"Hi, My Name is Frank, and I'm Terrified."

The room was filled with twenty and thirty-somethings, buzzing about, coffee cups in hand, smiling, greeting, laughing, conversing. Today was the first day they were meeting, starting off a relationship that would last at least three years, if not for the rest of their lives.

"Hi, my name's David, and you are...?"

"So, where are you staying?"

"Are you from around here?"

"Which medical school did you go to," were random components of the various conversations taking place across the room. Everyone was talking about everything except the one thing that was on their minds: "I'm starting residency, and I'm terrified."

It was the beginning of Orientation for the Internal Medicine residency at my hospital, and I was one of the calm-on-the-outside but petrified-on-the-inside people who mixed and mingled with now and future colleagues.

We got our schedules. We got our ID badges. We got our full-length white lab coats symbollic of all that is doctor with our names and medical degree neatly embroidered on them - a patch on the side with the name of our institution, its logo, and the words, "Housestaff Physician" on it. And, last but not least, we received our pagers - the little black box that would become a part of our bodies, reminding us at every moment with its panicked cry that our life was not our own any longer - that instead our life now belonged to the people we served. This is what we signed up for. This is what I wanted to be all my life. Now I stood with my white coat in one hand and my pager in the other, my bag slung across my shoulder, excited and scared at the prospect of slipping the coat on and clipping the pager to my side.

But I was also scared. Scared of what? Didn't I just go through four years of medical school; two years of studying day and night and two years of wandering the hospital floors learning about the practicalities of medicine and interacting with patients, physicians and nurses? Yet throughout that that time I was never the real decision maker.

The two years I spent in various hospitals were all about learning how to work in the medical setting, how to ask patients the right questions and about reviewing and increasing my knowledge. Then I was simply a medical student, and no one really expected anything of me except that I show up to work on time, give basic answers to basic medical questions, and be able to interact with a patient at some minimum level.

All that was changing now. Now, I will get paged and be asked by a nurse what to do for Mr. Johnson's elevated blood pressure. I know the answer. That's basic physiology and pharmacology, something I've seen a dozen times before in the hospital. But this time, what I say, she will do. And what she does, will affect the patient. All of a sudden I doubt myself. Do I really know which medication to give for this particular patient and his unique disease-state? How much should I give? Is there something better than the choice that I am thinking of? What if I say the wrong thing? In the past, the resident would have said, "No, you should do X instead for Y reason." Now, it's just me, the nurse and the patient. I'm the one who's supposed to direct the care of this human being. Of course I will always have senior residents around to help, supervise and teach, even now. Still, the knowledge that I will now be directly responsible for patient care, that nurses will be calling me to ask what should be done in a particular situation, is very burdensome, and quite unnerving.

Everybody feels the same. I know it. The chief residents themselves told us stories of how nervous and scared they were when they first started. My friends who have now finished the residency remember clearly the pure fear that drove them in those first few months. Fear of messing up, fear of not meeting academic expectations, fear of doing or saying something stupid - but mostly fear of messing up.

Of course for me, things are a little harder starting out. You see, the normal routine of residency is what's called working on "the floors" (the medical ward). You arrive at 7am, find out from the night shift people what happened with the list of patients you are taking care of, and then round on them. You check up on them, review and order lab tests as needed, and spend the rest of the day managing your patients, whom you know quite well. At 5pm you finish and go on to the next day (unless you haven't finished your work or you're on call, then you stay longer). The "floors" have 4 teams consisting of one resident and two interns each (an intern is a first year resident) and they altogether take care of 40 patients (10 patients per team). I, however, will be starting on something called "night float". This means that while everyone else starts on Monday at 7am, I will be starting on Sunday at 7pm. For the next two weeks, I will be working from 7pm to 7am the next day, and my job will be to admit patients who need to be admitted to the hospital and, mortifyingly, to take care of any random problems that come up with any of the 40 patients that my colleagues take care of during the day. This means that my pager will be going off all night - my first night - with problems of patients that I really don't know that well at all. That doesn't really help combat my urge to run into the first closet I can find and hide.

Regardless of the fear and the difficulty, I am excited. This is one of the most challenging moments of my life and I know that I do much better as a person in the face of a challenge than otherwise. Despite my misgivings, I feel full of positive energy, ready to tackle whatever lies ahead. This will be great, God willing. I just have to keep on reminding myself that every doctor, big-name or otherwise, started out as a scared little intern.

All physicians start out the same, like me and one of my colleagues, who candidly introduced himself to the class with the words, "Hi, my name is Frank, and I'm terrified."


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