Trial by Fire

22 Sep 2022

By Alyssa Brown 

I sat through orientation with a terrified look. We practiced placing central lines, arterial lines, and nasogastric tubes. They poured knowledge into us to try to prepare us, but I knew it probably wouldn’t be enough. I was starting my intern year in the surgical intensive care unit (SICU).  

The night before my first day in the SICU, I lay in bed and had questions flying through my head: would I be able to keep up? Would I be a good surgeon and resident one day? How bad is this going to be? Will people on the team like me? Will my black cloud have faded? My alarm jolted me awake as the sun started to peek through the blinds. I tossed on my scrubs and headed in. The SICU was packed with patients, nurses, and residents. The hustle of the morning and the newness of the interns to the hospital were evident. Our SICU workroom was small, but we packed in: three interns, two nighttime PGY-2s, the daytime PGY-2, PA, two medical students, and a PA student. We started sign-off, and I began to realize that these patients were mine now, which may seem like an odd thought, but in medical school there were fail-safes – you had a resident watching over you. I realized that I still had upper levels and help, but I was now writing the orders and responsible for their care.  

I made it through my first day with a lot of confusion and not a terrible amount of hubbub, but we also had four hours of protected education time that day. By the time I got home at 7pm, I had started to feel off. My skin started to feel prickly, and I was getting cold sitting outside. I took my temperature, and it was normal, but I went ahead and tested for Covid-19. Two little lines showed up. I cursed, called my chief, texted the intern group chat, texted the SICU team, and called the employee hotline (in that order). I was told that I needed five days and a negative test. I felt miserable that I was putting more work on the other interns in the SICU. I didn’t like feeling like I was causing the other residents to pick up my slack while I was out sick. I spent the next four days sitting on my couch and napping. I thought I would be more productive, but I was knocked out. I appreciated that my co-interns checked on me and offered to bring food.  

I made it through my quarantine, and it was like the first day all over again but now I felt behind everyone. The other interns had five days on me. I struggled to present patients and make plans for them. I felt like everyone else knew what they were doing. I felt like the medical students were doing a better job than me. I was lost. Also, the SICU was bursting at the seams with patients. On one weekend, we had four people out of twenty-two getting massive transfusions, two eventually coded, and two got emergently intubated. It felt like getting hit by waves in the ocean. As soon as one hit, you would take half a breath and get hit by another.  

I didn’t feel like I was keeping up. If I’m being honest, I started to question if I was cut out for surgery residency. I wondered if I was going to get better at this, if my knowledge and skills would catch up. There was not an insignificant number of tears shed, mostly out of frustration. I wanted to do better. I wanted to be better. By the end of the second week, I was tired of feeling like I couldn’t do anything right. I had put in medications wrong, I wasn’t great at reading chest x-rays, interpreting arterial blood gases, or really coming up with a good daily plan for my patients. I was lucky that my partner came to visit around this time. I got my first day off since being away for Covid, and we spent the day at Costco and buying groceries. It made me sad that it wasn’t that fun of a trip for him. I was at the hospital by 6am and got home most of the time just after 7pm, but I appreciated him being there. He made me food, which I appreciated like a good hug.  

One of the attendings pulled me aside after rounds one day for feedback. She asked how I felt that I had been doing, and I told her that I didn’t feel like I was doing a good job. I told her that I was incredibly frustrated that I was not better at all of it. She gave me some advice on how to improve and what to focus on, but most importantly, she sensed something else. She said, “you deserve to be here.” She said, “you worked hard and did the work to deserve a spot in residency, so don’t beat yourself up so much believing that you are not good enough or that it was just luck.” It was like a veil had been lifted. She hit the nail on the head with this statement. At least in part, I had been beating myself up in the feelings of imposter syndrome. 

I would like this story to have a happy ending. I would like to say that by the end of the month, I was on top of my game, but I can’t. I felt better at some of the day-to-day tasks of the SICU and presenting patients, but I still didn’t and don’t feel like I am confident in my abilities. I think that will take time. It will take time to get comfortable in residency day in and day out. It will take time to feel confident and leave some of the imposter syndrome behind. As one mentor used to say, “this is the hardest that this will ever be.” Logically, I believe him, but that doesn’t mean that sometimes the irrational part of my brain doesn’t take over and make me question whether or not I will ever be able to do this. For now, though, I am going to continue to work hard and tell myself that I will get better and more confident and that I deserve to be here.  

Alyssa Brown grew up in Chattanooga, TN.  She went to Centre College for a B.S. in Biology and minor in History.  She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school.  She finished her third year of medical school in 2018 and wandered off the beaten path to get a Ph.D., before finishing her MD.  She graduated with an MD from the University of Louisville School of Medicine in 2022, and her Ph.D. in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences in 2022.  She is now a PGY-1 general surgery resident at Northwestern University in Chicago. She has been a part of the AWS Blog Subcommittee since 2018. You will probably find her baking sweets and pastries that she saw on “Great British Bake-Off,” embroidering, or off on a new adventure. You can find her on Instagram @Alyssa_b_futuremdphd and on Twitter @Alyssa_B_MDPhD.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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