37 days down, 328 to go

Well folks, I made it through my first rotation on the floors and have completed 10% of my internship as of today! I got a little better each day and even shared many laughs with my wonderful nurses, resident, & medical students, but there nearly always seemed to be more work than I could finish in a timely manner. There is always more to do, and I did my best to not sign out anything to the night team if it should have been done during the day. The night team is plenty overwhelmed by covering half of the patients in the hospital while doing admissions in the Emergency Department.

I remember that one of the internship programs I considered emphasized that interns should be capped at covering no more than 8 patients each day for the sake of learning. The official ACGME cap is 10, which in hindsight feels like too many. That reminds me -- I'll publish a post with advice from the trenches for 4th year medical students choosing internship & residency programs.

The intern's role is mostly one of data gathering, communicating, and coordinating care dictated by the attending & consulting physicians. In theory, an intern should learn a lot about medicine through this process. In reality, covering 10 patients at a time (up to 14 on weekends!) makes it tough to spend much time learning. During my first month on the floors I rarely attended a full noon conference. Often, my resident and I would go just to sign our names to meet the ACGME attendance requirements yet still get our work done.

On my last day, a Sunday, I apologized for not being ready (i.e., finished seeing all the patients, writing notes & putting in orders) to round sooner with my attending physician. He said I should just keep doing what I'm doing and that his colleagues have told him what a good job I do. "Sure, some interns are faster, but they miss things, and then you know you can't trust them. Just keep doing what you're doing," he urged.

I don't mind coordinating care for patients and enjoy communicating with other team members, but I do mind the incessant pressure to go faster and get more done in less time. I'm a pretty deliberate & thorough person in general, but I found myself feeling rushed and late just about all the time once I started internship. As I know well, hurrying doesn't pay. I'm convinced it's the reason I totaled my beloved 16-year old car on the way to the hospital during my first week of internship (thankfully avoided other cars and have an awesome D.O.).

When I tried to cut corners last weekend in order to finish my team's work in time for my pending call, I missed a few things. The attending took it in stride and caught what I missed, but trading thoroughness for speed didn't sit well with me. Especially as a new intern, it takes time to ensure I really know a patient and her medical history well enough to provide adequate care. At some point, missing a piece of information will make an important difference. I'm responsible for what I miss, as one of my co-interns recently learned the hard way.

There are also times I am essentially expected to be in two or more places at once for important matters. And the nurse or resident in the place where I am not will duly note my absence in the computerized record. It is possible for an intern to get in trouble for this, which I have managed to avoid so far. There have certainly been times I didn't feel equipped with sufficient time and/or experience to safely handle urgent situations when I covered my team alone (with one upper year available to all interns by page) on weekends. They tell us we're never alone, but sometimes it feels as though we are. It can be overwhelming, which I mind a lot.

The good news is I made it through the first 32 days with just 3 days off and I'm still going strong. Well, I'm going, anyway. The morning veggie-fruit smoothies have surely played a pivotal role. I'm already gaining back some of the weight I lost power-walking the floors. It also helps tremendously that I find the vast majority of hospital staff to be friendly, patient, and helpful. I really do feel like an important & valued team member. This month I'm in the ICU, which in many ways is worlds better than the floors. In other ways it's less palatable, but I get to eat at least once a shift, which puts me in the lap of luxury for the next few weeks.