My service is a mess. Despite me and all the other residents and some mid-level providers scurrying around all day, every night we find ourselves with a crazy list, on which I don’t recognize half the names, don’t know what procedures they had done, why they’re in the hospital, what medications they’re taking, or what we’re supposed to do with them tomorrow. I’m not sure how it happens. Perhaps the habit of sending the intern to do the last cases of the day, which are the small potatoes, at the same time that the ER and the office flood us with new admissions and consults, might have something to do with it.

A few months back, when I was covering at night for vascular, I used to be very frustrated with the intern who signed out to me. He’s perhaps the most incompetent of our year, and he told me nothing useful; I was always left to figure out for myself who had had surgery and who hadn’t, who needed coumadin (blood thinner) and who didn’t, who needed to be prepared for surgery in the morning and who didn’t, and was always taken by surprise when patients were admitted in the evening.

Now, I’m ashamed of my frustration with him. I sign out nearly as badly (at least I make sure of the coumadin status before I leave) because even after evening rounds with the chief, it would take me another hour to go around by myself and figure out what’s happening, and although I’m fairly responsible, I’m not that crazy. So every morning I come in to find half a dozen people whom I’ve got to figure out completely in seven minutes each before sign-in rounds with the chief. Then it’s off to the races again, and by the time I’ve got the overnight people sorted out, a third of the list has been discharged and replaced by a whole new crowd with new problems.

I feel like I’m running very fast and just barely staying in the same place. It’s frustrating, after spending a year learning how to be a good intern, to find myself unable to manage what I think I ought to be doing. There’s just too much going on.

On the other hand, I’m doing way more surgery than I expected to, so I ought to be happy. This is how the service is, controlled chaos, and no one seems to expect any different from me or the list. Plus, the chief and other residents are almost a dream team – the ones out of the whole program whom I would have chosen to be on a crazy service with. We have a lot of fun, in spite of everything, and they don’t leave me alone with all the work, which some people would do. The patients are doing mostly well, as well as can be expected from the kind of sick people with lots of comorbidities who have vascular surgery, and that’s the best that can be hoped for.