Reconciling an intern year

Isabel Beshar reflects on the emotions and challenges of her intern year…

On my fifty second day of intern year, I deliver a fetus with its heart outside of its body. Ectopia cordis, my senior whispers to me. Our hands cover its moving chest. The heart beats within my fingers. Next to me, an eye to the clock, the nurse counts one two three. Minutes extend, my hands paralyzed, but those around me working hard: body wrapped in a blanket, fetus passed to parents, and door closed. Heart outside lies next to mom’s inside. Beat, beat, beat. That was a hard one, the RN says to me.

Whispers turn to shouts as I stand in an OR observing a stat Cesarean section. My chief, a knight on a horse, stands on a step, 10-blade wielded high. I scurry around her, providing little help. A moment of quiet, and the tissue dissolves as the blade slices. A breath and then Uterine! Delivery of the head, with a communal sigh of relief around the room. Tension grows with no cry, and then NICU is the one scurrying, rubbing, suctioning. My chief looks at me, and I’m off: back to the floor, triaging patients.

At home, I fall asleep on the couch more often than on my bed. Fresh groceries from an MS-4 summer of lust grow stale, rotting. Another house plant dies. Texts go unanswered, and my social world seems to narrow almost dramatically. Friends outside medicine do not understand, and my traumatizing stories about work land heavy on the table at brunch, poisoning a sunny Mimosa. Emails inquiring about research cause a deep guilt; but provoke no action on my part. I develop a new and severe aversion to movies with any source of true, genuine human emotion. I cry more often than I ever remember.

At work, though, I feel adrenaline. On Gynecology Oncology, the alarm rings before the fourth hour of the day and I launch out of bed, landing like a tornado in the workroom every morning. I perform the inefficient tango of medicine, copying numbers from the computer onto my paper list, then back onto the computer only an hour later. Our morning march begins: an army of doctors, moving from room to room, recording activities of daily human life: eat, pee, stool. The addictive rush only dissipates in moments of human touch. Before a favorite patient disappears into the void of home hospice, nasal canula keeping her breath alive, she brushes my cheek, whispering “thank you.” I wear my exhaustion as stoicism, and briefly wonder if I’ve become a monster.

The ninety-seventh night of my intern year, I wake up in pure panic. My hands are in front of my face. I lay back in bed, sweating, and my dream conjures in front of me: it’s a shoulder! I had been miming Woods maneuver. I laugh at myself – until the next time, when I foresee the outcome of ordering Lovenox at triple the dose. To calm myself, I begin stalking patients on my phone’s Epic app to double-check orders. I do this in the shower, on the bike, at 2-am. On the phone, my mother tells me my coping mechanisms could use some work.

As the days go on, I cocoon inside of myself. I receive constant feedback. My notes are too hasty, my surgical technique too unpracticed, my lack of anatomy knowledge unbecoming. I throw knots in the wrong places and I don’t ask open-ended questions. I over-call a cervical exam. I find out feedback is exhausting and that – in fact – I could work on that too! I go home and wish I could compartmentalize more. I wonder how on earth to disentangle from a job that feels it is seeping through my entire life, enveloping my identity.

The winter days subside, and California’s green hills become dry again. My co-interns vent to me, and we develop the uniquely powerful bond of shared strife. I feel deeply protective over my chiefs, who I realize have gracefully tolerated my incompetence for many moons. I now wage alongside familiar nurses in the power wars against pharmacy and lab. Even the grumpiest attending grows fonder of my knots. I find love in the hospital. The wards begin to feel like home.

Now as my intern year reaches its end, I realize the multiplicity of life is its enduring secret. That a single year can bring with it the most overwhelming cascade of conflicting emotions. That none of these are in opposition, but indeed exist to help determine the other. That work frustration and satisfaction are never too far apart. That hearts can be born both inside and outside of bodies. That moments of extraordinary humanity lie in rooms next to those of ordinary chore. And that the goal is this: to never understand or reconcile this difference, but simply to exist within.

Isabel Beshar is an Obstetrician/Gynecologist at Stanford Healthcare, in California. She is an 2014 American Rhodes Scholar, and her areas of research include family planning and access to reproductive services.

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