Dear Sanjay,

Hope you’re doing well. You’ve probably just settled into your first adult-sized Manhattan apartment. It may take a while, but you’ll eventually manage to find your stethoscope – it’s been gathering quite a bit of dust since Match Day. Your scrubs are free of bodily fluids – at least for now. And that shiny new badge with the letters M.D. probably feels a little heavy at the moment.

I write to you as your future self – almost a year older, hopefully a year wiser, and ever more confident that I made the right choice in devoting my life to this craft. I write to you in hopes that you heed at least some of my words, for the next twelve months will be some of the most challenging of your life thus far – physically, emotionally, and spiritually.

Much of intern year will be spent outside the walls of the emergency department.  You will be a stranger in a strange land for many months. And with these travels, will come its own set of ups and downs…

  • In the surgical ICU, you’ll take care of New York City’s Finest and the incarcerated mere feet away. You’ll witness the weight of a daughter’s guilt as you sustain her father’s blood pressure with push dose phenylephrine – just long enough for her to say goodbye.
  • On the trauma service, you’ll find out that sometimes bad things happen to good people. And regardless of how hard you fight, you just can’t save everyone.
  • Your first intubation will be in the neonatal ICU – on a 2-hour old neonate. (Don’t worry – no teeth)
  • Remember to take care of yourself. What you do is incredibly difficult. Vasovagal-ing halfway through rounds in the medical ICU because of exhaustion is probably not good form. (Thanks for walking me home, Tim.)
  • You will learn a valuable lesson at the “lower acuity” Veteran’s Affairs Hospital. As you and your attending are dragging an unresponsive patient from out of his car and initiating ACLS outside in the dead of winter, it will finally click – never get too comfortable.
  • And on the medicine floors, you’ll begin to understand the power of palliation– that sometimes there is just as much value in withholding care as there is in sustaining life.

The political landscape will change. And it will hurt personally and professionally. It will make your job more difficult but also that much more important – for you and your colleagues are the first line.

You are now a doctor, but still a human. It’s okay to feel overwhelmed. The first time you come incredibly close to losing your cool will be during the first month of intern year, when the triage board is blowing up and you still don’t understand the technical complexities of those urine vacutainers – true story.

Your nurses are your best friends; they are your eyes, your ears, your sixth sense. Listen to them. Trust them. They will save your ass countless times.

You will gain 59 brothers and sisters. You’ll marvel at their passion, humility, and intelligence. They will pick you up when you fall and will push you to places you never thought you could reach. You will laugh with them, cry with them, and ultimately grow with them. They’ll tell you that you’ve grown so much since July – admittedly, that’s still hard to believe.

This job has never and will never be easy. You will constantly question your own ability and if you’re capable of becoming great. Every once in a while, take the time to step back and realize your responsibility, your role, and your purpose. You are walking in the footsteps of giants, brushing elbows with attendings who have advanced the field and have sacrificed for the greater good of society. Trust the process and keep your ear to the ground.

You are about the enter an incredible world. You will see things that you can’t unsee. You will encounter pain, suffering, and death on a daily basis. And you will be humbled by the resiliency of the human spirit. All of which will make you a better physician and perhaps more importantly, a more compassionate human.

There is only so much I can tell you. The rest is on you. For now, I need to get some sleep. Next shift is in 12 hours.




Practice your ultrasound guided IVs.