Day in the Life of a Medicine Intern

As soon as I got the 4 am page about urinary retention in my patient with an infection in his spine, I knew my post call morning was going to be off to a memorable start.

It actually hadn't been a bad night. We capped (got our full quota of patients) by 8 pm, which meant I could have things wrapped up and people tucked in by midnight and actually attempt to get those few precious hours of vibrating pager-interrupted sleep. Plus the ED had given us some weak admits that probably should have been handled as an out patient. And one of them was a patient I'd had before (a "bounce back") so I already knew him well and it was a quick history and physical.

But post-call, as I drag to the end of the thirty hour shift, everything becomes just a touch more irritating and patience runs slightly thin.

The urinary retention patient needed a rectal exam. As a med student I dreaded these. As an intern, they just come with the territory. Better to just get it over with. So I did. And a good morning to you! The one fingered internal medicine salute. It was normal anyway.

I rounded on the rest of my patients, some of whom would be going home that day so I did their discharge med lists in rounds while the other intern presented to our attending. We were supposed to go to 1.5 hours of MTC ("morning teaching conference") that morning, but I knew it was not in my future as I looked at my patient list of things to do and notes to write and discharges to get in order and people to call and services to consult.

As I'm working my way through my notes and orders and discharges, there is the smattering of typical entertainingly ridiculous pages:

VIIIIIBRATTEEE, pager goes off at my waist: "Dr. you have to fill out this form for the patient to leave today." come to find out it was about her whole infectious diseases history.

I leave my pager on the desktop knowing it will go off again soon and wanting to save the effort of reaching under my coat to extract it from it's holster on my waist.

VIBBBRATTEEE, it rattles against my flip top clipboard: "31234" this time a call back number, a mystery, and I'm about to see why, "Dr?" "yes?" "Mrs. J wanted me to let you know that she things she put two tampons in a couple days ago and she can't remember if she got both of them out. She things one might still be up there." I'm speechless. "Uh, they have strings attached to get them out." "Yeah, but she can't remember." I feel bad for the nurse having to relay this message. Oh boy. So there will be a pelvic exam before my day is over, too.

VIBRatTTTEE, as I'm on the phone it goes off again: "Dr, can you print the discharge paper work for Mr. S. I can't find it." I call the nurse back, knowing that I have put these orders in two hours ago and that they print out as soon as I finalize them and they probably got misplaced in the paper shuffle. But I don't know how to make them print again. So I tell her this. "So you'll find someone to help you print them again?" She misunderstands me. "No, you're going to have to find someone to help you figure out how to do it. I have to leave in 14 mintues." "Oh," she's dissapointed that this will mean calling someone else, "Okay, Doctor, thank you!" I was getting close to my thirty hour work hours limit. I'm getting better at saying no and I was thinking of "Message to Garcia" and craving someone like Rowan.

viBRRATTTEE: "Mrs. J would like phenergan instead of zofran." She still has abdominal pain and at every change of nursing shift she has been asking for iv morphine, hoping someone will give in. Not me. I mashed all over her belly when she was all groggy and out of it and not a peep or a wince. Phenergan it is.

Noon conference to pass off my patients and sign out to the day float, with the burritos we have at least once a week.

Managed the drive home in the exhausted haze. My roommates parents were there. Her mom in the shower (and I like to take a shower when I get home) and her dad on the computer. And they have another cat with them. And Charlie has barfed on the floor. And, this must be where my roommate get it, they just ignore it and leave it there. For who knows how long it will be there. Probably will still be there when I move out in three weeks.

Finally got in the shower, now talking to S. and fading fast.

Just another day in the life.