Young, aspiring doctors are the Iron Youth of this generation. In Erich Maria Remarque’s All Quiet on the Western Front, young German soldiers are called the Iron Youth as part of a campaign to generate enthusiasm for fighting in the war; these soldiers soon realize the true horrors of war and its lasting impact on the psyche. The analogy is not necessarily to compare residency to war, but to highlight that many young physicians also experience similar disillusionment as they go through their training. There are long working hours, high-stress conditions, seemingly inadequate pay, and for some of us — surgeons, anesthesiologists, ER physicians — horrific traumas that sometimes make us feel like we work in a battlefield. There are many things I wish I knew when embarking on my medical journey; I like to think it may have prepared me better for what was coming, but who knows? At the very least I hope it will be useful to you or someone you know who is considering a career in medicine.

1. Learn how to live like a resident. College and medical school are expensive, and a resident salary is barely enough to make ends meet. We never grew up ‘rich’, but my parents always made my brothers and I feel like we were. I know many people raise families on a resident income and I admire them for it.

2. As a female, you will be treated differently. The way you dress, speak and perform your clinical duties will be heavily judged. This is a deep-rooted problem that we all collectively contribute to as a society. Remember when Dr. Tamika Cross was told to get out of the way during a flight emergency? This is not just about men treating us differently; as females, we need to lift each other up and take each other seriously. It took a solid three years for me to build the confidence to have a voice in the medical field.

3. You can do anything you set your mind to, including working >24 hours straight. It will teach you what true exhaustion feels like. My occasional insomnia is completely cured.

4. Every day is an opportunity to learn. It is a tough yet exciting transition to go from watching someone else learn to becoming the learner. How does one go from intern, hands shaking while wielding a knife for the first time to confident senior resident cutting into a patient’s neck for central venous access? Dr. Atul Gawande’s words resonate with me every time I learn a new procedure: “I still have no idea what I did differently that day. But from then on, my lines went in. Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you’ve got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.” It’s all relative: as the newly minted intern is amazed watching the senior resident smoothly put in a central line, the senior resident finds herself in awe watching the cardiac surgeons open the chest with a saw. Or maybe that’s just me.

5. You will feel burned out, but always look for the silver lining. Seeing the cystic fibrosis patient go from bed-bound to up and walking with a brand new pair of lungs is quite the miracle. Watching the screaming, laboring woman go from 10/10 pain to 0/10 is pretty great too. Then there are days like today where the only miracle was me not falling asleep at the wheel after a 24-hour holiday shift.

6. Identify your source of support (family member, spouse, friends) and hold onto them tight. You will need them. In addition, a good relationship will complement your time in residency wonderfully. However, a bad relationship will be destructive personally and professionally, so choose your partner wisely.

7. Take care of yourself. Exercise is an underutilized antidepressant that can improve both physical and emotional health, and journaling is a great way to handle the difficult emotions that come with residency.

8. These are the most difficult years of your life, but you will never regret them. There is a light at the end of the tunnel. The tunnel itself can be dark and damaging, but you will make it out of there stronger than ever.

Gawande, Atul (2003–04–01). Complications: A Surgeon’s Notes on an Imperfect Science (p. 21). Henry Holt and Co.. Kindle Edition.

These piece originally appeared at The Traveling Resident.