As the intern...

I have something of a writer’s block. I really want to write about residency and the amazing things that are happening in my day but the things I think to write about during the day are hard for me to muster again when I get in front of my computer. I’m doing a lot of thinking about personal things, there’s a lot going on in my life, in how I’m thinking about and reacting to my life. My kids remain brilliant and shining humans, doing such great jobs with the very difficult tasks of being adolescents, having a busy working mother and being in a new school & town. I want so very much to think about and write about what is happening at work but I’m just not in the head space for it yet.

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I just finished week 1 of 6 of the gyn oncology rotation. This is a challenging rotation - we have really sick patients, with lots of co-morbidities (they have more problems than just cancer), they are lots of different ages and at different stages of disease. We spend a lot of time in the OR and we have a lot of management responsibilities for the patients who are on the floor. The is significant learning is in every facet of our day. Interns cover the breast cases, which is fantastic experience that many don’t get in residency.

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I’m on my gyn/onc rotation now, and as the intern, you do a lot of breast cases, which is spectacular experience and a really special part of my residency program.

In the first few days of this rotation I have done breast cases for women ranging from their early 30s to mid 70s. One of the most striking things for me, as an intern surgeon, is the differences in the skin of women at different ages. Not the cosmetic, external differences, but the cellular changes. Cutting and suturing skin of women of different ages is different. With younger women you have to put more pressure on the scalpel to get through the dermis. With older women, the layers are thinner and suturing requires more precision to be certain you are in the correct layers.

All this makes me feel a lot better about aging. I mean, I may not like my wrinkles and the subtle (I like to tell myself) sag that my skin has taken on as time goes by, but it isn’t as if I can do anything about the fact that my collagen is breaking down and the cell layers in my skin are thinner than they were 15 years ago. So yeah, I have wrinkles, and I look like I’ve lived a life that could have raised 2 teenagers, and not have been a teen mother either. And sometimes when I introduce myself as “Larissa, one of the new OB interns” people can’t help but spurt out questions about my life before medicine. “You look old to me, I’m curious about why you don’t match my mental image of ‘intern’, tell me intrusive details about your life.” But it isn’t like I can help it. It isn’t as if there’s something I did to make my skin get thin. It just happens. Time marches on. And sometimes, depending on my mood and the setting and the manners of the person who asks, noting that I’ve got “mature skin” gets you an interesting, funny story about my life. And sometimes it just gets you a funny look and someone who pretends not to understand what you are asking her.

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As an intern, I have to work with a lot of new, different people. Nursing & clinical support staff deal with a new batch of interns every year and you know there are some who are a little tired of the same mistakes, slow technique, unfamiliarity with protocol. I don’t blame them. I”m fed up with my own amateurishness, and I’ve only had to deal with it once and for a few months! Generally speaking, though, the staff are very supportive and positive about helping us to learn to do our jobs. There is, at least in my hospital, a huge culture of respect. I think hope the douchey intern who disses nurses is no longer a real attitude and relegated to being just a tired, Hollywood trope (I’m thinking of that one episode of Grey’s Anatomy that I watched).

And each attending has their own surgery style, preferences and teaching method. Some are socratic, some are sink or swim, some ask you a question and then stare at you blankly while you fumble your way through an answer. Some are really good at giving positive feedback to the fragile ego of new doctors and others give less ‘sandwich’ feedback but when you get a “perfect” or “just like that!” from them, you know you really nailed it. With a rare few, I feel like it might actually physically pain them to say something positive.

And just like any workplace, some people are easier to get along with than others. Some people don’t gel as a pair or a team, others push your most tenderest buttons. I try really hard to see the Shadowself in my tough interpersonal interactions. Maybe there’s something they do that is a little too familiar in my own behavior? Maybe the way I perceive their treatment of me really feeds that negative self-talk I’ve been trying to overcome since the moment it was programmed? What is there that I can learn, change, adapt, in this situation? And I’m also trying really hard not to knee-jerk react. The hypervigilant streak I have is a mile wide and so easily fed just about any human interaction. I’m trying to sit with my feelings about these interactions and not draw conclusions. To approach them with curiosity. Often I am successful. Well, eventually I am successful. Sausages, laws and mature interpersonal reactions are all very messy in the making.