Blog: The 'first' of July

BySaleh Aldasouqi, MD, FACE, ECNU

Today is July 1, or the first of July, but this post will be published later in early July.

The first few days of July mark many occasions and milestones. To be clear, this post is not about Canada Day (which falls on the first of July). Nor is it about the U.S. Independence Day (which falls on the fourth of July).

This post is about the “Medical First” of July. The first of July is a milestone in medical schools and postgraduate medical education, where the fiscal year is not Jan. 1 to Dec. 31, but instead July 1 to June 30.

Medical students in clinical clerkships as well as residents and fellows start a new year of medical school or residency or fellowship (or move on to the next year) on July 1. Likewise, at the end of the day on June 30, a medical student becomes (overnight) a doctor (MD or DO), and a resident (or fellow) becomes a consultant!

In our medical department at Michigan State University, every year we celebrate the graduation of medical residents and subspecialty fellows, in a spectacular ceremony. These graduates suddenly become totally independent, overnight. Imagine a resident who was making decisions on patient care, following the instructions of his or her supervising attending on June 30, will now start making those decisions on their own the next day (July 1).

I thought of this transition as a fascinating human phenomenon. I myself passed through that experience multiple times. All of a sudden, on July 1, I found myself (overnight) to become a doctor (finishing medical school), then a consultant internist (finishing medical residency) and then a consultant endocrinologist (finishing fellowship training). I always pondered about that at each stage. How comfortable would I be to call the shots on July 1, with no supervising physician to staff with?

It is like the young birds learning to fly from their mother bird. One day, the young bird would be thrown alone in the air finding itself having to fly after numerous flying sessions by the mother bird.

One last note about the first of July is about foreign medical graduates coming to the U.S. to start residency training. On July 1, these medical graduates find themselves in a very difficult human experience. When I graduated from medical residency from Hurley Medical Center in Flint, Michigan, in 1994, I wrote a short play and presented it during a farewell ceremony. In the play, I expressed from a personal experience what it felt like to be a foreign medical graduate starting residency in the U.S. For the purpose of dramatizing, I pictured such a foreign medical graduate starting his residency on July 1 in the ICU of a busy city hospital. I published the play in my Healio blog last year ( https://www.healio.com/endocrinology/practice-management/news/blogs/%7B9950971f-74a7-42ad-9e94-5b0cb8d539d3%7D/saleh-aldasouqi-md-face-ecnu/blog-international-medical-graduate-icu-and-july-1st ).

The first of July represents a wonderful milestone in the life of physicians, multiple times in their schooling and training. For the vast majority of physicians, this overnight transition passes seamlessly, but I always wonder how that occurs. Undoubtedly, this transition applies to many other professions. Clearly, the human being is such a fascinating creature!

Coming back to Canada’s first of July, it was just now, as I was Googling for info about Canada Day that I realized that Canada Day is not about Canadian independence, but it is about the country’s unification back in 1867, joining the provinces of Nova Scotia, New Brunswick and Canada (now Ontario and Quebec). Those were the three major provinces at the time, and this unification produced one nation, which is Canada as we know it.

Canada’s sovereignty (independence) is a bit more complicated than many other countries that the old British Empire had ruled: This is what I have just read about Canada’s independence, from a piece in the Daily Mail published June 28 (http://www.dailymail.co.uk/news/article-5896197/Canada-Day-2018-celebrate-Canada.html), “Total sovereignty was only achieved in 1982, when the U.K. Parliament moved the power to change Canada’s constitution to the Canadian Government via the Canada Act.”

It is interesting that we, in the U.S., use the term “from coast-to-coast,” but it has never occurred to me prior that Canadians use the term, “from coast-to-coast-to-coast,” as stated in this piece that I have read on the Globe and Mail’s website (https://www.theglobeandmail.com/news/national/canada-150/where-the-water-takesus/article35526412/). This article was published on Canada Day 2017, and the author explained how Canada is surrounded by oceans from three sides.

Moving from the Canada Day on July 1 to U.S. Independence Day on July 4, it is interesting how the two occasions occur close to each other. One summer, several years ago (when the kids were young), our family visited Niagara Falls during the first week of July. We shared with the Canadians their celebration of Canada Day, and upon returning to Michigan, we celebrated the Fourth of July with the kids. In Lansing, the best viewing for the fireworks is the roof of Sparrow Hospital’s large parking structure, in downtown Lansing. The hospital opens the roof to the public on July Fourth and a large crowd of spectators climb the stairs to the roof to watch the fireworks. I went with the kids to the Sparrow roof a couple of times in the past.

A final thought about the Fourth of July is that this year: It is falling on a Wednesday, and that is a problem for many Americans. How to plan the time off? This was the topic of a humorous report on CNN, published June 30 (https://www.cnn.com/2018/06/29/us/fourth-july-wednesday-trnd/index.html ), titled “When the 4th of July is on a Wednesday, your long weekend gets confusing.” It includes this passage: “Everyone loves holidays. But you know what we love even more than holidays? Holiday weekends. There's nothing like taking a day that celebrates/commemorates something (insert the holiday of your choice here) and stretching it out to three, if said holiday falls on a Monday or Friday. Heck, we'll stretch weekends out to four full days if a holiday lands on a Tuesday or Thursday. But what if the holiday falls smack dab in the middle of the week? Oh, dear. And that's the dilemma that our great nation now faces. On which weekend should we celebrate the Fourth of July? This year, the Fourth falls on a Hump Day.”

At the time of publication of this post, graduating medical students would already be doctors (having started residency), and residents and fellows would be consultants in charge of their own patients in their clinics or at hospitals. And, Canadians and Americans would have completed celebrations of their national days! It is all in the first few days of July!