I have become my own old enemy. I used to wonder at the residents riding the interns and medical students – how could they be so harsh, when they had so recently come through the same thing themselves.

I know now. First, it doesn’t seem recent anymore. Intern year is a rapidly fading memory – let alone medical school. That was a different person, in a different galaxy. And second, I’ve realized that my program and my hospital will deteriorate rapidly if the interns aren’t taught surgical ethics. My seniors taught me – forcefully – about work ethics, responsibility to patients, responsibility to team members, deference to attendings and chiefs. I didn’t enjoy hearing about it when they thought I was out of line; but now I appreciate the strength of the standards they passed on – and I want the interns to learn the same thing. In a few months, they won’t be interns any more; and if my class has failed to communicate what seem to me basical principles (don’t leave till the work is done; don’t leave without signing out your patients properly to a responsible person; don’t walk away from a patient whom you’ve just decided to transfer to the ICU; don’t forget to write a note about any important patient encounter, or any procedure you do; don’t assume that the ER will get a patient to the OR quickly, or with appropriate medications; don’t assume. . . anything) – then they can’t teach it to the next class of interns.

I like my hospital, a lot actually; I feel very possessive about it, especially alone at night in the dark hallways; and I want it to continue to provide good care. Which is why my interns and medical students are going to find me being stricter for the rest of the year.