First day on call as junior resident wasn’t too bad, largely thanks to no really sick transfers or admissions coming in, and the ICU patients behaving themselves perfectly. One person had a minor airway problem, but was already intubated, so by the time I arrived the nurse had already figured out a way to make it work. Another patient wouldn’t wake up, and I was concerned about a stroke, but a young attending happened to be walking by at the moment, and came to help without me even having to ask (and started asking unhelpful questions like, “are you the only one here? don’t you have senior in-house backup? are you sure you’re the only one?” Which was kind of him to be concerned, but not extremely reassuring; I told him I’d been about to call a chief at home if he hadn’t shown up.)

My intern was good: hardworking, fairly smart, and didn’t seem too flustered by his pager going off every two minutes. It reminded me how happy I was not to have his job; although my pager was going off on a regular basis too. I told him to write short H&Ps, and he managed to fit everything into half a page – a little shorter than I had in mind, but acceptable.

The only thing I didn’t manage very well was the trauma part. The junior surgery resident, in addition to handling all ER consults, all floor and ICU consults, and all floor and ICU issues, is also supposed to attend at the trauma alerts and be of assistance, in case several patients come at once, or in case one is so sick that the team needs more help than the very young interns can provide. Somehow the trauma alerts didn’t make it as high on my personal triage system as they perhaps should have, and I didn’t get to many of them. As it was, I stayed nearly two hours after the end of the shift, finishing leftover work, so it’s perhaps as well that I didn’t spend more time with trauma. I thought it would almost have been easier if I’d been on overnight call, because then I would have had a few quiet hours after midnight in order to get things cleaned up before everyone came back.

The most bothersome part of it all was calling the attendings. As an intern, you’re shielded from the attendings (or perhaps, they from you). You tell everything to a junior resident or chief, and they talk to the attending if they need anything to be cleared. This year, I have to learn how to get all the relevant data (because no one else will be there to correct me), call the attending, present the information succinctly, and suggest a reasonable diagnosis and plan of action. The attending listens silently the whole time, giving very little idea of whether you’re on the right track, or making completely insane suggestions, and then finally gives his interpretation, and rattles off a plan, which you’re then left to implement as best you can. I hadn’t realized how time-consuming it would be, though, after having seen the new patients, to first call the chief, talk to them, then call the attending, talk to them, then call the chief back (if the patient is going to the OR, or will be soon, the chief has to know), all the while trying to write the necessary orders, arrange the procedures, and handle a dozen new calls. It’s most efficient if you collect two or three admissions and consults per service before calling people, but if you’re not careful you wind up after several hours with a dozen phone calls to make, and no time.

I have a couple more daytime calls, and then I’ll be on overnight at the end of the month. The good thing is that, in spite of the stress, I do seem to like the adventure that comes from working under pressure. It’s kind of like skiing down a steep hill – how far can you get before things fall apart?

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