By Lauren Burgoon, MD

We’ve all heard the tired cliché about July being the most dangerous time of the year to go to a hospital. All new interns — freshly minted doctors straight out of medical school — are on the loose. And you better watch out, the tale goes. That’s demonstrably false, and July is as safe as any month for medical care.

But there is still a big reason to worry — not about these new doctors, but for them. In a few months, these young doctors will have seen too much. In a system that demands more, more, more from residents, who barely make a living wage, we’re harming our nation’s healers, leading to burnout, depression — and suicide rates that far outpace the general public.

I wish someone had told me what the first year as a doctor would feel like.

No one told me, or maybe it’s more accurate to say no one could prepare me for what this year would do to me. I wish I knew how much of myself would chip away as my medical acumen grew.

Every new doctor knows the first year is going to be a hard one. This transition from medical student to intern is one of the biggest learning curves in a doctor’s career.

Intern year wasn’t just about learning as a pediatrician for me but also confronting the true enormity of this incredible, all-consuming career. There’s a rush of gratification after clicking with a patient, and her mom asks, “Can you be her doctor from now on?” There’s a hard-fought satisfaction in looking back at the start of internship last July and seeing my enormous growth in medical knowledge and confidence.

But no one told me what it feels like to get a 3 a.m. page because a preteen patient “just wants to talk to the doctor” and finds out that she doesn’t understand her degenerative disease or what’s happening to her body at all. Or to sit chatting with a teenager when suddenly she takes a deep breath and reveals she’s being abused. No one could prepare me to find the razor-thin balance between compassion and pandering, afraid my patient would shut down before she got all she needed from me and yet terrified my face or tone would betray the lump in my throat.

Who could possibly have prepared me to see kids die of cancer, of COVID, of gun violence, of trauma? Or watching a scan pop up on the screen to see tumors so large I don’t understand how they fit in these tiny bodies. Or the more mundane but truly maddening exercise of arguing with insurance companies about paying for a child’s crucial inhaler.

At the start of internship, I began having dreams about beeping pagers and monitors. That would soon pass, experienced doctors assured me, and they were right. No one told me nightmares of wailing parents standing over their child’s body would take their place.

So much of this carnage on our children has root causes in diseases I don’t know how to cure: institutional racism, intergenerational trauma, and unequal health care access. In this political climate especially, the children I care for — those robbed of equal access to safe neighborhoods, food security, good schools, and more — pay the highest price.

There’s nowhere to put these experiences that makes sense to a rational mind. At first, you talk about it a lot, your mind trying to process how a day’s work can rollercoaster between the joys and cruelties of life. Then, you learn to stop talking to “outsiders” about this world of medicine because who wants to be the downer friend at brunch on the one weekend you have off a month? Those who stop talking about our experience altogether are the most concerning.

With my intern year over, I almost don’t recognize the person who started residency last July. I’ve grown in endless ways as a doctor, and I’m truly proud of that. But I’m also fearful because I feel like a smaller, more closed-off person, and the demands of this job continue to grow. The biggest lesson I’ve learned is it’s not normal what we’re asked to do as doctors. There is a moral injury to bearing witness, and no one could have possibly prepared me for it.

Lauren Burgoon is a pediatrics resident.