Ooops, guess I totally neglected this little corner of my Tumblr lately.  However, I’m back to living more like an intern and enduring the pain, so hopefully I’ll write more regularly.  I’d forgotten how much I hate being on call every fourth night until I was reminded this week.  A “q4” (every fourth night) call schedule looks something like this:

• Day 1 - go to work at 6 AM.  Stay there.  Attempt to get some sleep during the late night hours of Day 1/early morning of Day 2. Likely fail in said attempt.
• Day 2 - Still at work until noon.  Go home, shower, nap, attempt to eat dinner. Get brave and attempt to run errands. Fall asleep in your own parking lot in your car, keys in the ignition (yes, I’ve actually done that).  End up not running errands and just going back to sleep.
• Day 3 - wake up in the dark thinking, “5 AM already?!?!” Make your way to work and spend about 11 hours there.  Go home and change into pajamas the moment you arrive. 
• Day 4 - wake up feeling something close to human.  Work 11 hours. Optimistically attempt drinks or dinner with friends. Excuse yourself at 8 PM to get some rest.
• Day 5 - repeat Day 1.

My string of shifts has left me sick.  Ironically enough, not because of something I caught from a patient but from my workplace.  One of the sides of the emergency room has light fixtures that are trapping a lot of dust.  My allergies have been nicely controlled without medication for 5, almost 6 years and suddenly I find myself coughing, sneezing, and developing a LOVELY new symptom.  Turns out that for me, exposure that that much dust results in an asthma exacerbation.

I spent Saturday seeing somewhere along the lines of 20 patients in 12 hours.  I’m usually running at a pretty good clip to see 15.  Normally I have backup in the form of a senior resident who then works with the supervising physician to help me get stuff done.  On the dusty side, however, I work directly with the supervising physician.  Dr. K was that physician on Saturday, and while he is a lovely lovely person, he’s fairly disinterested in moving patients through the ER or making treatment decisions/plans/writing orders.  As a result, a lot of what is buffered by the senior resident fell to me, who was already overloaded with patients.  In addition, the non-dusty side houses the trauma bay and all trauma patients who are being worked up.  6 fresh traumas in 2 hours ensured that there was not a single inch of free space over there.  As a result, all of the new patients who needed to come back were brought over to my side.

So picture this: little me at 5’0” running from room to room, house phone ringing every 3 seconds, being hounded by two nurses for my signature on orders at every turn.  I literally didn’t spend more than 5 minutes with each patient all day.  When the wheezing/coughing/burning in my lungs became unbearable I would find one of the nurses and she’d hand me two foil-wrapped packets.  I’d run to the storage room, where there is a forgotten oxygen connection, pour the liquid from the bullets inside the foil-wrapped package into the reservoir and inhale so deeply and quickly over and over again until I was lightheaded, trying to make sure I got as much of the precious liquid into my lungs before my next interruption.  At one point I received a phone call (damn house phone!) and the person on the other line said, “What is that noise?  Are you in a wind tunnel or something?”  “Um, no, ummmmm, let me fix that.”  AWKWARD.

And now, I’m on steroids so that I can finally breathe much better (yay!) but craving salt and retaining salt like it’s going out of style.  So if you see someone who is wheezing, coughing, sneezing down the street and doesn’t fit into her jeans, it’s probably me.

Last night around 6:00, I picked up my last patient of the night.  I wasn’t supposed to pick up any patients, but I had about an hour before the end of my shift and not much to do.  I told the PA working another “team” (there are several colors, and you only pick up your team’s patients) that I would start the workup on one of his.

The patient was an older gentleman, here with complaints of “dizziness” for the last few days.  Now, many of us in emergency medicine hate the chief complaint of dizziness.  It can mean so many different things.  Think of all the ways you (likely a young, healthy person) have been “dizzy” - there’s the room spinning, there’s that feeling like you are about to pass out, and then there’s that feeling like you can’t quite walk upright (like when you’ve had a few drinks).  Each one has its own meaning and workup.  However, this gentleman was not a native English speaker and had trouble conveying what he meant.  I was trying to get a translator on the phone, but hadn’t had any luck.  As such, we communicated through his wife and hand signals.  I came out of the room after a careful history and physical feeling incredibly unsatisfied with my work and a nagging concern that I couldn’t pinpoint.

I sat down to write it up and discuss with the supervising physician.  Knowing that there’s value in keeping your workup to a minimum (when possible) and keeping patient flow through the Emergency Department (henceforth ED) I was tempted to suggest some basic labs, IV fluids and a reevaluation.  In speaking with Dr. M, though, I suggested all that and said, “I think I want to bite the bullet and get a head CT and a neurology consult.”  He agreed - whether out of agreement with my plan or willingness to go along with my plan to further my education I’ll never know.  I finished up my shift and passed the information back to the PA.  I called neurology to see the patient and was put through the wringer by the neurology resident who answered.  I didn’t know how to explain that this guy’s story just didn’t fit, and I felt he should be seen by an expert in the field.  I hung up the phone at the end, realizing that frustration was palpable on both ends of the phone call - on his there was resentment at even more work to do, on mine there was frustration that he didn’t want to do work.

When my classmates arrived to relieve me, I joked with them for a few minutes and then got ready to go home.  Although it’s ideal for me, as an emergency medicine intern, to look at my own films I will openly admit that I rarely do secondary to time constraints.  Something inside me made me want to look at his film, though.  I pulled it up and scrolled through the images.  I’m not sure WHAT I expected to see, as the only thing I can REALLY identify on one of those is blood where it shouldn’t be.  These films, however, were grossly ABnormal.  I grabbed my supervising physician and we went over to the radiology reading room and asked the supervising radiologist there to pull up the film.  He did, and a few frames into the series was alread on the phone to neuroradiology (the specialists) asking for their opinion.

I’m not sure what the final results were (the thought was some sort of cancer vs. some sort of chronic infection) and we may never know as the couple was from out of town, but what struck me was how close I could have come to blowing this off.  I had no concrete evidence that made me think he needed the CT scan.  I could have easily been talked out of it, as I couldn’t verbalize WHY I thought he needed it.  I’m not even sure that deep down I thought he needed it, I might have been feeling a little overly cautious.  However, it was one of the first times in the last 26 days that I felt like I was able to make a potentially critical difference in someone’s life.  I didn’t just relieve pain (which is wonderful, but often temporary) or send someone who was a painfully obvious admission where they were going to go anyways (to be admitted).  I caught something before a patient was really handicapped by it, and depending on what it is I may have made a big difference.  It’s for patients like these that I became a doctor.

Last night in the middle of my night shift I slipped out of the emergency department to eat dinner.  Actually, to be fair, I didn’t even leave the department I just went to the resident closet, uh, LOUNGE to eat my dinner.  I ate pretty quickly and returned to the department to find the fire doors closed.  That’s fairly unusual as they are commonly propped open and violating fire code.  Only once I opened them did I realize that the department smelled like there was something burning! 

Turns out that a patient who was violent and in 4 point restraints had managed to sneak his hand into his inside pants pocket and get out a lighter, subsequently lighting the sheets on fire!

To be honest, I love my job for the excitement but that’s taking it a bit far.

Today, I am the proud recipient of technology dating back to the early 90s. Yes, I received my VERY OWN pager. We were informed that we were supposed to have them powered on and on our person at all times in the event of an MCI (mass casualty incident). I responded by tossing mine in the bottom of my book bag. I’ll fish it out one of these days…maybe.

PS: Please do not think that I wouldn’t find an MCI fascinating. It’s just that this is New Haven, CT. The biggest gathering on any given day is probably at the very hospital at which I work. If that blows up, we’re f-ed and there’ll be nowhere I can respond!

Please be better than Monday.  Trust me, the bar is set pretty darn low!

Thanks,

Dr. A

These words roll off my tongue quite frequently these days.  My mother and her friends like to joke about how terrified they would be if I walked in and introduced myself as their doctor because I look so young.  Trust me when I say that this is not lost on my patients, either.  Almost every single one of them asks me, in some form or another, if I’m old enough to be a doctor.  I usually respond with, “I’m older than I look!” or “Believe it or not, I’m old enough to have been a doctor for several years now.”  They can interpret the latter statement in two ways.  First, that I HAVE been a doctor for several years or second, that I’m older than the “minimum” age to be a doctor.  Of course, there’s no true minimum, but the vast majority of new interns are at least 26 years old. 

I know there has to be a certain demeanor and way of interacting with patients that reduces the number of times that one hears about how young they look.  I remember that my chief resident on my surgery rotation had this demeanor.  He was Indian, had a baby face, and was probably only 5’6” and yet only once during the entire rotation did someone comment on his age. 

I’ll keep you updated, but for now, if someone with a baby face walks in to take care of you, don’t be too panicked!

I might smack that nurse if she doesn’t stop chewing her gum at work.  So gross.

I’m too tired to get my ass off the couch and make a cup of coffee.

This is what being an intern is like.