It's only been 6 days, but it feels like an era has passed since my naive self stepped onto the salmon-and-gray-speckled tiles of 6 South last week. (Why do all hospitals choose that same 70's-esque color scheme of tan, gray and pastel pink accents?) Just as I've grown accustomed to the new feeling of my long white coat flapping around my knees (it even has a curious pseudo "belt" at the back, which, rumor has it, is supposed to create a "waist" for us females. Or, perhaps it will help hide our waist that we'll gain from eating hospital food over the years...), it's already no longer white - but instead taking on that familiar shade of coffee-and-stray-ink-mark mosaic. The pockets are already overstuffed with pocketbooks and other medical goodies, so that as I bend down to palpate an abdomen or reach to retrieve my stethoscope, I end up inadvertently showering the patient with M&M's, a stray pager or The Sanford Guide to Antimicrobials 2007. And after stuffing the front pocket with approximately 10 pens, I've already managed to lose 9 of them...and I've even earned the wrath of the clerk when I absent-mindedly walked off with the coveted front desk gel pen (despite its sporting a hot-pink tape flag sternly rebuking the thief: "This Pen is not Yours.")
You start hearing the phrase before your clinical years in medical school: "It's a steep learning curve." And then you hear the familiar phrase describing intern year, echoing through the halls of the hospital as kindly upper-year residents comfort bemused interns gingerly rifling through patient charts, searching in vain for the Truth.
Steep, perhaps. But no-one mentions how slippery it is. And how much is at stake if you fall off. The first day, walking into the residents' lounge at the decidedly non-cheery early morning hour of 5:45 am, I suddenly became the primary intern for 8 patients, who would all look at me wearing my white coat that morning, call me "doctor" and trust that I knew everything about them and would do all the right things to make them feel better. It's a good thing that the real world isn't like that bad movie with Mel Gibson where everyone could hear what he was secretly thinking about women. Otherwise, my patients would have heard something that goes like this:
Me (walking into room and waking up patient): "Hello there. It's nice to meet you. I'm - ah - Dr. - Dr. K, and I'll be taking care of you today."
Me: (inner voice, screaming): Oh My God. Did you just call yourself Doctor? Does she even believe you? Why is she reaching for the nurse alarm button? Wait, this patient is supposed to be male...did I get the wrong bed number?
Me (softly): Um. Sorry ma'am, I'll, uh, be right back. Just, uh, forgot something.
(Exits room, trying to retain remaining scraps of dignity)
At our program, 8 is the "cap" for the maximum number of patients an intern can carry at any one time. As a medical student rotating on the wards, I'd carried a maximum of 4 or 5 patients, and that was with an experienced senior resident monitoring me to ensure I didn't accidentally write for three enemas on the same patient. And all these were patients that I actually helped admit to the floor, thereby seeing them from the first day of their hospitalization and following them throughout their stay. They were patients I knew through and through.
That first morning, I started with 8 patients who had been admitted by the outgoing intern (who was now bidding farewell to the unenviable status of "intern" and climbing up to the more esteemed status of "resident"), and who were now being "handed over" to me. In the process of "handing over", the outgoing intern had talked to me about each one of the patients the evening before, making sure to cover main outstanding issues, letting me know that Patient Johnson was anxious about her upcoming liver CT or that Patient Smith firmly believed that he was Elvis and not to be alarmed if he might request me, as a new face, to be one of his backup singers. I had nodded and carefully taken notes, but everything blurred together as I now looked over the list of the eight unfamiliar names and the brief descriptions of their medications and history. I concentrated on trying not to break into a cold sweat (seeing beads of sweat on a physician's forehead, I figured, wouldn't exactly be conducive in inspiring patient trust and confidence)
A hospital isn't a hospital unless it is designed with bizarre staircases leading to nowhere, odd hallways that lead to exitless alcoves and hidden floors sandwiched between patient wards. As I would find, getting to the patients would prove to be one of the more daunting challenges of the day. Having reviewed the patients' vitals and information on the floor, I decided to take the stairs to the 6th floor, hoping the little burst of cardiovascular activity would prove invigorating.
You start hearing the phrase before your clinical years in medical school: "It's a steep learning curve." And then you hear the familiar phrase describing intern year, echoing through the halls of the hospital as kindly upper-year residents comfort bemused interns gingerly rifling through patient charts, searching in vain for the Truth.
Steep, perhaps. But no-one mentions how slippery it is. And how much is at stake if you fall off. The first day, walking into the residents' lounge at the decidedly non-cheery early morning hour of 5:45 am, I suddenly became the primary intern for 8 patients, who would all look at me wearing my white coat that morning, call me "doctor" and trust that I knew everything about them and would do all the right things to make them feel better. It's a good thing that the real world isn't like that bad movie with Mel Gibson where everyone could hear what he was secretly thinking about women. Otherwise, my patients would have heard something that goes like this:
Me (walking into room and waking up patient): "Hello there. It's nice to meet you. I'm - ah - Dr. - Dr. K, and I'll be taking care of you today."
Me: (inner voice, screaming): Oh My God. Did you just call yourself Doctor? Does she even believe you? Why is she reaching for the nurse alarm button? Wait, this patient is supposed to be male...did I get the wrong bed number?
Me (softly): Um. Sorry ma'am, I'll, uh, be right back. Just, uh, forgot something.
(Exits room, trying to retain remaining scraps of dignity)
At our program, 8 is the "cap" for the maximum number of patients an intern can carry at any one time. As a medical student rotating on the wards, I'd carried a maximum of 4 or 5 patients, and that was with an experienced senior resident monitoring me to ensure I didn't accidentally write for three enemas on the same patient. And all these were patients that I actually helped admit to the floor, thereby seeing them from the first day of their hospitalization and following them throughout their stay. They were patients I knew through and through.
That first morning, I started with 8 patients who had been admitted by the outgoing intern (who was now bidding farewell to the unenviable status of "intern" and climbing up to the more esteemed status of "resident"), and who were now being "handed over" to me. In the process of "handing over", the outgoing intern had talked to me about each one of the patients the evening before, making sure to cover main outstanding issues, letting me know that Patient Johnson was anxious about her upcoming liver CT or that Patient Smith firmly believed that he was Elvis and not to be alarmed if he might request me, as a new face, to be one of his backup singers. I had nodded and carefully taken notes, but everything blurred together as I now looked over the list of the eight unfamiliar names and the brief descriptions of their medications and history. I concentrated on trying not to break into a cold sweat (seeing beads of sweat on a physician's forehead, I figured, wouldn't exactly be conducive in inspiring patient trust and confidence)
A hospital isn't a hospital unless it is designed with bizarre staircases leading to nowhere, odd hallways that lead to exitless alcoves and hidden floors sandwiched between patient wards. As I would find, getting to the patients would prove to be one of the more daunting challenges of the day. Having reviewed the patients' vitals and information on the floor, I decided to take the stairs to the 6th floor, hoping the little burst of cardiovascular activity would prove invigorating.
Inexplicably, the particular set of stairs I took ended on the fourth floor, which opened out into a long, unfamiliar hallway. I wandered tentatively around with the trademark air of the Lost Intern on Her First Day, until the trademark sharp voices of Random Mean Scrub Nurse and Equally Mean Surgery Person both snapped, "This is a sterile area and you need to leave now." I was in SurgeryLand, not a good place for a hapless internal medicine intern to be. White coat billowing humorously around my knees, I quickly turned and scurried out another door, which led me into another equally unfamiliar hallway, with no exit or stairs or elevator in sight. I was trapped.
Looking around desperately, I saw a nurse standing in a corner flipping through what looked like a magazine. I summoned up courage and approached her with the decidedly intelligent query: "Um. How do I exit from here?" She looked at me coldly from the rims of her glasses and said, "I am administering medications right now and am not allowed to talk to anyone."
After taking the emergency measure of interrupting a group of nurses eating breakfast in a side room (usually verboten, but desperate times call for desperate measures), I finally found my way to the 6th floor. It then took me about 3.5 hours to go through my "rounds": getting vitals, examining my patients, familiarizing myself with their conditions and trying to convince them I was, in fact, a doctor. As I grappled with orders, notes and medications, all the while running through my head was the refrain: Please, please don't let me accidentally kill anyone. I found myself double and triple-checking every move I made, looking up the dose for Tylenol and Tums, paging my supremely patient and kind senior resident every five minutes to update him on bowel sounds and rashes.
Thankfully, most residency programs understand that incoming interns were hiking in Peru or skiing in Lake Tahoe only weeks earlier and have studiously avoided setting foot into a hospital after their graduation, so there is always plenty of backup. There's the senior resident, attending physician, nurses, and the ever-patient 6-South pharmacist, Jorge, who would send thoughtful "clarification pages" to interns writing medication orders. "Doctor, I'm sure you meant to write omeprazole 20 mg tablets, not IV, correct? Because, uh, it doesn't actually come in an IV form..." or "Doctor, you do know that 4 mg of morphine is an, um, pretty tiny dose? Did you mean to give that IV?" Thank you, thank you, my dear friend Jorge.
Looking back now on that first day, I am so glad it's over. The first day is really always the scariest, and I made it through without hurting anyone. It's only day 6, b
ut I'm slowly ice-picking my way up the curve: I remember all my passwords - an incredible accomplishment! - I can calmly write for Dulcolax without a compulsive need to check my pharmacy book just in case. I know where the secret cappucino machine is on the 5th floor, how to bypass the scrub machine to snag an extra pair of free scrubs. And lately, some of my patients even call me "Doctor". And I didn't even have to bribe them to do it.
After taking the emergency measure of interrupting a group of nurses eating breakfast in a side room (usually verboten, but desperate times call for desperate measures), I finally found my way to the 6th floor. It then took me about 3.5 hours to go through my "rounds": getting vitals, examining my patients, familiarizing myself with their conditions and trying to convince them I was, in fact, a doctor. As I grappled with orders, notes and medications, all the while running through my head was the refrain: Please, please don't let me accidentally kill anyone. I found myself double and triple-checking every move I made, looking up the dose for Tylenol and Tums, paging my supremely patient and kind senior resident every five minutes to update him on bowel sounds and rashes.
Thankfully, most residency programs understand that incoming interns were hiking in Peru or skiing in Lake Tahoe only weeks earlier and have studiously avoided setting foot into a hospital after their graduation, so there is always plenty of backup. There's the senior resident, attending physician, nurses, and the ever-patient 6-South pharmacist, Jorge, who would send thoughtful "clarification pages" to interns writing medication orders. "Doctor, I'm sure you meant to write omeprazole 20 mg tablets, not IV, correct? Because, uh, it doesn't actually come in an IV form..." or "Doctor, you do know that 4 mg of morphine is an, um, pretty tiny dose? Did you mean to give that IV?" Thank you, thank you, my dear friend Jorge.
Looking back now on that first day, I am so glad it's over. The first day is really always the scariest, and I made it through without hurting anyone. It's only day 6, b
ut I'm slowly ice-picking my way up the curve: I remember all my passwords - an incredible accomplishment! - I can calmly write for Dulcolax without a compulsive need to check my pharmacy book just in case. I know where the secret cappucino machine is on the 5th floor, how to bypass the scrub machine to snag an extra pair of free scrubs. And lately, some of my patients even call me "Doctor". And I didn't even have to bribe them to do it.
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