Post-Call Thoughts

At Pacific Hospital, we are obsessed with boats.

I just finished a month on the internal medicine wards. Had my first patient die. I am clueless as to what happened. He was doing fine and we discharged him back to his nursing home and the next morning I get a text from my attending saying, "Mr. Q expired this AM after an arrest; Weird, huh?" Did not see that coming.

More boats in the stairwells.

One of the best things about working in IM is all of the demented patients. Usually they like you. Usually they cheerfully endure all the crap we do to them. When they have agitation a little haldol goes a long way. And then sometimes this happens: 

Our hospital is obsessed with testing its fire alarm system, and one night, about 2 am, they tested it (WHY? Why do that to sick people in the middle of the night??). All of the bells start going off and Ms. M, a very elderly and very demented gal was sure she had won big in Vegas. She could be heard  shouting from her room, "I won! I won! Give me my money!" And she continued thus until the test was over.

More boats in the chart room.

and also secret chart room cookie stash

But Ka is a wheel, it's only purpose is to turn, and I definitely appreciate the irony of my position now. I remember my days of incarceration in the hospital and being irritable when the doctors would come in at the crack of dawn, poke me awake, and ask how I'd been sleeping. Now, I'm doing that to people even before the crack of dawn. Sorry guys.

A glimpse into the top-secret residents' call room.

complete with computer...

and bed--I'll give you ONE guess as to why I never sleep there

Here's a rundown of a day in the life of IM:

Hours are long on the medicine wards. I show up at 5am to review the overnight admissions and examine all the patients assigned to my team (anywhere from 4 to 12 people), check everyone's vitals, make sure the labs are ordered, and begin documenting the daily progress notes. Then at 7am it's Morning Report, where we dissect an interesting case from the previous night and go over the assessment and plans in minute detail. By 8am it's bedside rounds with the attending physicians as they trickle through. I usually had 3 at any time to juggle. 10:30am and it's back to the medical library for table rounds where we discuss our cases as a team with our program director and fine-tune the plans. Then it's back to the floor until 12:30pm when it's lunch-time lecture. The rest of the afternoon is spent reviewing the day's test results for all the patients on my team, doing procedures, and planning for the next day. All the hours spent on the floor are constantly punctuated by pages from nurses, nutritionists, case managers, radiology, pharmacy, etc. with questions or to address patient complaints. You may also do new admissions, unless you have reached your patient cap (12). At 5pm we sign out the entire patient census to 2 residents who cover the calls until the night team shows and takes over. From that time to anywhere from 7:30pm to mayben 9:30pm I spend dictating discharge summaries, finishing progress notes or catching the last couple of attendings for bedside rounds. If I should get home by 8, I have enough time to shove some food in my face, shower and go to bed if I hope to be conscious at work the next day.

3am face.

On weekends we share call, two of us on for the day shift and two on overnight. I'm amazed at how well I tolerate overnight call. It's because of my two superpowers (to review that is 1. not sleeping at night and 2. the ability to feed in record amounts of time). But I tend to hit the wall between 3 and 4 am. I'm sure my world-record feeding ability will come back to haunt me later in life (helloo lazy lower esophageal sphincter => GERD => Barrett's Esophagus => adenocarcinoma).

With the dawn comes my reprieve!

Buh. I made the mistake of sleeping this morning for a few hours and now I feel terrible. I shoulda just stayed up until my normal bed time.

Goodbye for now IM. I'll see you in a month.

And now for a relaxing, board-study-filled rotation on OB/GYN. I am back among my people.