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Your first is always special.

It is a mixture of youthful inexperience, awkwardness, anticipation, and giddiness that creates a cacophony of emotions and physical changes that is hard to describe unless you have experienced it yourself.

Your repertoire of techniques/maneuvers is quite sparse to say the least.

You might fumble around and accidentally put the wrong thing in the wrong orifice.

Not knowing what body part should go where, if you are doing it right, or if you are even causing the other person pain can cause you to underperform.

Sure you have read about it.

Perhaps even watched some videos late at night by yourself wondering what it feels like touching another person like that.

You may have even practiced some of the techniques on yourself (no judgement, it is only natural to be curious about the human body).

Heck, manufacturing techniques have gotten so advanced that there are many products you can buy out there that are so close to simulating the real thing that they make devices of the past look absolutely primitive.

But no matter how much practice and studying you do by yourself, you can never truly simulate what it actually is like to be one on one with someone else in the room.

So to break the taboo of this subject, I am going to open up and tell you about my first(s).

Yes I, Xrayvsn, am going to discuss the emotional and (when appropriate) physical reactions I experienced with the many firsts I encountered throughout my medical career.

Oh wait.

You thought I was talking about something else?

Get your mind out of the gutter!

This is, after all, a family PG-style blog.

I thought today would be a great day to publish this post because yesterday was July 1st.

What’s so special about July 1st you may ask?

Well July 1st is a very important day to the medical profession because, as you read this, there is a whole new cohort of medical professionals that have just completed their very first day of their new job.

July 1st signifies the day that the next class of medical residents arrive to grace the hospital wards and, depending on the specialty chosen, 3-7 years later will also mark the day they will officially become attendings.

I am going to go a little further back in time and talk about medical school when discussing my firsts as it is at that moment when you truly know you are on the path to becoming a physician.

The Medical School Years:

Up until medical school you could pretty much say I coasted through my educational life.

Because things came easy to me I never challenged myself and instead developed some bad study habits (leaving everything till basically the night before to study if needed).

Medical school changed that in a hurry.

I sort of vaguely remember the first day of medical school.

There was no orientation/gradual easing into the curriculum.

No, we pretty much hit the ground running.

This was the first time I could not wait until the night before to study for an exam, the amount of information was just too overwhelming.

One of the major courses in the first year was Gross Anatomy.

Only fellow colleagues who have gone through the same trial by fire can truly appreciate what it was like to be put through the gauntlet that early on.

It was a class that truly effected all of your senses.

The smells from spending time in the gross anatomy lab permeated not only through the fabric of whatever you were wearing but also into your very being.

As upper classmen you could always tell when a first year was in the elevator with you as the smell they brought with them was quite distinct and inescapable.

A few of my classmates actually turned vegetarian directly because of their experience with gross anatomy.

The first two years of medical school were not much fun.

The curriculum was designed to cram as much book knowledge as possible into these young minds before even letting them first touch a patient.

My first (and hopefully only) panic attack:

Back in the 90’s when I was a medical student, in order to become a physician and get that coveted M.D. behind your name you had to take and pass 2 out of the 3 USMLE exams that were offered (typically after your 2nd year of medical school (Part I) and between your 3rd and 4th year (Part II).

The third part was typically undertaken after your first year of residency.

Part I for me was the most challenging, and frustrating, one to take.

A lot of the information was purely rote memorization.

What made preparing for this exam so tedious was that I could see no real clinical application from a lot of the required material (such as memorizing every step of the infamous Krebs cycle).

[Some 24 years after taking this exam, not once has any part of the Krebs cycle ever come into play in my medical decision making.]

I took a preparatory course (Kaplan) during our break before taking the exam.

It was during this time that the sheer amount of information (essentially all the information in the first two years of medical school) I was supposed to be able to regurgitate finally got to me.

I truly did experience a panic attack with rapid breathing and becoming lightheaded.

I actually had to phone my mom and be talked down to a more reasonable state.

But that just goes to show you the stakes I placed on this test and what it meant to my career path.

[I did pass all three parts on the first go around.  The subsequent two parts were more clinically based, making them more relevant and much easier to study for and take.]

My first patient death:

Having passed Part I of the USMLE and completing the crucible that is the first two years of medical school I had my first taste as a doctor.

As a 3rd year medical student, it was the first time I got to don a (short) white coat and actually walk the halls of the hospital as part of an actual medical team.

During one off-campus rotation I was making the rounds and stopped into a patient’s room.

I came to the bedside and greeted the patient who sat up and then promptly slouched over on top of me.

I didn’t know what to do so I laid him back in bed and called for help but it was too late and, soon after, a time of death was declared.

I was actually quite shocked and questioned if I had precipitated this and played in my mind what I could have done instead (there really was nothing that could have been changed).

It felt like a gut-punch at the time and still had a long-lasting impact on me.

Residency Years:

It is funny because when you graduate medical school, get that M.D. behind your name, and people start addressing you as doctor you can actually fool yourself into thinking you are indeed a bonafide doctor.

[There was also a bit of symbolism at play because, as an intern, your white coat length increased to the same as that of an attending’s coat (although I hear some residencies may still require residents to wear short white coats (until recently Johns Hopkins was one such program)).]

Trust me.  That feeling is quite short-lived.

It took all of a couple of days in residency to show that you still have so much more to learn before you can go out in the world and practice medicine on your own.

First: The lesson of humility.

I am fortunate that this was not a lesson I had to learn but am including it for completeness sake as I witnessed some other colleagues learn it the hard way.

In the typical pecking order of a hospital, a physician stands at or near the top.

Although technically a resident is a physician, he or she should not assume that mantle.

One of the greatest allies a resident can have (or conversely if they feel mistreated one of your worst enemies) is the nursing staff.

An arrogant resident will be quickly put in his or her place by nurses who just may decide to call him or her for every minor thing during overnight call.

Earn their respect and you can have a much more peaceful night.

I had no problem whatsoever asking for help from the nurses and treated them on equal footing during my training.

I know my life was much easier because of it.

The First Night On Call:

As a resident on call you always have attending backup but it is an unspoken rule that you should not bother the attending with small things that should be handled on your own.

I experienced many firsts during my time as a surgery resident putting out some small and moderate fires on call (again the nursing staff was instrumental in helping me on the more challenging predicaments).

I remember being quite proud when, during a very early morning round from overnight call, I recognized a pneumothorax on one of my patients and successfully placed a chest tube before the rest of the surgical team assembled.

Even when I switched to radiology, being on call carried some uneasiness to it as you certainly did not want to miss an important finding that could have changed patient management/outcome (the stakes were even higher for me as my hospital was a very busy level I trauma center).

The following is what I actually wrote to a fellow first year radiology resident during my first night on call (I believe I was the first one in my year to do it and thought it would be nice to share the experience with them):

As you can see even an Xrayvsn-In-Training had a pretty good sense of humor 🙂

The Attending Transition:

Out of all the transitions, I honestly would rate this as the scariest.

Up until this very moment the buck never stopped with me.

As a medical student I had a resident over me who had an attending over him or her (2 layers of safety net).

As a resident, and even as a subsequent interventional radiology fellow,  again I felt protected having a supervising attending safety net.

But come July 1st, 2004, all of a sudden I am flying solo.

I remember the very first study I finished reading and dictating as a fledgling attending.

It took me an extra long time before I pressed send and made it official.

There were no co-signers on the report.

The official medical document just had approved by me on it.

Sure I had colleagues I could turn to for a particularly tough case (it also helped that I stayed as an attending at my place of training for two years before I bolted to my current private practice job).

But it would certainly raise eyebrows if I wanted every study I was responsible for to be double read just in case.

Sure those first day jitters quickly vanished as I grew more and more comfortable with my knowledge base.

Now that I am in year 15 of medical practice, firsts are very few and far between.

And now about that first that you originally thought this post was about……

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-Xrayvsn