S7E25: Intern Year Blues

Mariam: Hello, Bundlers. It is Mariam. Long time no see, listen, whatever. I really miss you guys. I miss being here in the virtual studio, but I'm so excited to be back here with Lilly to be recording our next episode, Intern Blues. Yay.

For those of you who have been listening, you're probably aware that Lilly and I just started our intern year residency. And if you're not aware, we just started our intern year residency back in . . . What was it? July? I guess that was the start officially. Oh my gosh.

Lilly: July 1st. Actually, mine started June 24th, so it was a little earlier.

Mariam: Yeah, orientation and all that stuff. So we are interns. For those who are not in the medical field or just less familiar with how doctor training goes, intern year is your first year of residency training. You are still considered a resident, but you get a very special title to designate you, or I guess . . . what's the word? Set you apart from all the rest of the other residents because you are fresh and new, and everybody in the hospital needs to know that.

And so intern year comes with lots of new challenges, definitely lots of new responsibility, but it's a mixed bag, I think, for most people. And so I hope this episode just sheds some light into the raw, vulnerable experience of two interns who are more than halfway through intern year now and incredibly burnt out, but also trying to find meaning in this process and trying to be the doctors that they always dreamed to be.

So anyway, Lilly, first of all . . .

Lilly: The good, the bad, the ugly.

Mariam: The good, the bad, and the ugly. I feel like for most of my friends who are interns that I haven't spoken to in a long time, I want to do a little check-in. Lilly, how are you doing?

Lilly: Yeah, that's so nice of you because I feel like we all . . . Have you ever heard that analogy where you have spoons, and then you give out your spoons throughout the day, and it signifies how much energy you have to give out? And at the end of the day, you have to make sure you have enough spoons to feed yourself or take care of yourself. I feel like intern year is a lot of giving out your spoons. So it's nice that you check on other interns, because usually you don't have enough spoons to be able to do that.

But I don't know, I think this episode will be really interesting for us to chat about, mostly because we have two very, very different experiences. One of them is surgical, and one of them is medicine, non-surgical medicine at least. So I'm curious to see what your experience has been like and what mine has.

And before we dive in any further, we just want to put a disclaimer out there that all the views that we share on this podcast are those of our own, and they don't represent any kind of institution or employer as we just chat about our experiences.

I think for me, life hit me really hard this year. And so putting that into the perspective of my intern year, I think a lot of things that I hear my peers talk about or vent about sometimes don't correlate to how I feel because I think, "Oh, I'd rather be busy and be in the hospital for long hours than have to go home and deal with my actual life." So I think that's definitely changed how I've experienced intern year, not really . . .

Oh, someone is ringing my doorbell. I'm so sorry.

Mariam: Oh my god, you have a delivery.

Lilly: Now the dogs are going to bark. Sorry, Chloe. We might have to pause while we figure out who is ringing my doorbell. And nobody was there.

Mariam: Weird.

Lilly: No one was there. We'll have to check the cameras later. Anyway, that was bizarre. Did you hear the doorbell ring, though? Or was that just . . .

Mariam: Yeah, it's going to be on the episode.

Lilly: That's so funny. But yeah, so my experience has been very different, and that's kind of framed how I view my intern year. But that also doesn't take away from the fact that intern year is exhausting, and mentally draining, and just a lot of learning and making mistakes.

But how do you feel? How's intern year been?

Mariam: I can definitely . . . Yeah. So the funny thing, when you were talking about the spoon analogy, my first thought was, "I'm at minus 20 spoons right now." That's how I feel at the end of the day sometimes.

But I think it's also interesting because when you were talking about when you have these personal life stressors affecting your life, your work does become kind of a way to just get out of your head.

And I think that's the nature of intern year, is your brain is totally dedicated to the work and it's totally dedicated to patient care, and figuring out the hospital system, and learning the medicine, and the practical skills that it takes to be trained in your specialty. And that in and of itself can be a really good coping mechanism for a lot of people who are just ready to dive in or if it's a good distraction.

I think, for me, this year hit me a lot harder than I expected it to. I knew intern year was going to be really difficult. The hard work, the long hours, the difficult patient interactions, the bad patient outcomes, because in OB-GYN there are bad outcomes, which is something, again, that I hadn't anticipated as much of, can really get to you.

But I think the thing that I struggle with the most from a mental health perspective isn't even that, although certainly all those things don't help. It's really the constant criticism, the constant feedback, the constant people just watching you and expecting you to mess up because you are so new and you just feel like a little baby all the time, but not in a good way. In a way of, "I'm so dumb. I'm constantly messing up."

I don't know about you, Lilly, but I feel like in OB-GYN . . . And I don't think this is specific to my program, but I think the nature of the specialty and the training, especially a surgical specialty, is constant feedback. Not only do you have to learn the medicine, but you also have to have the procedural skills and the skills especially on labor and delivery. And so it's constant feedback.

And as an intern, almost none of it is positive. A lot of the time, it's really just like, "Hey, you could've done this better." And there have been so many days where you're putting so much energy and so much time into patient care, and you're running around, and you're like, "Okay, I did this. I feel good about my work," and then an attending or a senior resident comes up to you and is like, "You weren't fast enough," or, "Why did you do this? You should have done this."

I think that, for me personally, has been the hardest part of the year. It's not the hard work. It's not the long hours. It's really just the constant criticism and the constant feedback. Intern year is humbling. It's just humbling.

Lilly: It's like expecting to know how to run when you're just learning how to walk.

Mariam: Exactly. Yeah.

Lilly: You're drowning, and yet it's this race that you need to constantly feel like you're catching up on. I definitely think your perspective is interesting with the immediate feedback that you get being in the OR of doing something and then having whoever's there in the room with you giving you that instant feedback. I think in medicine, it's a little bit more different.

I mean, you do get that feedback. Sometimes it tends to be towards the end of your week or rotation with the team, and then other times it just feels like, at least for me being a medicine prelim . . . which for those of you who don't know what a prelim is, it's a preliminary year intern. It basically is a group of people who go into radiology, anesthesia, dermatology, neurology, and you do a year of medicine before you do your field of interest that you specifically applied into.

So I am an internist this year in specifically medicine, and then I'll do neurology next year. So, for me, it's also been really weird of spending a year practicing a lot of medicine that doesn't really apply to the specific specialty I'll be going into.

Definitely chunks of it do apply, and I think, as a doctor, we should all be able to treat very basic, important, emergent things in patients and not be too scared to know a patient has diabetes, or an AKI, or whatever, and know how to treat that. But it also means that I don't really learn a lot specifically about the field that I applied into.

So it's interesting to also meet the expectations of people whose field you won't be in long-term either. I've had a small identity crisis this year of being like, "Oh, wow, I'm getting really good at treating heart failure," but then remembering I won't actually be treating heart failure in my day-to-day practice.

Mariam: Yeah. You're just going to have lots of patients with heart failure, and then you'll be like, "Go to your PCP."

Lilly: Exactly. Yeah.

Mariam: Oh my god. But also, internal medicine, that medicine prelim year, medicine residents work so freaking hard. As an OB-GYN, I can really appreciate this because my program, we don't rotate on other services. We're always on OB or GYN rotations, which thank God, because there are some programs that have you rotate on emergency or you do a block of medicine.

Honestly, medicine, you guys get . . . Not saying you're a medicine doctor, but this prelim year, you're doing medicine. You guys admit every patient in the hospital that nobody else wants. It's insane. Medicine is really, really hard.

So even though the surgical aspect of things, being a surgeon, being trained surgically is really, really challenging, I also see the other side of it where the medicine teams are taking literally everybody, even surgical patients, and taking care of them because the surgical specialties are like, "Nah, we don't want this patient."

It's funny because I'm on the GYN oncology service right now, which is a surgical service, right? GYN oncologists are mostly surgeons. And any time we have a patient with some type of GYN malignancy come in, medicine is like, "Can you please take this patient?" And we're like, "No, they have pyelonephritis," or, "No, they have an AKI. You've got it."

The politics of the hospital, too, are really interesting, and that obviously differs from each hospital that you're in. But those are all just really interesting things to notice, too, I think as an intern, is figuring out the systems that you're working in and how that contributes to your training as well.

Lilly: I have a lot of respect for medicine docs after this year, even though I'm not completely done yet, but I genuinely feel like every two weeks, I'm interviewing for a whole new job. Someone who's going to be going into neurology, next week, I'm going to be on the surgical trauma ICU, which is petrifying.

Mariam: Have fun.

Lilly: I know. It's literally terrifying. And then I've been in the medical ICU, I've been on cardiology, I'll be in the pulmonology clinic one day, and it's just wild how much falls under medicine and being on the other side of talking to consulting services like neurology, or pulm, or OB-GYN, or all these other ones. It gives you a different view of, "Okay, how do I want to be a consultant next year in the future as an attending or a fellow?"

Being on the medicine side, you can tell when you get a pretty poor consult, or they're not very helpful, or they're very dismissive, and you're like, "We just want to take care of this patient. Don't you want to help us out?"

So it has definitely taught me a lot of examples at least that I've had with different specialties, and like, "Oh, that's the way that you'd be a good consultant," versus, "Wow, that was actually really poor patient care and we shouldn't be so dismissive of when they need this expertise."

Mariam: Yeah, I think the ways that hospitals run are really interesting. Oh my gosh, I was going to say something and I forgot. There was something that . . .

Lilly: Oh, no. Sorry.

Mariam: My god, my brain is not working.

Lilly: It's that intern brain.

Mariam: It's that intern brain. Literally, it's rotting. Actually, that's a great topic to talk about, is intern brain.

So this episode is called Intern Year Blues, and I feel like that sounds really depressing, but I think it's important to kind of showcase the harsh realities of residency training.

I think we talked about this in a different episode last season. I remember Margaux . . . and I think Ha was also on this episode. But we talked about how residency training started and how it was pioneered essentially by Dr. William Halsted who . . . I hope it's Dr. William Halsted. That sounds right, but if that's wrong, please cut that out, Chloe.

Lilly: Let's Google this really quick.

Mariam: Can we just fact-check me before you put me on blast?

Lilly: He started the first formal surgical residency training at Johns Hopkins.

Mariam: Yes.

Lilly: So you were right.

Mariam: He essentially worked insane hours, and he was addicted . . . he was literally on coke, and he was on opiates. He was literally taking cocaine. Not a sustainable way of undergoing residency, but came up with the structure of what residency is right now, which is essentially where doctors-in-training lived in the hospitals.

Obviously, things have gotten better. I'm very fortunate to be at a program that's unionized, and I think the ACGME has tried to implement work hour restrictions. And ours, I think, is you can't go over 80 hours a week on average over the span of four weeks, which certainly happens.

And to speak quite frankly, especially in surgical specialties, but I know this is also the case for a lot of other specialties too, non-surgical alike, a lot of residents will go over hours, and then they're encouraged to lie about their hours.

I remember hearing that as a med student, and I was like, "That's crazy. I'll never lie about my hours, dah, dah, dah." But this year, I can kind of see why people do it, because you go over 80 hours, and then you have to report it, and then your program is like, "Why are you going over hours? Is it because you aren't being efficient? Let's work on efficiency."

There are lots of different problems within the system, I think, that are part of the training process that you're faced with when you're an intern. And then I think over the years, yes, you get more efficient. You kind of build that resilience because you get used to the system and you kind of figure out your way of coping through it. But I think my heart really goes out to my fellow co-interns because the adjustment period is really difficult.

I read something on Reddit during this really . . . I was having a particularly low day, and I think I had gotten some really bad feedback, or I just didn't feel very proud of my work and just messed up a lot. I think I googled something like, "Is intern year the hardest thing that I'm going to do?" And somebody said something on this Reddit chain that was like, "Intern year isn't going to be the hardest thing that you'll ever have to go through, but it's the longest hard thing you'll ever have to do," if that makes sense.

And that's true. Intern year is not the lowest year of my life because we've been through difficult things, whatever, and we have resilience, but it's exhausting and drawn out, and the hours are long, and it is tough.

I think with all that kind of being over the first half of intern year, I'm trying to think of ways to shift my mindset to make this process a little bit more sustainable.

I'm curious, Lilly, what things have you been doing this year to kind of create a little bit more balance for yourself when you're working all the crazy hours? I already know the answer to this because I know Lilly, but if you want to share with our viewers. Or our listeners, I should say.

Lilly: Yeah, I'll answer that by also kind of going back to what you were talking about with the intern brain.

One thing that really surprised me about residency was how taxing it would be on my body. I had so many systemic issues with my body this year that I was not anticipating.

I knew intern year would be stressful on my mind, and that I would always feel like I could make a mistake that could be detrimental to a patient's care. But then my body started to harbor all of that stress.

And so I noticed whenever I rotate in the ICU, I have horrible heartburn. Horrible, horrible heartburn that starts at 9:00 a.m. and does not go away until I'm off of the rotation because of how stressed out I am during those weeks on ICU.

You have critically ill patients literally in front of you, and then the constant sounds that you can just imagine of ICU monitors. And when you're on nights, it's just you and a senior who may or may not go and take a nap. And so then it's just you.

I remember my first week on ICU. I was on nights, and I didn't know any of the 20 patients, and I was just sitting there listening to the monitors going off by myself.

Mariam: Oh my god.

Lilly: It was the most terrifying thing ever. So I started harboring a lot of the stress of intern year in my body.

Besides that, I also got the stress runs every single morning in the middle of rounds.

Mariam: That's real.

Lilly: Yeah. I was like, "I need to go to the bathroom."

Mariam: You're like, "I'm so sorry. I have to leave right now."

Lilly: It's horrible. My GI tract was a total mess. I was not eating well. I was running off of a lot of coffee, which I have never drank coffee in my entire life besides just for fun here and there to coffee.

Mariam: Side note, Lilly used to make fun of me for drinking black coffee.

Lilly: I know.

Mariam: She'd be like, "That's going to give you diarrhea."

Lilly: Also, people who drink black coffee are a different kind of adult that I will never be. I still put creamer in my coffee. But I never drank coffee until I started residency because you don't have time to make a cute little matcha latte that I used to do in med school. You're just downing a coffee and you're going to go see your patients at 6:00 a.m.

And then I have chronic back pain, so my back pain got awful. My sleep was terrible. I would literally wake up stressed out that I had forgotten to order a lab on a patient.

And the first two months of intern year, I would literally get home, and at 10:00 p.m., I would log on and check on my patients and make sure I ordered all of the right labs on them, triple check that I had finished all my notes.

You know you did it and you checked your boxes, and yet you still feel so anxious because the last thing you want to do is show up in the morning and have a poor patient outcome that happened because I missed something. It's so terrifying.

And then when you go home after you sign out, sometimes I'll get a call about one of my patients from one of the interns that's covering, and they'll ask me a question. And sometimes it's not something that was urgent that they really needed to call me about, but we're all so new that we want to make sure we're not missing anything. But getting that call is also petrifying.

So I feel like my body really harbored a lot of the stress of this year, and I think that was a good and bad thing because, one, you should be scared, and you should be stressed, and you should really want to keep a close eye on things because these are real patients that we are responsible for.

But at the same time, sometimes it's so detrimental because you're overstressing about things that you did. And we also forget that there are things in place, like a senior, and then an attending, the night shift people. There are so many things in place to make sure that if something did get missed or if something does happen, there are people there to address it or catch it before it escalates further.

Honestly, that was really hard for me to let go of and be like, "Okay, someone else is checking my work," because I just felt the sole responsibility for the patients I carried.

So to kind of cope with all of those things, I definitely started taking more . . . I don't want to call them depression naps, but I started taking more naps that I used to take the first year of med school when I was just like, "I can't even function anymore." So I started incorporating naps more into my schedule.

Mariam: They're just called sad girl naps.

Lilly: I like that. Yeah, we'll call it a sad girl nap. And that has helped a little bit, I will say.

Then I keep Pepto-Bismol in my bag for when I get heartburn, which I'm happy to report, I have not had the last few months. So you adjust, I guess, to the stress.

And then the thing that I'm sure Mariam knows that I've been doing is I've been trying to get more into running, which we know Mariam is our running queen.

Mariam: Oh, I'm not. Not this year.

Lilly: Well, I feel like your body has muscle memory. But you're literally a gazelle when you run, and everyone should be able to witness that magic. I am not.

Mariam: You are. Lilly will literally be like, "Just ran eight miles." I'm like, "How? I cannot remember the last time I ran eight miles."

Lilly: Oh, very, very slowly. But I did pick up running this year. I was inspired by Mariam.

Mariam: Whatever.

Lilly: I used to do a lot of workout classes, but as an intern, you have no autonomy over your schedule, so you never know what day you're going to have off until you show up to work that week. And you also are most likely in the hospital from 6:00 a.m. until 7:00 p.m. So a lot of the classes I used to take, they're already done by the time I get off work.

So I picked up running because I felt like it was something I could do at any hour safely with someone with me and then also at any time I wanted to. I didn't have to worry about paying for it or signing up for it in advance, and I think that's been really helpful. Although running is really hard too, so sometimes I don't know why I choose to do that during my free time.

Mariam: Because you get the runner's high. It's so good. Honestly, exercise I feel like in general is so helpful.

I actually was thinking about this too. As somebody who tried to stay pretty active in med school and even years prior . . . I think I talked about this in other episodes too, but I suffer from really bad anxiety, and I always have. It didn't even start in medical school. I feel like I've had anxiety since I was a little kid. But as an adult, I've learned how to manage it better. And exercise, specifically running, was a really good way to manage my anxiety.

We as healthcare professionals know that consistent exercise is actually just as effective, or even probably potentially more effective than just medication therapy for alleviating symptoms of anxiety, depression, things like that. So exercise has been a huge part of my wellbeing, mental, physical, whatever. But with the time constraints of intern year, it is really challenging to get regular exercise in.

And when you were talking about the severe heartburn that you started to get and the GI upsets, I can definitely relate to that.

And one thing I also didn't anticipate is the . . . And actually, I should give a disclaimer. This might be potentially triggering for some listeners. So just a fair warning. If you struggle with conversations about weight loss or weight gain, you might want to skip ahead.

But just something that I've experienced is because I haven't been able to exercise as much, I have put on some weight. And that was a little bit difficult too because experiencing my body change and knowing that I couldn't really do much about it because you don't have as much control over your schedule and you don't have as much time, that was something that was really challenging, especially at the beginning of intern year.

Just feeling you're dedicating your whole life to your job and to your patients, which is a really noble thing, especially with patient care, but how not great it feels when you see your body essentially deteriorating from it, for lack of a better way of putting it.

I think our programs mean well when they say, "You have to incorporate . . ." We literally just had Wellness Week. I don't know if this is a national thing, ACGME, I don't know, but we had a residency wellness week where we were all trying to track our workouts and all this stuff.

I just thought it was so funny because I was like, "We're literally killing ourselves to squeeze in a 30-minute workout and then try to get some sleep and then incorporate wellness." It's like another box to check. And I was like, "Oh my gosh."

As much as our programs are well-meaning and incorporating that, at the end of the day, true wellness probably will not be achieved with this current system that we're working in of 80 hours a week.

And then, again, you do adjust. You adapt. Obviously, where I'm at right now, I have a better routine for myself than I did even a few months prior. I think that's something that's really promising that I would probably . . . If there are any med students or pre-med people wanting to go into this field and are worried about intern year and residency, it does get better. I can say that as an intern in the worst year of residency.

Usually intern year is the worst year of residency. It does get better. You do adapt. You do change. You have to just trust the process. But there are challenges, and kind of knowing that ahead of time can be really helpful, and knowing that you're not alone in that.

That was the other thing. I thought I was the only one who was getting bad feedback. I thought I was the only one who was dealing with the struggles of how I felt about my body. I thought I was the only one who just felt bottom of the barrel. But no, talk to your co-interns. Talk to your co-residents.

If you're somebody listening to this, literally find me on Instagram and message me and be like, "This sucks." And I'll be like, "Yeah." I will send you some of my written feedback that some attendings have literally given to me in the OR.

Lilly: Oh, gosh.

Mariam: Oh my gosh. You know what we should have done, Lilly? I should have pulled up my feedback and just read it during this podcast. I can tell you off the top of my head, they're so bad.

If you guys ever want to feel better about yourselves, listen to this. So I had feedback, "Good attitude, but very slow in clinic even with the help of attendings."

Lilly: Oh, gosh.

Mariam:"Has a good attitude, but below the knowledge base of what I would expect from her and the level of her peers. Needs to work on that." "Notably flustered and anxious when presenting patients. Could work on creating actual assessments and plans instead of muttering through the history and physical."

Lilly: That is so harsh. Oh my gosh.

Mariam: Can I just say the reason I can laugh about this right now is because I've talked to other residents, and they've been like, "Yeah, same." We're all just getting a little bit trashed on as interns.

I also will say I think that because we're interns, there's so much scrutiny, there's so much surveillance on us, and especially for people who are really anxious . . . We're smart people. We know how to take a good history. We know how to formulate a decent differential, assessment, plan, and all that stuff. But I think when you're doing it under intense scrutiny, you just look and sound a lot dumber than you actually are.

Lilly: You're doing it to the experts in the field who have seen . . .

Mariam: I know.

Lilly: . . . thousands of these cases, and this is your third case.

Mariam: Exactly.

Lilly: It's just such a hard spectrum to be scrutinized on.

Mariam: That's why I laugh, because I'm just like, "Oh, you forgot what it feels like to be totally scrutinized." It's so funny. One time I had a C-section and I scrubbed in with my senior resident who was walking me through it. And at my program, we do the primary C-section, so start to finish, unless there's something super complicated about the case, and then the attending watches.

And the entire time the attending was watching was when I was closing the uterus, which is the most important part of a C-section because the uterus can hemorrhage and bleed. It's important.

She made me so nervous because she was like, "Why are you doing that? Don't do it like that. Do you even know how to tie?" And I was like, "Ah."

And then when we were closing the subcutaneous and the skin layers, that's the easy part. So she just scrubbed out and left, and then I just started closing. And my senior was like, "See, I feel like you do a much better job when the attending isn't around."

Lilly: It's a microscope.

Mariam: Yeah. She was like, "You know how to tie. You know how to handle your suture. What's the issue?" And I was like, "The constant scrutiny."

So I think that's the other hard thing about intern years, is just the constant feedback. And that's not necessarily everybody's experience, but I would say if that is your experience as an intern listening to this episode, I want you to know you're not alone, and that they can't fire you because they need you. You're cheap labor. And to be totally frank, but also from a more empowering perspective, you can do this. It is brutal, but you can do this.

Lilly: I just want to validate that I'm sure you're doing an incredible job. People are so far out of residency that sometimes they forget what it was like to do their first C-section, and I think that's what makes them so critical.

I had an attending on one of my last inpatient wards who really made it a point to pull me aside and sit down with me and give me a lot of positive feedback, even though I felt like I was just barely surviving. And half of my presentations would be like, "I really don't know what's going on with this patient, question mark, question mark." My senior would have the same perspective, and so I felt a little bit more valid.

It's always nice when someone who has more knowledge than you also is stumped. If I miss a lumbar puncture and then the attending also misses a lumbar puncture, I feel a little bit better.

Mariam: You're like, "Yes."

Lilly: "I'm not that bad." Right? But he just really went out of his way to give me a lot of positive feedback. And then at the end of our conversation, he was like, "Throughout residency, you're just going to get so much negative feedback and you're not going to get as many thank-yous. You're not going to get recognized for all of the things you do right. So I just want to make sure that you heard some good things," which was really, really nice. Shout out to Dr. Hallowell.

Mariam: I don't know who he is, but I like him already. Sounds like the attending that I want to be.

Lilly: Yeah, he was great. But then the next week or two, I had another attending who just pulled apart every single thing I did on rounds and would constantly be like, "Well, why did we do this? Well, why did we do this?" And I'm like, "I just went off of what the consulting service gave me their expertise on."

Sometimes I don't have the capacity to know the answer to every single question, unfortunately. But then you feel really, really unconfident because you're like, "Why don't I know the answer? Why didn't I know how to address that?"

I spent a lot of time having to re-center myself of being like, "It's okay. I am not expected nor will I need to know every single thing about every single organ system, and I will never be an expert because medicine is always evolving.

And anyone who tells you that they're an expert in the field is probably not because there's new research popping up every single day that changes guidelines and changes practices that we learned even in med school a year or two ago. So it's okay to not know, but you still feel like crap when you don't know.

Mariam: It's just a natural feeling because the expectations are always so high. But I think one thing that made me feel a little bit better is I worked with an attending . . . and I'll be vague. I won't say where it was or when it was, but they gave me some pretty harsh feedback. It was fair feedback. It wasn't unfair or anything, but it made me feel not super great.

And she was like, "I expect more from you, Asadian. You can do this. You're smart, you're capable, you can do this, and so I want you to see you improve on this." I just felt so low, and I was just like, "Ugh, I'm dumb. I'm worse than the other interns, dah, dah, dah."

And then I read a discharge summary that this attending had written when she was an intern, because I had a patient who had delivered a baby a long, long time ago. I saw the discharge summary, and it was the worst discharge summary I'd ever read, for lack of a better term. And it's because she was probably a very tired intern when she was an intern, right?

I think it's funny because I'm like, "Man, do some of these attendings literally forget that intern year is just so freaking exhausting and that we make mistakes?" But I also kind of re-shifted this, and I was like, "I think the attending does remember what intern year is like and still felt like I was capable enough and smart enough to be pushed and to receive that feedback." And that actually really helped me kind of reframe it because I was like, "No, she believes in me. She actually just wants me to do better."

Lilly: Yeah, that tough love.

Mariam: That tough love. I mean, it was tough love. You guys, OB-GYN is just all tough love. If you're thinking of going into OB GYN, it's humbling. It's very humbling.

Lilly: I think surgical specialties, your experience will be so different. Your hours, your cases, your patient outcomes, they're very, very different from medicine.

One thing that Mariam mentioned that I really liked was talking to other interns. That's so important. And we don't have enough time to really get together with the interns. At least I don't feel like I do, because whatever quality time I do have outside the hospital, I really want to spend with my loved ones or my friends outside of medicine or in other states and things like that. So it's kind of tricky to also want to bond and spend time with your co-residents and your co-interns.

But I will say sometimes I'll have very humanizing conversations with other interns or other seniors who will be like, "Oh, yeah, I've worked without attending. They can be really harsh." And even though it's such a small thing, it really, really makes that whole . . .

Mariam: It validates you.

Lilly: Yeah. That whole experience I had, I felt so much better. A lot of the time, I put a lot of pressure on myself that, "I made the mistake. I did this wrong. I'm not up to par. Everyone else is doing so much better than me." I felt like that way more in intern year than I ever did in med school.

In med school, I was like, "La-di-dah, I'm a med student. They don't expect me to know anything. And if I do have a plan, even if it's wrong, they're going to be impressed." That's what you tell yourself.

As an intern, I feel the intense stress of really not knowing what my plan is and needing to figure that out in a very quick, short period of time. You'll get an admit in the middle rounds, and you're expected to break off, read about them, go see them in the ED, and then present them at the end of rounds and be like, "This is my plan," even if you haven't had time to really understand what's going on. Which sounds really scary, but like Mariam was saying, you adjust so naturally to these things.

My biggest fear was having to double my patient load from going as a sub-I to becoming an intern. I was so petrified of that, and yet now I can do it, and I don't think twice about it. When I'm capped, I'm like, "Oh, I didn't even realize that I was capped."

And this is double the amount of patients I ever carried as a medical student on top of the fact that now I'm putting all their orders, signing all their meds, doing all their discharge, doing all their follow-up. There's so much more that you do as well.

And so it's nice to also take a moment and be like, "Wow." You really do progress just through . . . I don't know if it's fight or flight. I don't know what it is. I don't know if you're building more memory bridges or what, but you figure it out.

But it is nice to have other peers that really, really humanize the experience for you and tell you that they're struggling or tell you that something is hard, because it is. And we definitely think a lot of times, "It's just me."

Mariam: Yeah. "You're not alone" is the moral of the story.

Well, we're kind of at time, I think. First of all, thank you, Lilly. Shout out, Lilly. I didn't want to do this episode with anybody . . . And it's not just because we're doing intern year at the same time. I feel like I vent to Lilly a lot about intern year.

Lilly: As you should.

Mariam: It's been a little bit of a difficult year, but at the end of the day, I'm very happy that I'm here. I'm excited that I am a doctor. It's weird being called Dr. Asadian by my patients and by the nurses that I work with. I'm like, "Who?" And then I'm like, "Oh, yeah, that's me." It's definitely a privilege, and I'm so excited to continue this training. Yeah, that's the positive note that I will end this episode with.

Lilly: I think it's a beautiful example of the fact that it took us over three months to even get on this podcast episode together . . .

Mariam: Oh my gosh.

Lilly: . . . because you're just struggling through intern year.

Mariam: Listen, for all the people who are listening right now, this episode was literally not going to get recorded because I kept rescheduling it. I was either still in the hospital, or in clinic, or literally just had no energy left in my body. And that's okay because we finally got here, and it's fine.

Lilly: Exactly.

Mariam: Well, thank you all for listening. This was a really, I think, healing and cathartic episode for me to record, especially with Lilly.

So for all of our listeners, I am very sad to announce . . . I guess this is more bittersweet but very sad right now in the moment to announce that this is indeed my last episode of "Bundle of Hers" as a full-on host. I have really enjoyed my time with "Bundles."

I think I started . . . was it my second year of medical school? And now I'm an intern. It's been a huge blessing and has been a really important space for me to connect with my community, and tell stories, and focus on the things in medicine that I find really important. I have just felt so fortunate to be a part of this community, and I've felt so fortunate to be a part of it with some of my best friends. And I just feel like this is a really unique space.

Now I actually am emotional. I told Chloe that I wasn't going to cry. No, it's fine. I'm fine. But I'm going to really miss the space, and I'm going to really miss the community. I wanted to do this episode because I wanted to highlight that intern year is really difficult even though it's a really amazing time.

And at this time, I feel like I really need to focus on this stage of my training, but I will always be a huge fan of "Bundles," and always promote the show, and maybe even be a guest star in future episodes, specifically with Lilly because I feel like our episodes are always just so bomb.

Anyway, I'm going to miss this space a lot, and I'm just really appreciative to have been on this podcast. Yeah, I'll just leave it at that.

For all of you who are loyal followers of "Bundle of Hers," continue to listen in on our podcast wherever you podcast. You can follow us officially on Instagram @bundleofhers.

Yeah, I will . . . I was going to say I'll see you in on the next episode, but . . .

Lilly: It's not a goodbye. It's a see you later.

Mariam: It's not a goodbye. It's a see you later. Okay, bye. Sorry, that was awkward.