Okay, now I’m annoyed. I left the hospital at 8:30pm, not because the patients were so sick or I was so busy (although they were and I was), but because the attending took twelve hours to round. I’m telling myself that I’m not upset just by the time of day, but because the time was wasted. I’ve stayed till 8 and 9pm before, and not been too unhappy, because I was doing procedures, or taking care of a patient who seemed too unstable to sign out. But twelve hours rounding?
This is the attending who can be found in the hospital most nights of the week, regardless of the call schedule. This morning we came for sign-in, and he told us about something he’d taken care of overnight. “But you weren’t on call last night. You’re on call tonight.” “Yes, but I was here, taking care of some things.” Um, sure. Today, the night shift nurses had gotten their change of shift report and were ready to discuss their patients, before we finished rounding on some people. Totally insane.
On the bright side, I am now better at putting in brachial and dorsalis pedis arterial lines than I am at radials, better at IJ than at subclavian central lines, and very handy with an emergent chest tube. I skipped half of rounds, taking care of those things. (That encompasses two or three patients who are terminal, and need their families persuaded that it’s ok to withdraw care; two critical head injuries in the ER that needed to be checked on every two hours; a tension pneumothorax that came up out of the blue; an emergent intubation; and a-lines and dobhoffs scattered like pepper and salt all over the unit.) And at the end of all that, I still had a long list of things to be done; I could easily have kept busy until midnight just fixing the feeding tubes, changing vents and checking repeat blood gases, and repeating electrolytes on my patients. That’s what sign-out is for, because this stuff goes on around the clock. So now I have one hour to eat and do anything else – scribble this – before I go to sleep and get ready to start again, with another slow attending, in the morning. At least the attending today has a sense of humor, and doesn’t mind if we crack jokes about his lengthy rounds; the other attendings take themselves much more seriously, and are consequently more difficult to work with, since there’s less legitimate stress relief.
One week. I can do anything for one week, right? And then I won’t be an intern anymore.
(And to be precise, I learned several tricks about chest tube placement; got to do a needle thoracostomy (actually two, just to be sure we did it right); got enough practice to get a dobhoff feeding tube in right on the first try; learned how to calculate how many amps of bicarb are needed to correct a base deficit (wt in kilos x .25 x base deficit = meqs of bicarb; don’t ask me why, I take this attending’s word for it); reviewed what to do for traumatic diabetes insipidus; did a bronchoscopy, and got the best explanation of bronchiolar anatomy I’ve heard yet; changed another whitman patch (basically velcro over an open abdominal wound, used to gradually pull the fascia back together) at the bedside; reviewed inumerable chest xrays, head CTs, and abdominal CTs, and discussed the significance of a wild variety of findings; and had at least six significant discussions with families; and exchanged jokes with an intubated patient (and what kind of a day is it when you feel cheered up by an intubated patient teasing you? unbelievable). Put like that, it was 15 hours very well spent. Until I wrote all that down, I’d forgotten some things that happened in the morning.)