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Marching Towards Greatness in Residency

By Dr. Sandipan Shringi

THE BACKGROUND

I am Sandipan Shringi, MD, a final-year resident in Internal Medicine at Saint Vincent Hospital in Worcester, Massachusetts. I am originally from a small town in India. My path towards medical practice began when I was 16 years old. As you will learn, my journey as a physician began dangerously and has taken unexpected paths.

THE BEGINNING

It is said that you can quit the army, but the army never quits you. I thought I had escaped my fate and left the battleground behind… but then, as one often does, I found my destiny on the path to avoid it.

Trinhhhhhhhhh! The alarm clock buzzed and woke me at 3:30 AM. It was near time to report for morning exercise. My unit was in training, and by extension, so was I. We found ourselves, amid a cloud, at the reporting ground. We arranged in a file of three and prepared to march to our destination. Usually, 700-800 people would participate in this march, which spanned 5 Km (3.1 miles), with 20Kg (44 pounds) strapped on our backs. The altitude, at 10,000 feet high, increased the difficulty of our exercise exponentially.

The beginning

There was a breakfast halt at mid-way, and then we would return to prepare for our respective duties by 8:00 AM. As a Medical Officer in the Indian Armed Forces, I saw patients all day. My brief daily respite was to play sports in the evening and finish my day in the officers’ mess with a hefty meal.

I had few, or no, medical resources and was responsible for managing unit rations. Practicing standard bread-and-butter medicine was often punctuated with the treatment of gunshot wounds, mine-blast injuries, and high-altitude illness. On occasion, a patient’s oxygen monitor would read out 85%, while I had no oxygen supply on hand. These were the usual days when I was an army doctor.

We often hear the words “No one said it will be easy.” I never imagined that some days would be that hard either.

THE TRANSITION

“The new interns have arrived!” This, the thought on everyone’s mind with first light on or near the first of July each year.

The next chapter of my journey began after I sat for three grueling exams lasting eight to nine hours each. I also survived harrowing experiences such as making my way to an interview during a record-breaking snowstorm during which every means of transportation were canceled. I made it on the last flight, and then the last Amtrak, from Philadelphia to Boston, while the temperatures dropped to that of Arctic standards (-21°C/-6°F). I also had been required to complete a ton of paperwork and relocated halfway across the world. But, finally, I secured a training position.

The transition

It was smooth sailing (albeit with some occasional choppy water) during the first six months of my residency, and it felt like I had a new family at work. Then, in late 2019, came a microscopic entity that would ultimately destroy all existing protocols and preconceptions. For us interns, whose biggest concern had just been navigating open enrollment and choosing health insurance, it was frightening, to say the least.

COVID was not the trauma that hits you lightning-fast and changes you immediately. Instead, it was the slow-motion, dramatic movie version—where your life, as you know it, flickers away slowly. It was and continues to be painfully unending, affecting everyone in some way. Here we are today, in 2022, still in the midst of the pandemic, fighting compounding issues like vaccine misinformation.

When it started, there was no certainty. Will there be a vaccine? Will we get sick? Will we survive? Naturally, such thoughts crossed my mind too. I felt unlucky to be living alone, reliant on public transportation as a non-driver, and with training hours that made shopping for essentials a significant challenge. My wife, who would usually help solve such problems, was in a different hemisphere, thanks to COVID. In short, resources were limited.

Fortunately, where resources were lacking, help from the people around me was not. There was not a single day that I went without food, missed a day of my training, or even got sick. I clearly had the support I needed to make it through. I wondered if my prior army training had helped prepare me for all of this. But when I looked around, I could see that everyone from all walks of life had risen to the challenge. I was, and am, surrounded by inspirational people. We are still here, marching on.

THE COVID RESIDENCY

A few months after it surfaced, COVID was a better-known disease, with unknown management. I was nervous to begin my first night shift as an intern, due to the sheer number of unknowns. Before long, my uncertainties were assuaged by my training, and my confidence returned.

The COVID residency

At one point, a nurse paged me, “Patient’s oxygen saturation is 85%.” I thought, “I have heard that before,” but that time there was no 10,000-foot elevation to blame. The third-floor patient was short of breath and needed to be on a non-rebreather. Suffice to say, I was almost running as I made my way to the patient’s room for an evaluation.

When a doctor in training finds themselves in an acute situation, they usually track through a series of questions and differentials to figure out what is happening and to treat it as fast as possible. Blood draws, radiography, and ABG are parts of this process. While sometimes it is possible to treat clinically, other times you take actions to stabilize the patient while waiting on the results. In this case, a respiratory therapist was called in and arranged for positive pressure ventilation.

It was then that another page came in, from a different corner of the hospital, saying that a patient had broken into a rash after starting a new medication. Again, a doctor in training thinks of the worst possibility first, and I practically ran again to evaluate. Anaphylaxis is a known condition with known management. On my way, I called my senior resident to help with the anaphylaxis case. This patient did well.

Next, a third page indicating another patient was having chest pain came. An EKG was commenced and some lines that should be flat, were not. After I finished stabilizing the patients who could be stabilized, shifting patients to ICU who needed it, and my regular follow-ups, I noticed the time. I thought that I was halfway through my shift, when in fact, I was starting to receive messages for sign-out. Time really flew by as a cross-covering intern.

For some of my fellow-trainee readers, this may send chills down your spine—but hear me out. Your approach to life and medicine decides everything. If one goes into a shift already fearful or lazy, it is not going to go well. However, if you go into a shift thinking, “I will be on time,” “I will handle everything,” and “I will learn from it because that is what I am here to do,” then every shift will be an awesome learning experience. Three years into my training, I feel extremely grateful for many such shifts. It has made me everything that I am today.

THE FUTURE

I Matched (again)! I recently completed another cycle of applications, interviews, and am now looking forward to beginning my fellowship this summer. Time flew by. In my short three years of residency, I have had the opportunity to learn various electronic medical record systems, gain knowledge and skills related to numerous specific subspecialties, meet lots of people from a range of diverse backgrounds, and overall, just learn how to be a better human.

The future is bright

In my time at Saint Vincent Hospital, I have been pleasantly surprised and took great inspiration from the people around me. I know now that it is the people who form any community, county, or country, and not non-living, man-made things that bring one contentment and satisfaction. If you take one piece of advice away, remember that to be a great doctor, one must treat patients both medically and on a personal level. Connect with people.

In closing, I will tell you what I wish someone had told me. Yes, nobody said it will be easy, and in fact, it will get harder and harder with every step. There will be days when you will feel like you are destined to fail. But, you will make it. No matter where you are and how your day has been, one day it will all make sense. Just keep doing what you are doing and do it in the best way possible.