Congratulations are in order – welcome! The title “Doctor” will feel strange, but in this moment, it will taste sweet, so savor it. I’m writing to you at the cusp of completing my own intern year. Yesterday I spent the day seeing patients for whom I’ve become their primary care doctor. I held space for the tears of dark depression and the physical manifestations of debilitating anxiety, and counseled on the importance of diet and exercise to control newly diagnosed hypertension and hyperlipidemia. Today I’m sitting at a coffee shop, at the hopeful end of a relentless pandemic that has marked my intern year, writing this letter to you not only as a method of my own reflection on the events and growth the year has brought me, but also as a means to prepare you — if only through a glimpse — for what intern year has in store. Tonight, I’ll be in the ICU. The last time I was in the ICU was in August; I was a terrified, month-old intern, unsure of my capacity to help people in their sickest moments. This time around, I carry a refined sense of weariness. I am no longer doe-eyed. I trust (in part) in the competency I have built. This transition has me in disbelief. I share this with you as you are about to embark on a similar transformation, one that will occur subtly until you find yourself at the cusp of completing your own intern year, marveling at how much of you has changed.
I must warn you, when your first day as an intern comes, it will undoubtedly be a shock to your system. You will inherit patients from ex-interns who are now your seniors, and the expectation will be to doctor. It will be an exponential learning curve. As those who have come before you will tell you, it is normal to feel uneasy in your new role – for the first time, you will feel the weight of a binding title. You will be engulfed by phones that never stop ringing, a pager you are still trying to navigate, calls of “doctor” from nurses you will try to learn the names of. You will be thrust into answering patients’ and family members' questions while wondering if you’re doing “this” right. After your first rounds, you will sit in front of a computer screen at a standstill, wondering what in your never-ending to-do list you should do first: the orders, the discharge summary, the progress note, the family updates, the follow-ups? Time will run. Your first inclination will be to stay late, to carry the weight of doctorhood heavy on your shoulders. We will ask you to go home and conserve your energy. At the end of this day – the first day in which your long-sought-after dream has finally become reality – you must give yourself grace.
There will be days that are exceptionally difficult. You will realize, while trying to coordinate care and advocate for patients, that we have a widely inefficient and broken health care system that prevents you from practicing the medicine you have learned. I want you, rather than be discouraged by this broken system, to be enraged by it. Let that rage turn into the action we need to change medicine. You will endure patients who, in their illness and mortality, vent viciousness at you. I want you to know that facing mortality is terrifying, and this is not a reflection on your ability to care nor your capacity for empathy but a lesson on setting boundaries. You will experience guilt that comes with loss – an incessant questioning of your knowledge and actions in a game of remorseful what-ifs. I want you to know this sense of guilt has befallen us all — it is not guilt you face alone.
I was told early that the biggest lesson of intern year is knowing when someone is sick. I could not fathom how that could be possible. The battle here will be impostor syndrome – you must trust yourself, trust your ability, trust the education you have received thus far, and trust in the capacity you have to learn, and to learn exponentially. A good intern does not know the answers – a good intern learns and absorbs them. When the moment comes in which you see how much you have learned and how instinctual medicine becomes, it will bring you simultaneous awe and grief. This is the practice of medicine: in continuously gaining knowledge, we lament the loss of our innocence. This is the year you will learn not only how to heal, but also the extent of our limitations. You will see how we prepare ourselves for what we know is beyond our control. You will see how this is medicine’s forever balancing act.
There will be days that are exceptionally beautiful. In your colleagues you will find a sense of camaraderie like no other. You will learn that we carry and uplift each other, that we give space for our rage, our grief, that we still remember to laugh. You will discover that there is a lightness in us, and that light survives courageously. In your patients, you will find gratitude in the gift of life, in the audacity of love, in the strength of compassion, in the resiliency of adversity. You will absorb the histories you acquire that give you a glimpse into people’s lives, and you will see how a single moment, a series of small acts, can reverberate for lifetimes. These will be the days you seemingly glide through halls, in which you remember your calling. These will be the easy days.
Among all the ebbs and flows, you will learn how to carry knowledge, perform miracles, give into fate, and repeat these actions hundreds of times. Write it into hundreds of notes. Speak it in hundreds of calls, to hundreds of families. You will take care of hundreds of patients, and hundreds of them will be able to go back to their lives. And eventually, you will learn how to go home, tuck doctorhood away, and be present in your own life. You will witness how limited our time is, how precious our love can be, how essential support becomes, and how every moment we spend with those outside hospital halls is a privilege to be cherished and honored. Do not let your intern year engulf your identity: let it be a continuous reminder of your humanity, your vulnerability, and a perspective on life few are able to see.
This year – your intern year — will not be about perfection, so do not let perfection consume you. It will be about survival. It will be a mixed bag of hope and despair, of miracles and tragedies, of loss and recovery. When grief comes – as it will – do not allow it to overwhelm you. When joy comes – as it will – cling to it with all you have. When guilt comes – as it will – know you are never alone. Humanity will feel as if it rests on your shoulders, but it does not rely on your strength alone. It is a collective of people struggling, guiding, loving, learning, together – it is us against a system that benefits from our compassion, empathy, and altruism. To be an intern is to learn that we become doctors that carry contradictions with firm tenderness.
Dear Doctor, congratulations. Remember when you’re in the drudges that some part of you always dreamed of this. Here you are living it. At the end of this, I hope you see what I see now at the cusp of finishing this year — it is truly worth waking up for.
What would you put in a letter to the next intern class? Share your advice below.
Dr. Zainab Mabizari is an internal medicine resident in the social medicine residency at Montefiore. She completed her medical education at Baylor College of Medicine and received a master’s in Narrative Medicine from Columbia University. Pandemic permitting, you can often find her reading in a coffee shop or performing poetry at a local open mic. She is a 2020–2021 Doximity Op-Med Fellow.
Illustration by April Brust