#intern year

[slf-cntrl]

ONE OF THE MOST ICONIC SCENES…

there’s just too much going on lol

[emgoesmed]

12/14/2024

I love the weeks leading up to the holidays- cozy sweaters, rich coffee, good cheer & fun with friends.

[whitecoatblackmarket]

When another specialty’s resident or attending is rude to you and your senior resident or attending asks for you to give them the phone

Hahaha you’re in trouble now 😂😈

[cranquis]

Wanted to send you a message - I'm from another country, but wanted to match into the US healthcare system for the longest time for several reasons. Followed you for the wisecrack insights, stayed for the soul.

I've matched into my dream Anesthesiology PGY1 spot this year <3

Thank you for all that you do.

I am so excited for you, my friend and colleague! Congratulations!!! Now keep your chin up as PGY1 year does its best to smother your dreams with scutwork and stress and lack of sleep.... this too shall pass!!!

[a-young-doctors-journey]

The worst part about the ICU is that you get to a point where you're on a first-name basis with family.

Frederick was at bedside every day, sitting beside his wife. When he wasn't, they were on speakerphone, her work of breathing worse each day. We explained to the family that she was really really sick, and they understood that the prognosis was poor.

But when it came time to decide about intubation, they couldn't bring themselves to withdraw care... so we intubated, knowing there was no way that she would ever come off the vent.

It was after 10pm when the nurse came over to us.

"Room 7 won't make it through the night. Maybe you should call family."

My senior looked at me, and asked, "You wanna call the husband?"

"Frederick? No."

"It's important to learn how to have these conversations, you know," he said, somewhat gently.

"I know. And I have them plenty. But you asked me if I want to call him and tell him his wife is dying, and I don't. But I can, if you want me to."

He nodded and dialed the number from our 'Next of Kin' list. "Mr. Smith, I wanted to..."

Not even half an hour later, the monitor by my computer started beeping furiously. Her blood pressure, which had been dangerously low already, tanked. I ran to Room 7 as nurses from surrounding rooms crowded into the little space, code cart already in place.

She had no pulse. The ICU team really did have an intuition for this sort of thing.

We went through the motions of the code, not for a moment believing that we would get her back. But we did. A short-lived miracle... but maybe it would give Frederick just enough time to come back.

The second time her heart stopped, my senior asked me to let the family know that we had done everything we could. I stepped outside, the sounds of the active code behind me, and explained that there was nothing to be done.

"So this is it?" he asked matter-of-factly.

I nodded. "I'm very sorry, Mr. Smith." He thanked me as I walked back into the room just in time to hear the pronouncement.

"Time of death: 10:39 PM."

Gloves came off. Supplies were discarded. The code cart was wheeled unceremoniously out of the room. One of the nurses placed a fresh sheet over the patient, tucking it gently around her.

As I headed back to my workstation, a heart-wrenching sob pierced the hallway. Frederick - a stoic, quiet man who had spent countless hours with wife, ever so hopeful - was sobbing into his knuckles.

I felt the tears well into my own eyes, swallowed hard, and looked up to see the surgery resident coming towards me, no doubt seeing my watery eyes but making no comment.

"Are you taking care of...?"

And the rest of the night went on.

[yoojkim]

There are LOTS of errors that can be made in a hospital. Fortunately, at every step of the way, there are people that can prevent it. In the Swiss Cheese Model (This is real! Look it up!), barriers against mistakes are represented as cheese slices. This is especially relevant in medical training, where mistakes (harm to patients) are prevented by having series of residents, attendings, nurses, pharmacies, etc.

[ontrackmind]

I am one month into residency. Here are a few things I've learned (mostly about myself):

1) I am, indeed, a textbook person. I always thought I was an uptodate person, but it's just not always the best resource for peds. I have looked things up in Red Book, Lange Neonatology, Bright Futures, and AAP Peds in Review multiple times this month already. They just seem to work better for me when I have the time. Uptodate is my second choice for on-the-go reading (like when walking to morning conference)

2) organization is key. I'm not sure what system works best for me on rounds since the handoff sheet we get is completely different from what we used at my med school. (Same info, just formatted differently on the page). But, I have found having a succinct cover sheet with all of my patients only and their to-do items for the day to be way more efficient than flipping back and forth in a big packet. I'm still working out how to make the handoff page work best for me during rounds though. One thing is clear though, if you're not organized, something will be forgotten. For me, keeping lists and check boxes is key.

3) if I don't write it down, it doesn't exist. How do people remember *everything*?? If I don't write it down within 5 minutes of doing it/hearing about it/being told to do it, it's forgotten in the abyss.

4) good sleep hygiene is my BFF. I probably have co-residents with wacky schedules, but I like my routine and I have noticed I do better when I'm well rested. I typically get 6-8 hours, but in order to ensure that happens, I have a pretty consistent routine in the evenings after work and the mornings before work (especially since I don't have a yard and have to walk my dog both times). I also like feeling well rested in the morning. I'm in a better mood, less stressed, and make fewer mistakes. (Maybe this one matters more since I don't drink coffee or soda so I don't get an extra boost from the caffeine?? I've debated energy shots, but I get heart palpitations with anxiety and they freak me out. I can only imagine what extra caffeine would do)

5) I 100000% prefer to work as a team than work alone. My last block was very team oriented and I felt like I thrived. We were always asking each other how we could help and getting lunch or snacks for each other when we couldn't go together as a group. It was very much a "we all lift each other up" kind of environment. I hope that carries into my other blocks, too. I'm going to do my best to continue to be a team player and help everyone with their workload.

6) I still feel pretty dumb and unsure of myself, but the imposter syndrome is WAY less than before. Idk if it's the new environment or what, but I just don't feel that same fear of being too dumb and undeserving and being the weak link like I did during med school. Sure, I have a lot to learn and I do sometimes forget things or freeze up (for instance, I completely forgot what DI was today during rounds. Literally could not have even told my fellow my name if she had asked.lol) and while I fell a little embarrassed, it's not the same as it was before. Maybe I'm in a better mental place for now?

7) Im somehow less stressed. Like, I work hard at work and sometimes I get frustrated or get stuck, but it's not the same as being a student. I read articles and do practice questions at home but it's much more leisurely. Despite the long hours, I find this WAY more enjoyable than med school. I don't feel guilty for taking time off or enjoying my hobbies and I actually enjoy studying and looking up stuff about my patients. Residency is hard, but I am so much happier than I was before. I hope it stays this way.

8) my dog is still one of the absolutely best part of my day. She's happy when we get up in the morning and happy when I get home in the evening. She will forever be the bright, sunny spot in my day. Its a lot of work having a dog while living alone, but holy crap is she worth it❤

[atmiger224]

Intern Year, Month 2–Friday night house coverage: (details changed to protect identity)

Im the only one on site and still working on a late admission from the day, ICU gives me push back on a patient my attending insists is not stable for the floors — AOx0, total white out of the right lung, hepatic encephalopathy, needs paracentesis but INR is 5. Call GI, they laugh at me, says to wait load up with vitamin K and monitor until the morning, no one wants to touch her. Call my senior who is going home because they have the blessing of freedom. Let them deal with this right now, I have to shift mode from floors coverage to house... because I have three calls, two for renewing meds, one for a pronouncement. While I’m with the family, barely get a “sorry for your loss” out when I get another call to renew restraints. And then another call for transfusion consent.

I take the paper consent and explain the benefits and risks of a transfusion to the 90+ yr old patient and her family when I get another call. This one is an emergency.

Im trying to announce myself in a room swarming with nurses. No one hears me until the third try. Thankfully the patient’s nurse tells me that the patient with dementia who was admitted for AMS has an even more acute AMS. Im looking at my patient, hx of stroke, lateral gaze deviation with temperature of 102. GSC 7. This aint right. I’m putting in stat orders when I get a call from my senior. “Are you ok?” I guess. I dont know. Im trying my best. I explain the situation and my though process. They suggest adding peripheral blood cultures. I call the primary who say this is his baseline. Like hell this is his baseline. I believe his nurse. Meanwhile no one has the EKG or stat CXR. No stat labs. Its nursing change of shift.

Dont know what to do, fine, lets escalate.

Call Code Stroke. Someone laughs, half of me is anxious its at me. No time for doubt cause the other half of me is focused on trying to read up on the patient’s med list as the patient is wheeled away for a CTA. Tell the off site neurologist the patient’s history and breath a sigh of slight relief cause here’s a Doctor Doctor and their team. Eventually we call the ICU down to evaluate and patient is upgraded.

My prayer for the rest of the night to be quiet answered, I can do all the melatonin refills.

I go home. The code continues to haunt me. Wake up this morning and read the ICU note— Pt is Covid positive. Septic. Fuck. Now im paranoid for a different reason 😂