Time Stamps
Previous Episodes
July Stories (2019)
July Stories 2.0 (2023)
Transcript
Dr. Shreya Trivedi: 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. Shreya Trivedi…
Dr. Marissa LoCastro: And I’m Dr. Marissa LoCastro. And to kick off our stories, we would like to introduce Dr Ali Trainor, a pulmonary and critical care doc from Mount Auburn Hospital. You may know her voice from our gray matter series.
Dr. Shreya Trivedi: 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. So that context makes this story even more of a shocker.
Worst Doctor Ever
Dr. Ali Trainor: It actually happened on the first clinical day of my internship. 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 is admitted by the IR team and interventional radiology doesn’t have their own service. Medicine takes care of those patients, and so she’s post procedure for a uterine artery embolization. The resident signing her out says, these procedures are painful, but she’s just here for post operative monitoring. Blow on your list. I see her plan to see her last. And the nurse comes and grabs me and says, Mrs. X is asking to see you because she’s really short of breath. 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 intern, so I take a listen to her lungs, take a listen to her heart. Press on her belly. I don’t find anything super abnormal. I go to my resident and I say, I don’t know what to do. She seems really upset and concerned. Can you please just come look at her with me? My resident comes with me. We step out of the room after she does her evaluation, she explains, she did have a uterine artery embolization, so essentially, her 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 together, we reassure the patient, we tell her we’re going to give you some pain medications. This is expected. This is normal. It’s uncomfortable, but this is within the realm of what we’d expect. 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 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 everyone on the entire medicine floor, comes rushing into this patient’s room, and she now is hypoxic bolt right 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, 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 told 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, it wasn’t common. The interventional radiologists weren’t exactly sure what happened to her, either, but the theory was she had some sort of reaction to the glue that they use to embolize her arteries, and then developed ARDS as a result, so not an expected complication. But in the moment when you’re that devastated and been outed as the worst doctor ever, none of that reassurance hits home. 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…
Dr. Shreya Trivedi: Oh no…
Dr. Ali Trainor: Immediately start sweating. Oh, shoot, he heard that I’m the worst doctor ever, and now he knows, and I’m getting fired, and so scared, and so I call him back, Yes, I’m free. And he’s like, Okay, “Where are you? I’m gonna come meet you in person.” And that’s it. Like you don’t get fired over the phone, he’s coming to fire me. The program director, he’s so nice, he wasn’t 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. No, it was ridiculous. It was absurd. I’m bawling my eyes out, and I’m like, you heard, and he’s like, “Yeah, I did, and I’m here to check in if you’re okay.” He said the same things, was very reassuring, “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 interim year, and I just wanted to check in and let 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, the imposter syndrome. I don’t know if it ever took, if it ever totally goes away, but I don’t. I wish I had a tidier way to tie up this story, it was like all my worst fears were realized and put on stage within an hour of being an intern. It was just…
Dr. Shreya Trivedi: Oh my gosh..
Dr. Ali Trainor: Horrifying!
Dr. Shreya Trivedi: And then looking at your successful pulmonary critical care doctor now.
Dr. Ali Trainor: It happens. You can make it. If you get called out on the first day of intern year as being the worst doctor ever, it’ll be fine, maybe.
First Night Shift
Dr. Marissa LoCastro: And Ally 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.
Dr. George Tran: So the beginning of intern year, which I started on a night float, because why not just dive into things and start cross covering 90 plus patients on day one? The first page of the night, the quintessential request for Tylenol for a headache, and I completely spiral. I start catastrophizing, and I’m thinking, what kind of headache is it? What if I miss something? Do I need to get a CT 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. Thanks.” 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 really hope reading it out loud to the patient will be in it. And so off I go, knock, knock. I introduce myself as the nighttime doctor, and then I do my best audiobook impression, right off like reading off this bronchoscopy report. Honestly, looking back, I had no understanding of what I’m reading, no context, no real clue on what’s happening. And then the patient, she asks, well, Doc, what does all of this mean? And at this point, my mind goes blank. The dial up tone of the modem plays in my mind as my gears are spinning. And then the dial like of the imposter syndrome just goes up to 10,000 right? I want to melt into the wall rather than admit like I showed up here not knowing what’s going on?
Dr. Shreya Trivedi: Yeah, definitely.
Dr. George Tran: I think she really caught on to my discomfort very quickly and saw that I was out of my depth. And then she asks me, “Oh, can you remind me of your name again?” And then my stomach drops because I’m immediately thinking, she’s gonna make a note of who this incompetent doctor is, so that she can avoid me in the future. Instead, her face lights up and she says, “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, I am trying to interpret a bronc report with my friend’s mom, who I hadn’t seen in over 20 years from elementary school, was just so shocked right by the sheer coincidence or serendipity of it. She doesn’t ask about the bronch 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 daytime doctors will be able to share more since they know me a little bit better.
Dr. Shreya Trivedi: You’re like, yes, that is what I needed to tell you in the first place.
Dr. George Tran: 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. 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.
Dr. Shreya Trivedi: 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.
Dr. Marissa LoCastro: I love that Mama Trivedi 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.
Imposter Syndrome
Dr. Ali Trainor: This was my second rotation of being an intern, so maybe, August, not July, but we were in the CCU, the cardiac intensive care unit, and I remember not feeling like cardiology was my strongest area. I remember even just struggling to find the JVP on everyone. I was just writing on every patient exam like, JVP, limited by body habitus, because I just couldn’t figure it out. And kindly, he wasn’t doing it meanly at all, but in front of everyone, the attending was like, “You got to try, you can’t keep writing that. You need to try”. And then right.
Dr. Shreya Trivedi: After your attending was like, literally reading every JVP exam part.
Dr. Ali Trainor: Well, I think I was saying it verbally on exam. I was like, JVP, couldn’t be evaluated. And he’s like, this patient’s BMI is like, 12, you need to try and so. And he was, again, so kind, but kind of right after that happened, then he asked me a question about anticoagulation, platelet management, and antiplatelet management. And I was like, “I don’t know what the right answer is.” And he was like, “That’s great, because there is no right answer. We don’t have any data on this yet. It’s a data free zone, so we kind of have to make it up.” And I’m like, okay, thank God. I’m safe. I got something. And then as we’re walking together to the room to examine the patient, my co-intern, tugs on my shirt, and he was someone I worked with while I knew him. I love him, but he kind of pulls, tugs on my shirt and whispers, “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. He’s publishing in the New England Journal, and I can’t find the JVP. So that was just like, it’s and all that again, just like.
Dr. Shreya Trivedi: 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?
Dr. Marissa LoCastro: 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.
Dr. Shreya Trivedi: Yeah, maybe the best way I think to end this July story is with everyone thinking about how we can best support each other with all the growing pains in a career in medicine.
Lean on One Another
Dr. Ali Trainor: It’s so important to rely on your co-interns. That same co-intern, because the way that we do it at BI is you have one or two people that you end up doing a lot of your rotations with, and my co-intern who is in the CCU, 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, had cookies delivered to the hospital to make me feel better.
Dr. Ali Trainor: Actually, that afternoon, I didn’t even know him, it was our first day, and he was like, “Wow, our day really sucked. Let’s get some cookies.” I think it’s just, lean on your co residents and co- interns, lift them up when you’re feeling a little bit better. Because that day, in hindsight, was hilarious, but in the moment, so traumatizing. And it did take off a bit of a sting that someone else have a cookie.
Dr. Shreya Trivedi: 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 context, new juggling acts are constantly being thrown at us
Dr. Marissa LoCastro: So we will leave you with just that. How will you lift up those around you this July?
Dr. Shreya Trivedi: Yes, I think baked goods are always a good one. I think if it were me, I’d love to have quick mini dance parties to shake off any bad juju and reset. But I think patients might think we’re a little crazy on the floor.
Dr. Marissa LoCastro: Hey, don’t knock it till you try it. Look. Listeners. If you have any creative ideas on how to build up your colleagues in July or just in general, anything you do or say or things that have been said to you, we’d love to hear it. Please write in the comments on our website.
Dr. Shreya Trivedi: Nice 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 value from this podcast, our ask is you share it with at least one other colleague with that. Thank you again, and take care and best of luck this July.
Tags: growth mindset, July Stories, medical education, medical training, residency