Three down, 362 to go

Yesterday I started my first shift as a doctor--in the MICU (Medical Intensive Care Unit)--and today at noon, that shift ended. Nothing like a 30-hour on-call shift to say, welcome to the field of medicine.

On Wednesday night, I got a call from the on-call resident saying that since I was on-call on Thursday, I didn't have to worry about showing up until 8. So on Thursday, I got up, showered, dressed in civvies, and headed for the hospital, where I changed into scrubs and my white coat (a long white coat now, which is a little weird), which is my 'uniform' while I'm in the MICU. Since it is a uniform, uniform standards apply, which means that my hair had to be up, etc. It also means that for some guys, they have to shave their five o'clock shadows while on-call.

Anyway, so I arrive to the MICU around 7:30, to discover that I should have been there at 6, because I was assigned a patient. Fortunately, my resident bailed me out and went with me to see the patient while explaining how things work in the MICU.

Rounds, of course, took forever. It's internal medicine; they like to round. And they like to throw around big words and quote studies and whatnot, so after a year of living the easy life as a fourth year medical student, it was feeling rather intimidating. After rounds, I asked one of my fellow interns if I could go somewhere and cry. He laughed and said there was too much to do to have time for that (which was true). We also have a Oral/Maxofacial Surgery resident (dentist) on the team, who is somewhere between an intern and a resident in terms of responsibility. It was pretty funny; at one point, I asked him what sort of clerical error allowed me to earn an MD, and he replied that at least I spent the last four years in medical school, and that I should just imagine doing all of this after four years at dental school. He had a good point.

I wrote a note on Facebook about my on-call experience. Because I'm too lazy to type it twice, I've copied and pasted it here:

So here are a few things I learned in my first on-call night as an MD:
1) After four years of wearing a short white coat and knowing that everyone around you knows that that means you have no responsibilities, it's a little weird to be in a long white coat. It took me a few hours for it to actually sink in that that's what I was supposed to be wearing and that nobody was going to get me in trouble for impersonating a doctor.
2) For military personnel, scrubs are a uniform while you're in the hospital. That means hair must be maintained to uniform standards (short for guys, above the collar/in a bun for girls). It also means that when on call, a lot of guys have to, at some point in the night, shave.
3) After the fiftieth page about blood pressure, you start to feel comfortable handling that alone without calling the senior resident.
4) ICU-trained nurses are AMAZING. I'm serious. When a patient was beginning to circle the drain, it took me about three seconds to realize that my job was to stand out of the way, and when the nurses asked, "Ma'am, do you want to give _____?" the proper response is, "I'll go put that order in right now."
5) Non-ICU trained nurses working in intermediate care, on the other hand... not so amazing. See point three about answering pages about blood pressure.
6) Doctors at Walter Reed wear their pagers clipped to the front of the scrubs top instead of at the waistband of the pants. This isn't to look cool. It's so when you're getting these constant pages, all you have to do is glance down to see what number you need to call back.
7) You very quickly learn to recognize the phone numbers on your pager of the units/nurses that will keep you up all night. See points 3 and 5.
8) At WRAMC, they have a policy where patients who are on a monitor must be accompanied by a doctor whenever they leave the floor. All ICU patients are on monitors. That means that when Mrs. X is going down to her MRI at midnight, the intern gets to go with her and sit there until it's time to go back.
9) The computers in the MRI suite don't have the program necessary to write patient notes. So while sitting there while Mrs. X is getting her MRI, there's nothing to do (assuming she doesn't suddenly crash), and notes that have to be written aren't getting written.
10) It's not Gray's Anatomy (well, I knew that point already). The on-call rooms are used for sleep, storing things in lockers, and grabbing thirty seconds to wolf down a meal at 0300 that was supposed to be dinner the night before. Nobody has the time or energy for sex while working. At least, I hope not. I caught an hour and a half of very interrupted sleep (see points 3, 5, and 7) on one of the very uncomfortable beds in the Transition Year call room, and I don't want to even think about when the sheets were last changed.
11) Brownies stolen from the Internal Medicine work room at 11pm taste really good at 4am.
12) White coat pockets are large for a reason. That way, in addition to carrying around reference books and patient notes, you have room for food, gum, chap stick, and a water bottle. And a stethoscope, if you get tired of wearing it around your neck.
13) After awhile, answering the phone, "This is Dr. Hesse, I was paged," loses its novelty.
14) You realize, sometime around 0200, that you almost know what you're doing, and maybe you didn't waste the last four years of your life in med school after all.

A few other things that I didn't add to the list that I just thought of:
1) Leaving the hospital after being indoors for 30 hours makes you feel like Rumpelstiltskin. You have no idea what day it is or why it's sunny outside.
2) When you don't know what day it is, it makes getting around a military base a bit difficult. This really only applies to today. Since the 4th is a Saturday, the 3rd is a training holiday, which meant the hospital gym was closed (and thus, there went my plans of working out after work), the road from the parking garage to the main gate was closed, and the 16th Ave gate, which I usually take, was also closed. To get from the garage to the main gate on a weekend or holiday (the only gate open), you literally have to drive all the way around base, and for everyone who has ever driven on a military base, you know that that's easier said than done--roads aren't gridded, they're narrow, and there are stop signs and speed bumps in seemingly random places. Now imagine doing that after working for 30 hours (when you're as impaired as someone who is legally drunk). All sorts of fun.

Anyway, that was my first day as an intern. I have tomorrow off (I'm planning on watching the fireworks from the Washington Monument), and then I'm on-call again Sunday (another 30-hour shift... yipee). Only three weeks of this, and then it's onto general medicine wards (which I'm not thrilled about, either).