In these first few weeks as a new cardiology fellow, it feels like I have seen as many low ejection fraction left ventricles as I did in my entire residency. It also turns out that it is the only useful measure I can point out when my attending pulls up an echocardiogram. In those snowy images, the dilated ventricle does not seem to accomplish much at all. At most times during my first month as a fellow, I have felt much like that left ventricle. I refer to it as HFrF: heart fellow with reduced function.

Until recently, I was at the peak of my powers as a medicine resident. I confidently introduced myself to patients and family as the "senior resident" after swooping down to the emergency department in all my internal medicine glory. I was functioning at an ejection fraction of 55 percent, maybe even hyperdynamic at times. I was called to interrogate pacemakers, STAT evaluate STEMIs and cardiac arrests in the emergency department, and make medication adjustments to patients in cardiogenic shock in the middle of the night. Now my introduction is, "Hi, I am the cardiology fellow," and quickly changes to, "I am the first-year cardiology fellow," in hopes of tempering expectations. During this first month of fellowship, I often find my output insufficient to meet the new demands of fellowship.

However, in my current low-functioning state, my colleagues have served as the diuretics (in the best possible way), helping to offload the everyday stressors of being a new fellow. Whether it is senior fellows sharing educational resources and the quirks of different attendings, my co-first-years sharing their lessons learned as we swap rotations, or attendings who FaceTime me at 2 a.m. to help troubleshoot an LVAD, I breathe easier knowing that I get to work with them for the next three years.

Still, there are good days and bad days. There are days when you tell your attending about the atypical chest pain patient unlikely to have cardiac etiology and the troponin comes back at 15. There are also days when you find your mind going blank in the middle of a crowded room as William C. Roberts, MD, DSc, MACC, asks a question while holding a dissected heart in his palm, and you realize it might as well be your heart he is holding. However, there are days when your program director commends you on a job well done. Realizing that you are not alone in your experiences is what helps the most. It is comforting to know that first-year fellows across the country are facing similar challenges and that the attendings you work with everyday faced these challenges not too long ago. With their help and your continued dedication to the field you have chosen, you may be able to treat both HFrEF and HFrF. It also helps to know that even after 36 months, you may still not be able to answer Roberts' questions.

This article was authored by Taimur Safder, MD, MPH, Fellow in Training (FIT) at Baylor University Medical Center in Dallas, TX.