finished up PGY1 year on palliative care, had some overlap with new PGY1s on the floor service... anyways, have a Ca pt who lost her IV last night and was placed on IM dilaudid q30 min. This lady is A&O, came in with uncontrolled pain but PCA w/ basal+bolus had it covered for >24 hrs, and can take PO with no prob. Already on po methadone for herion w/d coverage. I know the PGY1s are new, hell i was that less than 12 months ago, but you'd think the upper-level would say "hmm...maybe we don't need to turn this poor lady into a pincushion". Methadone + big doses of po dilaudid do the trick. You could fill a thimble with what I know, and the ocean with what I don't. Still... PGY1's are off the hook, but medicine residents should know how to cover this better. And I love palliative care.