Medicine Month

It's been over a week since I finished my month rotation in Internal Medicine at St. Francis hospital, but I still remember much of it vividly.

The first was chaos. I couldn't log into systems, didn't know how to get anywhere or any information and the job as foreign to me as Tokyo. The worst part of the month though, was the incredibly inefficient use of time and lack of learning. At least I had a pretty decent resident and one good Attending.

I ended up arriving each day by 6am to pre-round on my patients. Since I was the only Intern on my team (there was supposed to by two to share the load) I had to write Progress Notes on 5-6 patients as quickly as possible. Usually I just got vitals and new labs/procedure notes by the time my Resident arrived at 7am (7:30am in my case since he was always late). So 7-8am was wasted repeating my previous hour or trying to understand what the heck the Resident was trying to achieve as he mysteriously entered orders.

At about 8:30am we officially rounded with the first Attending. This Attending was a total waste. Didn't learn squat, but ran around chatting with everyone. Finally, we had 9:30am Attending rounds where we actually saw patients, but only the Housestaff patients. This system made no sense and seems even now detrimental to patient care. It also meant that I typically any lecture prior to lunch so that I could finish up Progress Notes by the noon deadline.

After lunch, we ran around trying to nail down details, implement our Attending's suggestions for Housestaff patients and make treatment plans for Private patients' clueless Doctors. Sometimes we got new admissions or transfer patients around this time as well. What should have taken a couple hours and allowed to get out by 3-4pm usually got dragged out until 5pm or so. My Resident loved to chat, write book length notes and move at a pace that made it obvious he was in no rush to get home.

These were the weekdays, when I didn't have Call, which came every fourth day. Weekends I had off, but given Call I really only got one weekend off. The other three included Call time. Call was pretty typical with little sleep and a chaotic mix of admitting new patients and dealing with cross-cover issues for the other Interns' patients. The nurses were a mixed bag, with many calling me at all hours for inane questions.

Again, if we were efficient and hard-working we could have left by 10-11am most mornings post-Call. But my Resident was in no rush. He certainly provided exemplary patient care. But I usually was dragging myself around until 1-2pm the following afternoon. Shifts lasting 30-31 hours take a couple of days to recover from. Even I managed to get 3-4 hours of sleep it was fitful sleep in my shirt and tie frequently interupted by pages from nurses with questions that could usually be answered over the phone or with an order.

I expected the hours, resentment for the archaic dress code, hospital inefficiency and politics, but I was surprised by how little I actually learned the whole month. Time constraints, exhaustion, a bad teaching Attending and a Resident with little teaching experience are probably to blame. But it seems like an opportunity lost.

In any case, I've paid my dues. IM is behind me and I should never again have to be the Intern covering the floors over night. And every day I had that moment where I felt my decision to go into Emergency Medicine was validated.