not seeing the light

[cleansocks]

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I guess it's normal to want to quit on the first day of internship. 30 hours straight, no lunch, no dinner, 2 bathroom breaks total, taking care of 24 transplant surgery patients with 6 new admits and 6 d/c's ... I don't understand how people do it! I even had help (though I won't next call 3 days from now!) but I'm still receiving a page every 2 minutes while trying to put in orders, consults, answer pages, and navigate an unfamiliar, quirky system. I can't keep a single patient's story in my head, nor answer a single question by the boss ie. "so, did she get up yesterday? So did we restart her Tacro? So why isn't she on SQH?'" - important Q's I just can't answer. Rounds the next morning were a disaster because i forgot to staple the list on the right side of the page, didn't fill out all of the signout that I thought auto-populated itself from the list, and forgot to place several, life-alteringly important orders (ie kayaxelate!!). I had like 5 different pieces of paper with orders/consults/recs/admits/signoffs on them that i'd switch to as i ran out of room on the last one... I just couldn't keep up. The fellow and chief just rolled their eyes, and casually cracked jokes about the various mishaps but didn't really provide criticism, sympath, or praise. And I did not sleep at all because I was trying to get that list ready... Perhaps what gets me the most is my fellow interns who admittedly weren't delegating or answering pages seem to KNOW these patients much better than i do - they KNOW that abd u/s took place yesterday. How do they do it? Honestly if it weren't for financial obligations... I truly don't want to stomach another one of those calls. Taking care of patients doesn't really scare me, although even refractory heartburn is a medical challenge for someone of my level. Admittedly I don't particularly feel a sense of "joy or satisfaction" from patient interaction either. But it's the logistics I can't seem to handle. I hope it gets better. I can't believe I have a year of this!

 

[Arch Guillotti]

lol, internship sucks but remember from the House of God that they can't stop the clock from ticking. Take some time to eat and perform basic bodily functions (even if you don't have the time). You'll feel better and likely be more productive. Good luck.

 

[Hockeyguy]

I guess it's normal to want to quit on the first day of internship. 30 hours straight, no lunch, no dinner, 2 bathroom breaks total, taking care of 24 transplant surgery patients with 6 new admits and 6 d/c's ... I don't understand how people do it! I even had help (though I won't next call 3 days from now!) but I'm still receiving a page every 2 minutes while trying to put in orders, consults, answer pages, and navigate an unfamiliar, quirky system. I can't keep a single patient's story in my head, nor answer a single question by the boss ie. "so, did she get up yesterday? So did we restart her Tacro? So why isn't she on SQH?'" - important Q's I just can't answer. Rounds the next morning were a disaster because i forgot to staple the list on the right side of the page, didn't fill out all of the signout that I thought auto-populated itself from the list, and forgot to place several, life-alteringly important orders (ie kayaxelate!!). I had like 5 different pieces of paper with orders/consults/recs/admits/signoffs on them that i'd switch to as i ran out of room on the last one... I just couldn't keep up. The fellow and chief just rolled their eyes, and casually cracked jokes about the various mishaps but didn't really provide criticism, sympath, or praise. And I did not sleep at all because I was trying to get that list ready... Perhaps what gets me the most is my fellow interns who admittedly weren't delegating or answering pages seem to KNOW these patients much better than i do - they KNOW that abd u/s took place yesterday. How do they do it? Honestly if it weren't for financial obligations... I truly don't want to stomach another one of those calls. Taking care of patients doesn't really scare me, although even refractory heartburn is a medical challenge for someone of my level. Admittedly I don't particularly feel a sense of "joy or satisfaction" from patient interaction either. But it's the logistics I can't seem to handle. I hope it gets better. I can't believe I have a year of this!

Welcome to internship dude. People aren't joking when they say it sucks! Hang in there man you'll pull it together. Before you know it it'll be Thanksgiving and you'll be intern extrodinaire. And in a few years you'll be doing the eye rolling 🙂

 

[Planktonmd]

From your presentation I can tell you that you will do great in anesthesia!
You would be a terrible internist though!

 

[ProRealDoc]

I guess it's normal to want to quit on the first day of internship. 30 hours straight, no lunch, no dinner, 2 bathroom breaks total, taking care of 24 transplant surgery patients with 6 new admits and 6 d/c's ... I don't understand how people do it! I even had help (though I won't next call 3 days from now!) but I'm still receiving a page every 2 minutes while trying to put in orders, consults, answer pages, and navigate an unfamiliar, quirky system. I can't keep a single patient's story in my head, nor answer a single question by the boss ie. "so, did she get up yesterday? So did we restart her Tacro? So why isn't she on SQH?'" - important Q's I just can't answer. Rounds the next morning were a disaster because i forgot to staple the list on the right side of the page, didn't fill out all of the signout that I thought auto-populated itself from the list, and forgot to place several, life-alteringly important orders (ie kayaxelate!!). I had like 5 different pieces of paper with orders/consults/recs/admits/signoffs on them that i'd switch to as i ran out of room on the last one... I just couldn't keep up. The fellow and chief just rolled their eyes, and casually cracked jokes about the various mishaps but didn't really provide criticism, sympath, or praise. And I did not sleep at all because I was trying to get that list ready... Perhaps what gets me the most is my fellow interns who admittedly weren't delegating or answering pages seem to KNOW these patients much better than i do - they KNOW that abd u/s took place yesterday. How do they do it? Honestly if it weren't for financial obligations... I truly don't want to stomach another one of those calls. Taking care of patients doesn't really scare me, although even refractory heartburn is a medical challenge for someone of my level. Admittedly I don't particularly feel a sense of "joy or satisfaction" from patient interaction either. But it's the logistics I can't seem to handle. I hope it gets better. I can't believe I have a year of this!

Just write stuff down when you hear it/know it so you can always refer to it.

 

[periopdoc]

A year from now you will look back on this and laugh a little bit while you are moving briskly through 10 discharges and 12 new admits and giving a hand to the newbies. In the meantime there is little that will make you feel better. In all likelihood your fellow interns feel exactly the same, although most of them will never admit to their true feelings.

The transition from medical student to doctor is brutal and no one who has not gone through it will ever fully understand it. Our spouses get an inkling, but only an inkling. Even the nurses that watch us day in and day out only get a glimpse (that is why many of them think they could/ can easily do our job).

Hang in there because although there is no light at the end of the tunnel, your eyes will adjust to the dark and you will be able to function in the tunnel in a way that no one else can.

Good luck.

- pod

 

[lushmd]

From a friend of mine (who just finished internship and is going into rads) re the top 10 things he learned a an intern:

10) The physical examination is over-rated. The name of the form for admitting people should be changed to H&I (history and imaging).

9) Taking a history is over-rated. It's called old records, people. So let's officially change that form to R&I. Records and Imaging. One day... one day...

8) It is possible to have a temperature of 108. And live.

7) The most efficient way to spell my name over the phone.

6) Somehow people magically get better on holidays and weekends. Hint: If you are not sick enough to come on Saturday, don't come on Tuesday either.

5) You *almost* passed out? I *almost* give a crap. I *almost* want you to go home, get some sleep, and forget it ever happened. Having the vapors is not a reason to be here. But the ER *completely* wants you in here to get an echo, carotid ultrasound, watch you on telemetry for 5 days, and watch the trend of your cardiac enzymes, which probably won't get drawn anyway.

... I guess that's not really learning anything, except patience.

4) The interns and residents at **** Hospital are universally awesome.

3) It is possible to take 41 medications every day.

2) The number of allergies you have directly correlates with how bat-**** insane you are.

and finally...

1) "Cocaine is a hell of a drug."

Don't sweat it dude. Internship sucks but you'll be amazed at you much better you become in fairly short order.

 

[mocdoc]

From a friend of mine (who just finished internship and is going into rads) re the top 10 things he learned a an intern:

10) The physical examination is over-rated. The name of the form for admitting people should be changed to H&I (history and imaging).

9) Taking a history is over-rated. It's called old records, people. So let's officially change that form to R&I. Records and Imaging. One day... one day...

8) It is possible to have a temperature of 108. And live.

7) The most efficient way to spell my name over the phone.

6) Somehow people magically get better on holidays and weekends. Hint: If you are not sick enough to come on Saturday, don't come on Tuesday either.

5) You *almost* passed out? I *almost* give a crap. I *almost* want you to go home, get some sleep, and forget it ever happened. Having the vapors is not a reason to be here. But the ER *completely* wants you in here to get an echo, carotid ultrasound, watch you on telemetry for 5 days, and watch the trend of your cardiac enzymes, which probably won't get drawn anyway.

... I guess that's not really learning anything, except patience.

4) The interns and residents at **** Hospital are universally awesome.

3) It is possible to take 41 medications every day.

2) The number of allergies you have directly correlates with how bat-**** insane you are.

and finally...

1) "Cocaine is a hell of a drug."

Don't sweat it dude. Internship sucks but you'll be amazed at you much better you become in fairly short order.

and in the end to cap it all off . . . as an attending you will work just as hard as a intern, and thanks to Obama, you might clear 80k/yearly, and you will work side by side with nurses that think they are physicians or have a DrNP . . . crazy . . . wow I am bitter tonight.

 

[mocdoc]

I agree . . . cocaine IS one HELL of a drug . . . I can't believe what it does to people.

 

[amyl]

don't get overwhelmed. one day at a time. if it doesn't kill you it will make you stronger. my intern rotations were a piece of cake, ca-1 is tough at my program. we all do our time at the bottom, hang in there.

 

[excalibur]

Rounds the next morning were a disaster because i forgot to staple the list on the right side of the page...

I know there was more to this, but just read this. IT'S TOO FUNNY!! I can't stop laughing because I believe it, I really freakin' believe it!!

That post is exactly why I did not go into a "rounding" specialty.

 

[maceo]

I guess it's normal to want to quit on the first day of internship. 30 hours straight, no lunch, no dinner, 2 bathroom breaks total, taking care of 24 transplant surgery patients with 6 new admits and 6 d/c's ... I don't understand how people do it! I even had help (though I won't next call 3 days from now!) but I'm still receiving a page every 2 minutes while trying to put in orders, consults, answer pages, and navigate an unfamiliar, quirky system. I can't keep a single patient's story in my head, nor answer a single question by the boss ie. "so, did she get up yesterday? So did we restart her Tacro? So why isn't she on SQH?'" - important Q's I just can't answer. Rounds the next morning were a disaster because i forgot to staple the list on the right side of the page, didn't fill out all of the signout that I thought auto-populated itself from the list, and forgot to place several, life-alteringly important orders (ie kayaxelate!!). I had like 5 different pieces of paper with orders/consults/recs/admits/signoffs on them that i'd switch to as i ran out of room on the last one... I just couldn't keep up. The fellow and chief just rolled their eyes, and casually cracked jokes about the various mishaps but didn't really provide criticism, sympath, or praise. And I did not sleep at all because I was trying to get that list ready... Perhaps what gets me the most is my fellow interns who admittedly weren't delegating or answering pages seem to KNOW these patients much better than i do - they KNOW that abd u/s took place yesterday. How do they do it? Honestly if it weren't for financial obligations... I truly don't want to stomach another one of those calls. Taking care of patients doesn't really scare me, although even refractory heartburn is a medical challenge for someone of my level. Admittedly I don't particularly feel a sense of "joy or satisfaction" from patient interaction either. But it's the logistics I can't seem to handle. I hope it gets better. I can't believe I have a year of this!

thanks for posting. You will finish intern year without any problems. it WILL get easier and better.
I understand what you are going through. I did a surgical internship at one of the most malignant programs in the country, admitted by the chairman at the time. this is before work hour reform. I was Q 3 the whole year with no post call days off my beeper going off so often i had to change the battery every shift.. no joke. We too had a list which needed updating every morning and it would take me like an hour to do. The program we had to do it on was constantly screwing up and i had to re do it. If anything on the list was wrong we would have to take an extra call.
hang in there. whatever you do..try not to QUIT. I know it sucks . i really do. and dont worry about your fellow interns they are probably just as lost as you are but better at faking it.

 

[cleansocks]

So I am now post-second call. Second went even worse since the surgeons have begun to expect us to have graduated from newbie status. I DID manage to go to the bathroom twice more than the last time (still no food or drink though) which probably means I got a tiny bit better. I think I'll bring a supply of snacks/drinks for these call days. Rounding was still very humiliating, though, as there was once again a "big" problem with the list that I did not anticipate. A really nice (rare) staff member in the ER noticed me at 2:00AM at a computer, recognized signs of dehydration, and gave me a cup of water! That was nice.

I think a major part of the problem I'm having is really poor teamwork - I'm more of an introvert and getting all these little details throughout the day is trying. That and I still don't understand how one can know the status of every single patient with regards to things like nutrition status or current pain regimen. We have had especially poor signout before rounds in the AM, poor delegation of chores on rounds, and poor group effort in keeping track of patients.

So I proposed to the team we fix this by coming in pretty early before rounds to go over as a group the major things on each patient they tend to ask about (ie for STX: nutrition, immunosuppression, sugars, antibiotics and cultures, labs, studies, dispo) and jot down these sets of info on our own notecards for each patient. A final person makes sure the logistics are taken care of (ie list complete and printed). I also proposed we fix the schedule so we'd have time off every few days to remain sane while being adequately covered on weekends. And finally I proposed a fixed, set way that the call, post-call, wedge1, and wedge2 people should run rounds (ie wedge1 read vitals, post-call do dressings, call is note-taker and wedge2 is backup note-taker/COW operator).

So despite my despair with all this I'm hopeful this will allow me to know by pt's better and be more prepared for rounds. Everyone agreed to the new system so we'll see how it works.

 

[Jeff05]

once you understand what your goals are for each patient and his/her condition you will perform much better. if you think of a patient as a story and not just a pile of numbers - you will be able to remember much more information.

hang in there. grind it out. internship blows hard.

use checklists.

 

[DO4lifer]

its good to know that we interns are not alone, and struggle with the transition. 😕

 

[soorg]

Don't let the bastards get you down.

Rage against the dying of the light...