July Intern

"I bet you can't tell that I just cried in the call room!"

"I had long since learned that the secret to a happy and successful life was to steer clear of any project masterminded by that young scourge of the species." - Bertram Wooster, "Stiff Upper Lip, Jeeves" (1926)

"I left them, and noticed them pointing at me to each other, pleased that I would be their brother's doctor. I was moved. I was a doctor. For the first time that day, I felt excited, proud. They believed in me, in my art. I would take care of their brother, and them. Take care of the whole world, why not? I marched down the hallway with pride. I fingered the chrome of my stethoscope with a certain expertise. Like I knew what I was doing. Far-out. It didn't last." - Roy Basch, "The House of God" (1978)

A July intern is a graduating medical student's first month practicing as a real doctor. In other words, a July intern is a deer in headlights except less likely to survive. The goal of a July intern is to survive irrespective of whether they are thrown into the fire or the deep end.^[1] The goal of patients under the care of a July intern is to survive as well.^[2]

Characteristics of a July Intern

Though the initial few moments of a July intern's day might be filled with positive energy and optimism, it very quickly degrades.^[3] For one, the downfall starts when a July intern first gets lost within the hospital.^[4] A July intern may further be rattled by a Code Blue for which their immediate instinctive response is to hide in a supply closet or suck one's thumb.^[5] By mid-morning, a July intern does not appear any different than an ER patient who is about to be admitted: chest pain, shortness of breath, palpitations, abdominal pain, nausea, vomiting, urinary and bowel incontinence, and syncope.^[6] Dehydration is very common among July interns due to the loss of fluids through not only sweating and bladder and bowel incontinence but also persistent crying.^[7]^[8] Do not surprised if a July intern turns to complete strangers for advice, food, or a hug.^[9] It also during this very first month that July interns - after working long hours, forgetting to eat, and finding that the cafeteria is closed - learn the value and life-sustaining wonder of graham crackers.

Finally, July interns are known to be notoriously clumsy, doing things like tripping over Foleys, dropping babies, or becoming proficient at pneumothoraces.^[10]^[11]^[12] As Bertram Wooster told his clumsy friend Stinker Pinker in P.G. Wodehouse's Stiff Upper Lip, Jeeves, "You move in a mysterious way your wonders to perform, Stinker. I believe you would bump into something if you were crossing the Gobi dessert," to which Stinker replied, "I've never been in the Gobi dessert."

The Difference Between a July Intern and a June Intern

This is best summarized here: July vs. June Interns. It can be best summarized as "July interns stink and June interns are better."

Impact on Society

The influence of July interns on modern society cannot be understated. Just by showing up to work on July, the chances of in-hospital fatality skyrockets towards infinity. It is so concerning that attempts have been made to eliminate July from the calendar entirely.^[13] In the event an 11-month calendar cannot be created, nurses are often seen fleeing the healthcare system in record numbers under the guise of vacation leave.^[14]

Figure 351

However, one sector of the economy does benefit from July interns: the toilet paper industry. The act of July interns sh*tting themselves has led to a predictable pattern of TP sales where toilet paper companies like Charmin see record sales as the month of July progresses (see Figure 351).^[15] Market economists project that 2017 will be a big year for other industries as well: the tissue paper and underwear industries.

July Interns in 2017

To better prepare the incoming crop of July interns starting on July 1, 2017, the Food & Drug Administration (FDA) approved 55-hour ENERGY drinks to help them fight sleep deprivation, which often leads to poor medical decision-making, and help them last through their improved but still brutal 168-hour work weeks.^[16]^[17] Most if not all residency programs across the country ensured each intern was supplied with a new white coat, pager, and gift bag full of 55-hour ENERGY drinks.

Advice to Patients