the story from your attending, I heard the story from your resident, nobody was tattling on you, but they just wanted to tell me because that was an exceptionally rough

first day of intern year and I just wanted to check in and let you know, you know, you're not the worst doctor ever.

We combed through these applications, we interviewed you, we ranked you, like you belong here. It's okay. And it did still take a few days for that to sink in. And you know, the imposter syndrome, I don't know if it ever totally goes away, but I just Yeah, I don't I I wish I had a tidier way to tie up this story, but I just it was It was like all my worst fears realized and put on stage. within an hour of being an an intern. It was just Oh my gosh.

Horrifying thing. Yeah. And then look at you, you're a successful pulmonary critical care doctor now. It it happens, yeah. You can make it. So if you get called out on the first day of interneur as being the worst doctor ever, it'll be fine. Maybe. And Allie isn't the only one who had a memorable first day of their intern year. Dr. George Tran, who is both a palliative care physician and hospitalist at the West Los Angeles VA Medical Center at UCLA, also took us back to his first night shift.

So the beginning of intern year, which I started on night float, because why not just dive into things and start cross-covering 90 plus patients on day one? And then, you know, the first page of the night, the quintessential request for Tylenol for a headache. And I completely spiral. I like start catastrophizing and I'm thinking, What kind of headache is it? What if I miss something? Do I need to get a C T scan? It takes way too long to order some Tylenol.

And then just when I think I'm getting my head wrapped around this, a second page rolls in and it says, Hey, patient is back from procedure and wants a medical update. At this point I had not yet learned the magic phrase defer to day team. And so I pull up the procedure report and I'm thinking in my head, saying a silent prayer, I I really hope reading it out loud to the patient will will be enough.

And so off I go, knock knock. I introduce myself as the nighttime doctor. And then I do my best audiobook impression, right? Of like reading off this bronchoscopy report. And honestly looking back, I had no understanding of what I No context, no real clue on what's happening. And then the patient, she asked.

Well Doc, what does all of this mean? And at this point my mind goes blank. The dial up tone of the modem like plays in my mind as my gears are spinning. And then the the dial like of the imposter syndrome just goes up. I wanna melt into the wall rather than admit like I showed up here not knowing what's going on. And I think she really caught on to my discomfort very quickly and saw that I was out of my death.

And then she asks me, Oh, can you remind me of your name again? And then my stomach drops because I'm immediately thinking. Huh. She's gonna make a note of like who this incompetent doctor is so that she can avoid me in the future. And instead her face lights up and she says, Huh. Where did you grow up? Because my son had a close friend in elementary school with the same name as you and he used to go on trips with us all the time and he used to come over to our house for sleepovers.

And then it turns out that Here I am trying to interpret a Bronch report with my friend's mom, who I hadn't seen in over twenty years from elementary school. Oh, what a small world. I was just so shocked, right, by the sheer coincidence or serendipity of it.

And w she doesn't ask about the Bronck report after that. She just says, Wow, I'm like so proud of you. You've come a long way. I appreciate you coming by. I'm sure the like daytime doctors will be able to share more since they know me a little bit better. You're like, Yes, that is what I needed to tell you in the first place. Thank you. Exactly. But what really struck me was, wow, it was helpful to get a reminder of how much this is just supposed to be a process and

I'm not really meant to start with all of the answers. And I think she really recognized that, right? Recognized that I was new, clearly didn't know what was going on, and at least I showed up. At least I showed up. That is great advice, not just for new transitions in medicine, but for so many things. Just keep showing up. And I think as my mom likes to add, when you do show up, show up with your full heart.

I love that Mama Trevetti says that to you. I feel like my mantra is when I do show up, try and stay calm through the many ups and downs in a given day. This was my second rotation of being an intern. So maybe August, not July. But we were in the CCU, so the cardiac intensive care unit. And I remember not feeling like cardiology was my strongest area. And I remember even just struggling to Find the JVP on everyone and I was just writing on every patient exam.

like J V P limited by Body Habitus'cause I just couldn't figure it out. Yes. And like in front of everyone and kind kindly. He wasn't doing it meanly at all, but in front of everyone the attending was like, You gotta try. Like you can't keep writing that. You need to try. And then right after Oh my gosh, you're you're your attending was like literally reading every JVP exam part? Well, I think I was saying it verbally on exam. I was like JVP couldn't be evaluated. He's like, this patient's

BMI is like twelve. Like you need to try and um So and he was again, he was so kind, but kind of right after that happened, then he asks me a question about, you know, anticoagulation platelet management, the antiplatelet management. And I was like, I I don't know. I don't know what the right answer there is.

And he was like, That's great because there is no right answer. We don't have any data on this yet. You know, it's it's a data free zone. So we kind of have to make it up. And I'm like, Whew, okay, thank God. I'm I'm safe. I got something. And then As we're walking together to the room to the examine the patient, my co intern kinda like tugs on my shirt.

And he he was someone I I worked with well. I I know him, I love him, but he kind of like pulls like tugs on my shirt and whispers, he's like, I have a paper. coming out in the New England Journal tomorrow that answers that question. And I was like Wow, I don't belong here. Like he's publishing in the New England Journal and I can't find the J V P like So that was just like you know, it's and all that again just what what a thing to whisper.

Oh man, it's amazing how our brain can receive a comment when our imposter syndrome can be so loud. Was the co resident just nicely offering some help for a possible answer? Or was it a comment to make someone feel that they don't belong? And I think despite how much grace we give ourselves, we all deal with the feeling that we don't belong here or frauds, regardless of how accomplished or capable we are. Yeah. And maybe the best way I think to end this July story.

with everyone thinking about how we can best support each other with all the growing pains in a career in But it's so important to rely on your co-interns is you kind of have one or two people that you end up doing a lot of your rotations with. And so the my co intern who in the CCU you know, told me he was publishing the answer in the New England Journal, he was also the one who

the day after that patient told me I was the worst doctor ever, had insomnia cookies delivered to the hospital to make me feel better. Actually, I think that afternoon. And I didn't even know him. It was like our first day. And he was like, wow, our day really sucked. Let's get some cookies. And I think it's just a little bit.

I don't know. It's like lean on your co residents and co interns and, you know, lift them up when you're when you're feeling a little bit better'cause that day was in hindsight hilarious, but in the moment so traumatizing and it did take off a bit of the sting that someone else was like, have a cookie.

Hey, I will take a cookie even on a day when no one is screaming that I'm the worst doctor to the entire floor. The learning curve is just so steep. Even when you're a seasoned attending, right? New situations, contexts, new juggling acts are constantly being thrown at us. So we will leave you with just that.

How will you lift up those around you this July? Yes, I think baked goods are always a good one. I think if it were like me, I'd love to have like quick mini dance parties uh to shake off any bad juju and reset. But I think patients might think we're a little crazy on the floor as doing that. Hey, don't knock it till you try it. Listeners, if you have any creative ideas on how to build up your colleagues in July or just in general. Anything you do or something.

or things that have been said to you, we'd love to hear it. Please write in the comments on our website. And with that, it's a wrap for our episode. We will link our other July stories we've done over the years in the show notes, in the podcast description. Check it out. Thank you so much for listening. If you got some is you share it with at least one other colleague. Take care and best of luck this July. Dinner time it's where

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