Thursday, July 26, 2007

First Night of Call as Intern

What did I get myself into? It is 6pm and I just got home from my first night of overnight call at the hospital. Yesterday was the first day of this rotation -- inpatient wards, which will be the bulk of my internal medicine training -- which means I was on call my first day. I guess I spoke too soon earlier when I said they hit you fast and they hit you hard.

Starting off the horrible day/night continuum was the fact that I took over the five patients the previous intern had. Taking on patients that you do not know is always difficult, especially medicine patients who have many problems to manage. Then throughout the night I picked up four new patients, each of whom takes awhile to admit because of admission H&P’s (history and physical exams) and admission orders. On top of this was the difficult task of cross-covering every other teams’ patients, which means getting paged randomly throughout the night by nurses about patient X’s tachycardia or patient Y’s diarrhea or patient Z’s itchiness. Itchiness? Come on, just scratch it yourself! When your team is being slammed with patients, prescribing Immodium is hard to take seriously.

On top of all that, add the grueling struggle of trying to keep my eyes open since it had been months since I was last on call -- last November, precisely, in medical school.

And then, post-call, dead tired, and zombie-like, I had to churn out notes for all my patients, none of whom I knew too well. It took me quite late into the day ... so much for the ACMGE mandated 30-hour limitation.

Again, what did I get myself into?

Sunday, July 08, 2007

Patient Surprises

Patients never seem to amaze or shock me. Every time I think I have seen and heard it all -- and I admit I have few clinical experiences to draw upon compared to others -- a patient will come and stun me with his response.

Recently, I was in clinic interviewing a very drunk man who presented with a benign complaint. He reported that he had been experiencing this complaint for several months, so I naturally asked him why he waited so long to present. In very slurred speech he replied that he couldn't return to the state ... because of the federal warrant against him!

I have had many jail patients in the past, but at least they were in restraints because of their crimes. This patient, though, was apparently still on the loose for his deeds ... and I don't know much about the law, but I feel a federal warrant seems fairly serious.

So immediately I distanced myself a few inches from him and made sure to keep a clear path between me and the door. I tried to probe a little and get some details on his warrant, but he really couldn't stay awake long enough. Plus, I quickly deemed he was not much of a threat after all, given that he kept nearly falling off the exam table.

But still, despite the amusement afterwards, it was for a moment one of my more frightening patient encounters.

Monday, July 02, 2007


I think my index finger spent more time inside rectums today than it did outside of them. Not really, but I sure performed a lot of digital rectal exams (DRE) ... in fact, I did more today than I did during my entire medical school career. In fact again, I was such an eager intern that I even gave one of my patients not one, but two rectals. Aren't you proud of me?