Sole Purpose 32
The First Month of Residency

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One of my attendings from podiatry school joked that he’d be able to see the exhaustion creep into my articles once I started residency and that my sunny demeanor might start to waver with the grueling hours. By the end of this article, you’ll have to let me know if my writing still has that bright, sunshiny glow or if it’s taking on a darker, more overworked and jaded energy.

I’m writing this article during my first month of residency and let me tell you—OH MY GOODNESS. Residency is really hard. I wanted to share some of my own mistakes, personal downfalls, and things I wish I had known beforehand.

The Hardest Part (for Me)
I absolutely hate being bad at things and feeling dumb. And guess what? Being a new intern is exactly that. I know I’m not suddenly unintelligent and that I was matched into a residency program I loved because they saw value in me. I KNOW that’s true, and I KNOW being new at anything involves a learning curve and that I will get better. But I HATE that after one day of being a resident, I haven’t magically become perfect with the best surgical hands in all the land (super realistic, right?).

Even though I know I’m not dumb or a “complete failure”, transitioning into residency is still tough. The hardest part is that I felt confident as a student—I was someone that attendings and residents could trust to help. But now, after overcoming the monumental hurdle of finishing medical school and finally becoming a doctor, I find myself not good at it?! What the heck? I’m a (new) intern, and I suddenly struggle and make mistakes daily. IT’S THE WORST.

To combat this, I try to ground myself in reality and remember that I’m new and will get better every single day. I also remind myself that perfection doesn’t exist. Talking to my medical school friends who are going through the same thing helps as well. Additionally, I wouldn’t be a resident if I knew everything and was perfect… SO I am in the right place and I will get better.

My First Day
My LITERAL first day of residency—July 1st, the actual first day—I was assigned to help my co-resident and fellow intern on her first call shift. We had an early morning ED consult for a dehisced TMA with a baseball-sized hematoma. We evacuated the hematoma and redressed the wound. The patient was on blood thinners, had a history of bleeding from his TMA site, and had reported dizziness and VERY low blood pressure, so he was admitted to the ICU as per the medicine team’s recommendation.

I didn’t think much more about the patient until the ICU nurse called, saying there was bleeding from the bandage once the patient’s blood pressure stabilized. I laughed it off, thinking it was probably just minor bleeding. When we got to the ICU, it was a literal blood bath. The patient was SHOOTING blood from his foot, and nothing seemed to slow or stop the bleeding. We even used mouth suction from the head of the bed to try to manage the mess.

My co-resident called our chief and attending while I held pressure, and a second-year resident from another service came to help us. The patient was rushed to the OR for cauterization, as hand-tying at the bedside wasn’t working. IT WAS A MESS. I have to give major props to my co-resident, who was the designated person on call while I was merely assisting; she handled the situation with incredible calm and grace. Moral of the story: ASK FOR HELP AND DON’T BE A COWGIRL (or cowboy).

Thankfully, we were quick to admit we needed help, but that patient would have been in a bad spot if our higher-ups and attending hadn’t been in the loop. BUT MOST IMPORTANTLY, two weeks later, when I was on call by myself, THE SAME THING HAPPENED—a one-day-old post-op patient fell in the bathroom and opened up a squirting bleeder. I was called to the bedside, but this time I was fully prepared and knew exactly what to do. That horrifying “Carrie” scene from my first day turned into an amazing teaching moment, and I was SO calm and ready the next time it happened.

Speak Up
This is almost embarrassing to admit, but sometimes I can be polite to a fault. During my second week of residency, I had my FIRST elective case (cue the “oooo” and “ahhhh”). I studied the night before, wrote out all the steps, and felt prepared and ready to go. I was the first assistant, but since I was SO green, the attending let me know I’d mostly be assisting and observing (which was completely understandable).

I knew the steps and what we would need next, but when the scrub nurse was engaged in conversation and the mayo stand was too far away for me to reach, I quietly asked for the instrument we needed. Unfortunately, the scrub nurse didn’t hear me, and a few minutes later, the attending grabbed the instrument and performed the step I had been mentally preparing for. ALL I HAD TO DO WAS SPEAK UP. I was prepared, knowledgeable, and could have, still politely, asked again to demonstrate my readiness. Lesson learned: sometimes being polite isn’t enough—don’t be afraid to speak up and show what you know!

The Littlest Things Are Suddenly Hard
I felt pretty competent in clinic as a student and was confident going into residency interviews, but as a resident, suddenly even simple tasks like ordering ibuprofen felt impossible. To top it off, I hadn’t been at our main hospital since my externship, so my first few days were filled with getting lost while searching for things like CAM boots, the surgeons' lounge (for the free food), and various supply closets.

As someone who holds myself to high standards, this was incredibly tough. I felt like I was failing just because I was so new. Writing an operative report? I had no clue who was in anesthesia or what we closed with. I was sweating just retracting, despite having logged 1000 hours of retracting as a student.

Just Be Normal
My residency involves going to many different hospitals and surgical centers, so my first couple of weeks were filled with anxious drives to unfamiliar places and scrubbing in with attendings I had never met before. AND I WAS HORRIFIED. I arrived early to the OR, got the local anesthesia drawn up, and set up the OR according to the preferences my chief had mentioned.

To my surprise, the attending was perfectly nice, chatting with me about my background and my Padres baseball scrub cap. IT WAS FINE. All I needed to do was take a breath, be prepared, and be myself. Sometimes the scariest situations turn out to be just another day in the OR.

Students
I love teaching and was genuinely excited to have students with me. However, I’m also self-aware enough to know that I’m not at my best when I’m hungry, tired, and frustrated (aka on call). I’d rather avoid taking out my on-call frustration on a student.

Having students around taught me that they can be incredibly helpful and their enthusiasm for every case can be quite contagious. It’s important to overcommunicate with them. For instance, if I need to finish my notes first, I’ll let them know, “I’d love to go over those radiographs, but please don’t talk to me until I’m done.” Setting clear expectations is key—like being here for rounds by 7 AM and having dressing supplies ready.

I also learned that not every student is a stellar student, and that’s okay! I remember struggling myself, and I’m happy to help students learn. However, I shouldn’t have to repeat myself multiple times or feel like I’m babysitting. If dressing changes are done, there are no more surgeries, and they’re just distracting, it’s totally okay to send them home.

You ARE a Doctor
I really struggled with this at first. During my first week, I let patients call me a nurse or a student without correcting them. But after a while, I started to stand my ground. I began repeatedly introducing myself as Dr Santiago, clarifying that I was part of the podiatry team and not the nurse. My male medical student also often got questions directed at him as the doctor. To address this, I would say things like, “My name is Dr Santiago. The person standing next to me is the medical student; I am the doctor.”

It felt very awkward at first, and I worried about coming off as “aggressive.” However, I worked incredibly hard throughout medical school to earn this title and secure a spot in residency. I realized I needed to use it with pride.

When to Sound the Alarm
While my podiatry spidey senses are still developing, I quickly learned when it was crucial to call an attending immediately. For instance, in cases of arterial bleeding, I knew my attending needed to be alerted right away. Similarly, a case of gas required an urgent call to my attending.

On the other hand, a stable eschar in a diabetic patient with Charcot at 4 AM—especially with no gas on radiographs, no elevated WBC count, and no systemic signs of infection—can wait until morning.

In conclusion, it’s been a WILD first month. My mom always says, “You grow through what you go through,” and she’s right. I’ve faced some of my toughest moments and biggest doubts in this first month, but I’ve also risen to the occasion and know that I can only get better from here! YOU ARE GOING TO GET BETTER! Good luck to everyone, and I hope this helps!