Why July is the Cruelest Month
Right now, more than 22,300 first-year residents are descending on hospitals across the US
In the US, July is known as the time not to get sick. Summer ushers in the new crop of medical trainees. Right now, more than 22,300 first-year residents are descending on hospitals around the country. The excitement is palpable. It is the first time these “student doctors” have the coveted “MD” after their names. They are qualified to care for patients – on paper, at least.
Patients are advised to avoid hospitals at all cost, jokingly – but a recent study in the Annals of Internal Medicine suggested that the “July effect” does, in fact, exist. The authors found evidence suggesting that patient mortality, length of stay and healthcare costs increase in US hospitals in July, when every division is in a state of flux.
Just a year ago, I was one of these fresh faces. I could order medications and tests without anyone else’s permission, and I was scared out of my mind. I quickly realised, however, that I had a safety net – my resident. It was a huge relief to know that my job was to get the work done, and to document meticulously, but turn to my resident for the difficult clinical decisions.
July is here again and I am now that resident, leading a team of two new interns. I am supposed be the safety net, providing unwavering reassurance for my interns, always serene and composed. Inside, I am a nervous wreck. Although there is always a senior clinician on every medical team, it is the resident who runs the team and helps make minute-to-minute clinical decisions. Now I am that person.
So when my intern rang at 6am the other day, I felt my stomach flip-flop. “Kiran, Mrs X’s heart rate is in the 170s, what should I do?” I was still at home, so I told him to page the night resident, then ran to my car and raced to the hospital, my own heart pounding. I finally arrived outside Mrs X’s room to find a crowd of nurses, the night resident and my intern, who looked as overwhelmed as I felt.
We brought her heart rate down quickly and I was left alone with two wide-eyed interns looking to their supposedly fearless leader. On rounds, one woman’s blood pressure dropped precipitously. Another person spiked a fever. Someone else became acutely short of breath. Each time, they turned to me. Unfortunately, I had a 2pm clinic session, 15 minutes away. At 1.51pm I was still on the wards trying to help them figure out how to survive the afternoon when a monitor started beeping loudly. Mrs X’s heart rate was now in the 180s. The nurses jumped into action. The intern looked at me. I looked at the time. How was I going to get to clinic?
The tears welled up in my eyes. If I didn’t do something, Mrs X was going to crash. I suddenly felt, acutely, the enormous responsibility that patient care involves. This time the burden was mine … my clinic patients would have to wait. I ordered several medications stat, paged another resident to help me and ran into Mrs X’s room. When I was sure that she was stable, I left my interns still standing at the computer and excused myself to the bathroom, where I burst into tears. One of the third-year residents found me. Without a word, she gave me a hug.
In that hug was the safety net that had got me through intern year. I knew that she was not judging me for my tears, or my admission of feeling overwhelmed by my new role. No matter where we doctors are in the hospital, there is always someone who has walked in our shoes and whom we can ask for help. Taking care of patients is a tremendous responsibility. And whether it is July or not, it takes a team to do it properly.
Financial Times Weekend Magazine | July 29, 2011