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an online version of the magazine Winter 2005
Learning Curve

An Intern's New Year

Dan Munoz
By Dan Munoz, '04

About an hour ago, I hit the halfway mark. The trouble is, I was asleep.

It's 1:12 a.m. on New Years Day. As my Federal Hill neighbors continue launching fireworks from their rooftops while loudly proclaiming their love of cold beer, the number 2006, and one another, I remain comfortably tucked in the bed where I'd collapsed yesterday afternoon when I arrived home. Two thoughts cross my mind: How is it that I can now take nine-hour naps? And is it really possible that I now have less of internship ahead of me than behind me?

No single story can capture my residency experience. Any single patient, call night, or work day could provide fuel for an entire column. But there are a couple of memories—one amusing, one serious—that help tell the story of what kind of a ride this has been.

One of the responsibilities of any resident includes cross-cover, where overnight you care for not only your patients, but your whole team's as well. On this particular night in early fall, I made a point of stopping in to see Mrs. J. She was in her mid-80s and a pleasant little woman from East Baltimore. She was admitted to the hospital with an angry-looking skin infection on her right hand after being scratched by her cat. The infection was sufficiently concerning that we decided to place her on intravenous antibiotics rather than oral medicine. Worried that her condition could deteriorate overnight, I wanted to check on her early in the evening.

Mrs. J was all smiles, with no pain complaints. In fact, she said she was feeling all right. And her hand looked reassuringly better—less red, less swollen. We talked for a few minutes about her hand, then for about 10 minutes about how much fun she was having being a grandmother. I wished her a good night.

“You know, you doctors just keep looking younger and younger every day,” she said as I prepared to leave.

Feeling good that the slog of intern year was perhaps not readily apparent in the lines on my face, I responded enthusiastically, “Thanks, Mrs. J.” Then, rather than graciously accepting the compliment and being on my merry way, I got greedy. “How old do you think I am?” I asked, beaming at her with my most disarmingly boyish smile.

Mrs. J smiled back and uttered a response that perhaps best sums up my intern year. “Baby, you can't be any older than your early forties.”

My heart sank, followed swiftly by my ego. For the record, though at times this year I have felt older, I am 27 years old. And yet I have to chuckle a little when I think about Mrs. J.




The second memory involves the value of having good crewmates when your ship hits rough waters. Come late fall, interns are on call on their own, admitting new patients to the Medicine service overnight. We no longer enjoy the warm, nearby comfort blanket of in-house senior residents. That reassurance is replaced by a sense of autonomy both motivating and intimidating.

On any given night, five to six Medicine interns staff the inpatient wards, each admitting patients to their respective teams. For two weeks in October, my call schedule and that of my friend and former medical school classmate Russ Hales were similar. Both of us also had a particularly ill group of patients.

On the first night, I had to devote much of my time to an actively unstable patient with end-stage liver disease. At a critical moment, Russ just sort of appeared, offering an extra set of hands or just another mind to bounce ideas off. It was neither his patient, nor technically his responsibility, but he showed up anyway. We constructed a plan together, weighing the diagnostic and therapeutic options for this poor woman. What was perhaps most meaningful was that none of the help Russ provided to me got him any closer to finishing his own work that night.

The next call night, it was Russ who had the unstable patient. And now it was my turn to provide whatever assistance I could. This pattern repeated itself over the next two weeks. And through it all, I came to value just how critical it is to have colleagues whom you can trust implicitly. I never had to call Russ to ask; he never had to call me. Both of us just showed up to assist when that was necessary. Perhaps most importantly, I think our patients benefited from our collaborations as much as we did.




From the silence that has descended, it sounds as if my neighbors have finally gone to bed. Their day tomorrow will likely start around noon, and involve ibuprofen, coffee, and sweatpants.

My day will start in four hours, with an early morning drive to the hospital.

But with patients like Mrs J and teammates like Russ, I'm oddly okay with that.

 The House that Sol Built
 Time Clocks in the Trenches
 Beyond the Abyss
 The Sum of All Fears
 Circling the Dome
 Medical Rounds
 Bench Press
 Annals of Hopkins
 Learning Curve
Johns Hopkins Medicine

© The Johns Hopkins University 2006