Thriving?

So you work eight days straight, finishing with 30 hours on call (and no sleep, natch). Then today you have your one day off, which you get to spend taking not one, but two standardized tests. Then tomorrow morning brings a third, half-day-long standardized test, after which you're on call again for another 30 hours, kicking off twelve more days of work with no days off.

If this sounds like a good work schedule to you, you would thrive as an intern. Me, I'm getting kinda tired of this.

Too close to home

Has anyone out there read Intern by Sandeep Jauhar? Last week, eight months into my own intern year, I picked it up and started reading and had to stop -- it just cuts too close to the bone right now. Please, somebody tell me that it has a happy ending....

On-call Liveblogging: Final Exam

In my line of work we perform physical exams all day long. Many of them can be quite specialized; for example, the exam of the patient with eye pain differs somewhat from that of the patient with rectal bleeding.

One of these specialized exams is performed when we are called to the bedside to pronounce a patient's death. There are certain exam criteria that must be met before we can officially declare a time of death, and sometimes it can be a slightly eerie experience. There's often no one else in the room. If this was your patient you may have been examining him or her several times a day for weeks. Often you knew the patient's body intimately, and now you're seeing it in an entirely different condition. There can be unsettling impressions: did I just see an eyelid flicker? am I certain that I don't hear the slightest murmur of cardiac activity? Just wishful thinking, unfortunately. (Although death can be a more dynamic process than one might think.)

Here's hoping that I don't need to perform this exam on tonight's call....

On-call Liveblogging: ICU Solfeggio

Things I think about in the ICU at midnight: the alarms on the ventilators sound out the melody "sol do fi sol sol."

How long have you been here?

Today one of my patients observed that I had been in to see him yesterday morning, then again in the late afternoon, then again overnight, then again early this morning, and now he was seeing me in the afternoon today. He asked "did you work the night shift?" but then realized the explanation was that I'd simply been there all along. At that point he started talking about how he wouldn't get in a cab driven by someone who'd been working for more than 10 hours, and I figured it was time to redirect the conversation.

I guess I can't complain. I did manage to get 30 minutes of sleep during my 30-hour call. But it does get a bit grueling. And now off to bed, to get some sleep before the cycle starts again tomorrow morning.

Goodbye cruel world

Tomorrow is my first Medicine call. I'm sure the next day-and-a-half will fly by....

Pain in the ass

As I was discharging a 96-year-old patient recently, he told me, "Doc, you're a good guy. Some people may tell you you're a pain in the ass, but I think you're a good guy."

Yes, establishing those bonds of trust and respect is what medicine's all about.

Seized by love

The other day I had two patients, a young man and a young woman, both about 20 years old. They had each had the first seizure of their lives earlier that day, within an hour of each other. Both were visiting from out of town, had friends with them, and required a slightly more complicated workup than is usual for a first seizure. They were lying in adjacent gurneys in the hall. When I spoke with the attending physician about them, her recommendation was: "we should introduce them; they'll probably hook up!"