Probably the best advice I received as an intern was, “The highs are high, the lows are low.” Ironically, the first time I heard this was after arguably my most difficult month of residency. After the initial adjustment period of a few weeks, I felt as if “this was easy.” I was fresh out of the 4^th year of medical school (i.e. well rested) and full of energy. I got along seemingly well with the staff and patients alike. The medicine wasn’t bad. Stomach pain + abnormal labs? Order a CT. Chest pain that radiates to the left arm? EKG + trop.

I thought, “Did I really have to suffer through four years of medical school for something I largely could’ve learned through experience?”

The short answer is yes…yes… and more yes.

For as soon as I thought “I could do this in my sleep,” I ended up doing it, without sleep… without help, and by myself at 4am in the middle of the night.

One of my highest points in residency had to have been when I intubated a patient during a traumatic arrest with CPR in progress. The patient was strapped to a back board, the airway was bloody, and the whole room was in chaos. Yet, in the madness of the trauma bay, everything came to a stop for me. I became completely focused, knew exactly what had to be done, and I executed it. Blade in the mouth, sweep the tongue, lifted the patient’s neck, perfect view of the vocal cords, and passed the tube all in one take. It was textbook and afterwards, I was on top of the world. In that moment, nobody could tell me anything. Between the congratulations and confirmation on the X-ray the tube was in place; I was so big headed my head could’ve exploded twice lol.

Funny enough, life has a way doing just that.

Almost two weeks later, I experienced one of my worst moments in residency. It is said, “You’ll always have one patient you’ll never forget.” Well, this was my one. Again, it was a traumatic arrest, CPR in progress, and I was at the head of the bed. I stuck the blade in the patient’s mouth, just as I had two weeks prior, and lifted, expecting to get a similar view. Spoiler alert, it was an awful view. From the moment the patient coded, everything that could’ve went wrong, went wrong. None of the airway supplies were in place how I would’ve preferred, the patient was positioned too low in the bed for me, and I could barely visualize over the epiglottis despite two attempts. I ended up handing off the intubation to my senior who seemingly got the tube in one swift try. To further add to the situation, after multiple rounds of CPR, we were unable to get ROSC. As such, I had a front row seat as the patient unfortunately passed away.

Have you ever seen the homer Simpson meme, where he fades into the bushes? Now imagine that x 100, and that’s what I could’ve done. I wanted to just disappear forget this moment even happened. But it did. Both of those moments happened and both of them were instrumental in preparing me to be a physician.

It’s part of the process, and I have to trust it.

To the new interns, the highs will be high, but the lows will be low. The goal is not to have more highs than lows. No, on the contrary. The goal is to remain grounded and balanced. Never too high, and never too low.

“Perfectly balanced, as all things should be” – Thanos

You will have highs, and you will have lows. That’s just what this is. You’re a doctor now. A new one at that. So don’t be too hard on yourself, but don’t go too easy either. For in the game of lives, such as the one we play, there is little room for error. However, just know you will have back up. You will have those who will pick you up when you fall, as well as those who will pull you back to earth when you get too high. Keep those people close. During both mentioned events, I leaned on my co-residents hard, and they held me up. Now, as a soon to be second year and senior resident to some incoming interns (it’s crazy that I’m typing this lol) I will be leaning on them even more as I step into a leadership role.

So, welcome to the best profession on earth.

You’re in for a wild ride.