The Intern and the Mundane

While cleaning up some papers around my desk at home (i.e. looking for something), I found a folded up piece of notepad paper. On the outside, it looks like an ordinary piece of college-ruled paper, maybe what one would use for a grocery list. But even though I hadn't seen this little scrap in about 9 months, I instantly recognized it for what it was, and instead of tossing it in the "trash" pile, I put it aside to look at later. 

This little scrap carried the hastily scribbled headline, "Hospital stories." Listed below that were brief summaries of what I thought were unique and interesting stories from my experiences as an intern. There were eight one-liners written in extreme shorthand which I assumed, that day, that I would still be able to decipher whenever it was that I got around to reading it again. 

After I finished cleaning (i.e. got bored and forgot what I was looking for), I picked up this little scrap intending to reminisce about these stories that I must have thought worthy of saving. 

I looked at the first one. I looked at it again. And again. But no matter how many times I re-read it, I failed to glean any meaning to the characters scribbled there.

Second one. 

Third one.

Same thing, all of them. I could ascribe no meaning to any of these shorthanded stories. Then I tried to work backward... what service was I on at the time, and at which hospital? What unique patient encounters or courses of care did I witness last October that inspired me to put pen to paper and preserve these memories? 

And I still couldn't recognize any of these.

But it's not because nothing unique or memorable happened. I think it's entirely the opposite. 

That one scrap of paper represented the stories from a single day on the Trauma service way back in the beginning of my intern year. Since then, I've seen so many countless repetitions of some of those "unique" stories, conditions, treatments, and failures of the medical system, that even if I remembered all 8 of these stories, they would probably not even merit retelling. I'm sure I've got five better stories from within the last two weeks.

This brought me to a new understanding of an idea that has likely been said before: the exponential growth of intern year cannot be found in individual "unique" stories. It develops from a compilation of all kinds of cases, "normal" and otherwise. 

Yes, "learning cases" are important and having crazy stories to tell your friends is fun.  It also gives you stuff to post on your blog, assuming you can keep safe from HIPAA. But it's the mundane, the everyday, which I think turns out to have the biggest impact on us as physicians. Seeing and treating the same conditions over and over, with minor variations, is how you develop clinical acumen and skills you need to be a good doctor. It's not from the little bits you pick up here and there during "crazy" cases. 

Nothing is mundane until you've seen it enough. And everything can feel mundane once you've seen enough of it. 

That's what intern year, and I think all of residency, is really about. That grind, seeing 100 of everything so you're not caught off-guard when something is a little off during case #101. 

Just something to think about for those days when the pager won't stop going off, or when you just keep getting admissions, or clinic has no end in sight.