One of the most read novels on medicine is Samuel Shem’s House of God. The reaction of people is most often to either love the fact that it dispels the facade of the all-knowing physicians and ideal medical educations or they hate the book due to the fact that it portrays medical residency as horrific and bleak. What is often missed in the story chronicling the intern year of Dr. Roy Bash is the point. Everyone needs someone. Everyone needs a team. Everyone needs a squad. During the course of the year the interns realize they need one another and they need their leader (the Fat Man).
Often medical students (and pre-medical students) buy into the notion of competition. That those students around them, in the classroom and on the wards, are their competition. In general this could not be farther from the truth. What Roy Bash realizes, and what medical students and residents alike come to realize is that the competition is not peers. Medicine and science contain enough challenges and enough problems by alone; imagined competition has no place. Most of the time medicine and science are enjoyable challenges. However, as with any pursuit, there are moments studying, days in the lab, and interactions with patients that are difficult. At these times it is the students and residents working together that get you through the day.
Recently I was working on a team trying to resuscitate a patient in full-code. Although I’ve seen people coding before, I had never actually played a part of the resuscitation effort. We worked for almost an hour. As I compressed the patient’s chest, a whirl of activity surrounded the patient. As part of any team, communication is key, so the room buzzed with commands, stats, questions, and observations. Alarms were sounding constantly. At some point it became apparent that additional resuscitation efforts will not yield any better response and after asking for any additional suggestions from the team, the time of death was called. What I did not expect was the silence. After an hour of hustle and activity, an odd hush fell over the room. As we took off our gowns, and gloves, the attending thanked everyone for their efforts. I was covered in sweat and the gown clung to my arms. Gloves and gown both had blood on them. Three minutes after the time of death was announced we were off to see other patients. I strangely felt nothing. The rest of the evening passed and I left the hospital late that night still without processing what had happened.
One of the struggles with pursuing a career as a physician-scientist is, unsurprisingly, that you bounce between medicine and research. The next morning walking into the lab I began to think about the resuscitation the night before. With patients found down out in the field, resuscitation efforts are often not successful. I knew that the team (with some of the best physicians, nurses, and residents) had done everything that could be done. But I still had it stuck in my head. The alarms. The smells. The rhythm of the compressions. The spurts of blood. Arriving in lab it was difficult to concentrate. With the patient dying in the back of my head, did I even care if a protein was being phosphorylated or dephosphorylated by a particular enzyme? It was the conversations and related experiences of other students that helped me process that night and prepare for more medicine, and more research, in the future.
The Tibetan saying goes “ Wherever you have friends, that’s your country. Wherever you receive, love, that’s your home.” It is said that students and residents more or less live in the hospital. It is the kindness, love, and camaraderie of fellow students and interns then, that must make the hospital a home.