Internship starts, not with a bang or a whimper, but with a barely noticeable intake of breath. Not a deep breath, a regular resting one. You don’t notice it until you do. That’s the only excuse I have for why there are no entries in my journal until six whole days into my intern year. I will attempt to recreate those first few steps now.
If you’re completely unfamiliar with internship in Jamaica, here is a brief overview. If you already know everything there is to know, feel free to skip this next paragraph.
When medical students graduate from UWI they have already applied to work at one of
five several government hospitals (and one semi-private hospital) qualified to supervise medical interns. What follows is a 12 month long, somewhat supervised trek through the four basic clinical specialties: General Surgery, Paediatric Medicine (babies), Internal Medicine (adults) and Obstetrics & Gynaecology. This experience is unique to each hospital (and each intern), but overall we’re expected to emerge from this year with the skills necessary to become a fully licensed medical practitioner. (Don’t worry, nobody tests you on these skills. Which is probably why so many bad less than stellar doctors slip through the cracks).
At my hospital, we received a one day orientation the week before we were scheduled to start working. I think this is the standard. We were introduced to key members of staff (bureaucracy, meh), discussed the housing situation (lacklustre at best), were given a tour of the facilities (too big to walk around without getting tired) and then spent two hours delving into grim and gory details of everyone’s favourite topic: remuneration.
Predictably, the session left us entirely unprepared for the actual first day on the job.
I started my internship in General Surgery and I remember feeling small. Not unimportant, just literally small. Like a child. In final year, patients would laugh when I approached them for procedures, asking if I was still in high school. And here I was not six months later as their doctor, their first point of contact with the surgical team. My first ward round passed in a blur of unfamiliar names, familiar diagnoses and trying to sign my name quickly enough to move on to the next docket.
It got easier. Those patients who were handed over to me left. I got my own patients. My handwriting got quick (and sloppy). I became familiar with the system through trial and error. I asked questions, I did things the wrong way, bore the scolding with chagrin and did it properly the next time. I learned how to brush off the rudeness that you encounter on a sometimes daily basis, grit my teeth through collecting and administering medications (because this is not my job*), learned how to smile the right way to get a porter’s help**, and how often to call the radiology department to actually get my patient’s goddamn x-ray.
If you ask me (and you are asking me), those are the skills an intern needs to learn and learn quickly. Your medical acumen is already there, you’re already familiar with every procedure they expect of you (it is okay to need supervision; my point is you’ve heard of or seen them all before). What you need to survive is the knowledge of how to navigate the complex social and professional sphere that is the tertiary medical facility. How not to step on toes, when to step on toes, what the unwritten protocols are and how to use them to your advantage (hint: they mostly involve doctors’ egos). I could write a book on helping the fresh faced med school graduate survive, a pocket-sized guidebook probably, but a book nonetheless. Yet here I am, giving it away for free. (I’m tucking this idea away for my first book though. Obviously).
From my viewpoint , having completed almost 75% of my internship I can tell you unequivocally that at some point you will fuck up (the scale of fuck-up varies widely and depends entirely on you). You will feel like you’re the worst, most incompetent intern that ever interned. And then you’ll survive Paediatrics, and you will feel like you can conquer the world. You’ll reach a point where it gets better and you’ll survive this are’t just aphorisms any more, they’re universal truths. You will surprise yourself.
Unless you quit halfway through. And that’s okay too! It’s better to figure out from early that you hate this job and run away to
rob run a bank somewhere. Everyone isn’t for Medicine and this is fine.
The first part is hard, and the middle part, and I think the bit at the end is going to be hard too. Every three months you start over, start learning something else. Carry the good lessons with you, drop the bad habits and keep your wits about you. If all else fails, remember, it’s only twelve more months***.
* Here I feel obligated to add that helping patients get better is my job. And if that involves getting their medication, mixing it, administering it, wheeling them down to x-ray or up to operating theatre by myself while manually ventilating so their oxygen saturation doesn’t fall below 95% then that is what I have to do.
**Before anyone gets into a feminism/sexism snit I would like to point out that each gender has its advantages in the hospital hierarchy. The guys get nurses and other female staff to do any and everything for their patients just by flexing a bicep. Therefore I am not above using my femininity to get shit done.
***Unless you’re a foreign-trained intern who failed their CAM-C exams. Then you could be here for a long, long time.