Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Heading into Residency!

It’s that time of the year when many recent medical school graduates are in the heat of getting things organized for the beginning of residency. Residency is the next phase of medical education in the United States and as such, is a period of rapid change and learning. You will be fairly independent in your care of patients; studying in a different manner from your medical school coursework but definitely getting your style of learning and practice honed.

This is a time to drop any pretenses of being the perfect “intern” and let yourself learn and absorb as much knowledge from those in your program who are more experienced. If you have traveled to a position that is different from your fourth-year medical school hospital, you have to learn how the place works as well as how you will work within your locale. When your ward work starts formally, you want to have your organizational system in place, know your way around and have your most important home location settled and ready.

For example, you should have made sure that all of your training licensure materials have been taken care of. You need to make sure you have your paperwork completed long before your program starts “New Resident Orientation”. There will be many details that need to be presented thus you don’t want to add to things by not having your paperwork completed.

For many, USMLE Step 3 will come into play rapidly. For this exam which becomes something of a nuisance for many, myself included, you have to have a date in mind to complete this test. For my residency, which was in General Surgery, I knew that my in-training exam was in January, thus I set a goal of taking Step 3 within the next two months after my in-training exam. I knew that I wanted to place most of my emphasis on my surgery exam, thus I dedicated about 30 minutes per day on reviewing my medicine for Step 3. I set this schedule into my schedule of reading so that it became a habit.

In terms of reading, I asked my second-year residents which books and papers would be best to start my reading for both my in-training exam and Step 3. Again, I wanted to rely on the experience of those who were immediately above me in my program. I also sought the wisdom of my faculty adviser in my baseline reading too. If there was anything that I didn’t count on, it was that I wasn’t able to set up a regular physical conditioning program, something that would have made my PYG-1 year more efficient.

In other posts, I have emphasized the importance of taking care of your physical conditioning. Not only is being in good shape helpful for stress-reduction, good conditioning is most helpful on those very long nights when call seems to go on forever. If you are in good aerobic condition, you perform better even when you are exhausted. Figure out a way to eat well, low fat and low sugar foods along with doing at least 30 minutes of aerobic exercise five to six days per week. Your rest and your brain with be grateful.

If you haven’t figured out how you will keep track of your patients, look into any system that might work for you. At this time, you can do a little experimentation and make adjustments when you begin seeing patients. I had to alter my patient tracking system from the one I used as a fourth-year medical student because my residency hospital patient tracking/health record system was different. It’s easier to make adjustments than find yourself overwhelmed because you didn’t have a system to begin with.

Make your home your sanctuary of solitude in any way you can. For me, my solitude involved investing in dark curtains in my bedroom that I could close on a bright sunny day post call. I found that I needed the darkness and cool for rest and relaxation. I also found that I functioned best post call when I didn’t encounter another human being for a few hours. Figure what works best for you and stick to it.

I made a schedule for my post call days so that I could do routine chores such as laundry and grocery shopping as part of my relaxation. Grocery stores that were open all night became wonderful for me. I planned my menus for the week, cooked on weekends that I wasn’t on call and kept my freezer stocked with meals that I could pop into the microwave rather than hitting the fast-food establishments. I have continued this practice even today because as I have aged, good nutrition is very important.

I used one of my spare bedrooms as an office. In my home office, I kept my textbooks, computers and study materials, much as I had done in medical school. Since I kept a regular reading schedule, I checked off book chapters and topics as I completed them. Even with a regular reading schedule, I always felt that my fellow residents were better read than I was, even though it probably wasn’t the case.

Finally, I had to schedule in time for my friends and family. Residency is a very hectic time but family/friend time is as important as reading and study time. Most Sundays, if I was able, I attended church if for no other reason, to thank my Higher Power for giving me the strength to stay on top of my work. Find a religious institution in your location and attend once in awhile if you don’t belong to any particular religion. It’s just another outlook and fellowship with people who are likely not hospital folk-good for your brain.

My favorite hobby, outside of sleeping on my rare days off, was going to the movies. My restless brain needed to enjoy some pure entertainment. While television can be tempting at home, especially since you can be in your “jammies”, it was better for me to get out of the house for a couple of hours and watch a movie or attend a concert. Football, lacrosse and soccer were also great getaways for me too.

In conclusion, residency is going to be a time of learning, reading and stress. Most of the stress will be self-imposed because any new situations are stressful for most humans. You will be learning about your patients in depth, trying to anticipate their needs and keeping your senior residents/attendings up to date on how you are caring for the patients on the services.

Again, try not to take yourself too seriously in terms of forgiving yourself for making mistakes but learn from those mistakes. The people who are more experienced on your team only expect that you do your share of the work and that you learn from your mistakes. It turns out that this is a great way to learn what you need and sets you up for getting the best experience for your program.

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17 June, 2017 Posted by | intern, life in medicine, relaxation, residency | | Leave a comment

Holding Out For a Hero

Occasionally, I have an opportunity to do a case with my senior partner,  a surgeon who spent the first 15 years of his career in the United States Army, having graduated from West Point before attending medical school. He retains many of the armed forces characteristics; not the least of which would be his closely cropped grey crew cut/buzz, no facial hair, excellent physical condition and minimal chatter with a clipped mid-western accent. When he walks into any room, we all tend to “stand at attention”.

On this occasion, he asked me to place a vascular access port for chemotherapy, for this patient who had cancer. He had another portion of the case to perform with a resident but thought it would be more efficient for me to place the port while they completed their portion of the case. Of course, this was a chance for me to enjoy the pleasure of doing a case with another physician; always a pleasure for me.

As I entered the operating room, I heard the wonderful sounds of one of my holiday albums (I realized that he had purloined my “Come to the Celebration” CD by the Birmingham Southern College Alumni Choir) thus, the atmosphere in the room was joyous and wonderful. A twinkle in the eyes of all participants in this case (light anesthesia); positive sounds for the patient.

I set about the work of placing the chemo port, finished and then took a seat at the circulator’s table. The lights were then lowered; the laparoscopic portion of the case began. The resident was in the middle of his first year; still becoming comfortable with the mechanics of the operation of the foot controls for the electrocautery. My partner, ever patient and calm, spoke encouraging words as the resident struggled with nerves and the foot pedal a bit.

Here I sat, an opportunity to listen to soft and melodious holiday music along with observing a master teaching surgeon. “How about if you hold the cautery this way, you can have more control,” he spoke softly as he corrected the hand position of the resident. I could see the nervousness of the intern start to dissipate with the touch and words of the professor. The dimmed lights, the soft holiday music and voice of the professor.

“Try to keep the instruments in the center of the field”, he said to the physician assistant who was driving camera for the first time on this case. “Move slowly but follow the case,” he said. I was reminded of my first camera drive when I was a medical student. Certainly, my professor back at that point wasn’t as nice or as instructive. He took the time to correct the PA too.

As the case moved on, the professor and student took turns making the repairs that were needed; hundreds of moves in almost perfect choreography. It became time to close the small incisions from the procedure. “Have you closed these before?”, he asked. The intern said that he had watched but hadn’t actually closed. “Let me show you the technique,”, my partner said. He took the suture from the scrub nurse and explained every hand position, needle angle and move that he made.

“Now you close the other one,” he said to the resident. He softly talked the resident through the simple stitch to close the small incision. He adjusted the hand position and kept encouraging the young surgeon. “I will show you a couple of ways to practice this at home so you won’t forget what you have learned today. You are coming along fine.” he said.

I was lost in absorbing the encouragement, the teaching and the affirmation that the professor imparted to his trainee. I was reminded that surgery is taught from master to apprentice. The better we teach, the better our residents become. It was wonderful to watch this master at work and savor every moment!

I was listening to a couple of the senior residents talk about the confidence factor that every physician has to develop. “Sometimes you have just be a jerk in order to get respect,” one of them observed. As I watched my partner teach his intern, I realized that being a jerk is the last way to earn the respect of others.

Here was a surgeon who had spent time in Army hospitals in Europe and the Middle East. He had attained the rank of Lieutenant Colonel before leaving the Army for the life of a civilian surgeon. He stood arrow straight most of the time with his 6’3-inch slender frame but readily adjusted the height of the operating table to accommodate the 5’7″ height of the resident.

As I watched my partner teach a relatively simple case to an inexperienced intern, I had nothing but infinite admiration for this father, husband and physician. I realized that with his day-to-day performance of his teaching and patient care, he is the “hero” that those of us in an academic practice should seek to become. With my years of experience, I had picked up a couple of new bits of knowledge by just observing  this case. I hadn’t said a word because the conversation from master to apprentice was a great instructive experience for me. “You still here?” he questioned when he finally looked up from the case.

There was never a time, even when the intern didn’t know the answer to a question, that this professor uttered a negative word. Perhaps it was the affirming holiday music, perhaps it was my presence in the operating room but I suspect that it was the result of just being an “everyday” hero.

 

9 January, 2016 Posted by | general surgery residency, intern, medical school | | Leave a comment

Suicide

I have wanted to push this post out for many months. This is very difficult to write about because I am still so close to the raw emotions and feelings. I want my readers to understand how much many of us who take on the task of teaching others medicine care about our teaching and our students/trainees. This was very close to me and stays with me because the young person that I write about left behind two young sons and a young spouse who is somewhat adrift even today when I spoke with them.

I met this young resident physician when they entered the program where I teach. That first day when everyone met and introduced themselves as we all sat around a large oval table. The PGY-1s and the faculty members who would get to teach them and get to know them. The resident was full of hope and anticipation being so happy and grateful for a match into our program. Everyone was so hopeful even knowing that residency pushes one to limits physically and intellectually in the case of surgery. Many believe that the major test of medical school is the measure of a physician but residency is where practice begins and starts the foundation of what will be a life of practice and learning. While medical schools gets one ready for residency, the experience of managing patients and performing surgical cases first as surgeon junior and then as resident is the making of a surgeon.

This resident started out on a ward-intensive rotation under a chief resident who was a patient teacher and generally supportive of the junior residents and medical students who were on the service. All reports were good and the resident was progressing well-not superior but more than adequate. All PGY-1 residents need to sleep more, read more and get out of the hospital as much as they can. The faculty in our program work with the chiefs to make sure that the workload is challenging but not oppressive. I love to do patient care along with my residents because I love taking care of patients. On many weekend mornings, I round, write my own notes and inform the chief of what I have been doing so that the junior residents and medical students are not so burdened.

By the end of the first half of the first year, all of the new interns (PGY-1 residents) seemed to be getting into a groove. The major services: general surgery, colo-rectal surgery, minimally invasive surgery and surgical oncology, were humming along well. The specials: vascular, pediatric, thoracic, critical care, cardiac and plastics were well-covered with interesting cases and patients. It seemed like the year was going to roll along in that predictable manner so that we could all gather at the end and make fun of ourselves while sending the graduating chiefs off in appropriate fashion.  Mid-way through this year, one of the new interns started to unravel a bit. I was asked to do a bit of counseling and unloading. I am happy to play this part for the program.

It is a general fact that most interns will not ask for help when they are getting overwhelmed, especially in a surgical program. There is the code of the surgeon being tough and resilient, thriving under pressure and invincible. Some of my fellow attending physicians still subscribe to this code of conduct but I am having little of this. I love showing my vulnerable side, and often do,  because it enables me to show my strong side at the same time. Yes, I am a human being that is the same as my patients and those I train. I learned from a very wise surgeon colleague that I have to allow those who encounter tragedy and stress to decompress immediately and to keep decompressing. As a leader, I owe this to those who work with me in this profession.

The intern seemed to have a difficult time dealing with the night float where one has to shift rapidly to cover the incoming patients. On my call nights with this intern, I would generally cap their load so that some rest and learning could take place. I calculated the average for the past week and capped when that number was met. Anything over the cap, I admitted, worked up and handled with the chief resident. This generally didn’t amount to many patients but it created a sense of teamwork and accountability for all of us. I loved presenting new patients in morning rounds and having the chief question me (same as the interns) about management. This is a great experience for all of us and continues today.

Along with difficulties on the night float service, personal problems at home began to creep into the picture. The spouse was having an affair and the children were feeling the effects of the strained marriage. Being single, I am surely not equipped to counsel anyone on marital stresses but I did strongly encourage this resident to seek some outside counseling. I assured this young physician that I would be as supportive as possible in making sure that my colleagues understood the grave nature of the home front problems without betraying any confidences. I know of great love and feeling for another person and the loss of that person can be raw. I also know that every person deals with loss in different ways and that with the stresses of a surgical residency, seeking some marital counseling is probably a sound idea.

Three week later, this intern was still trying to balance work and family struggles. Things were unraveling and I suggested taking a leave of absence for the remainder of the year. When things can’t be worked out and work can’t be done, a leave of absence is often the best solution. This was arranged by the program director with an offer for this resident to attend teaching conferences and educational classes as much as possible. We offered a research position that had been left by another candidate so that this resident could have some income. We all offered support and fellowship but substance abuse came into the picture.

I don’t know how substance use began but I noticed the smell of alcohol during one of our educational conferences. I immediately asked the resident to leave because the smell of alcohol can’t be on any physician who is in a clinical area without exception. I was deeply disappointed but asked to chat the next day when possible. The resident never contacted me. Later an admission for overdose of opioids (deemed accidental) along with alcohol. I rushed to the emergency department to find the resident semiconscious and unable to communicate. Clearly, as I spoke with them later, I emphasized the need to spend some extended time in counseling but I could sense a drift away. The shame of losing a training license and a residency position was more stress and deeper into a despair that I was not equipped to handle. I begged this fellow human being to reach out for the sake of the family and children.

Medicine and medical school into residency and practice attracts a person who becomes comfortable with work toward long-term goals. One has to have a high degree of comfort with the long term process because the journey is long. Along the journey goes the family and friends but the resident is the common factor. I know that my colleagues who have families are happiest when they spend as much time as possible with those families. One of my colleagues always says that he can’t understand where my recharging takes place (my spirituality, my adventures and my sheer wonder of all things as I go through this life). This experience rattled my entire experience with medicine and still does.

When this resident committed suicide, I plunged into a depression that only my faith could keep me going. I prayed myself to put one foot in front of the other one so that I could get out of the door of my house in the morning.  I know intellectually that I couldn’t force another adult human being into making better choices but I still can’t fathom leaving behind precious children. It is my firm belief that children can weather the disintegration of a marriage if the spouses involved are dedicated to raising them. I also believe that children only want your time and unconditional love (my experience with my nephews). In honor to this resident who felt so much pain and was unable to get the help needed, I listen intently to my trainees. In honor of this resident, I search intently for any shred of hopelessness in my colleagues, residents and students. In honor of this resident who was kind to their patients and to others, I strive to be kind to others. In honor of this resident, I try to learn the lessons of life and to be thankful for life.

30 June, 2015 Posted by | general surgery residency, intern, residency | , | 19 Comments

Being a good intern (PGY-1)

I was reading a post on one of my favorite blogs , Missionary  Doc in The Making  http://doctajay.com/?p=1489 , where a young orthopedic resident describes some of his experiences in striving to be the best intern that he can be.  I am reminded of my first months as an intern in General Surgery. I remember that my first chief resident chewed me out daily for the first week because of the things that I had missed in caring for the floor patients. By the end of that week, I was a better intern because of those “daily chewings” and my experience working under this chief resident. I learned how not to “miss” anything and how to become efficient enough to get into the operating room to scrub a case or two during the day. If I had not had a very demanding chief resident during my first rotation, I would not have learned as much as I did. It was an awesome experience and I am thankful for the heavy workload that helped in my early training. In short, I learned to “think on my feet” and to make detailed observations in a short period of time. I also learned to provide the very best care of the patients on my service that I could.

Yes, I was bone tired when I arrived home each day. I usually arrived at the hospital at 4:30AM and didn’t leave until after 7pm each day. By the time I arrived home, I took a shower and hit the bed so that I could get some rest to start the day over again the next day. If I was on call, the other interns would sign out to me around 6pm and I would generally make quick rounds on the sign-out patients so that I could see if there would be any issues. I was also a compulsive list-maker so that I could check off things that just needed to be done. I would try not to eat a heavy dinner because I found that the night would drag on. I kept myself well hydrated with iced tea (avoided coffee in the evenings) and generally used my call time (if I wasn’t busy) to dictate discharge summaries and get things ready for my patients who would be going home the next day. During the night, I would read and then nap (couldn’t really sleep soundly in the noisy call room) and rest as much as possible. At 4:45 AM, I started my post call day, did my morning notes and usually left the hospital around 12 noon after all notes were done. If there were many things to be done in the morning, I would help the on call intern and then leave when things started to slow down for him.  I learned quickly that teamwork was the best thing that we could do for each other to get the work completed as efficiently as possible.

On my very first rotation, my fellow intern on service was not much of a colleague. He left many things undone and generally refused to do work that needed to be done such as discharge summaries. I simply took over his paperwork and mine too. I knew that work had to be done for the service and I picked up the slack rather than complain. Again, it was good that I just pitched in and worked for the team and the patients. I wasn’t doing the other intern’s work for him, I was doing the work that was needed for excellent patient care. All of the patients on the service were mine as much as his. Again, the more work I did, the better I became at getting things done. I wasn’t long before my residency director figured out that I was keeping the service humming along and that I was always one for taking up the slack. I also earned the respect of every one of the chief residents who always wanted me on their services and were ready to teach me things that I was eager to learn.

The thing about being a good intern is that you learn to prioritize your life. You learn to appreciate how important your home life is to your work life. You appreciate just spending time with the people who you love. You also start to be come thankful for all of those hundreds of little victories that you get during the day. You learn to forgive yourself for missing things and you learn to not forget those same things the next day. The fortunate thing about medicine is that every day is a new opportunity to learn and grow as a physician if you take the time to do so. Medicine is a joy to practice and a daily reminder of those who are less fortunate than myself. In only a second, I can be the patient lying in that bed who is worried about recovery and how their life has changed by illness. One has to take good care of one’s life at home, one’s spiritual life and one’s health in order to be able to give our patients that best that we can.

I have written other posts about staying awake and keeping myself committed to the thousands of patient care tasks that residency will demand. Most of the things that I learned about patient care and keeping up with things, I learned as an intern. It took about two weeks into my first rotation as a new intern, to not be panicked with those “calls” from the nurses in the middle of the night. I learned that I actually know how to take care of patients and that I was confident in getting the best for the patients that were under my care. I learned to have a good relationship with the folks in the allied health care professions because they helped me take care of my patients. Medicine today is a team and not just one person doing everything.  Yes, the physician is at the head of the team but having good people around me who can do their jobs professionally, is worth gold. I am thankful that I am generally an easy-going person but can be pretty decisive when I need to make decisions.

If medicine becomes drudgery, then you have chosen the wrong profession. If you can’t keep your mind interested in the care of your patients, then you are likely not going to be a very good or very competent physician. Your patients teach you and your colleagues help you every day. Medicine is truly magical when every one and everything is in that zone where you start to appreciate the magic. Medicine is and never was a “job” for me but something that I feel blessed in order to do. When I read my friend’s blog about going through internship and all of the great learning that he has in front of him, I see myself and I see how far I have come.

16 October, 2011 Posted by | general surgery residency, intern, on-call | 3 Comments

Venting

I remember doing a case with one of my favorite attendings. This person was a colo-rectal surgeon who would talk through out the case. I was an intern at the time but I remember him saying that his talking was just “venting” and that he hoped it wouldn’t bother me.  I looked at him with amazement because his “venting” was putting to word, many of the thoughts that I was having as we went through the case.  I had felt honored to be able to scrub this case with him because usually, one of the chief residents would have taken this case but everyone was tied up and thus I asked if he would mind if I scrubbed with him. He said that he was happy to have me there.

The Teaching

He explained the fine technical points from skin to skin allowing me to mirror many of the things that he was doing. He pointed out anatomy and explained why he loved mobilizing the rectum and why colo-rectal surgery was always a rush for him. I was mesmerized by how fascinating going through this case was.  In short, I was being treated to the first of many one-on-one mentor-trainee sessions with this young colo-rectal surgeon. His enthusiasm for his craft and his ability to teach me what he found amazing was delightful. From that point on, I always held a special reverence for colo-rectal surgery.

He marked out the incision line for me and handed me the scalpel. He showed me how to make sure I had just the proper amount of tension and counter tension as we entered the abdominal cavity. He showed me how to explore the abdominal cavity and how to palpate the liver for cancer mets. He pointed out the fine points of living anatomy as we located the tumor that we knew we would be able to resect.

His next lesson was how to put two ends of bowel together. Today, he said, we would do a hand-sewn anastomosis. Sure the stapler is nice to use but once in a while, a hand sewn anastomosis is a good thing to do. He showed me how to resect the section of colon leaving plenty of margin and the fine technique of location the numerous vessels that fed this wonderful organ. Again, the living anatomy is a wonder to behold and being able to see how this tumor would be removed was great.

We carefully sewed the remaining ends of  the colon together using Lembert stitching. He talked, he vented and I watched and listened. Together we completed the case and at that moment, I understood why operating on the colon is both fun and something of a challenge. I had to always keep the anatomy in mind, the technique perfect and move in an efficient manner. I remember laughing at him describing the “big honking vessels” that we would be ligating and why one doesn’t want to even think about ties not holding. He said that when he started residency, he would lose sleep over thinking that his ties were not secure.

Technique

One of the great things about doing a case with an attending like my colo-rectal professor is that he does vent the things that go over and over in my mind. Are my ties secure with every knot? Are my hands going in the right direction? Have I identified the vessels correctly and ligated them using proper technique? After all, surgery is a practice which has to take place over and over for years. Even now, year’s later, when I don’t have to think about every suture or every tie, I still mentally revisit some of the cases that were turning points in my training for various reasons.

There isn’t anything magical about surgical technique but there is something magical about having the knowledge, background and education to use that technique properly. This is what I learned across the table from my colo-rectal professor. He vented and I listened to all of those pearls that he would verbalize. For me, his venting was golden and some of the best teaching that I ever encountered. He was an extraordinary teacher and he would often tell us that if he was in our position, his venting would drive him crazy. Well, that was never the case for me. His venting made me see the artistry of colo-rectal surgery and why having impeccable technique was paramount for these patients.

The best teaching

It’s no accident that the lessons that I remember best came from my first two years of surgery. By the time one reaches third year, there is a comfort level with being in the operating room. The lessons of my first two years were magical and have not left me. Those late night cases with the chief residents, moving through the abdominal cavity on a laparoscopic case or the first time I was able to close the abdominal cavity and feel confident that I had done this correctly, were memorable for me.

I was fortunate to be exposed to some of the greatest professors of surgery under a variety of circumstances in addition to having some of the best chief residents who were willing to give me their best too. There is much joy in this type of learning and a great amount of joy in venting.

28 December, 2008 Posted by | colo-rectal surgery, general surgery residency, intern | , | 7 Comments

Internship or PGY-1

After graduation was complete and I had finished filling out all of those thank-you notes for presents and good thoughts, I turned my attention to making preparations for my move to my residency location. Over my four years of medical school, I had accumulated loads of books and papers. The first thing that I did was toss out any papers that would not be helpful to my little sibs back at medical school. The next thing I did was get rid of the rest of my books and USMLE Prep materials. My little sibs split the lot of them.

We started packing on a small scale but quickly realized that we still had too much “junk”. I even had boxes of things that I had accumulated and had left unpacked for my previous move that had taken place at the beginning of my third year of medical school. I had moved to be located closer to the clinical affiliated hospitals to shorten my commute. A forty-five minute commute was OK for medical school because I could study on the subway but I wanted to spend no more than 20 minutes if I was going to drive.

I made a couple of trips to the location of my residency. I took one of my best friends so that we could scout out some great places to live. She helped me pick out a wonderful three-bedroom home that was located in a wooded area with plenty of jogging and bike trails. Since I have a couple of dogs, I wanted a spot where they could get some exercise and I could get outside. I found the perfect place and I loved living about 1,000 feet from a beautiful lake with woods and streams all around.

After the move, I had one day to get to orientation. I was still in the midst to unpacking on orientation day. I had completed my criminal background check and drug testing. I had also finished completing the materials for my license and smooth move to the local medical society. Orientation started early with mugs of strong coffee and plenty of folks who looked as scared as I was. We received our pagers, our lab coats and our directories. The second day of orientation is where we received our departmental information including our rotation schedule.

I started with Vascular Surgery. These patients are among the sickest in the hospital. I quickly got into the routine of rounding in the early morning (0400h), getting my notes written and then getting ready for rounding with the team. The team, which consisted of the fellows, the surgical chief resident, a mid-level resident, two interns and four medical students would then round. It was the duty of the interns to write every order and plan after we presented our pre-round findings to the fellow and chief.

The residents and students would head off to the operating room while the interns would get orders and discharges done. We would follow up on all labs and studies and then get the discharges completed. I quickly learned to “pre-discharge”, get the orders ready and then make one click to send them to the computer. The computer would print all instructions and prescriptions for me to sign. My dictations would be done at that time too.

Once the daily ward work was underway, one of us would try to get some OR cases while the other intern waited for new admissions and post-ops back from the OR. We would also follow up on all information that came from consultants and all studies as the patients returned. When the patients came back from the OR, it was my job to get them settled in and follow up on what had taken place during surgery. I would look at the OR reports, anesthesia notes and any history and physical information. I would also start a note sheet for tomorrow’s note and check all orders.

By the evening, the fellow would leave and I would report all studies and findings to the chief resident. He or she would add orders or give me the plans for the next day. If anyone was headed for surgery, they would need to have preoperative orders placed for things like nothing by mouth after midnight. Periodically during the day, I would visit each room and find out how the patient was getting along. I would also do things like debride (clean off dead tissue) wounds and follow vital signs and labs. If I was not on call, I would leave the hospital around 6pm after reporting to the on-call intern. If I was on-call, I would receive report from the services that I covered.

I had the unique opportunity of covering cardiac, thoracic and vascular when I was on call. The other interns only covered one other service and their own. At first, the cardiac patients were scary but later, I fell into taking care of them just as I took care of my own vascular patients. My patients were the sickest patients on the three services and I knew them best.

After vascular, I rotated as intern through surgical oncology and colo-rectal surgery. My program director was very impressed with my work so he decided to change my schedule to include a month as Surgical Intensive Care Unit resident. Usually, this rotation would go to a second year resident but a couple of interns managed to get this rotation. I was fortunate because the other two residents on this rotation with me were second year anesthesia residents. They taught me how to place internal jugular central lines and to float Swan-Ganz catheters. The nephrology fellow taught me to place temporary hemodialysis catheters and how to calculate fluid balance. I already know loads about mechanical ventilation but I learned even more from the critical care specialists. It was a great month for me.

I was then invited to spend a couple of months at the Veterans hospital. This was an away rotation that was totally awesome because there was so much operative experience. I honed my surgical skills and could hold my own in the ICU. My chief resident was very comfortable with my work and left me in charge of the service (as an intern no less) when he needed to go out of town. At first, it was scary but I learned that I could trust my instincts. My attending physicians were great teachers and things hummed along for me.

I went through another rotation on Vascular and then Thoracic. I made a deal with the other interns in that I would do all of the dictations and discharges if they would pull chest tubes and work out discharge planning. They hated to dictate and I had become very efficient at getting these things taken care of thanks to the VA hospital. My fellows were great to work with also. I was very comfortable calling them at home and updating. One of the most demanding fellows turned out to be one of my best teachers. He showed me how to sew down grafts.

I finished my year as Night Float intern. I covered all of the General surgery patients. There was an intern for Trauma who took care of the Trauma patients and did all admissions. If he or she was busy, I would admit patients and follow up on studies. I learned to anticipate problems and get them taken care of. I also learned to do make things happen that needed to happen. I made great friends with the night radiography technicians who would get studies completed for me and placed in front of the radiologists before I could get down to the department. They were great folks to work with.

As I headed into second year, I knew that second year would be my worst year. As a more senior resident, I would expected to play bigger role in keeping the service running. Since I would still somewhat junior, I still had a huge learning curve too. All in all, my intern year was great. Some of my chief residents and fellows were very difficult to work with but I always stepped up to the plate and got the job done.

Being a good intern is being anal about every detail of your patient’s care. It took a few months to learn the “ins and outs” of good patient care but I took careful notes and operated every chance that I could. The nursing staff also gave me high marks for getting things done and keeping the services under control. The hours are long and sometimes the work seemed endless but there was a learning point to every task. Intern year went quickly but I felt in control of my learning.

6 January, 2007 Posted by | intern, surgery, vascular surgery | 2 Comments