Being on call in medical school is much different than being on call in residency. We have 2 different types of call as interns. One person does adult/pedi admit and pedi floor call. The other person does adult floor call. I haven't had adult floor call. But it is much much nicer because you just occasionally get a patient complaining of something minor (if it hasn't been ordered yet, like prn meds). Or go to code blue (which doesn't happen that often either). You mostly get to sleep, watch movies, etc.
But I had admit call. Initially I was optimistic until I realized I finished a long day of seeing patients and doing discharges. I was tired and didn't want to do anything. After getting dinner, I met with my senior for the night to get an idea of what to do. Since I haven't had peds yet, I wasn't excited to have to deal with peds. I was given a handbook 2 weeks ago on everything I need to know for peds, but I haven't had time to read it yet. It's a very to the point book and tells you exactly what to do. But you still have to know what to look for. I had 2 admissions before midnight. I then had several pages from the nursery telling me what the bilirubin & RBC count were. How annoying? In my mind, I'm like, "Stop calling me! I don't know what those numbers mean." Eventually I was forced to open the pedi book, to figure out who is okay to go home and who needs bili lights, blah, blah, blah. My senior was kind enough to help me figure out what to do with these results. It was just overwhelming to have to think about kids and adults at the same time. Plus one kid had a high white count, that I wasn't checked out about and nothing was in the chart stating that they were aware of the white count. So we had to assume possible sepsis. Especially since the kid was hypothermic and the nurse put the baby in the warmer bed without telling us. So even though I was taught how to do a baby exam at orientation, I didn't feel comfortable doing the exam. Anyways baby looked fine and was eating better and repeat labs were normal.
My next admit call is in 2 weeks. Then I have floor call 4 days later. So this month I have 3 calls. My senior wrote down some pages of the book to read for next time. So I will try to be prepared next time. Thank goodness, I didn't have any pedi admits or newborn exams in the middle of the night. My other classmates have had it worse than me, but they weren't on inpatient service. I learned from one of them that they had 7 newborn discharges and that the paperwork was easy. It was just that they had to spend time to educate every mom on signs and symptoms of sepsis, jaundice, etc.
Overall, call sucks. But maybe it'll get easier next time.
After I finished call at 7am, I had to present my 3 admit patients and then had my patients to round on. I was tired. But I was so glad to be back in the day time. I finished seeing my patients and did 2 discharges. Got lunch and hung out with other interns for a little bit and went home at 1pm. The good thing is I get one day off every week and my day off this week is Thursday. So I had 1.5 days off if you include Wed afternoon.
Thursday, July 9, 2009
Saturday, July 4, 2009
My first rotation - Family medicine inpatient service
I started on Wednesday bright and early (although it wasn't that bright). Getting up was hard. Once I arrived at the call room where everyone gets together, I realized that this was the end of my vacation/freedom. I will be practically living in the hospital for the next 3 years.
I got a pre-checkout of my patients the previous day so I can get an idea of what to expect. I was really hoping for a short patient list. But it was almost FULL. Maximum is 8 patients per person. I had 7 to see. We round at 10 am and so I felt the pressure to start seeing my patients and be back on time. I got there at 6:30 but didn't really get started until 7am. After seeing one patient and about to see my next patient, my senior resident told me to discharge one of my patients this morning. She was really helpful and showed me how to write discharge orders and other paperwork I needed to fill out. So I finally discharged the patient which included discharge orders, seeing the patient, writing a note, writing new prescriptions, and calling the clinic to set up a follow-up appointment. Now I learned how to discharge a patient and it was almost 10 am. I still had 5 more patients to see. Yikes! My senior said to be quick and that we'll start rounding at 11am instead since it's our first day. I'm not used to feeling so rushed and overwhelmed. I finally finished a little after 11am. They were fine with me showing up late.
It was just crazy to go from not using my brain for most of 4th year, moving at a comfortable slow pace, and then to feeling like I'm running a marathon (not that I know what that's like). During rounds, I was finishing up the notes. I barely read most of the H&Ps of my patients to find out what to do next. btw, we do table rounds which is nice. When we finally finished, we had lunch around 2pm.
Afterwards, I had to put in orders in the chart or call the nurse to do it. We carry hospital phones and pagers. The hospital phones (called banana phones because they are yellow) are like pagers but the nurse can call you directly to ask a question. I also had to consult a few of my patients whom I knew very little about for GI consult or surgery consult. I finally got to sit down and rest at 6pm when my shift ended. My senior helped big time because I didn't have time to put in all the orders and she organized the checkout list of my patients for the incoming on call residents. This rotation is a lot of paperwork. I had 3 discharges on day one. Now I had to dictate 3 discharge summaries within 48 hours (that's the rule). I had Friday off this week so I spent most of my Friday working on discharge summaries (I had already accumulated 6 of them).
Day 2 was much better. I finally got a break at 5pm and had time to update the check out patient list. It was also easier to wake up on day 2.
Friday - day off, but technically I had a pile of catch up paper work to do.
Saturday (day 4) - I learned it was a short day. Yeah! I still need to work on my speed in seeing patients. We round earlier at 9 am. I had 2 new patients plus 4 old patients. I felt super rushed to see them all. Plus I had 2 discharges to do before noon. Overall, it was nice to be done by 12:30 pm and just hang and chat.
Then I went home to write this blog so I can remember what my first week as an intern was like. In a few words - crazy busy, overwhelming, clueless.
I got a pre-checkout of my patients the previous day so I can get an idea of what to expect. I was really hoping for a short patient list. But it was almost FULL. Maximum is 8 patients per person. I had 7 to see. We round at 10 am and so I felt the pressure to start seeing my patients and be back on time. I got there at 6:30 but didn't really get started until 7am. After seeing one patient and about to see my next patient, my senior resident told me to discharge one of my patients this morning. She was really helpful and showed me how to write discharge orders and other paperwork I needed to fill out. So I finally discharged the patient which included discharge orders, seeing the patient, writing a note, writing new prescriptions, and calling the clinic to set up a follow-up appointment. Now I learned how to discharge a patient and it was almost 10 am. I still had 5 more patients to see. Yikes! My senior said to be quick and that we'll start rounding at 11am instead since it's our first day. I'm not used to feeling so rushed and overwhelmed. I finally finished a little after 11am. They were fine with me showing up late.
It was just crazy to go from not using my brain for most of 4th year, moving at a comfortable slow pace, and then to feeling like I'm running a marathon (not that I know what that's like). During rounds, I was finishing up the notes. I barely read most of the H&Ps of my patients to find out what to do next. btw, we do table rounds which is nice. When we finally finished, we had lunch around 2pm.
Afterwards, I had to put in orders in the chart or call the nurse to do it. We carry hospital phones and pagers. The hospital phones (called banana phones because they are yellow) are like pagers but the nurse can call you directly to ask a question. I also had to consult a few of my patients whom I knew very little about for GI consult or surgery consult. I finally got to sit down and rest at 6pm when my shift ended. My senior helped big time because I didn't have time to put in all the orders and she organized the checkout list of my patients for the incoming on call residents. This rotation is a lot of paperwork. I had 3 discharges on day one. Now I had to dictate 3 discharge summaries within 48 hours (that's the rule). I had Friday off this week so I spent most of my Friday working on discharge summaries (I had already accumulated 6 of them).
Day 2 was much better. I finally got a break at 5pm and had time to update the check out patient list. It was also easier to wake up on day 2.
Friday - day off, but technically I had a pile of catch up paper work to do.
Saturday (day 4) - I learned it was a short day. Yeah! I still need to work on my speed in seeing patients. We round earlier at 9 am. I had 2 new patients plus 4 old patients. I felt super rushed to see them all. Plus I had 2 discharges to do before noon. Overall, it was nice to be done by 12:30 pm and just hang and chat.
Then I went home to write this blog so I can remember what my first week as an intern was like. In a few words - crazy busy, overwhelming, clueless.
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