sink or swim

Hope you're having a good Memorial Day weekend, everyone.  As we enjoy our holiday, of course let's not forget our brave men and women in the armed forces, without whom this beautiful summer weekend with our families and loved ones would not be possible.

In the States, Memorial Day marks the official start of the summer season, and this makes me realize that the idea of summer, to someone in or recently departed from academic medicine, is very different from the idea of summer held by the rest of the population.  For most, summer means school's out.  Summer means vacation.  Summer means sunshine and barbecues and leisure.  But for the eight years that I was in academic medicine (I'm leaving out the year that I was a first-year med student, since first-years usually get their summers off, though they usually spend the time doing something unbearably earnest), summer meant one thing: new beginnings.

The Gregorian calendar begins in January, and most schools from elementary to university begin somewhere in the neighborhood of August/September.  But in medicine, the new year always begins towards the beginning of the summer.  One chapter ends, another chapter begins.

During the summer, usually on or close to July 1st, everyone in academic medicine moves up a peg.  Third year med students become Sub-Is.  Interns become residents.  Residents become new attendings.  New people come in to fill the spots vacated.  Everyone is in new roles, figuring out what they're supposed to be doing.  Want to know why the conventional wisdom is that you should never be admitted to a teaching hospital in July?  That's why.

Here's an excerpt from my book that I was thinking about today, and after the excerpt I'll tell you why.

A sub-internship, or “Sub-I” (as it is known to those of us who cannot get through a sentence without acronym or abbreviation) is basically the training bra of residency. It is a pre-requisite for graduation from medical school, consisting of a month where we assume the patient load and care responsibilities of a first-year resident (or “intern”), albeit with the increased supervision and support required by logic and law. It is a dress rehearsal for the real thing.

In one sense, being a Sub-I the logical progression from being a third year medical student. See one, do one, teach one is one oft repeated credo of academic medicine, and after a year of watching residents in action, it seems due time for us to start “doing” on our own. Sounds reasonable enough. However, the reality of the transition from third-year med student to Sub-I is more like being lifted dripping from a knee-deep wading pool in which beach balls and foam noodles lazily float, and thrown headfirst into the churning ocean, your only instructions being to keep your head above water and not die.

So.  Cal learned how to swim today.





He's going to be six in about two months, so he's definitely not, shall we say, precocious in his mastery of water survival tactics.  He had all the requisite skills to swim, but mostly he's just been kind of nervous around the water.  Didn't like to put his head in.  Didn't like to be in the pool without a flotation device.  Worried about getting water up his nose.  Worried about sinking.  I don't think he quite trusted, despite a number of increasingly scientific demonstrations about human tissue and buoyancy, that he would float.  Being a bit of a late swimmer myself, I remember that feeling well.  But I also knew from my own experience that all it would take was one moment--one leap of faith, or more accurately a second of forgetting his own doubt--for him to realize that yes, he was going to be OK in the water after all.

It's med school graduation season now, of course, and I hope it doesn't sound disingenuous (because it is quite simply the truth) that I often think about the crop of newly minted practitioners joining us in the real world.  And look, I don't have any good advice, I'm new enough at the game that I'm still trying to figure things out for myself.  But there's going to be a moment for all of you when you look up and realize that you're doing something that you didn't think you knew how to do.  That something you practiced and practiced and practiced somehow, likely while you weren't paying attention, became automatic.  That in the recesses of your brain, you actually knew something, remembered something, that will help an actual patient in your care.  It's that moment--the leap of faith, the forgetting of your doubt--that's going to make you realize something that you're only being told now and may not quite yet believe.

You're a doctor.

Welcome to the team.