Best new intern stories: let em spill

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No, unfortunately, not fired. His uncle is the Godfather of the hospital CEO's kid, so this ***** was bulletproof.

Basically the unlucky bastard of a senior resident who took call with this guy had to follow him around ALL night to ensure patient safety. Consequently there were a lot of 3s and 4s who were re-living their internship for a month at a time, Q3 overnight in-house.

that's bull.

I have a (close) relative who is CEO of a small hospital. And I'm (reluctantly) doing a clerkship there. That is not a chance to be sloppy - I'll have everyone double checking my work!

Maybe nepotism only works if you're more than 2 degrees away....

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Whether nepotism is an advantage or disadvantage depends on the relative's viewpoint on the subject.

As a teenager, I worked at a hospital where my mom was one of the administrators, and all of the administrators' kids worked there in the summer. The others would goof off and basically do whatever they wanted, because everyone was afraid to fire them.

But my mom always made a point of telling me that she had already specifically told my boss that they were welcome to discipline me as they would any other employee, up to and including firing me if I gave them cause. And on a personal level, she would say, "people will judge me based on how you behave, so don't screw up."

To this day, I still work harder when I have an unfair advantage like that, than I do if it's just my own reputation at stake.
 
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One of my interns last year...

Put a patient's Foley catheter to wall suction. ("The senior told me to put the drain to suction.")

Cut a JP drain right at the skin and suture closed the skin hole. ("The senior told me to cut it at the skin and pull.")

Placed a TLC into a patient's AV fistula. ("I couldn't get an IV, so I decided to get a central line started, and I placed it into the biggest vein I could find!")

Hooked up a radical neck patient's tube feeds to the neck drain.

You gotta love July.

Now as a fellow, I leave most of the rounding to the Chief on the service. They tend to like it that way and, quite frankly, I don't know how much more grief this old ticker of mine can take before I just keel over and have a massive MI.

Word up.

The foley to suction had me crying.
 
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Old school urologists have been known to put foley to LWS in attempt to dry up a urethrovesical anastamotic leak after prostatectomy. Never seen it work.
 
When I was a fresh intern I wide open bolused a septic hypotensive patient the 2L of D5LR that was on his IV pole while my chief was en route. His sugar was like 750, woops! Worked out ok.
 
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During a kidney transplant, an intern was assisting me and the transplant surgeon. Case was going ok, we had the iliac artery clamped and were just beginning to sew in the artery. Attending asked the scrub for a clamp for something, dont remember exactly what, but pretty sure he was saying "clamp." She didnt hear, so he asked again, and then got frustrated and asked again, so the intern, trying to help, took the clamp off the iliac and handed it to him.
 
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We had a med student try to take off a caval clamp...because he couldn't see over it
One of my most shameful moments during med school, I was a 3rd year, and we were doing some sort of debridement I think on this like 400lb patient, and after the case we were trying to transfer the patient over to a gurney, and they were trying to extubate and having the issues you'd expect extubating a 400 lb person, and they had the portable monitor going and it was super loud and people were like yelling so I, trying my best to be helpful, turned the volume way down on the portable monitor so that everyone could hear each other better.

The anesthesiologist was.....uhh...not pleased
 
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noted-ryan-the-office.gif
 
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4 vascular surgery patients "repleated" with mag citrate following PM labs

big mess. my poor POD2 AKA man was desperately hopping to the bathroom when we came to see him on rounds. we initially worried we had a c-diff outbreak on our hands... it took us a couple minutes to figure out what happened

Another from when i was a med student- a prelim surgery intern (ortho... not that it matters) was told to confirm everyone on the floor had DVT prophylaxis, so he ordered DVT sonos on the entire trauma service. as i recall, a few got done before radiology called to ask what TF was going on
 
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OH! and when i was an MS3 one of the interns pulled out a feeding J tube instead of a JP in an esophagectomy patient. that was exciting
 
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As an MS3 I was sent to pull a drain prior to discharge. Had brief discussion with the resident wherein they made sure I had pulled a surgical drain before; I had, everyone parts ways confident in their respective roles. I go to pull drain. Drain looks strange, have not seen drain like this before, not sutured to skin. I assume suture has already come out at some point because I had seen that before. I removed the funny sticky dressing, take off suction pull drain. Drain doesn't want to come out and the patient complains of pain. But I am a determined MS3 who is starting to think she wants to do surgery. I do not want to admit I can't pull a drain after I so confidently told the resident I could handle it. The patient didn't like it very much but I got the drain out. Triumphant. Patient discharged. Thankfully didn't have bowel injury from me pulling his IR drain out without cutting the pigtail string. Next day saw an IR drain placed and had an "OH" moment. Now I make sure to carefully discuss the various drain types with students.

Every year we have interns attempt to order D-Dimers on fresh post-op patients to rule out bilateral DVTs when they have "leg edema." This leads to yelling NO and smacking them on the nose with a newspaper for multiple reasons, not the most important of which is that those legs aren't swollen, this is the southeast and the patient has baseline cankles.

Junior prelim res, not an intern, gets general surgery consult from ED for thigh abscess. Tells ED over the phone that leg problems all go to vascular so ED consults vascular. Vascular team dutifully sees patient with palpable distal pulses and big thigh abscess and writes note. ED lets gen surg intern know that vascular says no vascular issues so junior res says ok to discharge patient. ED thankfully admits to medicine for cellulitis. Hours later vascular team sees me and asks if I've taken the huge thigh abscess to the OR yet. What thigh abscess? Much yelling ensued including reminding prelim junior res he is not allowed independent thought on my service (due to prior issues of being a dope) and grounding him from the OR for 2 days. I go look at schedule and count that I have this kid on my service another 2 months that year. Silent tears of dismay.
 
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As an MS3 I was sent to pull a drain prior to discharge. Had brief discussion with the resident wherein they made sure I had pulled a surgical drain before; I had, everyone parts ways confident in their respective roles. I go to pull drain. Drain looks strange, have not seen drain like this before, not sutured to skin. I assume suture has already come out at some point because I had seen that before. I removed the funny sticky dressing, take off suction pull drain. Drain doesn't want to come out and the patient complains of pain. But I am a determined MS3 who is starting to think she wants to do surgery. I do not want to admit I can't pull a drain after I so confidently told the resident I could handle it. The patient didn't like it very much but I got the drain out. Triumphant. Patient discharged. Thankfully didn't have bowel injury from me pulling his IR drain out without cutting the pigtail string. Next day saw an IR drain placed and had an "OH" moment. Now I make sure to carefully discuss the various drain types with students.

Every year we have interns attempt to order D-Dimers on fresh post-op patients to rule out bilateral DVTs when they have "leg edema." This leads to yelling NO and smacking them on the nose with a newspaper for multiple reasons, not the most important of which is that those legs aren't swollen, this is the southeast and the patient has baseline cankles.

Junior prelim res, not an intern, gets general surgery consult from ED for thigh abscess. Tells ED over the phone that leg problems all go to vascular so ED consults vascular. Vascular team dutifully sees patient with palpable distal pulses and big thigh abscess and writes note. ED lets gen surg intern know that vascular says no vascular issues so intern says ok to discharge patient. ED thankfully admits to medicine for cellulitis. Hours later vascular team sees me and asks if I've taken the huge thigh abscess to the OR yet. What thigh abscess? Much yelling ensued including reminding prelim junior res he is not allowed independent thought on my service (due to prior issues of being a dope) and grounding him from the OR for 2 days. I go look at schedule and count that I have this kid on my service another 2 months that year. Silent tears of dismay.
Quoting to save for lols on future bad day. "Baseline cankles"...lol

My story is not as interesting but one day when I was an intern rounding on some now forgotten service I was told to transfer some patient to Ortho.

So I dutifully wrote the order "transfer to Ortho service" and went about my merry way. Sometime later the Ortho attending called my attending screaming about the transfer and that no one had talked to them about it.

I was quickly schooled in learning the culture which meant that transfers had to be discussed with the accepting team etc and not just an order written.

My attending told me several months later that while he had to apologize for me he actually found it quite amusing since the ortho attending was a bit of an arse
 
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Spine section chief is running 2 rooms and bouncing back and forth with cases. The chief resident was late getting to 2nd room, because he was still closing the first room, and gets thrown out for not being there from the beginning. Intern on service dutifully got his tasks done and is wandering the OR looking for a case to join, sees spine section chief with no resident and goes in and asks "No resident? Is this a Jr level case?" He gets thrown out too and then the chief resident gets yelled at again for having stupid interns.
 
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As an MS3 I was sent to pull a drain prior to discharge. Had brief discussion with the resident wherein they made sure I had pulled a surgical drain before; I had, everyone parts ways confident in their respective roles. I go to pull drain. Drain looks strange, have not seen drain like this before, not sutured to skin. I assume suture has already come out at some point because I had seen that before. I removed the funny sticky dressing, take off suction pull drain. Drain doesn't want to come out and the patient complains of pain. But I am a determined MS3 who is starting to think she wants to do surgery. I do not want to admit I can't pull a drain after I so confidently told the resident I could handle it. The patient didn't like it very much but I got the drain out. Triumphant. Patient discharged. Thankfully didn't have bowel injury from me pulling his IR drain out without cutting the pigtail string. Next day saw an IR drain placed and had an "OH" moment. Now I make sure to carefully discuss the various drain types with students.

Every year we have interns attempt to order D-Dimers on fresh post-op patients to rule out bilateral DVTs when they have "leg edema." This leads to yelling NO and smacking them on the nose with a newspaper for multiple reasons, not the most important of which is that those legs aren't swollen, this is the southeast and the patient has baseline cankles.

Junior prelim res, not an intern, gets general surgery consult from ED for thigh abscess. Tells ED over the phone that leg problems all go to vascular so ED consults vascular. Vascular team dutifully sees patient with palpable distal pulses and big thigh abscess and writes note. ED lets gen surg intern know that vascular says no vascular issues so intern says ok to discharge patient. ED thankfully admits to medicine for cellulitis. Hours later vascular team sees me and asks if I've taken the huge thigh abscess to the OR yet. What thigh abscess? Much yelling ensued including reminding prelim junior res he is not allowed independent thought on my service (due to prior issues of being a dope) and grounding him from the OR for 2 days. I go look at schedule and count that I have this kid on my service another 2 months that year. Silent tears of dismay.
Ha nice. I had a similar incident with a visiting 4th year student this year who pulled an IR drain and afterwards admitted he had never pulled that kind of drain before, didn't cut the suture, pulled super hard, caused the patient significant distress, and was "pretty sure" the entire drain came out.
 
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An ENT attending I work with told me one time he had a resident who left before the end of a big case with a flap and everything so he sutured an extra piece of vessel to the drain when he put it in so it would come out when he had the resident pull it later, just to **** with the guy and see what he would do. So mean.
 
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I think that's a ubiquitous surgery urban legend
Possible he made it up, but if you knew this guy you really wouldn't put it past him. He is a guy with a well developed sense of humor who likes to mess with the residents.

He also told stories about doing succinylcholine challenge during his training (whoever gets the farthest before dropping wins and then the other residents bag them till they can breathe again), and that at the VA they had to do an inguinal hernia before their subspecialty elective cases because the backlog was so bad. It could all be made up, but he has enough details it sounds believable.
 
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Ha nice. I had a similar incident with a visiting 4th year student this year who pulled an IR drain and afterwards admitted he had never pulled that kind of drain before, didn't cut the suture, pulled super hard, caused the patient significant distress, and was "pretty sure" the entire drain came out.
Yep we had the same happen in my office a few months ago.

Patient with persistent seroma has IR pigtail placed. Calls the office to say that the drain isn't putting out much and could she come in and have it removed. No provider in the office but the MAs say, "sure". Of course, they had never seen that type of drain before but shrugged it off and tugged.

We had a little meeting about that the next day.
 
This thread is honestly a little bit terrifying. I was excited to start intern year up until reading this. Now I'm kind of realizing how much I don't know and how that might actually end up hurting someone.
 
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This thread is honestly a little bit terrifying. I was excited to start intern year up until reading this. Now I'm kind of realizing how much I don't know and how that might actually end up hurting someone.
Good. A little fear keeps you safe. The ones who don't know what they don't know are the dangerous ones.
 
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Good. A little fear keeps you safe. The ones who don't know what they don't know are the dangerous ones.

Right here. I love an intern who admits he doesn't know and is uncomfortable. Welcome to the point of residency.

The ones who pull this "in my experience," "I used to do it this way," "I don't think we need to..." without sound medical (and medicolegal) rationale bull**** are intolerable. Don't be one of those. You'll be fine.

(Edit -- I'm an EM attending just reading this thread, but I'm sure my surgery counterparts won't disagree too much.)
 
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We had an intern who was alone on the trauma ICU service at night attempt to place a subclavian central line, break the wire off inside the patient, and call IR in to retrieve it WITHOUT TELLING ANYONE. The trauma attending on overnight saw the patient being wheeled to IR suite and was like "wtf is happening?"

We make the intern present this case at M&M and instead of humbly saying "I really F'd up", he says it must have been a defective wire. When asked why he didn't ask anyone for help, he says "everyone was in the OR." Because the OR is a hermetically sealed environment where you can't possibly enter and talk to anyone.
 
We had an intern who was alone on the trauma ICU service at night attempt to place a subclavian central line, break the wire off inside the patient, and call IR in to retrieve it WITHOUT TELLING ANYONE. The trauma attending on overnight saw the patient being wheeled to IR suite and was like "wtf is happening?"

We make the intern present this case at M&M and instead of humbly saying "I really F'd up", he says it must have been a defective wire. When asked why he didn't ask anyone for help, he says "everyone was in the OR." Because the OR is a hermetically sealed environment where you can't possibly enter and talk to anyone.
Well, at least calling it was the right thing.
 
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This thread is honestly a little bit terrifying. I was excited to start intern year up until reading this. Now I'm kind of realizing how much I don't know and how that might actually end up hurting someone.

I would say the first couple months to call your senior if you finding yourself thinking about anything.
 
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We had an intern who was alone on the trauma ICU service at night attempt to place a subclavian central line, break the wire off inside the patient, and call IR in to retrieve it WITHOUT TELLING ANYONE. The trauma attending on overnight saw the patient being wheeled to IR suite and was like "wtf is happening?"

We make the intern present this case at M&M and instead of humbly saying "I really F'd up", he says it must have been a defective wire. When asked why he didn't ask anyone for help, he says "everyone was in the OR." Because the OR is a hermetically sealed environment where you can't possibly enter and talk to anyone.

We had an intern do the same thing... Twice.
 
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We had an intern do the same thing... Twice.

Is there an objective ceiling before an intern gets fired for this, like first warning etc? Can you piss off the right person during your first stupid mistake and get fired immediately?
 
I dunno but in that particular case above there's like so many problems I think that resident would have been in some deep s*** at my program. Not fired but definitely meetings with the PD sort of thing at the very least.

1. We have a formal competency program for putting in central lines so depending on time of year that would be a big issue with an intern putting in a line unsupervised.

2. Competency sign off or not, I would be extremely upset if one of my interns put in a line at night without me at least knowing. That's a big enough event (or signals a change in patient condition) that I would want to be called.

3. Calling IR for management of the complication without alerting anyone that the procedure had even been done!??? Ugh where to start

4. The excuse of a faulty wire at M&M? We would just get destroyed if we tried to say that haha.

Yea, the procedural complication was bad enough, but it was mostly the attitude and fact that he never asked for help that were huge red flags for all of us. There were multiple fellows and attendings in house at the time that could have helped and didn't know. He didn't call the attending to report the complication. He did get destroyed at M&M for it. It was towards the end of his intern year so he should have been competent enough to know that he was having difficulty, abort the procedure, ask for help, and definitely notify his seniors. His presentation about it was more like "how can I shift blame away from myself".

The big take away point for interns is that mistakes happen, but that you need to always keep your seniors in the loop, ask for help, and admit and learn from your mistakes.
 
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Oh i just remembered one! An overnight intern independently arranged transfer for a sick ICU patient to a VA ICU because he noticed that it was a VA patient. Staff found out the next day when he was missing a patient on his census

My general thoughts finishing up intern year in a nonsurgical field: if you find yourself debating too much whether or not to loop in the senior / call pharmacy / etc, you're considering escalating level of care, or you're considering an invasive intervention of some sort, you should loop somebody in. Even if you're pretty sure you "got this", it's not going to hurt to get someone with, at this point in your training at least twice your experience, involved to at bounce your thoughts off of and give them a heads up in case a patient continues to deteriorate (even if your therapy was appropriate)
 
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Oh i just remembered one! An overnight intern independently arranged transfer for a sick ICU patient to a VA ICU because he noticed that it was a VA patient. Staff found out the next day when he was missing a patient on his census

My general thoughts finishing up intern year in a nonsurgical field: if you find yourself debating too much whether or not to loop in the senior / call pharmacy / etc, you're considering escalating level of care, or you're considering an invasive intervention of some sort, you should loop somebody in. Even if you're pretty sure you "got this", it's not going to hurt to get someone with, at this point in your training at least twice your experience, involved to at bounce your thoughts off of and give them a heads up in case a patient continues to deteriorate (even if your therapy was appropriate)

Solid advice. I think it can be tough sometimes to strike a balance between being annoying/dependent and wanting to show that you are developing into an independent, competent clinician. Tough balance to strike, especially early on.
 
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Solid advice. I think it can be tough sometimes to strike a balance between being annoying/dependent and wanting to show that you are developing into an independent, competent clinician. Tough balance to strike, especially early on.

It's definitely a balance. The "right" balance is going to vary in the minds of your seniors and staff. All you can do is what you feel is right for the patient. When I'm working with someone I haven't established a rapport with, I'm going to air on the conservative side of my general spectrum. Better to be the safe but a little needy intern than the dangerous one. An effective way to establish confidence is call and say "this is my take on the situation, this is my immediate plan, this is my contingency plan, sound good / anything else you'd do?". I mean, at least if your assessment / plan is good it inspires confidence, but if it's bad then good thing you called! All that said, if I'm giving the impression that I'm frequently in touch with senior / staff, I'm really not
 
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4. The excuse of a faulty wire at M&M? We would just get destroyed if we tried to say that haha.

Hahaha. Yeah. The general mindset in my program is "You're a surgeon. When something goes wrong with your patient, your own judgment and technical skills better be the first 20 things on your list of reasons why."
 
During a kidney transplant, an intern was assisting me and the transplant surgeon. Case was going ok, we had the iliac artery clamped and were just beginning to sew in the artery. Attending asked the scrub for a clamp for something, dont remember exactly what, but pretty sure he was saying "clamp." She didnt hear, so he asked again, and then got frustrated and asked again, so the intern, trying to help, took the clamp off the iliac and handed it to him.

Hahahaha omg i almost spit out my water.

This thread is amazing. I didn't do anything too crazy during my intern days, but some of my junior residents have had their share of experiences.

One story comes to mind....Ortho intern gets called at night for ankle fracture patient on our service. Nurse says on phone "there's something weird between her legs." He goes to check it out. Next morning:

Me: so what happened last night?
Intern: well I got up there and this lady lifts up her gown and there is this massive gelatinous wiggly ball coming out of her vagina.
Me: So what did you do?
Intern: I ...I just panicked and did what any man would do in that situation---I shoved it back in!
Me: .....

(Turns out patient had uterine prolapse and it happened to her all the time. She neglected to mention this to the terrified ortho intern. We called ob-gyn and they said it was actually exactly what they would have done. I told him not to shove things into vaginas anymore, unless he was sure what they were first.)
 
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Our program actually created guidelines stating that the chief and attending must be called if X happens. Most of these things are common sense, like escalation of care, conditions, procedures, and admissions, but it is nice having that codified so when you call your attending at 2am for a BS admission you can always say you had to do it.
 
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Thought of another:

Not an intern but a visiting 4th year subI/J-I. Intelligent, but did not understand and appeared not to be able to be taught, limits. Multiple instances of him doing something unsupervised that needed supervision. Initially we saw this as being overeager to please and show ability and he was counciled on appropriate ways to engage at a level appropriate to his role. But despite multiple such counseling sessions he continued to step over lines.

Examples include:

-starting to perform an I&D on a patient in the ED before speaking with anyone about the patient or the plan. He's been sent to see the patient and start/do the H&P while the intern was finishing up another consult. Senior/intern arrived to find him with scalpel in hand and making incision on a prepped patient.
-Sent to do a dressing change on a post BKA patient. Took a long time and when he eventually came back explained to residents that he decided that the dressing change would be too painful for the patient to endure (despite the fact that said patient had already "endured" multiple bedside dressing changes) and therefore "performed a popliteal nerve block" prior to doing dressing change. When asked who taught him how to do said nerve block, told us he watched a YouTube video just before doing it.
-Argued with OR staff about trying to start a laparoscopic procedure (injecting lidocaine/make periumbilical incision) before the chief resident arrived in the room. Tried to start despite staff telling him no.
-Consented patient for surgery before discussing plan with anyone, causing patient to think they were having surgery. This was a PSBO ultimately managed nonop. When asked why he decided to consent patient for surgery, said he thought it was a good idea "just in case" even though he knew we wouldn't operate that day on an uncomplicated PSBO that day.

There were others but all along this vein. He definitely didn't match with us and I think actually he ended up SOAPing into a prelim spot somewhere. This was last year and I don't know what his ultimate fate was. But he was the kinda guy that looked ok (not spectacular but decent) on paper but totally took himself out of competition by events when he was on his away rotation with us.
 
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Thought of another:

Not an intern but a visiting 4th year subI/J-I. Intelligent, but did not understand and appeared not to be able to be taught, limits. Multiple instances of him doing something unsupervised that needed supervision. Initially we saw this as being overeager to please and show ability and he was counciled on appropriate ways to engage at a level appropriate to his role. But despite multiple such counseling sessions he continued to step over lines.

Examples include:

- starting to perform an I&D on a patient in the ED before speaking with anyone about the patient or the plan. He's been sent to see the patient and start/do the H&P while the intern was finishing up another consult. Senior/intern arrived to find him with scalpel in hand and making incision on a prepped patient.
-Sent to dona dressing change on a post BKA patient. Took a long time and when he eventually came back explained to residents that he decided that the dressing change would be too painful for the patient to endure (despite the fact that said patient had already "endured" multiple bedside dressing changes) and therefore "performed a popliteal nerve block" prior to doing dressing change. When asked who taught him how to do asaid nerve block, told us he watched a YouTube video just before doing it.
-Argued with OR staff about trying to start a laparoscopic procedure (injecting lidocaine/make periumbilical incision) before the chief resident arrived in the room. Tried to start despite staff telling him no.
-Consented patient for surgery before discussing plan with anyone, causing patient to think they were having surgery. This was a PSBO ultimately managed nonop. When asked why he decided to consent patient for surgery, said he thought it was a good idea "just in case" even though he knew we wouldn't operate that day on an uncomplicated PSBO that day.

There were others but all along this vein. He definitely didn't match with us and I think actually he ended up SOAPing into a prelim spot somewhere. This was last year and I don't know what his ultimate fate was. But he was the kinda guy that looked ok (not spectacular but decent) on paper but totally took himself out of competition by events when he was on his away rotation with us.
How did he not get fired from the rotation?
 
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Thought of another:

Not an intern but a visiting 4th year subI/J-I. Intelligent, but did not understand and appeared not to be able to be taught, limits. Multiple instances of him doing something unsupervised that needed supervision. Initially we saw this as being overeager to please and show ability and he was counciled on appropriate ways to engage at a level appropriate to his role. But despite multiple such counseling sessions he continued to step over lines.

Examples include:

-starting to perform an I&D on a patient in the ED before speaking with anyone about the patient or the plan. He's been sent to see the patient and start/do the H&P while the intern was finishing up another consult. Senior/intern arrived to find him with scalpel in hand and making incision on a prepped patient.
-Sent to do a dressing change on a post BKA patient. Took a long time and when he eventually came back explained to residents that he decided that the dressing change would be too painful for the patient to endure (despite the fact that said patient had already "endured" multiple bedside dressing changes) and therefore "performed a popliteal nerve block" prior to doing dressing change. When asked who taught him how to do said nerve block, told us he watched a YouTube video just before doing it.
-Argued with OR staff about trying to start a laparoscopic procedure (injecting lidocaine/make periumbilical incision) before the chief resident arrived in the room. Tried to start despite staff telling him no.
-Consented patient for surgery before discussing plan with anyone, causing patient to think they were having surgery. This was a PSBO ultimately managed nonop. When asked why he decided to consent patient for surgery, said he thought it was a good idea "just in case" even though he knew we wouldn't operate that day on an uncomplicated PSBO that day.

There were others but all along this vein. He definitely didn't match with us and I think actually he ended up SOAPing into a prelim spot somewhere. This was last year and I don't know what his ultimate fate was. But he was the kinda guy that looked ok (not spectacular but decent) on paper but totally took himself out of competition by events when he was on his away rotation with us.

That is horrifying.
 
Thought of another:

Not an intern but a visiting 4th year subI/J-I. Intelligent, but did not understand and appeared not to be able to be taught, limits. Multiple instances of him doing something unsupervised that needed supervision. Initially we saw this as being overeager to please and show ability and he was counciled on appropriate ways to engage at a level appropriate to his role. But despite multiple such counseling sessions he continued to step over lines.

Examples include:

-starting to perform an I&D on a patient in the ED before speaking with anyone about the patient or the plan. He's been sent to see the patient and start/do the H&P while the intern was finishing up another consult. Senior/intern arrived to find him with scalpel in hand and making incision on a prepped patient.
-Sent to do a dressing change on a post BKA patient. Took a long time and when he eventually came back explained to residents that he decided that the dressing change would be too painful for the patient to endure (despite the fact that said patient had already "endured" multiple bedside dressing changes) and therefore "performed a popliteal nerve block" prior to doing dressing change. When asked who taught him how to do said nerve block, told us he watched a YouTube video just before doing it.
-Argued with OR staff about trying to start a laparoscopic procedure (injecting lidocaine/make periumbilical incision) before the chief resident arrived in the room. Tried to start despite staff telling him no.
-Consented patient for surgery before discussing plan with anyone, causing patient to think they were having surgery. This was a PSBO ultimately managed nonop. When asked why he decided to consent patient for surgery, said he thought it was a good idea "just in case" even though he knew we wouldn't operate that day on an uncomplicated PSBO that day.

There were others but all along this vein. He definitely didn't match with us and I think actually he ended up SOAPing into a prelim spot somewhere. This was last year and I don't know what his ultimate fate was. But he was the kinda guy that looked ok (not spectacular but decent) on paper but totally took himself out of competition by events when he was on his away rotation with us.
Ha oh man. I think the "tried to start a case by himself despite OR telling him no" is the best part.
 
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Ha oh man. I think the "tried to start a case by himself despite OR telling him no" is the best part.

I reread what I wrote and realized for clarification I should probably say that this doesn't mean he grabbed the local from the tech and made the incision. He insisted on initiating the timeout without the chief there even though the staff wouldn't recognize it and insisted to them that the local/incision part was the only part he was going to do before the chief arrived. Still not ok but realized my previous post sounded a little more dramatic.
 
Thank you for this thread. I just finished week 3 of internship and was feeling like the stupidest person in the hospital (until reading this). Friday afternoon I was sent to pull a chest tube, which I've done before. Asked if I needed supervision, was told no, and went ahead and did it. I took my time, made my occlusive dressing, clipped the stitch, had the pt take a deep breath in and pulled. Didn't come out. Had pt do it again, this time with a little elbow grease the drain pulled out. Noticed the tip was intact, but curled. F**k. So that's what they mean by a "pigtail" drain. Checked on him a lot until I left that evening, no acute issues. Spent the whole rest of the evening and next day refreshing pt's chart to see if he had any events or change in VS indicating hemothorax, tissue damage, etc. Late Saturday, note indicates patient is fine. I just gave him an experience to remember me by. Humbling experience, next time I know to cut the string, and to evaluate the situation for things I've never seen before, and most importantly, to fess up to my seniors that I f**ked up, as soon as I realize it. Had he had an acute event while I was gone, it might have gone unnoticed for a while if no one knew the situation. The whole thing made me sick this weekend. Only 5 more years of this to go!
 
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Thank you for this thread. I just finished week 3 of internship and was feeling like the stupidest person in the hospital (until reading this). Friday afternoon I was sent to pull a chest tube, which I've done before. Asked if I needed supervision, was told no, and went ahead and did it. I took my time, made my occlusive dressing, clipped the stitch, had the pt take a deep breath in and pulled. Didn't come out. Had pt do it again, this time with a little elbow grease the drain pulled out. Noticed the tip was intact, but curled. F**k. So that's what they mean by a "pigtail" drain. Checked on him a lot until I left that evening, no acute issues. Spent the whole rest of the evening and next day refreshing pt's chart to see if he had any events or change in VS indicating hemothorax, tissue damage, etc. Late Saturday, note indicates patient is fine. I just gave him an experience to remember me by. Humbling experience, next time I know to cut the string, and to evaluate the situation for things I've never seen before, and most importantly, to fess up to my seniors that I f**ked up, as soon as I realize it. Had he had an acute event while I was gone, it might have gone unnoticed for a while if no one knew the situation. The whole thing made me sick this weekend. Only 5 more years of this to go!

Yes, always tell your seniors!

It may seem stupid but not even from an acute event standpoint, it's important for us (and the attendings) to know about when talking to the patients.

We had a patient who had a horrible traumatic foley experience in the middle of the night. Nothing anyone really did medically wrong, just sucked and was very unpleasant for the patient. But the intern was so embarrassed about it he didn't call or let anyone know. So in the AM the chief and the attending both got REAMED by this unhappy patient without knowing anything about the event. The whole thing ended up getting patient relations involved, etc, and was a disaster. Which could have been mitigated by keeping the team informed.
 
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Medicine stories are probably a little less dramatic but I have some favorites too:
Frail old lady with chest pain admitted overnight. Intern presenting on rounds says that it was reproducible MSK pain. We wander into the room and the patient and nurse are chatting. Patient looks up and points at the intern "that's him!!". He'd pushed on her chest so hard that he'd bruised her sternum. Reproducible indeed. She had a dissection.

Also late at night, intern reviewing labs on a direct admission from an outside ER for pneumonia. Someone didn't notice a plt count of zero in the transfer process. He panicked when he saw the 12 hour old lab and decided the patient needed to be off to the ICU right now. Put him in a cardiac chair and wheeled him down to the ICU (complete with an elevator ride). No heads up. No discussion. Just arrived at the ICU pushing a patient in a chair. The reaction from the ICU nurses was so much fun I tried to convince him to do it again a week later.
 
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Medicine stories are probably a little less dramatic but I have some favorites too:
Frail old lady with chest pain admitted overnight. Intern presenting on rounds says that it was reproducible MSK pain. We wander into the room and the patient and nurse are chatting. Patient looks up and points at the intern "that's him!!". He'd pushed on her chest so hard that he'd bruised her sternum.

Reminds me of the junior medicine resident that consulted us for an acute abdomen.

I see the patient. No history of abdominal pain reported. She's resting comfortably, eating (of course). On examination of all 4 quadrants and flanks, there is no pain.

I call to report my findings and the resident insists she has abdominal pain, so I invite him down to "show me", because perhaps I am not appreciating it.

His exam was...interesting. Apparently somewhere along the line during his medical education, he was taught that an abdominal exam was best done with the forefingers held tightly together as one "stabs" into each quadrant suddenly, quickly and deeply. Points if the patient gasps and sits bolt upright.

I signed off.
 
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Reminds me of the junior medicine resident that consulted us for an acute abdomen.

I see the patient. No history of abdominal pain reported. She's resting comfortably, eating (of course). On examination of all 4 quadrants and flanks, there is no pain.

I call to report my findings and the resident insists she has abdominal pain, so I invite him down to "show me", because perhaps I am not appreciating it.

His exam was...interesting. Apparently somewhere along the line during his medical education, he was taught that an abdominal exam was best done with the forefingers held tightly together as one "stabs" into each quadrant suddenly, quickly and deeply. Points if the patient gasps and sits bolt upright.

I signed off.
Exam skills are very poorly taught in medical school these days.
 
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