New Anesthesia Interns

[jetproppilot]

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I'd like to direct a few thoughts to the dudes/dudettes who kissed wanna the best year of their lives goodbye a cuppla weeks ago and are now INTERNS....

....specifically the ones who are going into anesthesia.

First of all, congrats on finally getting the MD/DO degree! Been a long run, huh?

Now at least you're making ten bucks an hour.

SDN ANESTHESIA is a good place for you to hang out if you've got some free time and you're on the computer.

Between the main content of this forum which usually focuses on restaurants, vacations, booze, motorcycles, snowboarding, monsta trucks, bodybuilding, music-complete-with-You Tube-live-concert-clips, funny personal stories-especially-from-Zippy, food, faith or lack of, poker, how to top Wilt Chamberlain's numbers (Copralia), cool autos, dogs that look like Mike Singletary (Noy), etc etc

we actually talk about anesthesia sometimes.

A plethora of very useful threads have started with clinical vignettes that even the veterans can learn from.....and thats just the tip of the iceberg of the wealth of information on Da anesthesia biz available here.

About us, the dudes out here in the trenches mulling out case after case......residents and attendings.

Our lives, interests, schedules, interactions with surgeons/partners/paraprofessionals, business, partnerships, how we handle clinical and non clinical dicey situations, our successes, our failures.

We're also priveleged to have some loyal followers who are in our biz or closely affiliated that contribute greatly to this forum....namely Trinityalumnus CRNA, JWK AA, Express08 pharmacist, David Carpenter PA-C, Tussionex pharmacist....

So from the get-go I encourage you to read, and post.

Because more important than us is you.

Thats why Lee created this website. So you and I/Mil/Noy/UT/CF David/Zip/Cop/Plankton/David Carpenter PA-C/Trin/JWK/Hawaiin Bruin/Excalibur/Me45445/your colleagues/our colleagues et al can interact.

We'd like to hear about you and your experiences this year.

WELCOME TO THE BEST FORUM ON SDN.

Theres a wealth of information relevant to your new profession here.

All ya gotta do is interact and read.

 

[ozzie20]

Thx for the invite. Although intern year isn't mentally challenging (scut work), its just physically draining. The one thing i'm not sure on yet is as an intern, you defer to the gas guys whenever a code happens (if you call it, you start it, but then defer when they come), but next year we'll be it. Kind of a daunting task to think about, but as with everything, you get used to it.

 

[radslooking]

+1 for the best forum out there. Best clinical vignettes (and non-clinical vignettes). JPP's posts alone could be merged into a small novel that would be well worth reading.

 

[neuroride]

I have enjoyed this forum tremendoulsy. I started reading the posts back in med school when I started to become interested in anesthesia.

Now, as an anesthesia intern, things are becoming more relevant to what I will be encountering in the next few years.

As an anesthesia intern, things have not been so bad. It has gotten hairy a couple of times thus far though as we as anesthesia interns are house officers at our hospital. We are responsible for all codes, RATs, and pronouncements.

Last week had a guy that was s/p AAA repair and deceided to code in the middle of the night. Got the guy to the ICU from the floor. Called the attending surgeon once we got in the ICU because I couldn't keep his pressure up (on 2 pressors maxed out and fluids wide open) and really could use some advise/direction for management. His response was to just keep coding the guy until he got there in the morning. Great. And of course he did code minutes later with newbie me and grumpy, overnight ICU nurse as the only ones really involved.

But, I learned alot from that case and I am sure that this will not be a isolated incident.

 

[Express08]

For the new anesthesia & ALL new interns who started July 1 - welcome from Tuss, me and all of us in the pharmacy. If it has to do with drugs - we'll help you if we can & if we can't - we'll try to find someone who can. We often have multiple online drug resources running at the same time in all the pharmacies in the hospital, so you can track any one of us down & get a question answered. Tussionex is a wizard at the IT pharmacy system - so she's a huge resource.

If you need something & can't find it, want to know how to dose it, wonder if we carry it (or why we don't....), want to use it, want to know why it works (or sometimes more importantly...why it didn't...), how to write for it, want to change it or any other question, comment, suggestion or rant - let us know!!! We've heard most all of them at one point or another & if we can't come up with a reason or explanation - we'll find out for you or work to find a solution to the problem. You may have a better system - none is perfect & we'd be crazy to not want a good suggestion. Many of us have contacts outside the hospital so we can help you when you need to write discharge orders to be sure you're ordering something which is on the pts formulary (keeps you from being called by Walgreens at 10PM for a pt you discharged at 11AM).

We're usually up for a good joke & often have something to nibble on if you run late. We'll try to be polite until you get the physician order system down, but try to avoid ordering "docusate 250mg stat" if at all possible - that really can ruin our day.😉

Welcome!

 

[Noyac]

Last week had a guy that was s/p AAA repair and deceided to code in the middle of the night. Got the guy to the ICU from the floor. Called the attending surgeon once we got in the ICU because I couldn't keep his pressure up (on 2 pressors maxed out and fluids wide open) and really could use some advise/direction for management. His response was to just keep coding the guy until he got there in the morning. Great. And of course he did code minutes later with newbie me and grumpy, overnight ICU nurse as the only ones really involved.

But, I learned alot from that case and I am sure that this will not be a isolated incident.

Thats typical.

Reminds me of my intern year when a young mexican national was found down in the desert trying to cross the border for greener pastures. Apparently a snake had bit her and she died. The problem was that there were some bodily functions working (I can't remember, it was so long ago) and she was about 87 deg F. My attending (a trauma surgeon) told me to warm her up to normal temp and pronounce her dead at that point. It took me all night and morning. I needed to pound fluids and products into her (she was in DIC) to get her warm and pressors were full tilt. A total waste of resources. But I learned a sh*tload in about 8 hrs. When he came around in the morning for rounds I was just about done. My checkout on the pt was - cold and dead, now warm and dead.

 

[jetproppilot]

Thx for the invite. Although intern year isn't mentally challenging (scut work), its just physically draining. The one thing i'm not sure on yet is as an intern, you defer to the gas guys whenever a code happens (if you call it, you start it, but then defer when they come), but next year we'll be it. Kind of a daunting task to think about, but as with everything, you get used to it.

I learned a tonna critical care medicine during my ICU months as an intern, Dude.

Don't sell this year short!

Especially from Ben de Boisblanc MD.....a pulmonary/critical care dude in New Orleans that was my attending during my ICU months at Charity.....

Dude has a gift of being able to explain esoteric medicine stuff to stupid interns....in a friendly, non threatening fashion.

He was one of the best attendings I had as an intern, right beside Kevin Krane MD, ND (nephrology dude).

Dr Krane was an unassuming nephrology attending at Tulane who taught me a tonna medicine.... in addition to introducing me to the stairs since dude never uses an elevator........

.....dudes medical knowledge was unbelievable. He wouldnt let us call for a consult unless we already knew what the consultant was gonna recommend.

"Thanks, Doctor Krane. You contributed to my medical armamentarium more than anyone else......besides....uhhhh.....Doctor DeBoisblanc.......BOTHAYA'LL......UHHHHHH......THANKS DUDES......"

 

[OB1🤙]

Ahh, Kevin Krane. Great guy. His son graduated with our class at Tulane, also a great guy.

Absolutely agree with the above- intern year is most definitely a drag, but embrace it for the learning experience that it is.

You'll learn the most by far when it's 3:30 AM, you're in the ICU, your resident is fast asleep, and it's just you and the ICU nurses trying to keep people alive. It's scary and nerve-wracking, but it teaches you how to be a doctor.

Learn all the procedures you can, even if they aren't portable to anesthesia (i.e. paras and thoras). Stick as many IVs into as many people as you can. Learn the fine art of the EJ, then amaze your peers and nurses as you throw 16 gauges into patients they couldn't get a 22g into. Beg for central lines. Hunt for spinal taps. Learn ACLS cold, and be an active participant in codes. Etc. etc.

Learn all the cardiology and pulmonology you can. Learn pressors, inotropes, BP meds, drips. Shoot, learn all the meds you can. Know the physiology of whatever you're doing. Become a Vent Jedi.

Foster your team player attitude now. Help out your cointerns whenever you can. Make friends with your nursing colleagues, especially in the unit, where they will help you immensely. Make friends with everyone- the techs, housekeeping, everyone. People are much more willing to do things for you when they like you.

Realize that for some things to happen, you will have to do them yourself, even if you should not have to in an ideal world. If the patient urgently needs something done and nobody else is willing to do it, you MUST do it. You may not have signed up to be a patient transporter, but you sometimes must be. You may not have realized you would be a phlebotomist, but you sometimes must be. You probably didn't know you were going to be a social worker, but you sometimes must be. It sucks, but you are the patient's last, best advocate.

Be a problem solver. If someone tells you "we can't do X," ask why not, and figure out what kinds of things you can do that would allow X to be possible. Be creative, and think outside of the box when trying to make things happen.

"Fun" isn't the right word, but the year can be satisfying if you play it right. Good luck- the light at the end of the tunnel is every bit as sweet as it's made out to be.

 

[amyl]

all i can say about intern year so far is:
i cannot believe how remarkably intelligent i was to pick anesthesia. ;-)

 

[ozzie20]

I agree 100%, i am so lucky to be in gas, nothing against the people in the other specialties, they're in them cause thats what they love, but thank god i'll only have this intern year's worth of HP's, soap notes, discharge summaries the list goes on and on of redundant paper pushing....

 

[seamonkey]

word up to all y'all, and thanks for the invite. This year is already kicking my ass, but reading this forum reminds me there is a light at the end of the tunnel. Once I get some of this BS mickey-mouse crap down to a routine and can really start thinking about medicine, i'll be posting all kinds of questions. for now, i just want to take a breath.

 

[RockLee]

Hey there,

Just started my CA-1 year. And I can tell you, it's definately overwhelming. I feel like being an intern all over again.

Right now, just trying to keep my head afloat and not drown. And being a rookie again is terrible (ie. not knowing where things are, how the hospital work, and nurses who don't show one ounce of respect to new people no matter how nice and polite you are). *SIGH*

At least I'm learning new things everything and am enjoying every moment of learning anesthesia.

 

[Noyac]

and nurses who don't show one ounce of respect to new people no matter how nice and polite you are). *SIGH*

Dude (chick) this **** never ends. There are a few dept's were the nurses think they are the **** and that they know everything. I will say that it is rarely a male nurse that pulls this ****, IMO. It seems to be ICU and ER female nurses that think they know it all. I was called to the ER last night for a young woman that head butted the rear bumper of a car as her boyfriend failed to stop his motorcycle. Her face was mush. Blood everywhere and we were taking her to the OR to put her face back together again.

So I am talking to this girl b/4 going upstairs to the OR and she says "please do a good job". The f*cking ER nurse interrupts and says "he's just there to monitor your meds." What the F*CK😱

I told the girl "I'll see you upstairs. "

NOw there is an ICU nurse here that thinks she is the shizzle fa rizzle as well. She lets into me in a nice manner about how we anesthesiologists never use swans anymore and bring all these pts to the ICu without a swan. i asked her, "what information is it that you want from a swan?" She said, "SVO2"😱 So I asked if it is low what does that mean? She said if it is low they pt needs more O2. Then I blew her mind when I asked if it was a delivery or a utilization issue and how does she know. She hasn't spoken to me since, going on 2 yrs.

 

[Leverage]

Ahh, Kevin Krane. Great guy. His son graduated with our class at Tulane, also a great guy.

Absolutely agree with the above- intern year is most definitely a drag, but embrace it for the learning experience that it is.

You'll learn the most by far when it's 3:30 AM, you're in the ICU, your resident is fast asleep, and it's just you and the ICU nurses trying to keep people alive. It's scary and nerve-wracking, but it teaches you how to be a doctor.

Learn all the procedures you can, even if they aren't portable to anesthesia (i.e. paras and thoras). Stick as many IVs into as many people as you can. Learn the fine art of the EJ, then amaze your peers and nurses as you throw 16 gauges into patients they couldn't get a 22g into. Beg for central lines. Hunt for spinal taps. Learn ACLS cold, and be an active participant in codes. Etc. etc.

Learn all the cardiology and pulmonology you can. Learn pressors, inotropes, BP meds, drips. Shoot, learn all the meds you can. Know the physiology of whatever you're doing. Become a Vent Jedi.

Foster your team player attitude now. Help out your cointerns whenever you can. Make friends with your nursing colleagues, especially in the unit, where they will help you immensely. Make friends with everyone- the techs, housekeeping, everyone. People are much more willing to do things for you when they like you.

Realize that for some things to happen, you will have to do them yourself, even if you should not have to in an ideal world. If the patient urgently needs something done and nobody else is willing to do it, you MUST do it. You may not have signed up to be a patient transporter, but you sometimes must be. You may not have realized you would be a phlebotomist, but you sometimes must be. You probably didn't know you were going to be a social worker, but you sometimes must be. It sucks, but you are the patient's last, best advocate.

Be a problem solver. If someone tells you "we can't do X," ask why not, and figure out what kinds of things you can do that would allow X to be possible. Be creative, and think outside of the box when trying to make things happen.

"Fun" isn't the right word, but the year can be satisfying if you play it right. Good luck- the light at the end of the tunnel is every bit as sweet as it's made out to be.

This is a great post!

Exactly what we interns need to hear.

 

[cfdavid]

Dude (chick) this **** never ends. There are a few dept's were the nurses think they are the **** and that they know everything. I will say that it is rarely a male nurse that pulls this ****, IMO. It seems to be ICU and ER female nurses that think they know it all. I was called to the ER last night for a young woman that head butted the rear bumper of a car as her boyfriend failed to stop his motorcycle. Her face was mush. Blood everywhere and we were taking her to the OR to put her face back together again.

So I am talking to this girl b/4 going upstairs to the OR and she says "please do a good job". The f*cking ER nurse interrupts and says "he's just there to monitor your meds." What the F*CK😱

Noy, what did you do?? I'm quickly realizing (started my clinical rotations last week) that certain things just aren't worth it. But, man..... What a little b.tch! lol

I told the girl "I'll see you upstairs. "

NOw there is an ICU nurse here that thinks she is the shizzle fa rizzle as well. She lets into me in a nice manner about how we anesthesiologists never use swans anymore and bring all these pts to the ICu without a swan. i asked her, "what information is it that you want from a swan?" She said, "SVO2"😱 So I asked if it is low what does that mean? She said if it is low they pt needs more O2. Then I blew her mind when I asked if it was a delivery or a utilization issue and how does she know. She hasn't spoken to me since, going on 2 yrs.:laugh:

I'd think that's probably THE best way to respond to that. Do a lil pimpin.

 

[rickjamesbtch]

Dude (chick) this **** never ends. There are a few dept's were the nurses think they are the **** and that they know everything. I will say that it is rarely a male nurse that pulls this ****, IMO. It seems to be ICU and ER female nurses that think they know it all. I was called to the ER last night for a young woman that head butted the rear bumper of a car as her boyfriend failed to stop his motorcycle. Her face was mush. Blood everywhere and we were taking her to the OR to put her face back together again.

So I am talking to this girl b/4 going upstairs to the OR and she says "please do a good job". The f*cking ER nurse interrupts and says "he's just there to monitor your meds." What the F*CK😱

I told the girl "I'll see you upstairs. "

NOw there is an ICU nurse here that thinks she is the shizzle fa rizzle as well. She lets into me in a nice manner about how we anesthesiologists never use swans anymore and bring all these pts to the ICu without a swan. i asked her, "what information is it that you want from a swan?" She said, "SVO2"😱 So I asked if it is low what does that mean? She said if it is low they pt needs more O2. Then I blew her mind when I asked if it was a delivery or a utilization issue and how does she know. She hasn't spoken to me since, going on 2 yrs.

Finally there is a god!!! What a FUC*IN quack....I know exactly what u mean. I've heard plenty of glorified vital sign takers, nothing more than triage/monkey sheet filler outers who baby sit spider bites for 12 hours in the ER try to be the hero of the day and steal your thunder by ignorantly appearing to be a BAD ASS in front of family and embarrass you (THE MD)........WHAT A JOKE

R U Kidding ME?????

How humiliating, you should of ask her to recite the "MOA" of the drugs you'd be so called "monitoring", after you explained to her what the FU*K MOA meant.....contraindications...O and by the way when the patient crashes what the FU*K is this lame "monitoring meds" BIT*H gonna do? Cry for help? Run out of the OR? Abandon the patient? !!Your correct, answer choice (D) All the above......LOL (busting a gut laughing my AS* OFF)....

Put the indecent WHOR* in her place.....desperation and neediness....Open mouth-insert foot.....

Thank god someone has the TESTES to stand up to these idiots........

Kuddos 👍



RickJames....Peace!

 

[SleepIsGood]

welcome aldies and gents!

learn whatever you can. you'll be surprised as to how much you will learn during your intern/CA1 year!!

Have an open mind!

 

[Mista Suprane]

Hey there,

Just started my CA-1 year. And I can tell you, it's definately overwhelming. I feel like being an intern all over again.

Right now, just trying to keep my head afloat and not drown. And being a rookie again is terrible (ie. not knowing where things are, how the hospital work, and nurses who don't show one ounce of respect to new people no matter how nice and polite you are). *SIGH*

At least I'm learning new things everything and am enjoying every moment of learning anesthesia.

i feel exactly the same as you do. i am exhausted and overwhelmed every single day.

jet, how about some words of advice for the new CA-1s out here?

 

[cchoukal]

for the ca1s, yes, it can be tremendously overwhelming but it definitely gets better. it took me about 6 months to stop getting that butterflied-in-the-stomach sensation on the way to work everyday. it's perfectly normal to feel like you're starting over again, but it will pass.

 

[Green912]

i feel exactly the same as you do. i am exhausted and overwhelmed every single day.

jet, how about some words of advice for the new CA-1s out here?

Good to see you again Mista. I know exactly how you feel. Every day I'm a little further up on the learning curve but man it's a crazy transition. New hospital, new specialty, new everything. It's a load of fun when you're wheeling the patient out of holding and trying to figure out which way to go to get your room.

 

[DocTroll]

I learned a tonna critical care medicine during my ICU months as an intern, Dude.
...
He was one of the best attendings I had as an intern, right beside Kevin Krane MD, ND (nephrology dude).

Dr Krane was an unassuming nephrology attending at Tulane who taught me a tonna medicine.... in addition to introducing me to the stairs since dude never uses an elevator........

.....dudes medical knowledge was unbelievable. He wouldnt let us call for a consult unless we already knew what the consultant was gonna recommend.

"Thanks, Doctor Krane. You contributed to my medical armamentarium more than anyone else......besides....uhhhh.....Doctor DeBoisblanc.......BOTHAYA'LL......UHHHHHH......THANKS DUDES......"
...

Jet, you know he's one of our deans now at Tulane? He is awesome. Already had some interaction with him my 1st year and he knows EVERYTHING. Can't wait to have him for renal path this winter. And my estimation of him just grew that much more knowing that he has the JPP Seal of Approval!

 

[cfdavid]

For the new anesthesia & ALL new interns who started July 1 - welcome from Tuss, me and all of us in the pharmacy. If it has to do with drugs - we'll help you if we can & if we can't - we'll try to find someone who can. We often have multiple online drug resources running at the same time in all the pharmacies in the hospital, so you can track any one of us down & get a question answered. Tussionex is a wizard at the IT pharmacy system - so she's a huge resource.

If you need something & can't find it, want to know how to dose it, wonder if we carry it (or why we don't....), want to use it, want to know why it works (or sometimes more importantly...why it didn't...), how to write for it, want to change it or any other question, comment, suggestion or rant - let us know!!! We've heard most all of them at one point or another & if we can't come up with a reason or explanation - we'll find out for you or work to find a solution to the problem. You may have a better system - none is perfect & we'd be crazy to not want a good suggestion. Many of us have contacts outside the hospital so we can help you when you need to write discharge orders to be sure you're ordering something which is on the pts formulary (keeps you from being called by Walgreens at 10PM for a pt you discharged at 11AM).

We're usually up for a good joke & often have something to nibble on if you run late. We'll try to be polite until you get the physician order system down, but try to avoid ordering "docusate 250mg stat" if at all possible - that really can ruin our day.😉

Welcome!

Hey man. Thanks. That's cool that you guys come over to this forum. I think the pharm people are a huge resource.

Question for you. I'm a bit disappointed with the MOA's on Epocrates. What do you think?? Do you find it a bit shallow in that respect?

 

[scotchnwater]

Question for you. I'm a bit disappointed with the MOA's on Epocrates. What do you think?? Do you find it a bit shallow in that respect?

Agreed! Reading "exact mechanism of action unknown" is typically less-than-helpful.

 

[cfdavid]

Agreed! Reading "exact mechanism of action unknown" is typically less-than-helpful.

Yeah, especially when I KNOW there are some pretty valid hypotheses out there, so it's not like we have ZERO clue..... Oh well.

 

[toughlife]

Dude (chick) this **** never ends. There are a few dept's were the nurses think they are the **** and that they know everything. I will say that it is rarely a male nurse that pulls this ****, IMO. It seems to be ICU and ER female nurses that think they know it all. I was called to the ER last night for a young woman that head butted the rear bumper of a car as her boyfriend failed to stop his motorcycle. Her face was mush. Blood everywhere and we were taking her to the OR to put her face back together again.

So I am talking to this girl b/4 going upstairs to the OR and she says "please do a good job". The f*cking ER nurse interrupts and says "he's just there to monitor your meds." What the F*CK😱

I told the girl "I'll see you upstairs. "

NOw there is an ICU nurse here that thinks she is the shizzle fa rizzle as well. She lets into me in a nice manner about how we anesthesiologists never use swans anymore and bring all these pts to the ICu without a swan. i asked her, "what information is it that you want from a swan?" She said, "SVO2"😱 So I asked if it is low what does that mean? She said if it is low they pt needs more O2. Then I blew her mind when I asked if it was a delivery or a utilization issue and how does she know. She hasn't spoken to me since, going on 2 yrs.

Nice! It is sad and funny to see people who think they know it all by knowing the how and not the why. I see it all the time in the ICUs.

 

[toughlife]

Dude (chick) this **** never ends. There are a few dept's were the nurses think they are the **** and that they know everything. I will say that it is rarely a male nurse that pulls this ****, IMO. It seems to be ICU and ER female nurses that think they know it all. I was called to the ER last night for a young woman that head butted the rear bumper of a car as her boyfriend failed to stop his motorcycle. Her face was mush. Blood everywhere and we were taking her to the OR to put her face back together again.

So I am talking to this girl b/4 going upstairs to the OR and she says "please do a good job". The f*cking ER nurse interrupts and says "he's just there to monitor your meds." What the F*CK😱

Noy, what did you do?? I'm quickly realizing (started my clinical rotations last week) that certain things just aren't worth it. But, man..... What a little b.tch! lol




I'd think that's probably THE best way to respond to that. Do a lil pimpin.

My experience 100% of the time has been the same. I wonder what it is about them that triggers that kind of response.

 

[scotchnwater]

Nice! It is sad and funny to see people who think they know it all by knowing the how and not the why. I see it all the time in the ICUs.

I had an ICU nurse pulling this kind of crap on me last week as well. Our patient was (is...) septic and was tachin' out at around 130, which is where he has been for about the last month while he's circled the drain.

Page #1 From ICU Nurse: "Pt X is tachy and I think he needs some fluid. Would you like to bolus him?"

Me: I call back and say very politely that, no, we don't want to bolus him. We have discussed him on rounds and are fine with his fluid status.

Page #2 (45 minutes later) "Pt X is stil tachy and I still think he needs fluid, can I bolus him?"

Me: I go down there to check his number - just to be sure - and the guy is putting out good urine (>100 cc/hr), CVP around 12....and looks like the Michelin Man since he's hugely volume overloaded since his admission, and still on a vent. He is getting fluids at a rate we have worked out over several days. He has been tachycardic for several days, this is not new or acutely concerning to us. This is her first time to see the patient. Ever. This time I (mistakenly) take the time to explain my rationale for not giving this guy MORE fluid.

This apparently goes over her head, because the next question is: "So you're sure you don't want to give him fluid?"

Page #3 (from my Senior Resident): "Hey dude, I just got a page from this ICU nurse regarding Pt X - can you go check things out?"

Me: I respond to the Senior and communicate all that has transpired. His eyes roll knowingly.

I am down in the unit about 2 hours later working on another team patient, when my favorite nurse seeks me out and says:

"Just so you know, Pt X is still tachycardic. I hope your team is ok with that". This is said in a condescending, sarcastic way, as if she is expecting his imminent demise, and his death will forever haunt my conscience for my failure to give him the 500 cc bolus she is quite sure will prove to be the magic bullet and save his poor soul.

I take a deep breath. Clearly, we are making no headway here. I am frustrated. I am on-call and it is getting late in the afternoon. She has wasted precious moments of my life thus far that I am never getting back. I respond:

"Just so you know, in medical school they teach us that there are sometimes more than one reason a person can be tachycardic. We are also taught that sometimes giving people too much fluid can be bad. I am not going to give him a fluid bolus right now. Please don't page me unless you have new information to share."

I thought that we were done - once and for all - with that issue until morning rounds the following day. When I was done presenting the patient, the new nurse chimed in to say:

"And I have a note here from yesterday's nurse to ask the team about a fluid bolus. Apparently there was some confusion about that yesterday?"

 

[seamonkey]

wha ha ha ha ha !!!

holy crap that makes me feel a little better about the last 36hours of my life.

where i go, others have gone before, and emerged (relatively) intact. Keep on keepin' on. Thanks for the hope.

 

[Bertelman]

I had an ICU nurse pulling this kind of crap on me last week as well. Our patient was (is...) septic and was tachin' out at around 130, which is where he has been for about the last month while he's circled the drain. ..

Seriously, that story reminded me how much I hated intern year.


Yes. It really only takes two weeks of anesthesia to block that dreadful year from memory.

 

[OB1🤙]

Seriously, that story reminded me how much I hated intern year.

Word.

 

[DreamLover]

Seriously, that story reminded me how much I hated intern year.


Yes. It really only takes two weeks of anesthesia to block that dreadful year from memory.

That's the pure truth!

I don't care how many 5am to 6pm days I am working when the worst part of my day is doing preops Vs admitting my 8th cocaine positive atypical chest pain patient that needs placement!!

I Just keep reminding myself of the misery that I was in this time last year and anesthesia is just getting better and better...

 

[cchoukal]

Yeah, especially when I KNOW there are some pretty valid hypotheses out there, so it's not like we have ZERO clue..... Oh well.

You should read the PDR. TONS of "exact mechanism unknown" entries. Really surprised me the first time I read through it (in the context of being a grad student in psych, so maybe that's more true of psychotropic drugs).

 

[cockblockandrun]

Whatever miniscule doubts I had about anesthesia have completely evaporated during these last 4 weeks of medicine getting yelled at by social workers about poor admissions- as if I have control over who we admit as an intern- chasing after the wound care nurse to apply bacitracin over a patient's vagina, and getting paged 5 times in a day by a nurse to tell me that a ESRD patient in a coma whose family is undecided about hemodialysis has a BUN of 111 today when in fact, the team has known for the last 3 weeks that the BUN has been around 130. Yeah, thanks for letting me know. I didn't review the labs this morning.
But I can never understand why someone would go into IM.... you are just a biatch to the consulting services. 11 more months before CA-1 year!

 

[amyl]

Whatever miniscule doubts I had about anesthesia have completely evaporated during these last 4 weeks of medicine getting yelled at by social workers about poor admissions- as if I have control over who we admit as an intern- chasing after the wound care nurse to apply bacitracin over a patient's vagina, and getting paged 5 times in a day by a nurse to tell me that a ESRD patient in a coma whose family is undecided about hemodialysis has a BUN of 111 today when in fact, the team has known for the last 3 weeks that the BUN has been around 130. Yeah, thanks for letting me know. I didn't review the labs this morning.
But I can never understand why someone would go into IM.... you are just a biatch to the consulting services. 11 more months before CA-1 year!

Amen! why anyone would voluntarily submit themselves to this is beyond me.
today i was told that i couldn't give a pt more than 40 mEqs of K at a time either PO or IV...only 40 period, because it was a nursing standing requirement or something. despite the fact that my pt had a K of 1.8. i also was told that i couldn't send a pt to the floor from the ED until his K was in at least the 3s, preferably the 4s. wtf? but as the new intern i guess you just say okay...?
i can't believe i considered ED for even a moment. i am so sick of fighting with this team or that to admit half dead pts they want me to send home.
anyone who voluntarily chooses ED or medicine needs a psych consult stat.

 

[polkadotcap]

I am on call tonight.

i just got paged by a nurse who told me "doctor, the patient in room 3 had a systolic blood pressure of 146 just now. He is due for his diltiazem now. I just gave it and will update you on the blood pressure in one hour"

Earlier, I got a phone thrown at me when I told my cocaine, opiate + uds patient that no, I will not give him iv dilaudid.

I got paged seriously five times on five different patients to the tune of: "Potassium is 3.9, should we replace?"

Rounds yesterday took four, yes FOUR, hours. My progress notes are not "sufficient" per my attending unless they are at least two pages long.

I go home and thank GOD that I had enough foresight to pick anesthesia. Otherwise I think I would honestly be looking for a pharmaceutical job right about now.