Is the answer to the question what I will be when I grow up! Besides last month the last few months haven’t been all that bad. I was on Neuro for a month and then GI, my role was somewhere along the lines of a med student with the ability to write prescriptions. I got weekends off, and for the most part was home well before 5pm. Nothing to complain about at all, in fact I was starting to slip away from the reality that intern year is supposed to be hard.
The slap back to reality came last month when I started on the CCU service, or cardiac critical care, other known as the soul crusher. I wrote a post a few months ago where I over exaggerated a mythical intern being physically beaten with charts. It wasn’t until I started the CCU that I felt that post was actually gaining legitimacy instead of absurdity.
So just to get the basics down, the CCU is the admitting service for cardiology. We admit patients to the ward, or the ICU and we admit everyday. If the rotation of Pluto is at 72 degrees above the horizon there is a chance that all the days work can be wrapped up by 4:30 and all of our patients can be signed out to whoever is on call for the night. There are two interns on the CCU and three on the regular ICU, we all rotate call (that whole 30 hour thing). As you may have guessed it was pretty rare to sign out before 8pm. The only issue with this is that in order to see all my patients in the morning I was getting in around 4am, sometimes earlier. It is not hard to see how you can be pretty screwed if you're getting out at 9pm and then are on call the next day going on about 4 hours of sleep. The thing is I have no place to bitch about a Q5 call schedule, as my surgery friends can testify that it would be a vacation compared to Q3.
Actually working almost triple the hours what the average American works wasn’t even the worst part. The worst part was working with bitter, aggressive, tormented, and all together angry people that redefine passive aggressiveness. This in combination with a breakdown of communication at almost every conceivable level is the perfect formula for Intern hell. There are two fellows that basically run the service, two senior residents below them and of course two interns. The fellows run around all day long tending to the patients and performing mysterious procedures that ultimately get transmitted to the team, by either illegible notes, or I guess telepathy. And who is ultimately responsible for tending to these micro-details, on a service that will admit three patients and discharge them the same day, you guessed it.
Basically the team moved so fast, and with so much miss-communication I had to pretty much revamp the way I did everything. The issue with that is that after doing a few months on the medicine wards, not to mention two years in med school I felt pretty good about my system of organization, so the fact that one month could basically make me feel like a new third year med student again is pretty impressive.
As an example, when we rounded on the patients I would often get scutted out to go make some phone call and miss some key thing that the attending said and of course later get yelled at about it later. To counter this I started bringing a recorder on rounds and would tape entire presentations, and listen to the things I missed after rounds. Its sounds over the top, but it turned out to be a lifesaver more than once.
On my last day I remember walking outside and the sun hitting my face, having not felt it in over a week in conjunction with being done with the nightmare I think it was the happiest I have been all year!