I’m starting a bad habit of ignoring my alarm clock, and sleeping until my mother figures that it’s about time for me to be leaving, and then I wake up with a jerk and make a very loud noise, which disturbs my sisters. . .

The other day I worked an afternoon shift. The first doctor I was with moved and talked very fast, and didn’t talk to me much, but he did look upset when I handed him a chart without having written orders on it. So after that I wrote the orders I thought of, and he added the rest, and I liked it fine. One unfortunate man sliced his wrist longitudinally, missing every important artery, nerve and tendon, but creating a nice cut for me to sew up. I got to hear all about his job and his children (in one ear and out the other, but every tenth word sounded nice) while I sewed and he ignored the needles. That felt very very good, to sew it up neatly, and see it clean and not bleeding at the end.

The night shift doctor I thought would be as nice as Dr. Dimant, since they both just graduated from the same residency program. I forgot that he’s the resident whom the surgery folks hated when they had him on at nights in their ICU, because he would never finish what they were counting on him to get done. He started off by warning me not to write on the charts, on the basis of an order he didn’t like, which actually had been written by the previous attending, not me. So I wasn’t thrilled with that change. For the rest – I guess I’m paranoid about ER patients, and way too meticulous for the setting. But I didn’t like his statement that “that’s why you never go back in the room to check on patients” (after I noticed a new physical exam finding), or “interns are fun because they have no idea what to do when their patients are crashing,” when I said I was nervous about becoming an intern. Note to self: if you have to notice details about the patients, try and not tell them to him.

The doctor today was a powerhouse – always running, talking fast, jumping from task to task. Partly the ER was busy, and partly he makes it feel busy when he’s in it. He let me do pelvic exams and all with just a nurse, not him, and would write orders based on my report, and talk to the patient later. I had a patient with remarkable abdominal pain, who turned out to have ruptured appendicitis. I was strongly tempted to try to follow her to the OR. (Finally, real appendicitis, after five patients who didn’t have it, in spite of my best efforts to diagnose it.) Another guy came in with several broken ribs, so painful that the doctor was very concerned and did a trauma workup on him, including a fast exam. He let me use the ultrasound a lot. I might actually learn to do and read abdominal ultrasounds by the end of this month – an unexpected bonus.

The patient who occupied us all afternoon presented with several episodes of syncope, and almost non-stop vomiting. After a dramatic series of tests to rule out rupturing triple AAA and various bowel problems, we fell back on “really bad gastroenteritis” and got him admitted. Another lady fell and broke her arm, and I examined her and figured things out myself. A young lady who was only a few weeks pregnant was worried that she might be miscarrying. In the absence of any suggestive symptoms, the attending didn’t really want to do anything at all, but did order an ultrasound. Presently the tech came back with a smirk on his face, and suggested that we might want to look at the pictures. He explained that he had left to us the job of explaining that she had twins. . .

I am enjoying the opportunity to see patients and make diagnoses and plans, and have to defend my ideas to the attendings. They’re letting me do I&Ds, and I’ve put in a couple NG tubes. Tomorrow I’m going to see if the lab techs will let me try to draw blood and start ivs, early in the morning, before they get too busy.

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