A letter to my future intern

*from your future chief

There are many things that I’ve learned in the last six years of residency that I want to share with you now that I’ve been a resident for a while (longer than most, get ready for it) - 

Congratulations, and welcome to the field of neurosurgery!! I am so so proud of you for making it here. This week marks the culmination of everything you have worked so hard to achieve for so long - you did it, you actually did it. Take your time - celebrate - enjoy these moments. You deserve it! Think of nothing else for the next several months and allow yourself to thoroughly savor these feelings, these moments of peace. You are still so young, and so full of hope, and so excited for the challenges that lay ahead. I urge you to remember those feelings as you embark on the journey of residency. The real work begins soon.

Say goodbye to the person that you are at this moment in your life. This version of yourself will no longer exist in seven years, for better or for worse. You cannot go through this process and remain the same as you are now. Residency is in many ways the most difficult portion of a physician’s career, and neurosurgery is no exception. Often quoted as the most difficult residency program that exists, it is designed to push you beyond the limits of what you thought was possible - physically, mentally, spiritually, in every way you can imagine.

You have the honor of joining the ranks of a privileged few - over the next (seven+) years, your minds will be molded and your hands will be shaped and your bodies will be trained to make you better and stronger than the situations you have to deal with. 

The situations that you will be exposed to will have you questioning much about life itself, about the goodness of the world, of humanity. The three-year-old with the gunshot wound to the head - you have to tell the parents about the outcome and can’t breathe as they break apart in front of you. The newly married couple in a near fatal car accident - you have to talk to a bride still in her wedding dress about the critical nature of the options for her groom, none of them good.  The career professional, about to be a grandfather, who came in to get his headaches checked out - your heart sinking to a pit as a you see a butterfly-shaped lesion on the imaging and trying to remain optimistic as you describe the next steps, all the while knowing what you know about glioblastoma. 

These situations don’t just happen just once in your seven years, but oftentimes you will have multiple just like it in the same night. The majority of patients that you see and treat will have their lives irrevocably changed by the experience that brought them to you. I urge you to never forget that, while the hours can feel endless and the nights drag on, the 5 minutes you’re able to spare (between the millions of tasks and critical situations tugging at your attention) to spend with the patient and their family will be the most important moments of their lives. 

There is no time to process or reflect in the moment, and I remind you that it’s important to do so after the fact or this field will tear you apart. Your belief in whatever worldview you hold will be tested again and again (and again). In those moments of complete despair - of your own, of the families that you serve - there will be small pockets of light. Reach for those, seek those. There is no one else in the world who will understand what you are going through than those who have been through it before you - if you ever feel like you’re broken, remember that we are always here to pull you back. Do not forget to take care of yourself during this whole process.  Also - in spite of it all, you will see goodness around you. You see it in the nursing staff who use their own resources to buy the best body care products for their patients so they can give their comatose patients dignity, and show them the love they deserve. You see it in the families, during their own time of grieving, who bring you treats because they see how hard you’re working, and want to make sure you’re okay. You see it in the providers who buy their patient’s favorite snacks for them, because they mentioned it once. You see it in all the staff who came together to arrange for their patient to see their puppy at the hospital, one last time. You see it in the patient who walks back into clinic ready for his cranioplasty, when just months ago he was chemically paralyzed on the ventilator for weeks in the ICU and you counseled his family that the prognosis was not good. You see it in your co-residents checking in on you with a “hey, are you okay? I heard about your case, let me know if you need anything at all”, after your patient passed away during surgery. 

You see it all around you, and most importantly, you see it in the people who are around you who are not in this field. They can never know exactly what it feels like to go through all of this, yet they will be subject to the experiences and emotions through you. They are the easiest ones to forget about and to treat poorly, but they will be the ones who are most important to you throughout this process. The amount you will work over the next several years of your residency will quickly force you to realize your true priorities in life - the ones who supported you all along and got you to where you are today should be at the top of that list, even if it isn’t always pragmatically possible. In the end, they will be the ones who will be there alongside you even after it is over. 

As your incoming chief, I know what it was like to be in your shoes - and every neurosurgeon before you has also been through it. These will be some of the hardest years of your life. Excellence will be demanded of you every single day. It will feel like the things you do well will hardly be recognized, and every flaw that is apparent will continually be criticized. Realize that, though the weeks are very, very long, the years are very, very short. You will not feel it on the day to day - in fact, it usually feels like it will never end - but in no time at all, you will have learned such an incredible amount of information about the (best and coolest part of!) the human body, and your (surgical) abilities will come to a point where you’ll say – “wow, I did that!”. You will experience some of the lowest lows and highest highs of your life. Nothing will quite prepare you for it but starting the process. Take care of yourself and we will see you in July!