I managed to look completely stupid coming and going today. On early rounds, I told the chief my management ideas for the patients, and he acted as though I was trying to assassinate all of them (or give them pneumonia, bowel obstructions, and wound infections). So I arranged to follow his plans, and rounded with the attending a few hours later, giving the chief’s plans. The attending, not very surprisingly, was thinking in quite the opposite direction, and directed different plans – usually the exact thing I’d suggested at the beginning. So now the chief and the attending both think I’m insane and don’t know how to manage patient care.

It’s nothing really, just the usual difficulties of adjusting to a new service. I can’t wait to stop being the intern. Essentially, your job is to be always running errands, and always wrong. I got to keep going in the OR to talk to people; but it got rather depressing to keep walking out again, all day. Another six months until I can stay there properly.

On the plus side, while I was rounding on patients at 5am, I heard the nurses across the hall in another unit talking: “My guy just dropped his sats.” “How low?” “70s. And his heart rate is dropping. I better go check. . . Where’s the code cart?”

There is a team assigned to respond to these kinds of things, but it would have been downright irresponsible not to go see, since it was just across the hall. I dropped my papers and ran over. This was better than most codes, in that the poor fellow’s heart was still staggering along, and he hadn’t completely stopped breathing, just mostly. I managed to get most of the right actions started (the nurses knew them anyway, but it seems to help the effort to have one person in a white coat saying out loud what everyone knows needs to be done). Then by the time any real decisions were needed, ie he went into asystole, other residents and the official code team had showed up. So I just put a line and left, in the good old surgery tradition. But still encouraging, since my last line on a patient with a good pulse and sitting still hadn’t gone well, so to be able to get a line fast on a patient with no pulse and being bounced around by CPR and intubation was good. By the time I finished they had a pulse back; and I was still able to finish rounding on schedule.

Then our service had conference in the afternoon, and every single one of us fell asleep while our attending was lecturing. Most embarassing, but since the chief and senior did it too, I don’t feel too bad. I think the med students were the only ones who stayed awake. (So nice to have the students back around; knowing that they’ll be writing notes in the morning gives me an extra half hour to sleep.)

In December I was feeling thrilled to be half way through the year. Time seemed to have gone fast, and next July seemed just around the corner. Now it’s back to a crawl, and I’m remembering how difficult these six months really were, and how much I hate waking up at 3:30am for two or three weeks straight. The month of January, let alone February and March and April, seems to be piling on top of me and stretching forever. I need to stop thinking ahead, and just consider what needs to be done tomorrow.

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