Not a great day at all. We got snowed overnight (and how exactly do you double a trauma unit’s census on a Thursday night? what happened to the concept of partying on weekends?) (although, of course, it’s the elderly people falling and breaking things that really does us in), and I came in expecting a short list, to find a combination of crashing patients brought up from the ER, and patients in extremis brought down from the floor, such that I didn’t manage to do any kind of decent pre-rounds before attending rounds. I’d seen the patients, written down the vital signs, and was staking my life on my belief in the nurses’ statements that “yes, everything’s ok, no major problems.”

They were correct, but I hate rounding on the fly. I know I’m not doing my duty by the patients, if I don’t go through all their labs separately, review the trends, and flip back and forth between recent white counts and culture results and what antibiotics they’re on, or between electrolytes and current iv fluids, or between blood gases and vent settings. If I just rattle those numbers off to the attending and make some off-hand statement about the glaring abnormalities, I haven’t done my job properly, and it makes me grouchy for the rest of the day, until I get the time to sit down and think through everything.

Today, that didn’t happen till 5pm, so I spent the day feeling grouchy, and guilty about not doing my job and about being grouchy. . . not much good there.

Plus, another patient came crashing in at noon, and I volunteered to take care of him (my fellow intern has a highly developed survival reflex which prevents him from volunteering for such disasters; his labs get looked at early in the morning, which puts him on good terms with the nurses, who don’t have to chase him to ask if he’s noticed certain aberrancies). That was what took until five o’clock to sort out. Let’s just say that my hopes for next year are reaching a very low point, due to my utter failure to perform even simple procedures which I thought I had mastered a while ago. I’m having to rethink the entire concept, including set-up, and the very foundational anatomical landmarks; I still don’t know what I’m doing wrong, and it’s very unsettling.

And then, several people decided that would be a good time to raise all sorts of interpersonal issues. . . leaving me with the impression that I’m a technically incompetent intern, a bad person, and no good at communicating even the most basic concepts. . . .

Only ten days left in this month, and I can start being a bad junior resident instead of a bad intern.