At the beginning of this year, I bought a ukulele. I started intern year at a sprint, like anyone does, arms full of hope which was quickly extinguished, lost in an atmosphere so devoid of hope that all of it flew out of my arms to settle into places so far in between it might as well have been floating in the vacuum of space.

The cloak of physicianship burdens upon you suddenly not just the obvious — the responsibility for human lives — but also darker, sinister things that are similarly heavy: a power over people nobody shows you how to soften, a tradition of institutional oppression that’s now officially dirtied your own hands, the towering knowledge that much of the time medicine is hurting people. Adjusting to the new responsibility of being a doctor felt really impossible.

In a hospital, there is no luxury of the mundane to fill in the gaps between flashes of drama. Going to work every day was a new jack-in-the-box of horrors, each one a stab at the raw place in me that bleeds for people but which progressively softened my cringe reflex into something that was like having the chills almost all of the time, hair on perpetual end.

So for a while, I got home every day and played the ukulele. I sucked at it, but playing would massage that raw place a little; it meant the hard places in me from medicine didn’t become as hard. It was a balm that helped replace bitterness, which abounds, because of tragedy, because of onerous work weeks, because of disparity, because it’s hard to help sometimes — it’s a sticky plethoric tar that protects you if you paint yourself with it but hardens in layers until before you know it the only touch that can mark you is a scratch.

Intern year loped along, and by the end of it, I was thin and ragged, gasping for air and just trying to make it to the finish line. Hope felt long gone. I was well aware it was a perspective problem — the patients that did well left the hospital, and so I didn’t hear from them, and the ones that did poorly bloomed in my awareness, taking over my ideas about how medicine works and what’s likely to happen to people. Pessimism was joined by sacrifice; in my last month, I’d become uncomfortably accustomed to losing the things I wanted to be as a doctor for the sake of getting to the next admit, writing more billable notes, or working my 85th hour in the week.

It sucks when these are the sacrifices, when you’re used to that sting. It sucks when getting a win is the only thing that’s going to inject some hope into the situation, but you can’t. It sucks when hope is so thin on the ground.

I didn’t enter medicine because I thought it was easy but I did go into it thinking I could do it proudly. Towards the end of intern year, I was very seriously doubting that. Would I ever be able to find a way to do this so that I’m proud of myself, and think I’m doing more good than harm? Is there a way to tolerate all the tragedy without becoming a monster?

I still don’t know the answers to those questions. (Spoiler: Not being an intern anymore helps.) Sometimes I would get home from work, and I’d get my ukulele out and claw for hope by playing sad songs fast and fiercely, feeling something besides sorrow, rooting myself in one of the human traditions that helps to share the burden of hardship and the balm of joy (music). I’d do this at 1 a.m. when my alarm was set for five the next morning. I’d do this after really hard days when patient courses were long and arduous. It was a balm when hope was thin.

And then, on my very last day of intern year, and I still can’t believe it went down like this, I taught one of my patients how to play the ukulele.

I had entered this patient’s room in order to give a few updates before I sat down for the afternoon to write notes. But instead, I saw that little plastic four-stringed piece of magic. I saw my patient struggling to finger a G chord (I had struggled too, at first). I saw a person clawing hard at hope in a hard situation. I saw my humanity rushing back at me during all those late nights playing sad songs fast and fiercely, thinking of patients that did poorly and situations that were messed up and all the ways bodies and minds and medicine failed us. So I sat on that hospital bed and together we sang songs I’d been playing for myself all year, the ones I had chanted like a prayer hoping to ward off black clouds, hoping to make the hospital feel more like a team room than a battleground.

Ultimately, this tool I had been cultivating for my own sanity was one I got to share with a patient as I crossed the threshold from intern to resident.

So here’s my intern year survival tip: Go to the place where hope seems thinnest.

I don’t know why. It’s something I felt compelled to do.

Go to the place where the darkness is thickest, go with all your hope gathered in your arms and into the vacuum it will disperse until you’re gasping, breathless, from the scarcity of hope in the sparse and lonely atmosphere, reaching in the darkness with hands wet with its thickness, its beefy angry sopping heaviness, drowning in the horror, hope lacking.

There, find it again. Reach and reach. Dig and dig. Fight harder for hope than you ever thought was possible, than you ever imagined, than you ever thought you would. Pile it back into your arms and get ready to plunge again.

Monica Samelson is a psychiatry resident who blogs at her self-titled site, Monica Samelson, MD.  She can be reached on Twitter @monicasamelson.

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