Tag: Intern

Celebrate the Small Stuff: Surviving the Marathon of Medical Training

In just two short months, thousands of newly minted young physicians will be walking into new hospitals, new jobs, and new responsibility. They’ll notice something unfamiliar tickling their calves on that first day – a long white coat having replaced the short one, which in our case went up in flames just days earlier. They’ll be excited and terrified, nervous and naïve.

A doctor’s “intern year” has become something of a legend in pop-culture, portrayed as twelve months of rude awakenings, sleep deprivation and verbal abuse, +/- a love triangle or two. Having been there, done that and proudly owning the t-shirt, I can say the reality couldn’t be further from the truth – at least it doesn’t have to be.*

To all the newbies out there – yes, there will be long hours and sleepless nights. You’ll occasionally go a full week without seeing your loved ones and eat whatever/whenever you can. Med school will seem a lifetime ago when you’re being asked at 3am what to do for a dying person, and you’ll wonder why they never taught you all the things that matter. But Steph and I have stumbled across the solution to all of that.

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Champagne celebration for med school graduation | Photo credit: Amy McClure

We celebrate the small stuff.

Sure we popped champagne like we’d just won a Grand Prix on graduation day, but we’ve also raised a glass to finishing tough rotations, making a clutch diagnosis and running our first double cardiac arrest. We’ve made a ritual of rare Sunday mornings off together with a supply of cinnamon buns always available, just in case. Sometimes we just celebrate because it’s Tuesday and we can. By making a big deal of small victories, the roadblocks become surmountable.

 

Don’t get me wrong – residency is tough. In the past month, three of my patients have died, and I’ve told four others they have cancer. But for every bad day I have had there have been a dozen that left me thinking, “I have the best job in the world.”

I encourage all the newbies out there to approach this next chapter the same way. And remember: when the champagne runs out, there’s always more coffee.

 

*Note: does not apply to general surgery residents. Your life will suck.


How do you like to celebrate the small stuff?

~Amir

 

If pages came as emojis

Right now there’s a whole new crop of medical school students graduating in a month who will start their careers as doctors on July 1. There are two things every medical student looks forward to receiving as an Intern – a long white coat and a pager. But any Resident will tell you: after your first night on call, you want to throw that pager against the wall and then stomp it into little pieces.

But what if pages, instead of boring B&W text, arrived as an emoji puzzle to decipher? That just might make getting 84 pages in a 12 hour Trauma shift slightly more tolerable.  See if you can figure out these common pages.


The “Frequent Fliers” of Pages

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Answers to “Frequent Fliers” Pages

  1. Mrs. Jones has a headache, please order tylenol
  2. Mr. Smith has post-op pain, please increase his pain meds
  3. Code Blue, Mr. Jones
  4. Please renew Mr. Smith’s order for restraints
  5. Mrs. Jones needs a diet order
  6. Baby Davis is febrile and has no PRNs
  7. Mr. White needs zofran for nausea
  8. Another ED admit
  9. The transfer from the OSH is on the floor
  10. Please call Pharmacy, you messed up your order again
  11. Who is going home today? -Bed Flow
  12. Mr. Smith needs a laxative
  13. Mr. Jones needs CIWA scoring

And, just for fun, some not some common but ridiculous (and true) pages:

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FYI: 3AM page for a “fever” of 99.0F

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Mr. X had a nightmare. He’s awake now.


Add your own favorite pager stories (and emoji puzzles) in the comments!

~Steph

 

Ups and Downs of My Intern Year in Emergency Medicine

Everyone warns you that Intern year is hard. It’s a year of little sleep; a rollercoaster of emotions both good and bad. Frustration and guilt in wanting to know everything NOW, because everything you don’t know might be what matters for this patient, this time. And trememndous successes. Some of the things I did this year, I really can’t believe I was able to do. And survive. Mostly, I’ve learned a lot about myself, and have been reminded yet again, that I work with an amazing group of people.


UP – Running a trauma when I thought I could never do it

I have a distinct memory of standing in the Trauma Bay at Norfolk General Hospital, watching the Trauma Team work its perfectly organized chaotic magic. I paid particular attention to the young female physician leading the whole thing – inserting an airway, calling out physical exam findings, doing an eFAST ultrasound to look for bleeding. I remember hoping, wishing I could ever have her confidence and calm demeanor. That thought was followed quickly by being thankful I wasn’t yet in that spotlight myself. I could never do that, right? In September I ran my first Delta Trauma at a Level I Trauma Center, and I survived to do it again.

VCU Medical Center Resuscitation Bay, Richmond, VA
VCU Medical Center Resuscitation Bay, Richmond, VA

DOWN – Those 2-week stretches not seeing my husband

I had no idea how much I need my husband to help me feel like a normal, healthy, centered human being. Amir and I had about four 2-week stretches this year where he was on nights and I was on days, or vice versa. One day we were so desperate for a date we coordinated a 20 minute coffee meet-up at the au bon pain in the hospital. Let’s not talk about what the house or laundry pile looked like during those stretches.  This is the video we play each other if we ever need a pick-me-up:


UP – Procedures, procedures, procedures

Open Thoracotomy

Paracentesis

Lumbar Puncture

intubations, central lines, suturing, joint reductions, even a c-section… you get the idea. I get to work with my hands a lot.


DOWN – Crying in the ICU

So I’m a crier. Always have been. I have distinct memories of my dad trying to help me with math homework as a kid, me getting frustrated and crying (my stress response), and my dad getting frustrated because I was crying. “What’s crying going to solve?” he used to ask me, which of course, made me cry more.

To be honest, I was expecting to cry multiple times the first few months of residency. tumblr_inline_mhsu6v3NBF1qz4rgpI actually made it to late February before it happened. Combine working 12-14 hours a day, 11 days in a row, with little sleep, food, potty break or non-medical human interaction (one of those 2-week stretches) – and now add to that a dozen of the sickest patients in the hospital. I broke down – red face, tears, snot, the whole nine yards. The nice thing about Intern year though is that everyone around you has been there, so I had about 4 senior residents plus 3 PAs sharing their crying stories right along with me to help pick me up. And that’s what you learn to do – pick yourself up, learn and keep going.


UP – Finally learning my way around the hospital (which is actually 4 hospitals)

Anyone who works in an old hospital knows how the building just gets added onto over the years, creating a behemoth maze of windowless hallways and floors that don’t match up. “Take the elevator to the 5th floor of North Hospital, turn left and you’ll be on the 1st floor of Main Hospital.” As if there weren’t enough to learn as an Intern.


DOWN – Cancer. I diagnose a lot of cancer.

I didn’t go into Oncology for a reason. It takes the smartest, strongest, most energized people to be cancer doctors. As an Emergency Physician, I expected to treat people with cancer, but I hadn’t thought of cancer as something I would diagnose. I guess I assumed that people would present to their PCP with concerning symptoms, get an outpatient workup and diagnosis by a specialist. But people do come to the ED for hematuria (blood in the urine), anorexia (lack of appetitie), back pain and weakness. And sometimes at the end of the workup, it’s cancer.


UP – Baby Mint Mochachino for a dying patient

Baby Mint Mochachino made with honor
Baby Mint Mochachino made with honor

I’ve seen a lot of amazing, caring people do a lot of touching things in the medical setting, but one moment stands out from this year. I had a patient who had chosen to pursue hospice care. He couldn’t stop telling me how beautiful his wife was and how he looked forward to seeing her soon. He had stopped eating and drinking days ago, so when he asked me for a “real coffee,” I was intrigued. He’d requested a cup of coffee from the medical student who poured him a cup of the hospital grade mud available to all employees. His dying wish was to have a real cup of coffee. How reasonable. I went to the ABP counter, told the story to the barista, and she whipped up the only coffee worthy of such a role – a baby mint mochachino, which she made with honor and pride in her work, even adjusting the temperature down to avoid any burned tongues.


So that’s it – Intern year is coming to a close, and July 1 I’ll be a “Senior Resident,” fraught with its own challenges and lessons to be learned.