@southernhomo dishes on Intern year, anesthesiology, and being gay in medicine.

What is your typical day like as an intern?

It depends on which service I’m currently on. On internal medicine I get to work at 6 AM, get overnight sign out from the night team, pre-round and see all of my patients, and then round with the attending from 8 AM – 11 AM. The rest of the day is spent taking care of patients, calling consults, discharging patients, and admitting new patients. My day ends anywhere from 5 PM – 9PM, depending on the day. On services where I take call, like the cardiothoracic ICU, my days start a little earlier, around 5:30 – 6 AM. However, I will stay until 9 – 10 AM the next day, for a total 27 – 28 hour shift. Responsibilities vary as well. In the ICU, we will put lines in patients (central lines, arterial lines) or actively code (CPR, intubate) patients who are decompensating. On vascular surgery, we monitor patients for any signs of ischemia to see if we have to emergently head to the OR.

How did you successfully transition from med school to residency?

I don’t think anybody has a successful transition from med school to residency. I would guess that it’s rocky for all interns. Medical school was all about learning as much as you can while having the time and backup (from residents and attendings) to do it. You can make mistakes without ever actually making them because there would be so many people watching your every move. Residency on the other hand, is about working as hard as you can and trying to learn along the way. For example, it’s harder to “learn” when I have 10 notes that I have to write beforehand. My first few months of residency were very scary. I wouldn’t even order Ibuprofen for anyone without first double-checking their creatinine level. As I’ve progressed and learned more, I’ve become slightly more confident in my medical decisions. I’ve also learned that it’s actually very hard to accidentally kill someone.

Why did you choose anesthesiology?

I love the high acuity. When I was a medical student, we had a patient with placental abruption which was obviously an emergency. I saw four anesthesiology residents race back to the OR and instantly knew what to do and I knew that this was the field I wanted to be in. I then learned that high-acuity anesthesiology doesn’t just exist in operating rooms, but in the ICU as well. In fact, many critical care departments in the country are actually run by anesthesiologists. Anesthesiology is misunderstood in that people think all we do is push drugs and put patients to sleep. We are actual physicians and treat and take care of patients in a perioperative setting. I’ve seen patients decompensate before going to surgery and even after and anesthesiologists were there to take care of everything. Picking a specialty is a lot of that “gut” feeling. You just know when you know.

What advice do you have for med students interested in anesthesiology?

Learn as much about other fields of medicine as you possibly can. I did a total of 6 weeks of anesthesiology rotations in medical school. It doesn’t seem like a lot of time, but it’s honestly enough time to decide on your field. I remember interviewing and meeting people who spent their last year in med school doing 5-6 months of anesthesia rotations and I thought that was the most stupid decision. You’re going to spend the rest of your life doing anesthesiology, and this is your chance to broaden your general medical knowledge.

My other piece of knowledge is this: anesthesiology isn’t just about intubating or sticking patients with needles. It’s applied physiology and pharmacology in real time: SUCH a great opportunity to learn. I remember one of my patients actively dying, and everyone thought there was an active bleed internally. My attending put an ultrasound probe on his chest and diagnosed him with systolic anterior motion, completely changed his vasoactive drips, and I watched the patient recover before my eyes. Or with one of our patients who was on a nitroprusside infusion whose arterial oxygen levels kept dropping, and I couldn’t figure out why until I remembered that nitroprusside can worsen a V/Q mismatch. I turned off the infusion and the oxygen levels shot up after 5 minutes.

How did you become such a twitter icon and where does your inspiration stem from?

I started tweeting during med school and people just kept following me. I still don’t know why. Most of my tweets stem from gay culture, pop culture, reality TV, memes, or just events in my life that I guess people find relatable. I actually tweet very minimally about medicine.

What is it like being gay in medicine?

I can only speak from my point of view, but for me, being gay in medicine has been completely fine. I’ve been fortunate enough to be able to have options to attend different medical schools and different residency programs, so I picked the medical school that was the most LGBT-friendly where I knew I would be supported. I did the same when ranking residency programs. I’ve been able to bring my partner to every event, and my friends all know my partners, and we’ve become friends with many attendings as well. I can’t speak for what it’s like at other places, however.

Should you bring up sexual orientation in a residency/med school interview?

For me, the answer is yes. I was “out” during my medical school interviews and also “out” during residency interviews. I wanted to be at an institution that knows up front that I’m gay. Not only is this important to me, but it’s also an important gauge to see how people react. You can ask what LGBT opportunities are available at the institution (Do they have an active LGBT student group? Are there LGBT residents or will I be the only one? Are there mentorship opportunities and other ways I can participate in LGBT healthcare?). I think if you’re closeted during the interview, you miss the chance to see how open and accepting a place is. Med school/residency is already very hard, and I didn’t want to be at a place that would make it harder.

Have you ever been discriminated against  in medicine at any time during your career or ever came across “homophobic” attendings, preceptors, and/or patients? 

I have never been personally discriminated during my education. I have been around homophobic people, however. The event that pops into my mind now is a patient from my last semester of medical school who routinely used the word “faggot” (among other slurs) and my chief resident actually called them out.

What are some problems that gay men face in medicine but in the world today? How can we alleviate some of these?

There is a disparity in LGBTQ healthcare, particularly for trans patients. Where I was educated, we had an LGBTQ health clinic, where patients could come and get their medical care. It was routinely booked 3-4 months in advance. Patients traveled HOURS to make these clinic appointments. For trans patients, these clinics may be the only place they can feel truly safe and know that they can get accurate, evidence-based medicine without discrimination.

I think many people don’t think sexual orientation if important for your physician to know about, but it is. Your sexual habits determine what we screen you for. I recently saw a poll on Gay Twitter asking other gay men how often they get throat and rectal swabs for STI screening, and so many of the comments were just asking about what rectal swabs were even for (HPV, if anybody is wondering). Medical schools are beginning to train physicians about LGBT-specific healthcare, but it’ll be quite a long time before everybody catches up.

I also acknowledge that it’s very hard to come out to your physician, especially if you aren’t “out” or are only recently out. For physicians out there, an excellent way to show that your clinic or office is a welcoming space is to have a Safe Zone poster (if you are trained in Safe Zone) or any message affirming the atmosphere. I wear a rainbow pin on my white coat.

What are your tips for those who are gay but are not comfortable coming out?

My tip is to take your time, make sure you are safe, and make friends who will be there when you are ready.

If you’d like to learn more about @SouthernHomo, follow him on Twitter & Instagram and check out his blog here!