Becoming A Doctor
June 30, 2020
Medical interns across the nation are starting their first days as doctors. One resident’s hopes and fears before her first shift in the COVID ICU.
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Tamar Pounardjian: All right, set the scene: Never written any orders, never actually had any responsibility for any patient. Now we are going to start in a hospital taking care of patients on our own. It’s terrifying.
Dan Gorenstein: Tamar Pounardjian is eight hours from pulling on her teal scrubs, long white coat, and securing her PPE for her overnight shift in the COVID ICU.
This month, close to 40,000 interns — people who have just graduated from medical school — will step into a hospital or clinic for the first time as doctors.
No surprise here — this happens every year.
But with coronavirus, 2020 is different; the job seems tougher, the stakes higher.
One intern’s hopes, expectations and fears hours before her first moments in the COVID ICU.
From the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein and this is Tradeoffs.
DG: The morning Tamar graduated this past May, she realized something.
TP: That, years of doodling, Dr. Pounardjian secretly in my diary was actually something I could doodle in public.
DG: Tamar is an internal medicine resident at Brown University in Providence, Rhode Island.
Here’s how she describes the patients she’ll be seeing.
TP: Usually if you come in with pneumonia, heart failure, these kind of things, you get admitted to internal medicine. Internal medicine works ICU, which primarily will handle a lot of COVID patients. So I knew that I would be working directly with COVID patients. There’s not going to be much downtime, I suspect.
DG: Two minutes into the conversation, I can tell how excited Tamar is to start.
In this moment — hours before her first ever shift — she is looking ahead but she is also remembering back.
DG: Tamar had volunteered at a hospice house in Cleveland. She was 19.
She struck up this friendship with one patient, an older woman.
TP: The hospice house was right on the lake, which was really pretty. So I would take her out there and one thing that’s really great is that they let the patients smoke. So I would take her out for a smoke break, which I think is wonderful, and during one of our conversations, she mentioned that she missed going to church.
DG: That gave Tamar an idea.
TP: I walked into her room and she she was really funny.
DG: Tamar had a little gift.
TP: I rolled her out in her wheelchair. So in between her smoking her cigarette, I was like, oh, I brought you something — piece of communion.
And immediately her face changes and she starts to cry and she says, you just answered my last wish — to have communion for one last time before I pass away. Really it was in that moment that I realized, end of life, dealing with death, it’s where the meat of life is. It was in these kind of moments that I wanted to have for the rest of my life.
DG: That afternoon on Lake Erie, and a hundred other moments since, have kept her going on her long journey to becoming a doctor.
A calling, she thinks, full of purpose for her and value for her patients.
Tamar starts her internal medicine residency, having missed a milestone she had planned for years.
TP: El Camino de Santiago is a pilgrimage walk in northern Spain and it’s 550 miles.
DG: A week before her walk through vineyards, the Pyrenees Mountains, and historic villages in northern Spain, health officials declared coronavirus a global pandemic, the U.S. locked down international air travel, and Tamar’s opportunity vanished.
Instead of the five-week, 550-mile pilgrimage, Tamar found herself on Interstate I-90, driving 650-miles of highway from Cleveland to Providence — no spiritual journey across Spain.
But alone in her blue Volkswagen Jetta, the 10-hour drive east turned out to be more of a pilgrimage than she expected.
TP: I was listening to — ugh so nerdy — but I was listening to a medicine podcast.
DG: With a bit of a refresher course from the Clinical Problem Solvers podcast.
Clip: Clinical Problem Solvers
TP: Basically they go through a case and I think I had a pause like halfway in between those like oh my God. I don’t remember. Like what’s a hemoglobin? What is all this?
DG: Think of it a little like doc spring training.
DG: Deeper into the trip, she listened to a playlist put together by a friend.
Soften the Blow by Xavier Rudd — struck a chord
TP: It’s basically about how he would lay himself down on the ground to soften the blow for his sons. And I was thinking about the support and how important it is to have people in your life that will soften the blow for you.
DG: Looking back on her drive, Tamar thinks the song hit her on a few levels.
There’s restarting her life at 30, as she says, leaving behind all the people she loves, needing to make new friends.
Then there’s the realization that she’ll soon have the responsibility — what she considers a privilege — to soften the blow for her patients.
TP: As a med student, you’re so limited in what you’re able to do. I feel like I finally have the opportunity to really own my patient. And I’m really excited for that, to be like I am your doctor.
DG: What does that mean to you — own your patient, I’m your doctor?
TP: It means knowing how are they doing? What is their diet? Like just really knowing every aspect of their care. Knowing who your patient is and where they come from, the human that’s behind all the tubes and lines of IVs.
DG: The resident class of 2020 will face the same challenges, all newly minted doctors face: grueling hours, medical mysteries, cafeteria food.
But this class also must learn on the job in the midst of a global pandemic.
Tamar admits, hours before her first shift starts, she’s scared, unsure how she’ll navigate the new demands.
TP: Preparing myself for the weight of what’s about to happen, i.e., working with COVID patients, thinking about holding up an iPad for a family member to say goodbye. That just seems terrifying to me. Really thinking about you know what it’s going to be like working with those patients. It’s going to be tough.
I’ve always tried to communicate effectively, and I wonder how will I be able to navigate speaking to the patients themselves, talking to his family members on the phone and be able to have really, really, really hard conversations.
DG: It seems to me like these hard conversations, these difficult choices, are where you personally find, as you said before, the meat of life. And that is where you’ve always wanted to be. And starting tonight, you will be there.
TP: Yeah. Yeah, I guess so. It really does come full circle.
DG: Tamar left us a voice message the morning after her first shift.
TP: Hello. I had to pronounce a patient dead within the first hour of my shift, was not expecting that one, and then I had to admit a very young COVID patient, which was really sad. It was basically just non-stop for 14 hours. I’m gonna go and sleep. Peace out.
DG: Already, Tamar says one of her first lessons.
Balancing her desire to support her patients fully with the emotional weight of the job.
I’m Dan Gorenstein, and this is Tradeoffs.
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Select News, Analyses, Resources:
Ensuring and Sustaining a Pandemic Workforce (Erin P. Fraher, Patricia Pittman, Bianca K. Frogner, et al; New England Journal of Medicine; 06/04/2020)
Training Tomorrow’s Physicians: Recommendations for Expanding Graduate Medical Education Funding in California (Diane Rittenhouse, Alexandra Ament and Kevin Grumbach; California Health Care Foundation, 2020)
U.S. physician shortage growing (Patrick Boyle, AAMC, 06/26/2020)
Doctors In Training Learn Hard Lessons During The Pandemic (Will Stone; NPR; 05/18/2020)
Residency in a pandemic: How COVID-19 is affecting trainees (Brendan Murphy; AAMC; 04/01/2020)
Tamar Pounardjian, MD, internal medicine resident at Brown University in Providence, Rhode Island
The Tradeoffs theme song was composed by Ty Citerman, with additional music this episode from Bliss Blood and Al Street, Xavier Rudd and Blue Dot Sessions.
This episode was produced by Victoria Stern and mixed by Andrew Parrella.
Additional thanks to:
Vishal Khetpal, Amy Engler, Holland Kaplan, The Tradeoffs Advisory Board…
…and our stellar staff!