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I remember it like it was yesterday. Orientation had concluded, and it was showtime. Officially July 1. It felt like all the cramming from the last few weeks was sitting astutely in my upper chest. My breathing was fairly shallow, and my brain was in an emotional fog, resembling a salad. Internal neon flash signs were going off every few seconds.
Many of these thoughts went like, "This is where they find out that you are a fraud," or, "I can't believe you forgot the Krebs cycle!"
I tried to shake these thoughts away, but more would follow. "Yup, do you remember the pathophysiology of all the renal tubular acidosis types?!" Or "What if you are the only doctor around and someone codes, and then you have to run the code!"
My new, crisp lab coat pockets were stuffed to the max. Stethoscope, reflex hammer, measuring tape, monofilaments, my trusted Massachusetts General Hospital pocket handbook, pager, and notepad of pearls from orientation, to name a few items.
I couldn't eat breakfast that day. There was no room for an actual meal in my excited GI tract. I tried to remind myself of positive affirmations, but they all fell flat. Although they were nice words, they didn't feel true to me.
Breathless, trying to suppress the acute exacerbation of imposter syndrome, I walked into the hospital. I had tried very hard to remember which hospital hallway to take and not get lost, but guess what? I got lost. Thankfully, I was as early as sunrise would allow and was able to navigate my nervous steps to find my senior resident.
In the preceding weeks, I had tried very hard to retain every ounce of the knowledge I had absorbed from the orientation fire hydrant. I meticulously took as many notes as fast as possible so that none of the sage wisdom being bestowed upon me would slip away. This resulted in mostly illegible handwriting and some finger cramps.
Sitting down next to my senior, I pulled out my notepad and tried to read through the text in hopes of advancing my electronic medical records skills with this new system I was not used to. It was harder than I had predicted, and I kept feeling like the most useless member of my team. I earnestly wanted to help put in orders but kept running into computer roadblocks. Luckily, my senior resident was the most patient and kind doctor any new intern could hope for. She gently answered my apparently menial and sometimes repetitive questions.
Rounds happened. Surprisingly, I lived to tell the tale, and all the patients were OK.
As I look back to that day and the first weeks of residency, what would I change? Maybe nothing. I would want to fall, fail, and learn again. Thinking deeper though, there are some things I wish I would have tweaked. Here's a list:
1. Practice self-compassion. Extend the same kindness that I share with my colleagues, friends, patients, and everyone else to myself. Self-flagellation was not productive in achieving the outcomes I desired.
2. Be professional, not perfect. I felt that I needed to know all the answers and remember every minuscule detail from medical school on day one. I did not. No one was expecting me to be perfect. They were only expecting me to be professional and willing to learn and grow.
3. Don't believe every thought my brain offers. This would have helped immensely with imposter syndrome. Our brains are wired to find faults and create cognitive distortions. If I had taken more moments of pause and reflection and truly questioned the negative soundtracks in my head, it would have been more helpful.
4. Mind-body connection. If I went back in time, I would try not to completely disconnect from my basic human physical needs. I would pause from rounding to use the restroom, remind myself to hydrate, and be gentle, allowing moments of true rest and sleep when I was not in the hospital instead of buffering with food or social media.
5. Mindfulness. Mindfulness is the practice of being fully present and aware of the present moment, without judgment or attachment. Having even an informal practice where I can be present in the current moment would have allowed a perspective shift and the ability for more calm to descend.
6. Asking for help. One of the best things I did was seek counseling during a stressful health situation in training. I wish I had done more of that. Finding a therapist, counselor, or coach, depending on one's concerns, is likely the best form of self-care and growth in training.
To all the incredibly talented and dedicated medical trainees entering residency this year, know that you will be OK. You have triumphed over adversities before. You are the embodiment of resilience and excellence. Do not tell yourself otherwise.
Amna Shabbir, MD, is an internal medicine physician.
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