"Rather than discuss something useful, I decided to make a trip-down-memory-lane speech: a talk about my time as an intern," said Dr. Kent Sepkowitz, professor of medicine at Weill Cornell Medical College and attending physician at NewYork-Presbyterian Hospital. On May 16, Dr. Sepkowitz gave a wry, homespun talk — the second in a series of lectures of the Weill Cornell chapter of the Alpha Omega Alpha Medical Honor Society — to a captive audience, largely comprising students who are about to embark on this journey themselves.
Dr. Sepkowitz offered reassuring words to the students but kept the lofty myths surrounding medical interning anchored to the ground. "Thanks to repression, I don't remember much about it," he joked, confirming that the experience 26 years ago had indeed been harrowing. "I don't remember any of my attendings, and being an attending now this is somewhat disconcerting."
He warned the students that an internship is "an intensely false hothouse" at times, as they seek their career paths in medicine and feel pressure to have ready answers when asked by their superiors what they plan to do next. He urged them to have a sincere answer to that question, but to know inside that the answer, whatever it is, is "baloney." "The idea that you know now what you want to do 25 years from now is comic. Some of you might, but most of you don't."
To illustrate, Dr. Sepkowitz recounted how as a young physician he was the company doctor for a major financial management firm — a cushy, low-stress position that he wanted at first, but one that he soon lost interest in. "I realized I don't like well people. I like sick people," he said. Dr. Sepkowitz soon returned to the trenches, accepting an infectious disease fellowship at Memorial-Sloan Kettering Cancer Center. The moral of his story? "Be alert to opportunities when they arise. Don't start believing your own baloney. Don't get seduced by that which is 'fun.' Satisfaction is what you're after."
Dr. Sepkowitz also spoke about the kind of impact that an internship, and an entire career in medicine, can have on one's identity. "Internships are a lot like marriage. You hear about it your whole life. You wonder, will it turn me into someone else? But in the end you're still you. It's transforming but it doesn't remove you from who you are."
He elaborated by speaking about the "unteachable" elements of becoming a doctor that each intern must experience firsthand in order to learn from them. He recounted the unforgettable time he and a colleague had to administer a spinal tap to an unruly drug abuser suspected of having meningitis. In the midst of the procedure the patient suddenly became calm and began to sing improv jazz tunes, causing the young doctors to start laughing. "You'll find yourself in the most bizarre human situations," Dr. Sepkowitz said. "How do you react? What is your role when things are surreal?"
As a more serious example Dr. Sepkowitz recounted the drowning death of a fellow intern during their residency and its impact on him as a physician. He recalled that for a time it made him question his choice to pursue a career surrounded by constant death and sickness. "Don't believe as an intern that your personal life stops for you. Junk happens, and it will intrude on you in the midst of dealing with other people's tragedies."
He concluded by saying that these unteachable lessons are the most memorable, influential experiences to be gained from a medical internship. When patients seem prejudiced against young doctors, Dr. Sepkowitz believes, it's because young doctors seem unscathed by life. "They're looking for somebody who has also suffered like them. They want that level of humanity that can't be taught."
Written by Jeffrey Stanley.
June 4, 2007
