Welcome to Ward 75

I officially began my general medicine month (Ward 75) on Tuesday, after having been post-call on Monday. It's going to be a rough month.

To start with, my fellow intern is a jerk (and that's being polite). He thinks he knows more than I do because he's an internal medicine intern (which to me just proves how little he knows), because he went to USUHS (the military medical school), because he's just a jerk, I don't know, but he was trying to tell me how to put in orders, which I definitely don't need help with, as I probably put in more than 50 a day in the MICU. And he seems to think he's exempt from doing the 'scut work' (the little things that need to get done that have nothing to do with the four years we spent in medical school), for unknown reasons. He actually told off the discharge planner, which is probably his biggest mistake ever (don't piss off the person you're going to have to be depending on for the next three years), by saying, "I went into medicine to do medicine, and since starting this rotation, I haven't done any medicine, I've just been making all these calls to get this guy discharged, which is supposed to be your job, so tell me what you need from me that's keeping this guy from getting out of here." Yes, doing all that stuff is annoying (I spent half an hour being shuffled around the VA on the phone trying to get my patient's out-patient follow-up appointments scheduled today when I just wanted to go to sleep), but that's what being an intern is about. You don't do medicine; you do everyone else's scut work. They say to put an order in, and you say, "Yes, sir" (or "ma'am", whatever the case may be).

Anyway, enough about him (I'll probably be complaining more about him in the course of the next three and a half weeks). We also have med students, two third year med students from USUHS and a fourth year HPSP (Health Professions Scholarship Program, which is what I was--sponsored student at a civilian med school) student from the University of Buffalo. The third years aren't too bad for it being their first rotation (they've done four and a half weeks of their initial six week rotation), but to quote Scrubs (the most accurate medical TV show out there), a good med student is only who only doubles your work load. I'm pretty quick about getting my orders in and getting my notes written, but they're supposed to write their notes first, and then I'm supposed to correct them and sign them. Since they're still so new to note writing, it takes them forever to figure out what's important and what's not, so I waste time sitting around not doing anything, just waiting for them to finish their notes so I can get around to writing mine. It's rather frustrating.

Having a fourth year (a "sub-i", as I'm sure you remember from my experience in April), is actually quite helpful, especially when getting slammed with new admissions on call, which is what happened yesterday. Our team can take up to ten new patients a night, which is typically split 5/5 among the interns. With a sub-i, though, we had three people to split it between. We ended up taking nine (which is a lot; the team on the night before us took three, and two of those were transfers from the MICU, which come early in the day). I took four, my fellow intern took three, and the sub-i took two.

So that brings us to this morning, after dealing with these admissions and being paged from the nurses on patients from other teams (when on call, the other interns sign their patients out to me, so I manage them overnight only knowing what is on the slip of paper they hand me), it was time to round and get my work done on all five of my patients (four new ones, one from before). I thought I was getting rid of two, so I was frantically trying to get their discharges done (something we didn't do in the MICU; they just got transferred to the wards), and being shuffled around the VA trying to get appointments. As it turned out, neither was quite ready for discharge, so in addition to doing all that and getting them more or less squared away to go home, I had to go back and write a daily note on them and figure out how to get them medically ready for discharge, hopefully tomorrow (because I work for the government, nothing happens on weekends). Great fun.

I left the hospital after 29.5 hours of work (legally, I can't exceed 30), hit the gym (typical post-call activity to get the adrenaline running and keep me awake to drive home), then it was home for lunch before collapsing into my usual post-call coma.

And tomorrow, it's back to work for more Ward 75 fun.