It’s 3 AM And I Wanna Go To Bed

If you’re wondering why you haven’t heard from me in awhile, it’s because I went directly from the Potassium Repletion rotation, which I absolutely despised, onto internal medicine wards. I am not sure why it is called a “wards,” rotation, but basically it’s the same thing I did in med school – rotating on an internal medicine team. I actually finished my “IM” rotation two weeks ago and have since been on an obstetrics service catching babies, but that’s a story for another time.

I’m behind. Residency is hard. Leave me alone.

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Potassium.

I am on the cardiac care unit, which is a supposed intensive care unit. I say “supposed” because none of the patients I am caring for are actually sick; almost all of the patients in the “CCU” are in a holding pattern until something definitive can be done by another person. For instance, there are people awaiting heart transplants. Others are awaiting implantation of an implantable defibrillator. Continue reading

Awaiting Return of Bowel Function

As I wrote last week, I am on a surgical service, trauma, at the moment. And my day is governed by, and revolves around, poop.

It is astounding how much of my daily well-being on trauma is influenced by the ability of someone else to poop. I think about it literally all day. It is often the first question I ask patients in the morning and the last question I ask them before I go home. It sits on my constantly-growing, frequently changing TO DO list I carry with me as the only constant: “Check on BMs for Patients A, B, F, W, P.” Continue reading

A Traumatic Recollection

Okay so in case you were wondering, being a resident is way better than being a med student.

Residency started with an ultrasound block. The ultrasound block consisted mostly of watching videos about How To Ultrasound Stuff, and then going to the emergency department and trying to ultrasound stuff. It was a very relaxing time. I even tried to teach the med students with us stuff about ultrasound, although this was limited by the fact that both students were smarter than this July intern and knew it.

Sadly, that glorious two weeks of Ultrasound and Chill has ended and I’m now on the trauma service. This sounds far more glamorous than it is, but before we get to talking about the actual job of being an intern, I should mention that I came on to this rotation with a significant amount of baggage and apprehension.

I never mentioned this while I was in med school, because I was afraid one of the school administrators would find this blog and come after me with a scythe and a referral to the student psychiatry center, but I had a truly awful time when I rotated through trauma as a med student.

One day in particular sticks out: one day on our daily six-hour rounds, our senior resident – a fifth-year general surgery trainee who was in charge of the entire service – got yelled at one day by the attending physician for doing something trivially incorrect. It does not matter what she did wrong, but it turned out to be the last straw.

We had watched as the trauma service had slowly beaten this poor woman down over the course of a week. She became more snippy toward nurses and staff, less tolerant of our errors, and was prone to fly into fits of rage. But that day was exceptional: under the fire of the attending, she melted down like a stick of butter in the microwave, burst into tears, and RAN OUT OF THE HOSPITAL. She literally abandoned ship. As the psych people would say, “she eloped.”

Besides the fact that she was living my dream – see “Round and Around We Go” – this left everyone in a bit of a lurch, inasmuch as we couldn’t do any work until she came back.

This, in a nutshell, was my previous trauma experience. I was thus nervous to start this one.

Thankfully, this service is much better. First of all, my team is great. Everyone is relaxed, and the senior residents basically just tell me what to do so I don’t have to engage my atrophied and tiny brain. No one yells at me, at least so far. Aside from the fact that my day starts at 4:30 am and involves essentially zero medicine, it’s a pretty tolerable block.

Yes, you read that right. 4 fucking 30 am.

One thing I realized: even though my job objectively sort of sucks – it’s 95% answering pages, calling smarter doctors to ask them what to do, and typing on a computer – it’s still far more fun and interesting than being a med student. Here’s why.

When you’re a med student on an inpatient team, you have basically three jobs:

  • Look interested
  • Know about your patients
  • Do random tasks the residents ask you to do.

The problem with these responsibilities is that your knowledge of what actually happens during the day for the “team” as a whole is tiny. You see what residents call “floor work” through the limited prism of your handful of patients, having to leave for classes or study for the exam, and the often clouding lens of being burnt out and just wanting to go home and drink a beer.

The chief downside of this narrow field of view is that you rarely have a full understanding of the service. A huge amount of communication goes on between the on-service residents, and even more happens through pages to nurses and other consultants. As the med students, you’re not privy to any of that. You come in and preround on your patient, not knowing that the day intern already heard from the night person that Bed 18 had a rough night and Bed 12 finally pooped.

(These are the things that get talked about in morning handovers.)

Being a resident is much better because, quite simply, you’re in the loop.

There’s also a fair amount of troubleshooting that you do as an intern that you aren’t comfortable (or at least shouldn’t be comfortable) doing as a med student. For instance, one of my patients with no history or reason to have an elevated blood pressure suddenly showed a high reading on his monitor one afternoon. The nurse paged me and I went to check him out.

(By the way, this was the only bit of medicine I have done so far, and of course I am changing many details.)

The guy was totally fine. He had no symptoms, no danger signs, and really no reason to have a high blood pressure. I walked back out, googled a few things to make sure I wasn’t missing anything obvious, and then went back and gave the universal “welp” symbol to the nurse.

“Yeah, that’s weird, I don’t think we need to do anything about that.”

I paused. After all, I had largely no idea what I was doing.

“Do you?” I asked, hesitating.

“Nope!” the nurse replied. Evidently this was the right answer.

Okay,” I said, visibly relieved. “Let me know if he goes over, uh, 180.”

Why 180? No reason. I picked it out of some dark recess of my mind that says “MAINTAIN BLOOD PRESSURE UNDER 180 SYSTOLIC IN PATIENTS WITH A SUBARACHNOID HEMORRHAGE.” Which my patient didn’t have, and is probably wrong anyway.

Unrelated, but if you google “maintain blood pressure below 180,” this is what comes up. I would love to see someone take straight-up garlic to the face. This is an amazing graphic; you will very likely see it again.

Anyway. So I could have called my senior resident about this high blood pressure (I told him about it hours later), but if I called my senior on every single question I had, I suspect he would go full Hulk Smash mode and rip my tiny brain right out of my skull. Lest you think I am being overly cautious, here is a (very) partial list of questions I have asked my senior over the last 48 hours:

  • Can the patient in bed 19 eat?
  • Can I eat?
  • What’s the dose for hydralazine?
  • How do I document a procedure?
  • A consultant was mean to me. Can you talk to him instead?
  • Am I supposed to be doing something right now?
  • Where do I find the room you want me to meet you in?
  • How do I admit a patient? Like, physically, what boxes do I click?
  • How do you possibly know all this?

You can see how this would become very annoying very fast for an upper-level resident if I asked even one additional stupid question, like “why is my patient randomly hypertensive?”

Plus, I’m not sure my senior likes me all that much as it is, and I’m trying not to piss him off.

Hulk references, blog lifetime: now up to 7.

Putting In Orders

Although most of my medical school classmates have already begun their formal residency rotations, we here at the Necessarily Anonymous Emergency Medicine Residency have yet to officially start. This is, depending on your point of view, either because our residency is warm and fuzzy and wants us to have a high quality of life, or they lack so much confidence in our abilities that they feel it necessary to train us up for an entire month. Continue reading

Intern

So, we’re interns now. At some point in the last two weeks, someone handed me a pager and an ID badge that says “M.D.” after my legal name. Next week, my co-interns and I start taking introductory shifts in our emergency room.

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IMPOSTOR SYNDROME EPISODE IV: The Intern Menace

Well, it’s been an entire eight months since my last away rotation and the attendant crippling anxiety brought on by the realization that everyone else is smarter than you, so we’re overdue.

The fourth year of medical school is especially strange with respect to my favorite syndrome.* After the end of away rotations and the submission of your residency application, interview offers start rolling in. As a medical student who by definition has spent the last 40 months getting emotionally kickboxed by people higher up on the totem pole (which is everyone), the interviews come as a wonderful respite.
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