How do you deal with call as an intern?

[lvspro]

Let's hear it.

I just remind myself that it's only a year of medicine, while all these other poor saps will still be doing the same crap in their 3rd year.

Rectal exams... bah humbug.

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[Laryngospasm]

Let's hear it.

I just remind myself that it's only a year of medicine, while all these other poor saps will still be doing the same crap in their 3rd year.

Rectal exams... bah humbug.

I drank a lot

 

[racerx]

Just remind yourself that it's better to give than receive. . .rectals that is.

 

[aredoubleyou]

One of my anesthesiology attendings at med school said that you have to do more than one thing wrong to kill a person, you have to do a lot of things wrong.

So far that seems to be true!


All I can think is- I have to assume that the peds interns are just as cluless and unsupervised as the med interns overnight - which really frightens me (now that i have a baby), so I hope the same principle holds true regardless of age!

 

[VentdependenT]

Call yer senior if you can't handle something. Nobody will fault you.

Oxygen is good.

Fall precautions are good.

CPAP/BIPAP is good.

Writing for prn ativan and narcs means that the night nurse WILL GIVE THEM in order to not deal with the patient. Beware cause patients can go down big time. Happened to me and I never forgot.

Not all chest pain is friggen ACSI. Milk of magnesia is your friend (after a clinical eval of course).

If all else fails just keep em alive until sign out in the AM.

 

[serenity]

Let's hear it.

I just remind myself that it's only a year of medicine, while all these other poor saps will still be doing the same crap in their 3rd year.

Rectal exams... bah humbug.

What should help...........
1.Lots of coffee
2.Having four hands and three ears
3.A lot of patience
4.Ability to give prn orders on phone even if half asleep

Just keep in mind,the harder you work in your internship the more sweeter and appreciative you will be as a CA1
Atleast now,as a CA 1, I am doing one thing at a time.......wow

Serenity
CA 1
Yale Anesthesiology

 

[VolatileAgent]

Call yer senior if you can't handle something. Nobody will fault you.

Oxygen is good.

Fall precautions are good.

CPAP/BIPAP is good.

Writing for prn ativan and narcs means that the night nurse WILL GIVE THEM in order to not deal with the patient. Beware cause patients can go down big time. Happened to me and I never forgot.

Not all chest pain is friggen ACSI. Milk of magnesia is your friend (after a clinical eval of course).

If all else fails just keep em alive until sign out in the AM.

truer words were not spoken.

also, if a nurse pages you at 3:00 AM because a patient doesn't have diet or ventilator orders entered, report her/him. you don't have to tolerate abuse from nurses. they will keep on picking on you if you let them. it's a power trip thing.

also, if you don't know something, ask one of your colleagues to explain it (even if it needs to be at an appropriate time later). never ask a nurse. they may be happy to explain it to you, but it will be seen as a sign of weakness. and, often in their simplistic thinking, they will believe because you don't know something that you don't know anything.

 

[dhb]

All true exept :

Oxygen is good.

in the COPD prone to carbo-narcosis

 

[VolatileAgent]

one more thing while i'm on nurse bullying...

always remember that you are an agent for your attending. he/she is ultimately responsible for what you do. i've found that this frame of reference helped my "attitude" during long and painful calls as an intern. if some nurse was hasseling me, it was helpful to remind them that the buck didn't ultimately stop with me, but with my attending instead. sometimes you have to remind them that you are just the messenger or person who doesn't have the final say in the patient's management. you can't use that all of the time, but 100% of the time, when i pulled that out, it was enough to shut them up/make them stop bugging me.

 

[VentdependenT]

All true exept : in the COPD prone to carbo-narcosis

theoretical.

 

[Laryngospasm]

theoretical.

One of my very smart pulmonologist attendings during residency also disagreed with this.

 

[supahfresh]

Serenity, we got killed last night. couple of traumas and a heart transplant.

What should help...........
1.Lots of coffee
2.Having four hands and three ears
3.A lot of patience
4.Ability to give prn orders on phone even if half asleep

Just keep in mind,the harder you work in your internship the more sweeter and appreciative you will be as a CA1
Atleast now,as a CA 1, I am doing one thing at a time.......wow

Serenity
CA 1
Yale Anesthesiology

 

[dhb]

theoretical.

i've seen a couple though...

 

[militarymd]

truer words were not spoken.

also, if a nurse pages you at 3:00 AM because a patient doesn't have diet or ventilator orders entered, report her/him. you don't have to tolerate abuse from nurses. they will keep on picking on you if you let them. it's a power trip thing.

Usually means YOU have been an ass...AND been on a power trip.

also, if you don't know something, ask one of your colleagues to explain it (even if it needs to be at an appropriate time later). never ask a nurse. they may be happy to explain it to you, but it will be seen as a sign of weakness. and, often in their simplistic thinking, they will believe because you don't know something that you don't know anything.

 

[militarymd]

i've seen a couple though...

What you saw happen is not necessarily explained by your hypothesis which has been DISproved.

 

[bullard]

also, if you don't know something, ask one of your colleagues to explain it (even if it needs to be at an appropriate time later). never ask a nurse. they may be happy to explain it to you, but it will be seen as a sign of weakness. and, often in their simplistic thinking, they will believe because you don't know something that you don't know anything.

I'm just an intern, but I couldn't disagree with this more. Asking a nurse a question (well, assuming it's not utterly stupid) is showing them some respect, and they will pay it back to you. I actually spent some uninterrupted time in the call room on my unit month, whch is more than some of my cockier cointerns can say.

 

[dhb]

What you saw happen is not necessarily explained by your hypothesis.

True,

DISproved.

do you mean this?
Lancet. 1977 Sep 3;2(8036):483-6. Links
Hypercapnia during oxygen therapy in acute exacerbations of chronic respiratory failure. Hypothesis revisited.

* Rudolf M,
* Banks RA,
* Semple SJ.

A modification is proposed to the well-known hypothesis which explains the development of progressive carbon-dioxide retention in patients with acute exacerbations of chronic respiratory failure when they are given supplementary oxygen to breathe. It is suggested that, in these patients, increased production of lactic acid by the brain, due to profound hypoxia, leads to a central hypoxic drive to breathing which is absent in remission when the arterial oxygen tension is higher. Evidence from the literature in support of this modification is sought by comparing the respiratory response to oxygen of patients in an acute exacerbation of respiratory failure with the response of patients in a chronic stable state. Three patients are described in whom the response to oxygen during an acute infective episode was very different from their response when in remission.

ps sorry for the hijacking

 

[militarymd]

no...the reference is in the ATS guidelines for COPD.

 

[dhb]

Thx
Oxygen is good

 

[VolatileAgent]

Usually means YOU have been an ass...AND been on a power trip.

wrong. case in particular: it was noted after a couple of particular nurses were doing this to several, if not all, of the interns at the VA hospital on night call, it became a point to note such instances with the clinical coordinator there. reports were filled. result - it stopped.

whatever, dude. i also saw this happen with a radiology resident (who was doing her medicine internship). after about a week of asking nurses what certain things meant and how to do stuff, they basically just began to ignore her when she asked for something and then began to repeatedly make fun of her behind her back.

the more **** you take, the more **** you get. there is a way to be both professional and respected. i have no problems expertly accomplishing both of those goals, and all the evaluations to prove it.

 

[militarymd]

My, my....someone thinks highly of herself.

 

[VolatileAgent]

I'm just an intern, but I couldn't disagree with this more. Asking a nurse a question (well, assuming it's not utterly stupid) is showing them some respect, and they will pay it back to you. I actually spent some uninterrupted time in the call room on my unit month, whch is more than some of my cockier cointerns can say.

we'll see. good luck. it has been my observation, not experience (those concepts are different), that interns who ask the nurse how to do too many things are the ones that will not get any respect when push comes to shove. suddenly, orders are instead seen as suggestions. requests for certain things to get done urgently get ignored. being too nice and asking to be shown how to do things, even though you're probably doing so to try to avoid it, will ultimately lead to confrontation. i've seen it before. point is, you can be friendly without befriending. take those words to heart. if you don't know how to do something or what something means, that's what your seniors are there for. it is, quite frankly, disrespectful not to give them the opportunity to teach you first.

but, having said that, the whole "asking for help" does ultimately depend on the situation. for example, when running a code and having run out of ideas after you're loading up your fourth pressor, it doesn't hurt to ask out loud "anyone else have any other ideas?" or the sort. that shows respect, and occasionally someone does have a good idea. just don't make a habit of it. remember, you are the doctor. you're already battling the perception with some of them - not all of them - that they've been doing this longer and that they are smarter than you, which may or may not be true. point is, don't feed that.

the fact is that many perceive interns for many different reasons as being an easy target. i really work hard to teach and protect my interns and med students. so, if you're working with me, come ask me first if you don't know something. don't disrespect that offer. or, if you'd rather be a nurse, quit and go to nursing school.

p.s. btw, i was never called out at 3 a.m. for b.s. as an intern, except at the VA. and, actually, there were more than a few times i wished i had been called when i wasn't.

 

[VolatileAgent]

My, my....someone thinks highly of herself.

referring to oneself in the third person is a clear sign of a mental disorder, in this case perhaps narcissistic personality disorder mixed with gender confusion. you should get checked out by a qualified mental health professional.

 

[swpm]

My, my....someone thinks highly of herself.

Pot, meet kettle.

 

[driverabu]

That's **** is the worst, getting called in the middle of your wet dream to give verbal orders about a sick as* patient you know nothing about. My last call (last night) was all about that. It seems like you never get called about YOUR patients, only everybody else's! My secret is Haldol.....got called in the middle of the night for a pt with DTs and was already on ETOH precautions...told the nurse to give some haldol and she loved me in the AM....sometimes I think I need some haldol! It's not so bad though...the one thing that keeps me going is knowing that after this year, when I get called in the middle of the night, you better bet it's an emergency, not some crap call. Thank God for Anesthesiology!!!

 

[Laryngospasm]

That's **** is the worst, getting called in the middle of your wet dream to give verbal orders about a sick as* patient you know nothing about. My last call (last night) was all about that. It seems like you never get called about YOUR patients, only everybody else's! My secret is Haldol.....got called in the middle of the night for a pt with DTs and was already on ETOH precautions...told the nurse to give some haldol and she loved me in the AM....sometimes I think I need some haldol! It's not so bad though...the one thing that keeps me going is knowing that after this year, when I get called in the middle of the night, you better bet it's an emergency, not some crap call. Thank God for Anesthesiology!!!

Unless its an IV start

 

[serenity]

Serenity, we got killed last night. couple of traumas and a heart transplant.

OOOPs Came to know of that.............I spoke too early!!!

Serenity
CA 1
Yale Anesthesiology

 

[onyX]

i hate it when off-service interns on Medicine get more complicated patients, more house officer call nights, more responsibilities, etc. than the medicine babies just 'cause we retained more knowledge to ace USMLE tests and get into a better field. bitter...bitter...

 

[underdog27]

Pot, meet kettle.

Only difference is that Millitary has years of private practice in anesthesia and critical care medicine to back it up!!

 

[lvspro]

i hate it when off-service interns on Medicine get more complicated patients, more house officer call nights, more responsibilities, etc. than the medicine babies just 'cause we retained more knowledge to ace USMLE tests and get into a better field. bitter...bitter...

I've been wondering about this. One of the attendings I've been rounding with takes a shot at how dense/lazy anesthesiologists are whenever he gets a chance. Of course, he's always kidding, but the idea had to come from somewhere, and he's helping to propogate it. Anyhow, I know for a fact that my classmates and I are way... way the hell ahead of any of those fleas.
I just can't wait to be back in the crisp, clean, OR with all my focus on one pt.