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- Mar 22, 2005
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My first call day of internship. 😀 It started on a Sunday morning when I arrived at a city hospital (in our program, the surgical interns are assigned to several different hospitals to cover nights/weekends on top of covering the University hospital) to meet my upper resident at 5am in the morning on the 2nd floor of the surgery floor. Since I have never worked in or seen this hospital before in my life, I was under the impression that my first day was going to be somewhat of an orientation. I met my resident in front of the war computer (this is the computer with all the patient lists that as an intern, it is your job to update each morning). The over night PGY-2 handed me a list of the patients and says this will be all of the floor patients that you are responsible for today. Looking down at the pieces of paper in my hands
there was 6 pages stabled together with 7-8 pts per page = ~ 40-50 pts from the Gen Surg/Vascular/and Plastic services. Each page includes all of the pts diagnosis, surgery, labs, studies, to do list, and many blank spaces for the vitals/input/outputs/etc (which is the interns job to get for every patient before the 6 am morning rounds). So I am responsible for all of these patients that I have never met before????!!! I knew this was going to be one of those days. 🙁
After getting all of the vitals and seeing all of the patients for the morning rounds, once again, it was the interns job to write all of the notes and orders for all of the floor patients (yes, I needed to write the orders on all of the surgical patients in this hospital that I know nothing about because I just joined the service today!!) But hey, a quick 15 min run down of the list with my PGY-2 resident was all that was needed. Or I thought. Needless to say, the orders took me a long time, considering that I have not written much orders as a med student and my school operated on a completely different computer system. (this hospital was still utilizing hand written orders).
Before my PGY-2 took off (he was post call and I can definitely tell that he wanted to get the hell out of the hospital), he handed me the ER pager and said have fun, oh by the way, did they tell you that you were going to be first call for the ER. So now I have both the floor pager and the ED pager hanging on my scrub pants. I always thought having a pager was pretty cool, but now I have 2, wow, what a great feeling. 😀
As I struggle with the technicalities of how to write a competent CT scan order vs Meds order vs Social service vs all the other things that I needed to write I hear the floor pager goes off, my First page, I was a little nervous but kinda excited as well. Called the number back, I hear on the other end, Dr.______, (that feels a little weird to be called a doctor) On the patient, _________ , she is having some shortness of breath, can you come down here? (I was frantically flipping through my patient list to see why this patient was here, because I have no idea who she was). As I made my way down to the patients room, thoughts were running through my mind about things that can cause SOB, what I need to do at the bed side, and what I can give her. Also the things that I did not want to miss (Essentially, the issues that can kill her in a short period of time). Its been too long since my last clinical rotation in med school, and as you will learn, 4th year of med school is somewhat like a vacation. Once I walked into the room, I found this obese pt breathing heavily. I reviewed the chart for her meds and medical history, got a quick O2 sat, looked at the vitals, asked a few questions (thank god she didnt have any chest pains), and did a quick physical assessment. Also got an ABG just to make sure she was not acidotic. Now, I was thinking back to med school about the things you can give to the patient for SOB, (should of paid more attention on the lecture about SOB 😀 ) and I said to the nurse what about a stat Albuterol/atrovent nubulizer and please put her on 2L of Nasal Cannula oxygen,.. 😕 ... does that sound right, I mean, is this what you would do also? The nurse says yes, I would give her a dose of nubs as well. Yes, I was saved by the nurse. 🙂 Walking out of the room, I felt pretty good that I was able to take care of a problem and also realized how important nurses play in the role patient care, (they can definitely make or break you) and also.. This last thought was interrupted by another page from the ER.
Is this surgery? This is Dr. _____ from the ED, we have a 90 yr old nursing home patient here who has been experiencing several days of abd pain with recent incease in intensity, exam significant for a stiff abd with + rebound, + guarding, decreased bowel sound, the CT shows free air and fluid in the peritoneal cavity, can you guys come down here to see her ASAP? 😱 Just Great, a perforated bowel in the ED on my first call day, as I made my way down, my floor pager went off .
To Be continued in Part II (Sorry, I couldn't post the whole thing in one section)
After getting all of the vitals and seeing all of the patients for the morning rounds, once again, it was the interns job to write all of the notes and orders for all of the floor patients (yes, I needed to write the orders on all of the surgical patients in this hospital that I know nothing about because I just joined the service today!!) But hey, a quick 15 min run down of the list with my PGY-2 resident was all that was needed. Or I thought. Needless to say, the orders took me a long time, considering that I have not written much orders as a med student and my school operated on a completely different computer system. (this hospital was still utilizing hand written orders).
Before my PGY-2 took off (he was post call and I can definitely tell that he wanted to get the hell out of the hospital), he handed me the ER pager and said have fun, oh by the way, did they tell you that you were going to be first call for the ER. So now I have both the floor pager and the ED pager hanging on my scrub pants. I always thought having a pager was pretty cool, but now I have 2, wow, what a great feeling. 😀
As I struggle with the technicalities of how to write a competent CT scan order vs Meds order vs Social service vs all the other things that I needed to write I hear the floor pager goes off, my First page, I was a little nervous but kinda excited as well. Called the number back, I hear on the other end, Dr.______, (that feels a little weird to be called a doctor) On the patient, _________ , she is having some shortness of breath, can you come down here? (I was frantically flipping through my patient list to see why this patient was here, because I have no idea who she was). As I made my way down to the patients room, thoughts were running through my mind about things that can cause SOB, what I need to do at the bed side, and what I can give her. Also the things that I did not want to miss (Essentially, the issues that can kill her in a short period of time). Its been too long since my last clinical rotation in med school, and as you will learn, 4th year of med school is somewhat like a vacation. Once I walked into the room, I found this obese pt breathing heavily. I reviewed the chart for her meds and medical history, got a quick O2 sat, looked at the vitals, asked a few questions (thank god she didnt have any chest pains), and did a quick physical assessment. Also got an ABG just to make sure she was not acidotic. Now, I was thinking back to med school about the things you can give to the patient for SOB, (should of paid more attention on the lecture about SOB 😀 ) and I said to the nurse what about a stat Albuterol/atrovent nubulizer and please put her on 2L of Nasal Cannula oxygen,.. 😕 ... does that sound right, I mean, is this what you would do also? The nurse says yes, I would give her a dose of nubs as well. Yes, I was saved by the nurse. 🙂 Walking out of the room, I felt pretty good that I was able to take care of a problem and also realized how important nurses play in the role patient care, (they can definitely make or break you) and also.. This last thought was interrupted by another page from the ER.
Is this surgery? This is Dr. _____ from the ED, we have a 90 yr old nursing home patient here who has been experiencing several days of abd pain with recent incease in intensity, exam significant for a stiff abd with + rebound, + guarding, decreased bowel sound, the CT shows free air and fluid in the peritoneal cavity, can you guys come down here to see her ASAP? 😱 Just Great, a perforated bowel in the ED on my first call day, as I made my way down, my floor pager went off .
To Be continued in Part II (Sorry, I couldn't post the whole thing in one section)
) but I really didnt. Even in medical school, it is not until the clinical years that you really experience the field of medicine. But I just want to say to all the SDN members that are applying to medical school, that medicine is a great field!!!!!! (I just see all these posts on this site about how doctors telling undergrads to not do medicine, and med students regret that they have gone to med school, etc. So I just wanted to post my experiences and how much I love this field.) Yes there are problems with the current medical system, yes, you will work harder than your friends, and sometimes you will fail or not be able to do enough to save or help someone (just today before I left, a woman in her 50s was brought in with a huge intracranial bleed, GCS of 3, no hx of any medical problems in the past, me and the attending had to sit in the room to tell the husband that there is nothing that we can do for her, and at best she was going to become an vegetable if we went in and evacuated the blood with surgery. It was very hard watching the husband cry and shake uncontrollablly in the room 
I seriously wonder how I will ever be able to handle what lies ahead. I don't function well (or at all) on no sleep, and I'm terrible with remembering things that are not written. Are most people this terrified before they even begin?
Somehow my verbal sccore shoot way up 
