InternPrimerEpisode - FINAL

Hey everyone, and welcome to another episode of Behind the Knife. Today we are joined by our Behind the Knife Fellows and we'll be discussing what we wish we knew before our intern year started. Everything from the mistakes that humbled us to the lessons we learned from them, and the surprising ways we grew.

Whether you're gearing up for your first day as an intern deep into the trenches of your first year, or looking back at those chaotic early days as a senior or an attending, this episode has something for you. We're joined by the fellows who've been through it all and are shameless enough to share their most cringe worthy intern moments and the lessons that stuck with them.

Why don't we introduce everyone? I'm Elizabeth. I'm President at the University of Nebraska and a Behind the Knife Fellow. Excited to be here today. I'll go next on Nina. I am a gen surg resident at the University of Washington and former. DTK, surgical education fellow who's just continued to hang around.

Also excited to be here. Iman, I'm a PGY by three. I almost said four for no reason. But I'm a PGY three at Duke and current behind the Eye Fellow. You're just trying to get further and further away from your intern year. I meant it's true. We said internet. I'm

so traumatized already that I can't even remember who I am.

Hey everybody, my name's Michelle Abella. I'm a journal surgery at UNC also. Happy to be here and hey guys. I'm Emma Burke. I am a general surgery resident at Baylor College of Medicine and a current BTK fellow. Also happy to be here. All right, Nina, we can start with you. What was your biggest misconception about intern year?

So as with medical school, I felt like I got told a lot that I would just be like barely getting by, kind of treading water for the whole year. Totally overwhelmed, not able to do really anything except for be an intern work and study. And I really found that once I figured out my workflow, there are so many ways to get involved, help with the fun parts of surgery, mostly.

Cases and continue to like, have a life outside of the hospital. It requires a lot of discipline. You definitely have to be intentional with your time and set aside specific time to do things like study prep for cases, prep for clinic. But there are little things that you can do throughout the year that really helped me get into my flow, feel like I kind of had my feet under me, and

then get to those more fun.

Parts of the job. So I would get in early, I would get my notes drafted. I would make the electronic medical record work for me and not the other way around. So like leveraging things like dot phrases so that my notes were really quick in the morning, but it's all possible and you actually can do it and have a fun intern year.

Also, I think something that I. Learned more as a senior and now appreciate a lot more as a senior resident than I ever did as an intern. But taking a little bit of extra time to communicate with folks that you're working alongside pays so many dividends in the long term. So what this looks like for me now is it's like I will Epic chat the nurse that I just ordered a CAT scan or labs or made the patient NPO so that they're not trying to catch up with my orders.

And I'll even explain sometimes what we're specifically thinking about or worried about. It's. Spared me many, many pages. I think later in the day asking clarifying questions or like wondering what is going on when you feel like the nurse is like on your side and they are helping you execute the plan for that

patient as opposed to just like.

Putting the orders in, running it off and doing something else, which I, I did admittedly a ton as an intern. And I think having those conversations really helps you feel like you're on the same page as the rest of the care team taking care of your patients. I totally agree. I feel like the, a little extra communication in a text really does help smooth over things in the future for you.

Yeah. I mean, totally agree, Nina. I, I actually do the same thing Nina does. I epic chat, all the nurses, the plan for the day, and it has saved me so much time. But for, for me, you know, I didn't realize how much responsibility you have as an intern on day one, but to be honest, you, you kind of adjust to that pretty quickly.

You think the more intimidating misconception and what, what I think everyone. Thinks about before intern year is their personal life. And I really thought I would be miserable and I kind of braced myself for that. I was like coming in like, you know, this is gonna be tough and you're gonna be like horribly upset.

But in reality, intern year turned out to be probably the most rewarding and. Honestly fun time of my life at that time. You know, you're

gonna be tired and there's so many lows, but you meet so many people and patients and you really do feel like every day you're making a difference and you're helping people and it, it is worth it.

It's a lot different than being a medical student and in my opinion, so much better. And you know, this isn't really a misconception, but you get really close to people you know, sometimes. These things are really hectic and crazy, and we don't go through events I think that other people do outside of medicine and especially not surgery.

So you, you get close to everyone, including nursing and you rely on, everyone really is a team sport. And I don't think you fully appreciate that until day one as an intern when you're trying to figure out how to order a, you know, red blood cell count, right? So. Yeah, you never know who's gonna be the person who's gonna have that answer to the really dumb question that you have.

It's sometimes it's just the person who's in the room. It's the, or the, you know, the nurse on the floor can help you out. Like, how does this order come through for you? That that really does help. Emma, what was your biggest misconception of intern year? I.

Kind of like Nina and Iman. I had heard I was not gonna get to do anything outside of the hospital.

I think one of our older attendings said like, intern year, you just give yourself up to your residency program. Like you should just expect that your life belongs to the residency. But that was so not true. It was the first time in my life I had made a paycheck other than like. Coaching swim team or like working at the Master's Pro shop for a week every year in school.

And so I think I did a lot more living outside of work than I ever expected to, you know, like going out on the weekends with my husband or my friends. My biggest recommendation, I did schedule a week of vacation at the end of our worst rotation of intern year and C-V-I-C-U. I was on a Ttra Nights. I went to Disney for a week.

It was fantastic fun. Yeah, so definitely. Live outside of work. I think I was afraid I was not gonna get to do those things. I was always gonna be sleeping or eating if I wasn't in the hospital, but that is so not true and agreed with. I'm in, make friends with those nurses, the Ben Top Stick nurses save my life more times than I can count whether I was actually in the ICU or not.

Or sometimes it's just the pharmacist who's gonna tell you that you're

not actually gonna send your patient into liver failure from the Tylenol that you're ordering. Having pharmacies number in your back pocket is critical, and they probably will have yours to like fix your five times the recommended dose of Dilaudid that you just ordered for your patient.

Michelle, anything for common misconceptions. You know, I don't feel like I really knew what to expect going in as an intern. Honestly, my family's in medicine and like I agree with what Nina said. You're told that you're gonna start treading water, but I had never experienced that until working medical school is a lot less emotionally intense.

Like you're talking to people constantly and I know how exhausting. Thing that was gonna be, but I think it's really important, like you find your group of friends, you really bond with people intern year, and I think that really helps to get through it. And I think that's something that people should keep in mind when they pick residency programs.

So now that we're all warmed up here, let's get into some of the nitty gritty of the embarrassing things we have or have heard of or witness other people do as interns. Full disclosure, everybody makes

mistakes. Wait, who sang that song? Everyone makes mistakes. Everyone has those days. Is it Hannah? It might be Hannah.

Oh, Hannah Montana. Oh yeah. It's Hannah Montana. Yes. Phenomenal. In the words of Hannah Montana. Everyone makes mistakes. Everyone has those days and so did we. Intern year and likely so will you Intern year. So we're gonna tell you some of our funny, embarrassing moments, and maybe this will remind you of some of the ones that you have had in the past or will have in the future.

I'm gonna kick us off your story. Yeah, I can start on it. I'll say that. I'll say anything I bring up. I'm sure that my chiefs have way worse stories. But I have two, I guess I have two favorites that I like to tell that make me look pretty bad. One of the first few nights of residency I got assigned to nights and, you know, you're cross covering.

More patients than you ever realized you could. And one patient had some hyperglycemia. I had no idea what to do. So a nurse kindly suggested, you know, maybe you should try sliding scale. And at this point I was, I was losing it. So, the medi, the medicine team happened to have their team room right outside.

You know, day three intern, I walked in and kind of like drop on the floor and I said, please, for the love of God, can somebody teach me how to order sidey scale insulin? And it was pretty embarrassing, but a medicine chief took me under the wing and taught me how to treat a glucose of like. 250. So that was, that was pretty nice, but quite embarrassing.

Another one is the first, the first day of residency I was on vascular and it was a really late night. And I had a patient who needed a very, very urgent CT scan for an acute limb ischemia picture. And the fellow said, you need to get this patient a CT scanner yesterday. So transport unfortunately said about an hour, and I was truly scared for my life.

So I decided I would transport the patient myself and. I happened to get lost on the other side of the hospital with a screaming patient and no clue where I was. And it turned out that I needed the radiologist to come and escort me to the right place. And it was a whole shenanigan with going through the wrong elevators and the wrong thing.

But we got it done in the end and she

did well. But I think that the most important thing from all this is that. You'll make many, many mistakes. And the the thing that I learned is that as long as you're safe and you learn and the patient is always coming first, then there's really retrospectively nothing to be embarrassed about.

We all go through this. You, you grow. And that's, that's worth it. So good motivation with a scary fellow. Exactly. I do think that you make a really important point. The knowing when to ask for help as an intern is crucial and there's always somebody you can ask. I mean, if it's for the safety of the patient and you're risking getting yelled at, it's, it's always gonna be worth it in the end to to just ask the dumb question, even if you think it's dumb.

And medicine was very helpful to me. Yes. I don't know about you guys. I would walk by a medicine hospitalist and I would say. Finally a lifeline and I would just, you know, and they, they were always so great. So being able to ask for help was huge. Emma, what, what do you got for us? I started off my intern year in the CT surgery service.

I'd never seen a heart before, was, you know, freaking out in the OR every day.

But my fellow told me to order a voodoo heparin drip. He kind of gave me some like vague grunt of like what that looks like. And I think it was like 500 units an hour, flat rate, non titrable. I like a genius like go over to Epic, log in, and I ordered the ECMO strength heparin drip for this valve patient.

And within half a second pharmacy called me and they're like, you cannot get your hands on that outside of the or. Are you sure? And I was like, no, you're right. I don't know what I'm doing. That was the last time I ever ordered anything that I didn't know how to order without calling pharmacy. I call pharmacy all the time, still when I moonlight.

Now on research time, I'm calling them 'cause I forget how to order things, not seeing patients every day. So my biggest piece of advice is find those people that are helpful. You know, the medicine residents, the pharmacist, the dietician to help you order TPN and just reach out to your people the second you think you need them.

A again, another win for pharmacy right there, Michelle. What? What's

the most embarrassing thing you did as an intern? So my embarrassing story, I was on our thoracic surgery rotation and you know, a lot of chest tube patients. We had one patient with a C clogged chest tube that we were injecting TPA into the tubing to try to dissolve the C clot and like make it functional so we didn't have to, you know, put another chest tube in or do a procedure.

So it was my first time doing it without like somebody showing me, and I used like the blunted needle to try to inject the TPA and it wasn't going in for whatever reason. So I pulled the needle out and I was like, all right, you know, let me just like try again. Stuck the needle in a different place and the, the TPA or whatever was in the chest tube, shot right back at me and like went in my eye.

Had to go to occupational health. It was a whole, they had to draw a lap from the patient. It was a whole ordeal. Was super embarrassed at the time, but like, honestly looking back, it's like kind of funny. And the patient even thought it. Was like really funny when they were like, why are you drawing my labs?

Like I was there. I was like, well, you know, it kind of went in my eye and he's like, oh wow, that's hysterical. Take whatever you need from me. That's good. And I, I don't know,

I feel like everyone has an occupational health visit at some point as an intern, especially as a surgical intern, it's. Almost not avoiding it unfortunately.

I will share my story really quick. So I was probably two or three months into intern year and it's 2:00 AM in the morning on a 24 hour call shift. It's me and my senior. We got a page that this patient's midline incision looked in fact. Did and we needed to go up to pop some staples out of the bedside.

And I'm walking up with my senior and he is pontificating as seniors typically do, telling a story about how, oh, as a junior resident, you get to a point where, you know, you kind of just have to figure out some stuff for yourself. Sometimes you can't always ask, and maybe this was a reflection of me asking too many questions.

But and you gotta just something. You gotta figure things out. Okay? So we get up to this patient's room, he goes, the suction tubing doesn't fit. We're gonna need new suction tubing. He tells the nurse that, and then we're kind of getting everything ready to pop these staples. Out of this patient's midline incision, I look at the suction tubing, I go.

That reaches,

what is he? Talk crazy man. That reaches just fine. I'm gonna take his word of advice and we're gonna fix this problem right here. And now we get the midline incision open. Tons of puss. Lots. Most puss I think I have seen to this date, coming out of this midline incision. We got four by fours.

We got the suction tubing, everything is set up. We get the patient all nice and cleaned up and ready to go. And he turns to me and he goes. So how much, how much like pus came out of there? That was a lot. And I go and I look at the wall and I see a clean, pristine suction canister, and I go, I don't know, it's in the wall.

And it was, at that moment, I knew that I had truly, truly messed up. I like hand over my mouth in stun silence. He goes, what? I go, it's, I, I hook the suction tubing directly up to the wall that is like, that is like. I had to tell the nurse I had to call the maintenance people and it was very. Very much like dog with their tail between their legs to be like, so I'm so, so sorry.

I don't know what to do about this, but

there is puss in the wall of this room. The house vac at my hospital is still okay. And, and the, there was no, no suction mis mishaps in the future, so that's good. And now I know how to hook up suction tubing. 10 outta 10. We learned. That does kind of remind me as as an intern, I think like day three, I was trying to take out a staple once and fired it the wrong way.

And I dunno if anyone else has done this as an intern, but had to unfortunately put some lasting on a patient's deadline to get outta stable from firing it the wrong direction. So, no, no puss in the wall for me yet. There's still time. So those are the funny, embarrassing mistakes that. Make great stories today, but what are some of the mistakes that actually taught you something important?

Yeah, I, I mean, I guess I can start, it's e even that little stapler thing firing the stapler, the, the staple remover, the wrong direction and putting it into the patient. I mean, that, that teaches you so much. Unfortunately, I think anytime that you make a mistake that has any potential to hurt someone, even if it's like.

Ordering maintenance was on the wrong patient. Right? You're not it, it's anything like

that and people will always do it. It doesn't matter how good you are, but it always reminds me that you need to pay attention to the details. And these are people that you're working with. I think I. The other really big mistake that has taught me a lot is once in a while I think that I may have been rude to a staff member or maybe just said something and it came out the wrong way.

And that's a terrible lesson to learn. I think that's a mistake that taught me kindness and humility and empathy really go very far away in the hospital. I think every time that I learned that lesson, it hurt and it probably should hurt. And hopefully I don't do it again. There's also that point, kind of intern year, I think it's March AB site might be done and you think that you're gonna see a light at the end of the tunnel, but like the light's not quite there.

Worse. Yeah, it gets worse somehow. And it's like, again, 2:00 AM 'cause everything always is 2:00 AM when it happens and you just have like that little bit of crust on your personality and you do even like the nicest person will have that moment where they say. Slip and kind of say something that's maybe not the nicest, but yeah,

that is true.

Always remembering the kindness, empathy and the humility really, really brings you back. So I'll start with a story. The first time I put in a chest tube was kind of a terrifying experience. We was on a patient who had a ated fluid collection. She was a transfer from an outside hospital and it was the first time I ever tried to put a chest tube in and my senior was so amazing, tried to walk me through it.

She was awake, she was super anxious. She was, she could barely lay on like her side for us to like get the chest tube in. So, needless to say, like I was not the one to get that actual chest tube in. I just, you know, kind of made an incision, got down to the chest wall and actual pleura was so tough. So I did not get that chest tube in.

And then I think for a while after that I kind of felt like I didn't really fit in. I was like, am I gonna be able to do this? I can't even get a chest tube in like over, we're like six months into intern year, like why can't I do something? And I think like the imposter syndrome hit. And I felt pretty bad about it for like weeks.

And I think eventually you realize like how much of a learning curve residency is, and especially intern year is, and you're not supposed to know how to do that stuff before you do it. But then you know, you

practice and you keep going and you show up every day and you work really hard. And like now I love putting chest tubes in and it would be like I probably could put a chest tube in somebody like that.

I haven't in a while, but it probably could. And figuring out that quote unquote failing is just a part of residency. Yeah, my engineer, I made a list of all the things I did wrong. Do not do that. It's a horrible thing to do, but it started kind of after the wall plus thing. 'cause I was like, this is so embarrassing.

I wanna remember this story to tell it forward. So I made this list of all the things I did wrong and. It was a little bit funny, but also like a little bit horrible on my self-esteem, as you can imagine. And I had one of my seniors be like, okay, if you're gonna have a list of all the things you did wrong, you also have to have a list of all the things you did, right?

So do remember that? Although these mistakes seem so embarrassing and so big, you are doing right things every single day and every day there are more correct things that you can do. And you don't even notice your growth throughout the days, the months, and then eventually the years. That's true. I feel like every single second, honestly, we're just.

Doing stuff right. And it's because it's, that's the expectation. And

there's like, you know, not supposed to be room for error. It doesn't get registered by us or anybody. But that's so true. In surgery, especially, there's so much, everything that we do, you know, anything procedure based has some potential to be not perfect.

Right. The first time you close skin or anything. And we just think about it constantly. And so that's a good point that we do do a lot of things right, but especially in our field, it can be quite brutal to think about all the things you do wrong. Mm-hmm. I do think also though, as a more senior person leading teams and watching interns kind of push that learning curve for themselves, you're, if you're getting things wrong, it's like you're on your learning curve, right?

Like you're, you're at the cusp of the wave. So if you're just riding and you're doing things that you a hundred percent know how to do, then you're not. Doing the job, which is to learn and push yourself and get better every day. I do think that the times that I've screwed up something stupid, that's how I avoid spiraling.

Like 80% of the time I would say is by just saying that that means that I was doing something that I've never done before, which is most of your year into year. And you have to kind of get comfortable with that. 'cause otherwise you don't

grow. So the whole point is to go and figure out where your pain points are.

Yeah. To make mistakes is definitely to. To learn and then to grow, unfortunately. Yeah. Yeah, yeah. All right. Should we move on to the next question? What does being a good intern actually mean to you, and how has this changed since you were one? I think my first day of work when I showed up, I thought I had to know the answer to everything.

I needed to get every question right. I needed to know every plan for every patient. When my senior asked me for a plan, rather than just kind of get my most educated guess, I. But as when we're PGY twos, we manage interns in the ICU and then also overnight at our pediatric hospital. And what I realized when I was managing the interns is the best interns are the ones who really wanna make the team look good.

You know, they're circling back. When you say you wanted to order 10 labs on somebody, they're making sure you ordered all 10. Are there. Getting that note done that you don't have time to do 'cause you're scrubbed or you're seeing another consult. And I think it's those people who are real team players and wanna make the entire

team look good.

'cause honestly, when the whole team looks good, then like. That all the attendings are gonna think well upon all of you that are on the team. So being a team player and just not being afraid to double check everything and get those small tasks done so that the team can function at the highest level, that's also how you get into the OR more when your senior is happy, 'cause then you have more time.

Surgery is a team sport. 100%. Nina, you wanna go next? Yeah, I second everything that Emma just said, because I think those are all super key points and they just make, like, they make it more fun to be on that team when it's firing on all cylinders and everyone's helping each other out. It's just a better vibe on the team when everyone's working together.

I think the best interns are the ones that I can really trust to execute and. The ones where I can see their wheels spinning on a day-to-day basis. I definitely don't expect interns to like know every answer to every clinical question. Like, that's not your job. That's not where you're at on your curve of accomplishment in clinical medicine.

But when somebody can reliably tell me the data that they need to know when they can

bump things up with a plan attached to it even if it's not the right plan, I don't care. And then if I can see them execute on plans that we just. Develop together efficiently, then that spares me so much anxiety and work throughout a day-to-day basis on a team.

I really think that at this point in your medical career, when you're starting your intern year, you are a doctor. You are not a baby. I know we talk about baby doctors all the time and, but it drives me nuts because I really think that you are a smart, capable, efficient person who has gotten this far.

Use that and also step up to the role, and you should be telling your senior residents what you want to do, not just the. Vital signs, abnormality or something like that. So use that because it helps us know where your pain points are as a learner. It helps us teach you better, and it helps us see those wheels spinning and see that you are working hard to become the next level up from where you are at that point.

That's so well stated, especially I think the idea that we forget how much. Training we have gone through to even get to this

point. It's okay. Like, obviously, you know, you don't wanna get too big on your britches or like your head too big, but, but you don't wanna get too, what is the, what am I trying to say?

Too big of a britches too, too big. Too big of an ego. I dunno, an ego your head be No, it's definitely four. Wait, who said that? Big? Your bri Too big for your britches. Okay, so you definitely also don't want, I don't even know what that means. You don't want big britches, you don't wanna get too big for your britches.

But at the same time, you do have to remember that you've come and done a lot to actually get here. You know Elizabeth Snu most embarrassing moment of. No. Then you'd be like, this is how far we've actually come. Okay. The same, I, I can't say I've worked with too many interns, maybe only a couple rotations.

But I would say that. Probably, to me the best is just a really great attitude and being reliable. I think

that it's completely okay to say, I don't know, to something, and it's much preferred than making something up and being reliable is great. Being able to look something and be like, Hey, can you take out the drain and know that that drain will come out is pretty big.

Having really good attitude is, is so, so helpful. I mean, it makes rounding better. It makes the entire. Team start the day better. You're happy to talk to each other, and you really can't understate the importance of that when you work so many hours with one another. So having a good attitude and just having passion for what you're doing, I think is quite important.

Even if you know, maybe. Attacking a little abscess is not the most exciting thing in the world. I, I used to make it exciting for myself, and I think because of that I had a lot of fun, you know. But you know, my friend, my, my good friend and I, we would, we would have so much fun putting in NG tubes together.

We would, we would run around the hospital like having a blast. And I think that it made everyone's life. Yeah, I totally agree. Just like hardworking,

happy to be around, trustworthy. Always be honest. All the things everybody said. So true. All right. Last question. What's one thing you wish someone had told you before intern year started?

No, I love this question 'cause I think you very easily can get tunnel vision as an intern and really only see your job and see your seniors disappear during the day. And you're like, they're off doing the fun part and they're not doing any work. And I'm here like cranking through all of this, like lowbrow stuff, like writing notes or.

Hacking abscesses like I'm, but happy about it, but happy about it. Very happy about it. To be happy about it. Right. I, I think a. Remember that no job is too small for anybody on the team. And as a senior resident, it's easy to forget this, but as an intern, you should watch the people that you really respect.

And usually it's those people. For me at least, it was those people that no job was too small. They would write a progress note if I was drowning, they would go pack the abscess if I was drowning. Like they would do things like that on the team to take care of people. And again, it goes back to what we've

said a bunch.

This, this episode is. Those fun team dynamics happen when everyone is sharing the load, so to speak, at the beginning of the year. It's really hard to see the role of other people on the team sometimes because they're physically separate from you. You never have as big a team there to support you specifically as you do when you're an intern, especially on day one.

So this is like the time to ask the dumb questions, to check the dosing of your Tylenol orders to whatever, like be that person on the team. 'Cause you're never gonna be the dumbest person on the team again. After that day somehow, and I feel like it's still six years into this, but I'm expected to know stuff that my, you know, mid-level residents that my interns don't know.

And it's terrifying. And so this is like the time to really lean into that discomfort and learn as much as you can as a result of it. Nice. Emma, do you have anything that you wish someone had told you before engineer year started? Yeah, so I kind of a couple months into intern year decided I was just always gonna show up and I was always gonna say yes.

Like that was my role that I lived by. I

realized it after I win double scrubbed, actually I was probably like triple scrubbed. I think there was a senior, a mid-level and me with an attending in the OR and the attending looked at me and was like, oh, I love when the interns show up. Like they, it reminds me they love surgery and they're not just hiding in the workroom all day.

I was like, first of all, rude second, like, yeah, I actually, that's why I'm here. You're right. That's why I'm here. I do love surgery. And so after that I kind of made it a point to always show up. I would go lurk in the hallway of the, or see if it looked like there was something I could do and like pop in the room for my team.

The other thing is just always saying yes. So, you know, say yes to the thing that might turn into a research project that might just turn into one paper. It's fine, but it's also saying yes to. Going across the street and getting boba, that's like a huge thing with me and my career residents or saying, yes, we play music league.

It's amazing. Highly recommend. But saying yes to those little things that also just helps you bond with these people you're gonna spend the next five, seven years of your life with. 'cause that's what's really gonna matter when you're. Pants are like falling down from the

five pagers and you need those people around you.

So always say yes and just always show up. It's kind of exciting to think of the incoming interns listening to this and, and they don't know all the friendship, the people they're gonna meet and the amazing memories that they're gonna have in residency. It's really, the world is their oyster, I guess.

Right. My like wedding invite list of the number of weddings I get to go to is like through the roof now. Oh yeah. You know. Okay. Any other final points guys? I think, I think just that it's gonna be more fun than you think as it's, it really is and it's totally fine to be nervous, but it really is a great, great time.

Yeah. And I guess the only other thing I would say is just, just make sure that you take care of yourself. People focus a lot on the I. On the residency aspect of everything, and it is quite intense, but just make sure that you take a couple minutes for yourself every day because it, it seems trivial a few minutes, but sometimes that's all you have.

And to make a conscious effort to do so is, is quite helpful. In, in Harborview there's a, they call it the sky bridge. That's between the two

main hospital buildings and you get this really dope view of Mount Rainier in the mornings. And like I would make a point to walk up to the seventh floor and just stop and have like a very quiet, sad moment to myself sometimes at four 30 in the morning with the sun coming up over Rainier and just like.

Sit there for 30 seconds and then go on with your day. It can be like game changing in the middle of the doldrums of intern ear when you're just feeling like you're underwater the whole time. So find, find little moments, even. Even like 30 seconds just to. Have a, have a, have a beat for yourself. Remind yourself that it is intern years temporary and the days are long, but the years are short, which I know is a cliche that everybody says 9 million times, but it really is true.

The like years go by quick, but the days may be maybe a little grueling and dragging sometimes. Can't stop the clock. Can't stop the Glock. And with that, we will be stopping the clock soon. So thank you for joining us for this Behind the Knife episode, and thank you to our Behind the Knife Fellows for being vulnerable

and sharing some of their wise words of wisdom as well as their embarrassing moments of intern year.

Remember, intern year is messy, humbling, and full of moments. That feel like the end of the world until they really don't. We hope this episode reminded you that everyone, even those surgeons you look up to, had to start somewhere, make mistakes, and learn how to keep going. If you're headed into engineer, you've got this, and if you're further along, maybe this was a good reminder of how far you've come.

And as always, thank you for listening and don't forget to dominate the.