Trial by fire - Day 1

Today was D-day. My first official day as a doctor. Just wrapped up a week of "orientation," basically a paperwork-fest including the all-too-fun activities of obtaining IDs, getting oriented to fifteen different libraries, getting half-useful tours of the facilities, meeting the other poor souls in my shoes, and jumping through other various hoops that have little to nothing to do with easing into my job.

What is my job? I'm an intern resident [first year, aka PGY-1 (post-graduate year 1)] in general surgery. So what do I do? Basically anything that any of the atttending doctors, senior residents, nurses, experienced medical students, and even patients tell me to. It's rough being the low-man on the totem pole, and being totally unfamiliar with the infrastructure and common workings of the facility you are newly employed at - yet being legally responsible for the "medical care" you provide. Our orientation covered some basics like how to use the computer system to enter orders, but neglected to go over basic workings, such as who ends up doing which aspects of patient care. I guess I shouldn't be surprised at the "trial by fire" nature of the beast.


So how did it go? Due at the hospital at 5:30 am to prepare to round ... I got there at 5:45 after getting only 2 hours of sleep the night before - half nerves and half procrastination, taking care of all sorts of business EXCEPT preparing for possible tasks and making up for knowledge deficits that might present during the day. Got started with the team, finally met the senior residents, and then went bleary-eyed at the pace with which the day proceeded.

About 18 patients to care for total, located on 8 different wards around the hospital - rounding on them, making decisions for orders like advancing diets or getting special labs or tests. Thankfully we worked as a team, and I wasn't left out to dry too much. After some quick rounds in the morning, we had M&M (morbidity and mortality) conference, and then I busied myself with taking out staples and sutures, pulling drains, and doing other scut-work - like running a packet of x-rays down to radiology to have them read by a specific doc (only to find out that she's out until next Tuesday!). All in all it wouldn't have been bad, except that the infernal pager I was so eager to wear was vibrating NON-STOP. I was too busy to even get a little smile off that. Apparently, I was the lucky bastard that was assigned "on call" during the day - would have been nice to have known that AHEAD of time. And about 95% of the calls I was getting were for issues that I couldn't handle on my own, with my limited knowledge of the patients on our service. So I spent a LOT of time chasing down my seniors and running interference between the nurses and other residents. And of course, running back and forth across the hospital. A LOT.

Also threw a wrench into the works that my access to the computer-based order entry was not functional. Should be fixed for tomorrow ... we'll have to see. And of course, several pages were follow-ups / complaints about the fact that I hadn't managed to get a medication order ready for a patient fast enough, or that I still had a patient's daily note in my possession instead of in the chart for the beaurocrats to play with. Little details that a more solid orientation to the inner workings of the facility would have helped.

At least they fed us periodically during that orientation week. Besides a half-bagel snagged during the M&M conference, I did not stop ALL DAY to eat or rest or veg. My only down-times were the nearly peaceful minutes between paging a senior resident and finally getting a call back to deal with the latest crisis. It was a blissfully short day as well - I was actually out of there by 5:45 pm. Only 12 hours. Not bad!

And some firsts: Wrote my first prescription as a doc (for colace - a laxative - who still says I'm full of shit?!?); went around in a long white coat; nearly peed on said coat (sometimes it is NOT easier to be a guy); applied steri-strips (glorified band-aids / step-down from staples) on my own; and threw out "disposable" tools like suture scissors with hardly a twinge of regret at the waste. Made a few good "catches" about orders that were not yet put through - hopefully I helped out the team.

Now to see if tomorrow will be less dramatic. Fortunately I won't be the on-call resident. And thankfully there is a system to prevent pages to my number from getting to me when I'm off duty - they get forwarded to the night call resident. Now if I could only forget to switch that back tomorrow.... :-) But at least my pager won't stop me from getting a decent night's sleep. Hopefully I'll be able to wake when my alarm goes off at 4:30 am. Fun, eh? G'night!!

my H & P [history and physical]

ID [identifying info]: 32 y/o WM, intern in general surgery
CC [chief complaint]: see above
HPI [history of present illness]: don't get me started
PMH, FH [past medical history, family history]: non-contributory
SH [social history]: insufficient EtOH consumption, non-smoker, eats on occasion
ROS [review of systems]: deferred

VS [vital signs]: Temp 98.6 F, Pulse 60, Resp 10, BP 110/70, oxygen sat 98% on room air, Ht: 5'4", Wt: roughly ~165 lbs, BMI [body mass index]: math is hard, about 28.3 (goal is < 25).

Remainder of physical exam deferred, as the subject was compelled to leave to answer a page. Let it be noted that mental status was impaired, physical conditioning was poor, and posture was stooped.

A/P [assessment & plan]: Highly stressed individual with increasing demands on his limited intellect and experience. Encourage extensive reading, rest, exercise, and healthy diet - none of which are compatible with expected lifestyle over next year. Expect some relief with expanded support system, if red tape ever clears. Wish him best of luck, and follow-up as needed!