INTERN

SURVIVAL
GUIDE
BECAUSE YOU GOT THIS
TOP TEN RULES
FOR INTERN
SUCCESS

1. Eat Breakfast
2. Don’t Lie
3. Be on Time
4. Know your patients
5. Communicate frequently
6. Always ask: what’s keeping this person in the hospital.
7. If you don’t know the answer, ask the question.
8. Never underestimate how poorly someone will do their job.
9. Do not forget to care for yourself
10. You only need to be 3 things as an intern: reliable, hard-
working, and a team player.
SIMPLE THINGS TO DO BEFORE INTERN YEAR STARTS
Home Life

 Automate all and any bills or things that require payments

 Create a schedule for: cleaning, chores, groceries, etc.
 Even if you can’t adhere to schedule, when you’re exhausted after a long day,
you don’t want to think. Let the schedule think for you
 Update or maintain all your tech. Get an external battery.
 Unpack as much as you can (bribe with pizza and beer if you must), you
won’t have time to unpack once intern year begins

Personal Life

 Let the people in your life know that intern year is a black hole.
Repeatedly. Over the year. They forget.
 Significant others: I’m not going to speak to this because I have never
had a significant other so just communicate honestly and frequently
 Dry shampoo is magical
 Get your car maintained before intern year starts
 Commit to doing at least one non-work activity once a week. For sanity.
 Work clothes: scrubs and clinic clothes
o Scrubs: Get >3 sets. Minimum 4-5 so you’re not washing them all
the time
o Clinic clothes: Comfortable, easy to launder and maintain
o Shoes: COMFORT above all. you better be able to walk quickly
and/or run in them. At least have one pair of sneakers for
overnight calls and ICU rotations.

Work Life

 Decide on how much time you’re willing to spend after work studying/taking
stock in the day. It doesn’t have to be tons of time. But commit to, for
example, fifteen minutes a day. And stick with it.
 Vent as needed but also remember that your loved ones do not want to hear
about your work life 24/7
 Try to make some friends with your co-interns
 Get the names and phone numbers of people from different specialties. And
nurses. And therapists. Make them your allies. Or at least know who the hell
they are when so you can hunt them down when shit is going crazy.
WHITE
COAT
ESSENTIALS
OBJECTS
BOOKS
APPS
SITES
OBJECTS
MEDICAL STUFF

 Your tools: Stethoscope. Reflex hammers for neuro peeps. Surgeons

and ER docs: holsters for your stethoscopes (surgeons, do you guys
still use stethoscopes? JK), trauma shears. Peds: cute pen-light or toy,
stickers.
 Pen light or your phone
 Pager
 At least two black pens, and a colorful pen or two to highlight things
on your list
 A notebook for rounds, lectures, personal to-dos
 YOUR LIST
 ACLS manual
 Pocket Medicine or a small reference text. Unless you’re like me, you
can always put that on your phone
 Directory. Which you can always put on your phone as well
 Badge/ID

NON-MEDICAL BUT ESSENTIAL STUFF

 Your wallet and keys!

 Gum and/or ibuprofen. Trust me.
 Lotion. Sanitizing solution.
 YOUR PHONE
 Charging cable
 Headphones
BOOKS
Every discipline has its books. Here are some books (because I’m an
internist) that I can’t live without, nor can my colleagues across
several disciplines.

 The ICU Book and The Little ICU Book both by Marino (I got the
small one.)
 The Ventilator Book by William Owens (for all ICUs, including
SICU, PICU)
 Pocket series (Pocket medicine, pocket pediatrics, etc.)
 The only EKG Book You’ll Ever Need by Thaler OR Dubin’s Rapid
Interpretation of EKG’s book
 Harrison’s for my internal medicine brothers and sisters
 The Red Book for my pediatricians
 The Chief Complaint by Feier and Mallon for my ER people.
APPS
Some apps I’ve picked up along the way that I’ve come to rely on (not
an exhaustive list, but my personal favorites)

1. Uptodate
2. Translator. It talks, writes, and converts your spoken words into
the language of your choice
3. Epocrates. Especially the interactions checker.
4. Qx Calculate
5. Qx Read (tailor your reading and learning, it will collect papers
on topics you are interested in and forwards it to you!)
6. Figure 1 (Instagram for medicine people)
7. CDC Vaccine Schedule
8. Journal Club (has made me look smarter than I actually am all
year. This is worth the money.)
9. USMLE Qbank
10. EyeMD
11. iBooks/Evernote. Something to manage documents. I download
tons of pdfs and papers onto iBooks for future reading.
12. Whatsapp or another secured texting app for team texts.
13. Photos. Genius because of the simplicity. Take photos of good
EKGs, CXRs and save images or good tables from the internet.
Make yourself a “Medical” album for all these goodies.
SITES/LINKS
If I want to learn how to do ANY procedure:
http://www.nejm.org/multimedia/medical-videos

http://radiopaedia.org/ for radiology findings

http://www.medfools.com/downloads.html scutsheets to keep you

organized

https://onlinemeded.org/index you don’t need to register to use the

great videos!

http://lifeinthefastlane.com/ amazing EKG library. If you can read

these, you are officially an EKG master

Strong Medicine youtube channel. I swear by the EKG section

INTERN 101
DAY-TO-DAY
EXPECTATIONS
 Know your patients medically and as people.
 Keep your senior and your team updated on your patients
 Communicate with your nursing staff and consultants to
coordinate plans during hospitalization
 Take admissions by completing an H&P, placing admission
orders, and writing out a plan you go over with your senior.
 Keep your patients updated in regards to the day’s plans,
anticipated discharge, education on changes in their medications
 Complete the tasks you said you would complete for your
patients
 Tell your team if you CAN’T complete the tasks you said you
would complete so that they can help you
 Learn to plan one, then two steps ahead
 Anticipate and order the tests that your consult services will
need to do their job prior to consulting them (if possible). You
will be able to this by the end of the year, but likely not at the
start.
MY GENERIC WARDS DAY (ADAPT TO YOUR NEEDS)

Time
0430- Wake up, get ready, get to work
0530
0600- Get breakfast
0630 Print out the list.
0630- Sign-out with night-team
0700
0700- Review: sick/unstable, anticipated discharge, medically stable
0930 How to review: overnight vitals, events charted or told to you by
nursing, labs, pending items for overnight, new labs and imaging.

Run the list with your senior to assess the priority tasks for the
day. See your patients.

Prioritize what must be done by the COLD or DCOL method.

Discharges: Get the 5D’s ready (discussed later).
Consults: place consults before lunch hour, out of courtesy
Orders: imaging studies, lab studies, patient care, etc.
Labs: either to follow up, order, or address
0930- Round with the attending.
1100 The 6 things you must know on ALL your patients:
or  Overnight events
1130  Vital sign abnormalities overnight
 Labs (if they’re up)
 Imaging studies
 Cultures
 What your consult services want
1130- Run the list with your senior to confirm:
1230 -what orders need to be placed now
-what labs/imaging/studies must be followed-up now
-what appointments and other things must be arranged for
discharging patients now
1230- Eat food. Pee. Breath for a second. Answer calls and pages, follow
1330 up with consult services, place new orders, remove old ones,
adjust orders.
1330- Run through the list with your senior or yourself to confirm what
1730 has been done, what needs to be done.
Follow-up on pending items.
See your new day-time admissions, your sick patients, anyone
who needs anything from an MD.
Finish your notes, discharge summaries.
1730- Sign out to the overnight team
1800
MY GENERIC SHORT CALL

Time
0600- Wake up, get ready, get to work
0700
0700- Get breakfast
0800 Print out the list/lists
Review: sick/unstable, anticipated discharge, medically stable
0800- Sign-out from the night-team about old patients and new patients
0830 overnight.
0830- Familiarize yourself with overnight admissions.
0930
Run the list with your senior to assess the priority tasks for the
day, the patients who will need the most attention.

See your patients. See the new ones first to confirm the story
and do your own exam. See your old patients.

Again, using the COLD/DCOL method to get through tasks

0930- Round with the attending and team
1100
1130- Run the list with your senior, complete tasks
1230
1230- Eat food. Take sign-out from overnight team who needs to leave.
1330 Ask/confirm if they need help tying up loose ends.
1330- Complete tasks for your patients.
1800
Print out the other teams’ lists, contact teams to confirm when
and where they want to sign out.

Take admissions as they come

Follow up tasks, monitor sick patients. If you don’t know the

answer, read the progress note or defer to your senior.

Make sure discharges happen.

1800- Update lists so everyone knows what has/has not been done
2000
or Finish writing H&Ps, progress notes, discharge notes
2100
Signout to overnight team
MY GENERIC ICU OVERNIGHT
Time
Day- Enjoy the day!
1900 Make a thermos of coffee, pack snacks for overnight
Shower and get to work
1900- Print out the list
2100
Receive signout from day teams and daytime updates.

Review: sick/unstable, anticipated discharge, medically stable

Review labs, vitals, progress notes from the day
2100- See your patients. See the new ones first to confirm the story and do
2200 your own exam. See your old patients
2200- Round with senior, fellow, and attending
2230
2230- Run the list with your senior to confirm:
0000 -what orders need to be placed
-what labs/imaging/studies must be followed-up
-who is sickest and needs to be monitored most closely overnight

Begin to answer calls and pages, go by and see the sick patients again.
Talk to nursing as well.
0000 Midnight snack and coffee
Take admissions
Complete H&Ps and admission orders
0000- Daily labs begin to come in so:
0600 -replete electrolytes
-transfuse people who need blood
-confirm those going into procedures are NPO with IV maintenance
fluids

Follow up on AM CXRs and EKGs

Take admissions, nap if you have the chance

Check on sick patients. Call senior/fellow if they are not

0600- Update the list to reflect the overnight admissions and events
0800
Print yourself a new list if your old one if you’ve written all over it

The day teams will begin to come in, provide signout

Print out your H&Ps, see patients.

Eat some breakfast, drink some coffee
0800- See your patients, start writing progress notes
0900 Prep discharges.
0900- Round. Finish progress notes, H&Ps, discharge notes.
1230
Wrap up tasks, provide sign out to the on-call team.

GO HOME AND SLEEP.

ADMISSIONS 101
In the age of EMR, most of you will have automated admission plans or preset
admission orders that you check off to admit a patient. That said, using the ADC VAN
DISMAL acronym will keep your mind organized to make sure you don’t miss
anything while you create your admission orders.

Admit Order: admit to med unit, telemetry, ICU, CVICU, CCU, etc.

Diagnosis: What’s the chief complaint/problems.

Condition:

 Good: that means stable, no anticipated complications

 Fair: patient’s clearly uncomfortable, may have complications, but is
not going to crash and code in front of your eyes.
 Poor: Ill, not super stable. A patient like this needs to be in a
monitored setting
 Guarded: very ill, this person needs to be in an ICU
 Critical: VERY ILL AND UNSTABLE.
 My little addition is “Code Status” for C. Know who the patient’s
emergency contact is. Their MPOA (medical power of attorney). If they
have a POLST form, where is it.

Vital Signs: Remember to place “call parameters,” what values you will be
called or paged for by nursing. For example: Call for HR>100 or <70

 Add ons: orthostatics now, daily, after fluids?

 Neuro checks: for seizure, alcohol withdrawal, altered mental
status you may want to do frequenc neuro checks
 Cardiac monitoring: continuous or intermittent
 Pulse oximetry: continuous or intermittent

Activity: Ex. bedrest, out of bed, walk with assistance, up ad lib.

Nursing Orders:

 Intake and Output: Strict? Fluid restrictions?

 Daily weight?
 HOB (head of bed) elevation, turning
  Wound care; you don’t need to say what type of care but specify the
location of the wound. If a surgeon has already decided on a type of
wound care, specify for nursing
 Lines/Tubes
o Peripheral line or none
o Foley catheter or condom cath or regular bathroom privileges?
o NG/OG tube?
o Supplemental O2? How much? And what are your weaning
parameters?
 “Call orders”: anything that you want to be notified about that the
nurse might not know you’re interested in. For example UOP over an
hour, Pain despite PCA pump, etc.

Diet: because people want to eat!

 ALWAYS put a start and end time for NPO orders

 And ALWAYS specify any exceptions to your NPO orders. For
example, “NPO except medications”, “NPO except ice chips”
 If someone is NPO, if they are not volume overloaded, remember to
put them on maintenance fluids (D5 1/2NS) and if they are
diabetic, sliding scale insulin
 If on PPN or TPN, get a nutrition consult or find out what formula
they are on, the rate, the number of units

IV Fluids: specify type, rate, and quantity (continuous or bolus)

Studies: EKG, CXR, TTEs, etc.

Medications: name of med, dosage, schedule

 Write out anticipated PRNs on admission.

 GI prophylaxis, DVT/VTE prophylaxis
 Write holding parameters. Ex. Hold labetalol for HR<70, SBP<100

Allergies: Pro tip: ask what the allergic reaction was/is.

Lab Studies: Make sure have labs on admission to establish a baseline, and
write for daily labs. Review daily if daily labs are necessary, and remove as
needed.
ICU NOTE (SYSTEMS BASED)
DISCHARGE 101
THE 5 D’S OF DISCHARGE.

HAVE A PLAN FOR ALL 5 PRIOR TO DISCHARGE.

THEY ARE… MEANING…

DME (durable Do they need a cane? Walker? Wound care

medical materials? Foley caths?
equipment)

Driver Who is taking them home?

Destination Where are they going?

SNF/rehab
Home
LTAC (long term acute care)
Nursing Home
Halfway Home
Shelter

Drugs Do a med reconciliation

Stop unnecessary PRNs
Refill any prescriptions needed
Explain changes to med list to patient

Dates Follow-up appointments

Blood draw appointments
Imaging appointments
SIGNOUT: THERE ARE MANY METHODS, I’LL
PROVIDE TWO
Method 1: SIGNOUT acronym (Horwitz et al. 2007)

S Sick, stable? He’s our sickest patient on the list, but DNR/DNI
Code status
I Identifying data Pt is a 54 male with metastatic colorectal cancer
(one-liner) presenting with intractable pain secondary to tumor
burden and septic
G General hospital course He’s still here because we’re trying to transition him to
PO pain meds and figure out why he’s septic
N New events of the day Blood culture and urine still haven’t grown anything out,
but because he’s neutropenic and now febrile, we started
him on acyclovir, fluconazole, flagyl, and ceftriaxone
today.

O Overall health status Overall, he’s uncomfortable with his fevers and
tachycardia but stable appearing, non-toxic. Pain is
better controlled but he still needs IV Dilaudid for
breakthrough pain
Upcoming Things you anticipate, If he becomes febrile again tonight, please draw blood
possibilities and what you would cultures and expand his antibiotic coverage by adding
want done vanc
To Dos Things to f/u or do If you wouldn’t find following up the CXR he just to got
overnight to see if he has a pneumonia or something going on in
his lungs, I’d really appreciate it!
Always end with: ANY QUESTIONS?

Method 2: I-PASS (Starmer, 2012)

REPLETING ELECTROLYTES
Before repleting, always ask yourself: how’s the patient’s
renal function? 
 For decreased renal function: Always error on
the side of UNDER replacement. 


To remember how to replete, remember: 4-3-2

K (goal around 4.0): usually 10 mEq will give you a rise of 0.1 mEq/L; IV
and PO have an equivalent effect. Fastest infusion time is 10 mEq/hr through
a peripheral line, or 20 mEq/hr for a central line if on a monitored bed. 


- Examples: 


- 3.0 – 100mEq 


- 3.5 – 60mEq 


- 3.8 – 20mEq 


Phos (goal around 3.0): choose KPhos or NaPhos. If the patient needs K as
well, they will get 4.4 mEq of K for every 3 mmol of Kphos. Be careful
in the setting of hypercalcemia. 


- Examples: 


- >2.0 – oral neutraphos 2 tabs po TID x 3 doses 


- 1.5- 2.0 – 0.08 mmol/kg IV over 6 hrs 


- 0-1.5 – 0.16 mmol/kg IV over 6 hrs 


Mg (goal around 2.0): usually 1 gm for each 0.1 mEq/L. Magnesium oxide
can be used PO (4 tabs being equal to 1 gm) but it is not absorbed
well. 


- Examples: 


- 1.6–4gmIV 
 - 1.8–2gmIV 

 Things to keep in mind about Mag:

1. If you give it PO, so get ready for some diarrhea

2. If Mag is low, you’ll need to replete that so that your K can also rise

TOP TEN PRN CATEGORIES

This is not an exhaustive list, but an idea of the types of issues that frequently
come up which benefit from having PRNs in place.

1. Bowel regimen
a. Everyone will thank you for starting a PRN bowel regimen.
b. I like: senna 1 tab QPM or senna elixir 8.6 QPM PRN constipation,
Colace BID, miralax PRN constipation if needed
c. Remember that cancer patients, chronic pain patients, those on large
doses of opioids require aggressive bowel regimens. That means 2-3
PRN meds for pooping. Or just schedule them.
d. If that’s not working and you need bigger guns, try:
i. Suppositories
ii. Enemas
iii. Lactulose, maalox
iv. KNOW THESE ARE OPTIONS BUT USE WITH CAUTION:
magnesium citrate and GoLytely
2. Pain regimen
a. Pick 1 for each category (1-3), (4-6), (7-10), breakthrough
b. Ibuprofen, aspirin, acetaminophen, for pain 1-3
c. Tramadol, ketorolac, morphine, norco, for pain 4-6
d. Mo’ morphine, MS Contin for long-term control, dilaudid, norco, tramadol,
fentanyl patch, PCA pain 7-10
i. Also use your palliative care/pain management services to guide
your management
e. If it’s a headache/migraine, also try: Compazine
f. If it’s nerve pain, also try: gabapentin, pregabalin
g. If it’s abdominal bloating/pain and there’s no concern of an SBO:
simethicone
3. Nebulizers
a. Albuterol, atrovent Q4H-Q6H PRN wheeze
4. Mucolytics
 a. Glycopyrrolate, mucomyst, guaifenisen, chest physiotherapy
5. Nausea/Vomiting
a. Zofran PO, sublingual, or IV. Zofran can cause headaches.
6. Anxiety medications
a. Ideally, restart them on their home anxiety medication
b. If they don’t have any, try to avoid starting a benzo.
c. Alternatives: hydroxyzine, Benadryl, supplemental oxygen, call a
chaplain, call social worker, breathing exercises
d. Make sure it’s not a sx of an underlying condition (pulmonary embolism,
MI, aura before a seizure)
7. Agitation medications
a. Haldol PO or 5mg IM.
b. Ativan 0.5mg, 1mg, 2mg sublingual, PO, IM
c. Benadryl PO, IM. IV works, but if anyone is calm and asking for it they
want to get high.
d. Antipsychotics: Zyprexa/Olanzapine, Risperdal, Seroquel, Geodon,
trazodone
e. Opt for the antipsychotics in the elderly.
8. Sleep medications
a. Much like agitation meds: for the elderly, avoid benzos. Seroquel,
Risperdal. Amitriptyline, restoril (temazepam
b. Trazodone, ambien, benadryl are usually okay for everyone else
9. Alcohol withdrawal
a. Ativan, Librium are the mainstays at my institution. Everyone has their
thing. Q2H-Q3H-Q4H in closer intervals so nursing can also monitor the
patient for symptoms
10. Hypertension
a. You really should not have PRNs on for HTN. But in the setting of HTN
emergency/urgency, you’ll need something
b. Remember: don’t drop the systolic more than 25% of the highest SBP you
record over the course of 24 hours
c. Urgency (DBP >120 or SBP >180):
i. gradual reduction over 24-48 hours
d. use ORAL meds: labetalol, hydralazine. Do a Q8H or Q6H to avoid
rebound
i. and uptitrate those long-acting anti-HTN meds!
e. Emergency (evidence of end-organ damage): Immediate reduction of
SBP by 15-20%
f. Use PARENTERAL agents (nitro drip or paste) and transfer to ICU
PROPHYLAXIS
GI (stress ulcer) prophylaxis
 The only people who MUST get GI ppx are ICU patients IF…
o Mechanically ventilated >48 hours
o Known coagulopathy
o GI ulcer or bleeding within the past year
o TBI (traumatic brain injury)/TSI (traumatic spine injury)
o Burns> 35% of the BSA
 Who could get GI ppx
o For critically ill patients without any of the above, consider case-by-case.
 Your options:
o H2 blockers: rantidine, famotidine
o PPI: omeprazole, pantoprazole, esomeprazole

DVT/VTE prophylaxis
Every institution has its own guidelines. I think in a step-wise approach:

1) What is the patient’s risk of developing a DVT? I like the table below

J Hosp Med. 2010 Jan;5(1):10-8. doi: 10.1002/jhm.562. Maynard.

2) What options for anticoagulation does this patient have?

Heparin, warfarin, lovenox, LMWH, argatroban, NOACs (ex. epixaban), SCDs

3) What other considerations should I take?

 -renal disease: opt for heparin or warfarin, dose adjust NOACs

-vision problems, fear of needles: warfarin

- HIT (heparin induced thrombocytopenia) diagnosed in the past

PAIN MANAGEMENT 101

OPIOID EQUIANALGESIC DOSES

All equivalencies should be considered approximations only and can be affected by

interpatient variability, type of pain (ie, acute vs. chronic), chronic administration, tolerance,
etc.
Dose Equal to 10mg IM of Morphine Sulfate

Generic Oral Injection (IM/IV/SC)1

morphine2 60mg (30mg) 10mg

codeine 200mg 130mg

fentanyl3 N/A 0.1mg (100mcg)

hydrocodone4 30mg N/A

Hydromorphone (Dilaudid) 7.5mg 1.5mg

levorphanol 4mg 2mg

meperidine 300mg 75mg

methadone 20mg 10mg

Oxycodone (Oxycontin) 30mg N/A

oxymorphone5 10mg 1mg

http://www.empr.com/clinical-charts/opioid-equianalgesic-doses/article/125879/

Changing Routes of Administration (conversions based on morphine)

PO/PR IV/SC/IM Epidural Intrathecal

3 1 0.1 0.01

Combination Products Equivalent Morphine Dose

Acetaminophen 325mg +Codeine ~morphine 3-4mg PO
30mg PO (Tylenol #3)
Acetaminophen 500mg + ~morphine 5-6mg PO
Hydrocodone 5mg (Vicodin)
 Acetaminophen 325mg+ Oxycodone ~morphine 7-8mg PO
5mg PO (Percocet)

Morphine 50mg PO in 24 hours is approximately = Fentanyl 25mcg

transdermal patch Q72H

PEARLS
-if anything ever needs to be done stat, verbally communicate your order
first and then place the order. Or do it simultaneously. Refer back to intern
rules number 5 & 8.

-You WILL copy your notes. Other people will copy your notes. So make
them good. Don’t ever write “yesterday” or “today”. Write the date that
something occurred.

-write/dictate summaries the day of discharge.

-create templates and short-cut texts for yourself to write notes faster

-create custom order sets on your EMR

-create a ‘follow’ list. These are patients who were interesting cases (possible
case reports), people who may need to be called back, people who you
just…want to know what happens!

- Start notes early and add throughout the day.

-Sign out on time. It’s a small thing but everyone will be grateful.

- if someone asks you for IV Benadryl it’s to get high. I just want to put that
out there. That’s why they’re asking.

-you always have time to think, gather information, and get help when the
patient has a pulse.

-The first thing to do in an emergency: Check the pulse. get all the vitals, get
them on oxygen, get two IV accesses, grab a crash cart, flag down help.

-that said, if the patient doesn’t have a pulse, ACLS. ABCs. Call the code.
-when speaking to nursing colleagues. BE POLITE. Tell them the plan for
today. Ask them to provide more information, because you’re going to make
a decision based on their observations. Understand that their training
teaches them to address and treat symptoms, not diagnose. And go see the
patient, if you’re worried.

-ALWAYS. INTRODUCE YOURSELF. TO EVERYONE.

FAQ
Q: WILL I KILL SOMEONE?

A: No. Wards are run by teams, not individuals. You will always, as an intern and
even as a resident, have someone to help you. Your fellow interns, your senior, your
fellow, your attending, the nurses, basically anyone who might know something, so
long as you ask them politely, will be more than happy to answer your question so
that you will NOT kill someone.

Q: I DON’T REMEMBER ANY MEDICINE, AM I IN TROUBLE?

A: No. Because no one remembers shit when they come back. Also, what you’re
about to learn, as an intern, is management skills. In med school, you learn
pathophysiology, biochemistry, etc. Not how to work-up or manage a patient. The
stuff from med school will come back VERY quickly. The management and day-to-
day function will come with intern year. That’s why we do intern year!

Q: THERE’S SO MUCH INFORMATION COMING AT ME, WHAT DO I DO?

A: Prioritize, organize, itemize. Good residents will tell you exactly what they
want prioritized. You will learn your way/style and how to do these three things. And
when in doubt, run your list.

Q: I FEEL LIKE I’M DROWNING???

A: That’s normal. Every intern working with you and across the world feels this way
at the start.

Q: DOES THE FEELING STOP?

A: Yes. It varies for everyone, but a few months into intern year, everyone feels
better.

Q: I AM OVERWHELMED, WHAT DO I DO?

A: Take a DEEP breath. Take out your list. Run your list. Prioritize, organize, itemize.
Remember your organizational acronyms. Take another deep breath. You can do
this. Now go forth!