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Sunday, July 04, 2010

Don't go to the hospital in July

Friday night was my first call night as an Internal Medicine Intern. No, I am not going into Internal Medicine, but I have to do 1 year of general patient care before specializing in eye surgery (ophthalmology). Things have started out well and my first 1.5 weeks have been rather smooth. My first month is at a rather nice private hospital in the Medical Center here in Houston, in contrast to the more hectic teaching hospitals I will experience later this year. I thought I would write a brief story of the goings on of a brand new intern on call for the first time.

At this hospital an intern on call has 3 jobs over night (after a regular full day of work):
  1. Admit new patients - of course these are non-surgical patients, just coming in for whatever reason
  2. Cross-cover patients - this means that when questions arise with patients already in the hospital that require a doctor's help, the intern on call gets paged by the nurse
  3. Respond to codes - a "code" is called when a patient is doing VERY poorly and is about to die if something is not done (usually heart or lung related problems)
Fortunately, no codes were called all night! Praise God for that!

I ate dinner with my other residents on call around 6:30 pm and got my first admission around 8 pm. Actually, 2 came in at the same time, so I got 2 around 8 pm. I went down to the ER to see them, find out what is going on and get them admitted to the hospital. All went well but it was not until around 12 am that I got absolutely everything done (writing an admission History & Physical, calling the attending physician on call, writing orders, re-writing orders because I wrote some wrong the first time, then re-writing orders again because the patient had some objections to the orders I had written. She really preferred her meds to be administered IV...like she always gets when she comes to the hospital every couple weeks. Please tell me which one of us went to medical school? Yikes. It's too early in my career to be saying things like that.)

That sounds fine enough, but in the midst of these admissions, I start get the first few of about a dozen calls throughout the night from nurses (see job #2 above). "My patient in room ### has a history of hypertension, diabetes, and kidney disease and came in with abdominal pain but the pain medication is not working well enough, is there something we can give her?" Hmmmm. Good question. Did anyone mention to you that this is my first time on call and really have no idea? The nurses are very good and spend a lot of time with the patients, so they are definitely a good resource. On the other hand, their education/training is different not every suggestion should simply be agreed to without thinking. So I pause my admissions and go see patients with pain, nausea, insomnia, low blood sugar, whatever and try to figure out what to do for them, if anything. Many of these questions got referred up to my upper level resident for advice.

By 2:30 am, everything was calm and I had nothing to do, so I went to try and sleep a little. It was nice, for about 1.5 hrs. At 4 am I was paged by my upper level for my 3rd admission for the night. I was pretty tired at this time and a little more interested in the bed than seeing another patient, but to the elevator I went. That one actually went rather smoothly. Around 4:30 am, I was fully awake and it didn't bother me that I was seeing a patient. Believe it or not, after only 1 hr 45 min, I had seen the patient, written the H&P note, called the attending, written orders (this time without having to re-write them) and dictated the noted. Let's just say that's a record for me!

Now it was 5:45 am and I was starting to see other doctors coming in to start their regular morning work. Ha! I was just finishing my night! Unfortunately, I also had regular morning work - seeing the patients that I had been following this week and writing a progress note on how they were doing.

In the end, I laid down for 45 min of sleep from 7:15 to 8 am before finishing my first call shift. That's a total of about 2 hr 15 min of sleep, somewhat broken up and of low quality.

So why the title of this post?

Just because the person in the hospital has an M.D. behind their name that doesn't mean they know what they are doing. Just because I have the title of "doctor" or "resident" or "intern" that doesn't mean they gave me a special magical dose of knowledge with it, so as to know what to do. A brand new intern in July was just a med student a short 2 weeks ago! Therefore, avoid the hospital in July! or August or September for that matter. By October, I bet I will be getting the hang of things.

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