I just happened to watch this scene years later as a resident, and it nearly brought me to tears because I saw myself in that scene. I’d been that doctor to break the bad news to a family and then went on to work for another 8 hours. In my clinic, I’d go from talking to a patient about severe depression to a patient happy about her new pregnancy to a patient struggling with 3 or 4 chronic medical conditions, and all in the span of an hour or two. It’s emotional whiplash, and it’s HARD. And we do it every day.

Get out, because nobody is going to turn to the pharmacist and rightfully so. The family needs time with the physician, and what you do, as the pharmacist, is your level best to buy time for the physician. You watch over his patients, go among the nurses, answer their questions so his pager doesn’t go off. You keep an eye on all of the vital signs and labs and the piggyback administration times to make sure that the rest of the patients stay safe.

Two hours ago I was in a trauma room doing compressions on a toddler. The mother’s screams mixing with the sounds nursesdoctorstechs calling out, the beeping monitors telling us what we already know. Now I’m sipping a raspberry vanilla latte out of a mug with red birds riding snowflakes listening to some 80s music. The baby inside of me is kicking. My hands still smell like gloves and hand sanitizer.

And while we were taking history, the patient beside ours (it’s a government hospital so the beds are literally right next to each other), was surrounded by family.

They were talking. I couldnt see them but judging by the sound of their voice, i was pretty sure they were holding back tears. A few minutes later, there was a long pause and a longer songular beeping sound. The patient had flatlined, as confirmed by the sudden wailing from maybe his wife? daughter? Anyway, all I could see through the little slit between the thin drapes that divide us was a lifeless body.

And it was weird to see someone die up close, right in front of you. I wasn’t disturbed or anything. It was just… the first time I saw someone die. I’ve never even seen an old relative die. After that, I continued with our Hx and PE taking like I had not just witnessed death for the very first time. Like nothing happened. By the time we were finished with hx taking, the body had already been moved.

Happy International Women’s Day! Here’s a list of TED-Ed Lessons to watch as you celebrate all of the world’s women, past and present.

The genius of Marie Curie: Marie Skłodowska Curie’s revolutionary research laid the groundwork for our understanding of physics and chemistry, blazing trails in oncology, technology, medicine, and nuclear physics, to name a few. But what did she actually do? Shohini Ghose expounds on some of Marie Skłodowska Curie’s most revolutionary discoveries.

The contributions of female explorers: During the Victorian Age, women were unlikely to become great explorers, but a few intelligent, gritty and brave women made major contributions to the study of previously little-understood territory. Courtney Stephens examines three women – Marianne North, Mary Kingsley and Alexandra David-Néel – who wouldn’t take no for an answer (and shows why we should be grateful that they didn’t).

Equality, sports and Title IX: In 1972, U.S. Congress passed Title IX, a law which prohibited discrimination against women in schools, colleges, and universities — including school-sponsored sports. Before this law, female athletes were few and far between, and funding was even scarcer. Erin Buzuvis and Kristine Newhall explore the significance and complexity of Title IX.

The true story of Sacajawea: In the early 19th century, a young Agaidika teenager named Sacajawea was enlisted by explorers Meriwether Lewis and William Clark to aid her husband Toussaint Charbonneau as a guide to the Western United States. Karen Mensing debunks some of the myths that surround the familiar image of the heroic woman with a baby strapped to her back and a vast knowledge of the American wilderness.

Why should you read Virginia Woolf?: How best can we understand the internal experience of alienation? In both her essays and her fiction, Virginia Woolf shapes the slippery nature of subjective experience into words, while her characters frequently lead inner lives that are deeply at odds with their external existence. Iseult Gillespie helps make sense of these disparities to prepare you for the next time you read Virgina Woolf.

A day in the life of a Mongolian queen - Anne F. Broadbridge

The breathtaking courage of Harriet Tubman - Janell Hobson

The princess who rewrote history - Leonora Neville

Did the Amazons really exist? - Adrienne Mayor

How one scientist averted a national health crisis - Andrea Tone

In 2016 58% of people applying to medicine and dentistry courses were women. However, according to the Royal College of Surgeons of England, only about 12% of consultant surgeons in 2018 were women. Why? A small survey in the BMJ medical journal points to the level of discrimination. As a general surgical trainee, I have been shocked by the experiences reported by some female colleagues. The discrepancy in the number of women applying to medicine and those going on to become consultant surgeons can partly be explained by the higher dropout rate. Could inherent gender discrimination within surgery itself play a part in that?

Female colleagues with children have struggled to be accepted and are seen as less than full-time surgeons, despite working similar hours in hospital to those surgeons with part-time hospital and research commitments. A female surgeon returning from maternity leave didn’t dare tell colleagues that she had a 10-month-old baby at home, fearing that she would be viewed as lacking “commitment to speciality”. Female surgeons are continually asked about their family plans. I was even asked at an international conference if colorectal surgery would be the correct career path if I plan to have children. These aren’t challenges that are unique to surgery – or to women, with more men taking longer paternity leave – yet the stigma seems more entrenched in surgery than other specialities.

I’ve had female colleagues who initially were really interested in surgical specialties or clinical specialties that require several years of training drop those dreams because they eventually would want to have a family and they couldn’t do a career in ‘x’ specialty and raise their kids, because “who would take care of their kids then”.

I’m on nights in the ED, and last night was an intense shift. 

My first patient of the evening was a woman who was sent to the ED by her PCP for an indicentally-discovered WBC count of over 200, with 8% blasts (immature cells). That, non-medblrs, is very high, and she came in the door already understanding that she almost certainly had leukemia. I sat down with her and explained the next steps, and gave her The Talk that I have started to routinely give to people with new, serious diagnoses. The Talk goes roughly like this:

“A lot of things are about to happen in a pretty short amount of time. There will be a lot of people helping to take care of you. It might feel invasive and overwhelming, but I want you to know that you are the driver. If you are confused, ask questions. If something is happening that you don’t like, you can tell us to stop. This is your body and you always get to decide what happens to it. As doctors we sometimes get swept up in treating your disease, and I apologize in advance if you ever feel like we’ve forgotten about the rest of you, but please feel free to remind us. We are experts in medicine, but you are the expert on you.”

I then placed her first IV. It felt like I was firing the starting pistol at a race that this woman really didn’t want to have to run. 

Unfortunately, she wasn’t the last person to get The Talk last night. The second person came in with abdominal pain, something we see often in the ED. While this patient wasn’t feeling all that sick, his story worried me, and on exam he had a large palpable mass in his abdomen. As soon as my hands touched the mass I could envision his CT scan in my mind. We ordered the test, and the actual scan looked worse than what I had imagined. There was really nothing that could look like this except for a widely metastatic cancer. 

It was a very busy night, and my (awesome) attending was running all over the place. I offered to go tell the patient the bad news, imagining that she would probably want to be there for that conversation. But she just thanked me, and off I went. 

I’ve had serious conversations with patients and families, sometimes unsupervised. I had not, however, actually delivered this kind of news before. Of course it was somewhat hedged; cancer is diagnosed by biopsy, not by imaging. But it would have been impossibly dishonest not to tell them that all of the testing we were about to recommend was a cancer workup.

They were fairly stoic about it, which probably made it easier on me, though it made me worry at first that I wasn’t being clear. They asked good questions. They wanted to see the CT scan, so I went over it with them. I gave them The Talk, and they seemed to appreciate it. We wanted to admit him, but they decided to go home and plan further diagnostics as an outpatient, and I felt like The Talk had worked. He wanted to go home, so he did. 

In the wake of Carrie Fisher’s death four days after she suffered a massive heart attack, one thing that was reported by some news outlets was that she had been in “significant distress” on the flight. We don’t know the exact details of this, but in my experience as an EMT, it often means “hysterical woman having a panic attack and thinking she’s dying…*woman dies* …oops, guess she really was dying.” 

It is SO IMPORTANT to remember that many women present in what medicine considers an ‘atypical’ manner for heart attack, but it actually IS typical…for women. Women are more than twice as likely to die from cardiac emergencies, not because our physiology is that much different than men and thus gives us a worse chance at survival (it’s actually better if treated promptly and adequately), but because our symptoms are more likely to go unrecognized or to be dismissed entirely.

Thus, please take a moment to review and pass on this list of cardiac distress symptoms as seen in women: 

Shortness of breath - This is the most common one. If a woman, especially one without prior history of respiratory issues or shortness of breath, seems to be having trouble catching her breath and/or complains of such, pay very close attention. If she continues to feel winded after sitting or laying down, it’s probably time to call for help.

Feeling of impending doom - This can range from a sense of general unease to a full-blown panic attack. This one is extremely important, and is the symptom most commonly disregarded by doctors and hospital staff. If a woman tells you that she feels ‘not quite right,’ or like something terrible is about to happen, or that she’s about to die, LISTEN TO HER FFS. 

Nausea and “indigestion” - Also common. Heart attacks frequently present as a feeling of vague nausea or indigestion, but unlike typical heartburn, antacids and other OTC treatments will not alleviate the symptoms.

Hiccups - Unexplained hiccups, especially if seen with any of the other symptoms listed above, can be indicative of heart muscle that is being acutely or chronically starved of oxygen.  The exact mechanism isn’t known, but it’s thought that the enzymes released by the dying muscle irritate the pericardium and adjacent diaphragm, causing spasms in the healthy muscle. 

Fatigue - This is another commonly seen symptom, and is often overlooked or ignored as just transient tiredness. Many women having a heart attack will complain of feeling “flu-like” symptoms of nausea, sweating, fatigue, and shortness of breath, and they’ll lie down for a nap and never wake up. 

Lightheadedness - A feeling of being lightheaded or about to faint isn’t terribly uncommon in many benign conditions, and many women experience it on a monthly basis. However - be aware when it appears unexpectedly or unexplainedly, and/or with one or more of the other symptoms on this list. 

Sweating (diaphoresis) - Heart attack does funny things to the sympathetic nervous system, which is behind reflexes such as sweating and hiccups. If a lady is experiencing unexplained or excessive sweating, pay attention to anything else that might be going on with her. 

Tingling or numb extremities - A feeling of numbness or “pins and needles” tingling in the extremities can be an important sign that cardiac function is being impaired and those body parts aren’t receiving enough oxygen. 

Peripheral and/or central cyanosis - Often accompanies tingling or numbness, and is considered a later-stage symptom of cardiac distress and heart failure. Finger and toe tips will turn pale or blue first, and lips and gums after that. Important to remember that darker-skinned women may present cyanosis as ashen, grey, or darker purple rather than pale or blue. 

Back pain - Pain between the shoulder blades, in the cervical spine, or even further down in the torso or lumbar region can be a symptom of heart attack. Alone, it isn’t that suspicious, but if it’s unrelenting and presents with any of the other symptoms above, keep a watchful eye on things. 

Classic “crushing” or “tight” chest pain or pressure - Women DO experience this classic pain, too, just not as frequently as men do. This may be due to our higher pain threshold, or differences in blood volume, or maybe we’re just not sure because nobody’s bothered to really study it. Whatever the reason, some women do still experience the crushing or tightening pain, and others may experience less painful pressure or tightness that doesn’t seem to be relieved by anything.

Me: *walks into patient room in emergency department* Hi, my name is--

Toddler patient: HEY! THE FLOOR IS LAVA YOU CAN'T JUST WALK IN HERE YOU'LL BE ON FIRE!

Me: *gasps and jumps onto nearest chair, then proceeds to use another chair to climb over to the patient's cot to sit next to him*

Toddler patient: *watches approvingly*

Me: Wow, thanks for saving me, buddy! *high-fives*

(Proceeds to get history, etc. Toddler patient attempts to climb onto the chair I used to get across the room)

Me: Hey, my friend! You have to sit on your bum to use the lava transporter.

Toddler patient: *sits as I use my legs to push the chair across the floor, then bring it back toward the cot*

Me: Okay buddy! Now we will use the lava transporter to get to the lava checker! *pushes chair toward the otoscope as I switch spots with his mom on the cot, then checks his ears*

Toddler patient: There's something in there! *gestures to left ear*

Me: Oh, well you're in luck! This lava checker can also suck the lava out of there. *imitates sucking noise while checking ear* All better?

Toddler patient: Yah!

Me: Okay, I'm going to talk to my boss doctor and come back, okay?

Toddler patient: STEP ON THE ROCKS, NOT THE LAVA!

Me: *mimes putting on boots* Don't worry little man, I have magic lava boots!

Toddler patient: *high-fives*

End of encounter

Me: See you later, buddy!

Toddler patient: *runs up to me, hugs my legs, then licks my hand*

AS PROMISED, IT HAS ARRIVED.

What this is: ideas and tips from a soon-to-be R2 who has survived intern year to help you function as an effective intern so you can focus on the important things: caring for your patients, learning and growing as a physician

What this is not: an encyclopedia, a bible you follow to the letter. The Immutable Truth of Intern Year Reality. This is not going to teach you medicine. This is not geared toward a specific specialty; it is designed to be helpful to an intern starting in any specialty training program.

Where did the self-care part go? For every time I attempted to write it or sought folks to help me write it, I came to realize that everyone’s idea of self-care is different. The basic tenet of self-care in intern year is: remember that if you don’t care for yourself, who will care for your patients? So remember that you deserve and need time and attention for your sanity. And everyone gets by better when they help each other.