Always be prepared.

Practically, this means you should at all times have the following basic supplies about your person:

- Trauma shears, because trauma patients are not the only things that need to be cut. Vascular dressings can be taken down with these; and I have found them handy for cutting JP stitches when it’s impossible to get ahold of a proper kit (after first cleaning them asepticly, of course). Attendings and chiefs tend to get testy when no one, not even the intern, can produce scissors upon demand. We live to cut, after all. Keep something semi-sharp handy.

- Lube. You’re a surgery intern, and there’s something else that you should be doing with practically every patient you see, especially the ones with abdominal complaints. (Which is one thing I love about general surgery: no matter what the reason for the consult, you can always write down the chief complaint as being abdominal pain, and you’ll be close enough.) You don’t make yourself popular with the seniors by saying, “I skipped the rectal exam because I thought you would like to see for yourself.” They are very happy to take your word for whatever you find.

- Notes on your patients. You should be able to spit out the creatinine, potassium, hemoglobin, and white count of all of your patients upon demand; and since I doubt that you can memorize all these, especially the first month, I recommend making a habit of writing down every lab value you see, since someone will inevitably ask about the one you didn’t write down. If the value is significant (new anemia, leukocytosis, renal failure) also make notes of the previous values so you can show the trend. At the beginning of the year, I also had to write down lists of medications, since I found it difficult to remember which antibiotics and antihypertensives everyone was on. As you get more used to the job, these things will start to stick without notes.

- A working pen. This is almost more important than any of these other things. If you can’t write on the chart, you basically can’t get any work done. The worst possible way to start the day (other than with a code) is with your pen running dry at the first chart, and there are no loose pens in the nurses’ station because either they’ve confiscated all of them and aren’t sharing, or they’re all using pencils tonight. With as many drug reps as there are floating around, this shouldn’t be too hard (but be wary of the cheap reps, whose pens fall apart after five days).

- A penlight is handy, if you can find a small one that works reliably. I tried four or five, but they all either quit working or fell apart on short notice, so now I borrow other people’s when I really want a cranial nerve exam. This is not efficient.

- Your beeper. I’ve tried leaving mine at home, and somehow it never makes the day any smoother. ;)

Other articles which are not as universally necessary: needles, scalpels, lidocaine, stitches. In my hospital, at least, these things are now (for “patient safety”) kept tightly locked up on only one floor, and it’s usually a long run through the hospital if you want to restitch a wound, or put a stitch on a bleeding vessel at the bedside, or anything like that. Fortunately, these happen rarely enough that you don’t get good return for the weight by keeping them in your pocket.

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