Not a fun night. One of the services I cover did its usual crazy thing, admitting three patients right at sign-out, and spending five hours in the OR with one of them. I’m getting a little tired of working with the intern on this service. He means well, and I don’t think he’s deliberately neglecting things; but it’s getting to the point where I feel I have to double-check every point he tells me in sign-out, otherwise the nurses will be calling me at 2am: “this patient is for the OR today, did you mean him to be NPO?” “this patient just started coumadin, do you perhaps want an INR drawn this morning?” “this patient got a transfusion, would you like to check the hemoglobin count?” “this patient was admitted the other day, would you maybe like to write an H&P for him?” and so on.

Then, the ER called us with the most outrageous consult. There was no imminent surgical issue – maybe in a few days, maybe – and the patient was to be admitted to another service, but somehow we were called to see the patient in the ER before the admitting service was called. I and the senior resident got so frustrated we actually started arguing with the ER attending, who is a frequent offender on such points. Usually as a resident you try not to get into it too much with attendings; but still. And then there’s this other ER resident who is making a habit of calling me the minute a surgically-related patient hits the door, without having even labs, let alone basic imaging (I mean xrays; I support the idea of not scanning people unless the surgeon asks for it), sometimes without a complete history or physical. I mean, he’ll call me about vascular issues without bothering to check pulses, based simply on the report he was given. I keep meaning to make an issue out of it, because all it does is make me wait in the ER for an hour before I can call anyone (because you bet I’m not calling my attending without a white count and a creatinine), instead of him waiting for an hour before calling me (because once he’s called me, I don’t dare to simply wait for the labs to come back before looking at the patient; maybe the patient is acutely ill and requires emergent intervention without labs; hasn’t happened yet, but it might). But then every so often there’s a delicate patient who I am happy to hear about quickly, so I haven’t managed to argue about it yet. And he’s senior to me, and thinks he’s being efficient, which also makes it difficult.

Finally, and this is the real reason that I am fed up with the day intern, I had to manually disimpact a patient, for the first time in my career. (Yes, I know, you’re not allowed to be done with internship, especially surgery internship, without doing this; and it so serves me right for the time I was a medical student, and ran away from helping a resident do this.) I’m not completely sure how this is the day intern’s fault, but I’m sure it connects somehow, so I’m blaming him.

Back at the beginning of the year I heard some conversation among the seniors to the effect that “it’s your worst nightmare, to be told that your patient is coding and so-and-so is running it.” I couldn’t imagine how they could say that. Now I know. There are a couple of people who already make me uncomfortable when I have to sign patients out to them. Maybe I’m just being arrogant; who knows how the other interns feel about leaving patients with me? I think I’m at least diligent, but I make lots of mistakes.

Plus, my pager broke. All the floors except for the one that pages me most often were still getting through, but the nurses on that floor became convinced that I was deliberately ignoring them, and started telling all the other night staff so, before I heard about it. Bother. I was surprised to find out how much of my identity is tied up in that little pager. I had to trade it for a different one, and I felt disoriented all night. I have my buzz, and my alarms, and my screen style; and without them, I forget how to process calls. Fortunately it’s fixed now.