I watch a lot of movies and a lot of television. One of my favorite shows is M*A*S*H. I can't remember when I started watching M*A*S*H. It must have been on Nick at Nite. But, I eventually bought the box set and I've watched every episode a dozen times. I can quote it, I can give the blow-by-blow of most episodes. But, there are some episodes that stick with me more than others. One in particular is a Christmas episode where an injured soldier is flown into the unit during a party on Christmas Day. Colonel Potter, BJ, Hawkeye and Hot Lips keep everyone else in the dark while they try and save this man. Eventually they realize that he can't be saved and they instead settle for keeping him alive just long enough so that his kids don't find out that their father died on Christmas. Unfortunately the soldier dies just before midnight. They bluff the death certificate anyways. It's a good episode. One of many good episodes. But, like I said it always stuck with me.
Last night while I was on call I replayed scenes from that episode over and over again. When I got sign out for the Thoracic Surgery service I was told that one of the patients was circling the drain and that I would be notified when the decision to withdraw care occurred and that I would be required to pronounce him and fill out the death packet. This was the 4th and last time I'd cross-covered for Thoracics this month and I knew this kids story.
He was a 20 year old Cystic Fibrosis patient. He'd actually had a relatively benign course with the disease up until about 8 months ago when his lungs started tanking. But, about a month ago he got a bilateral lung transplant. And we thought that he'd stabilized and would continue being a healthy kid until he suddenly started getting sick again. A couple of biopsies later and we realized his right lung and a horrific necrotizing pneumonia tearing through it. He and his family made the decision to have that lung removed even though it meant that they would be off the donor list instead of waiting for another new set of lungs which would probably have been too late anyways.
Now, our boy might have rallied until one of the lines he had in him grew out a couple of multi-drug resistant organisms and he ended up septic. We loaded him up with 8 different antibiotics by the end of his course in an attempt to stop the bugs tearing his system to shred. But the CF had left him so weak he couldn't mount his own immune response. Not to mention that we couldn't keep his respiratory status up.
This was the story my co-intern presented me with on Sunday morning. Now, my co-intern is doing his intern year in surgery before moving onto the good life in Radiology. He chose a much harder specialty than he had to and he works harder than I've ever seen anyone work. In addition he's married with a daughter at home who is only a few months old. He's pretty strong guy but I was afraid he was going to break down while he was telling me about this patient. He asked that I keep him updated as changes were made for this patient. So when the family made him DNR/DNI I called him and when we de-escalated care later that night he said he was coming in.
He paged me when he got to the hospital and I stopped by the unit to check in on him and the patient. My patient's whole family was crowded around his oversized ICU bed and I felt like a voyeur looking in on them. I sat next to my co-intern and we talked about who should pronounce the patient and who should fill out the patient. He wanted to take that responsibility and as much as I didn't want to do it I was the one that was on-call and it was my job that night. Not to mention that as hard as it was going to be for me it would have been ten times harder for him. I hadn't spent the last month following this patient and watching him get sicker and sicker. Watching as every intervention we tried failed and sometimes even seemed to make things worse. That was what my co-intern was already struggling with that night. I wasn't about to add to his burdens for my peace of mind.
So at quarter to 2 when I got the call from the Thoracic ICU saying it was time I went there to do something I wasn't remotely prepared to do. The whole time I was walking over from the children's hospital to the TICU I kept trying to remember the words that are used when we pronounce someone. I couldn't find the right ones. I kept thinking "I now pronounce him dead," or "This man is pronounced dead," or "By the power vested in me." It sounds ridiculous but I could not get the words right. Then as I swiped my ID badge to enter the unit the words hit me "Time of Death ..." But then I realized that I didn't know what I was supposed to do before that. They don't teach us this in med school. I know what criteria must be met in order to determine brain death vs cardiac death. Was I supposed to check his brain stem reflexes or just listen for a pulse. I was frozen in the doorway of the TICU trying to figure out my next move.
I knew that the way I handled this could make an awful experience for this patient's family ten times worse. I grabbed one of the ICU nurses and pulled her aside asking what I should do. She told me to listen for a lack of heartbeat and check that there was no peripheral or central pulse and then call it. I asked if her just had to say "Time of death" or if there was anything else. I wanted to talk to her for a few more minutes to by myself some time. But the family was waiting and she ushered me into the room.
I tried to introduce myself but the looks on the faces of his family left me tongue tied. I mumbled my name and walked to the edge of the patient's bed. After years of patient contact my first instinct was to say loudly "Hello, sir, I'm just going to lay this stethoscope on your chest and take a quick listen." I always tell my patients what I'm going to do to them, even the comatose ones. But, knew that this was not a situation where that would be appropriate or appreciated. I placed my steth on this young man's emaciated chest and heard . . . nothing. No heartbeat, no lung sounds. At first I thought my steth was broken. I might as well have placed the bell on his bed for all I was hearing. And then I realized that nothing was what I was supposed to be hearing. I checked for a radial and central pulse but without a heart beat it seemed a little redundant.
Then I looked up and without realizing it directly into the eyes of this young man's Father and said "time of death 0200 hours on september 27th, 2010." Dad started crying his sobs mingling with the tears his wife had been crying since I'd met her earlier this morning. His younger sister looked shocked as she leaned against her mother's chair. The various grandparents, aunts, uncles and cousins crowded into the room were crying or standing their stoically waiting for me to leave. I mumbled how sorry I was for the loss. My words sounding hollow in the face of their grief.
As I walked out of the room a nurse handed me a stalk of papers and told me my co-intern was on his way down. I wanted to get the bulk of the death packet taken care of before he arrived but I also wanted to break down and cry. This time I couldn't wait till I found a supply closet. I sat down at the nurses station, put my head down and let the tears come. Then I started on the paperwork. It was painful and made even more difficult when I realized that I still had questions for the family. Such as, did they want an autopsy, was it okay of I called donor services?
I somehow got through most of that and my co-intern arrived right as I got paged to check on another sick patient (who later had a rapid response called on him and got transferred to the SICU, it was not a good night). I was done. I had survived my first pronouncement. About 6 hours later I got a stat page to come to the TICU. I had a few more forms I needed to sign. I was on rounds with my attending so I rushed into the unit hoping to get this taken care of quickly and stopped in my tracks. My patients room had been cleaned and was already housing a brand new patient. It as surreal. I wondered if this patient knew about the previous occupant and how that would make them feel. I signed my papers and left.
When I got home this morning I tried to sleep but all I kept hearing was my voice falling on deafening silence saying "time of death 0200 hours."
9/27/10
9/20/10
Proud owner of a used heart
On occasion my chiefs will tell us lowly interns about what it was like when they were first years. Sometimes it will be just to tell us how easy we have it, or how they were better than us. But every now and then you'll get a little nugget of truth out of one of them. A few weeks ago one of my chiefs told us how he used to go home and curl up in the fetal position while listening to Megadeath. He said it soothed him.
Now, I've heard the music he listens to cause he has one of those fancy ipods with built in speakers so the Megadeath doesn't surprise me. But the admission that he got upset during his intern year was surprisingly gratifying. Because this Chief of mine is pretty good at his job. He definitely puts me to shame on a regular basis.
I know that intern year is hard, I know that everyone goes through it and handles it in their own way but it's always nice knowing that you aren't the only one who feels incompetent and bad at their job. Of course, he is generally the one that makes me feel that way. But, every time I screw up I work ten times harder to prevent the next one. So, that's the positive side.
Anyways, I walked out of the hospital today feeling pretty medium about life. I'd screwed up on a number of things and I'd beat myself up pretty good about all of them. But, I'll fix those mistakes and make a whole new set tomorrow. What's really got me feeling iffy is the outcome of my trauma victim from last week. Her heart went to save the life of another little girl who just turned 1 a week and a half ago. She's spent her whole life in this hospital. When she outgrew her NICU crib she moved down to the PICU and now she has a heart that works and will finally be able to see a world outside of the hospital.
That story should give me the warm and fuzzies. Except, I know where that heart came from. I was in the room with the donor when we were trying to save her life. I saw the book that the nurses put together for the grieving parents. It has the little girl's hand and foot prints stamped in it. A nurse and a bereavement counselor sat with the parents and filled in her first words, favorite foods and all her hopes and dreams. And that is all that is left of her. Because even though her heart is beating in another little girl's chest she is still gone.
Now, I've heard the music he listens to cause he has one of those fancy ipods with built in speakers so the Megadeath doesn't surprise me. But the admission that he got upset during his intern year was surprisingly gratifying. Because this Chief of mine is pretty good at his job. He definitely puts me to shame on a regular basis.
I know that intern year is hard, I know that everyone goes through it and handles it in their own way but it's always nice knowing that you aren't the only one who feels incompetent and bad at their job. Of course, he is generally the one that makes me feel that way. But, every time I screw up I work ten times harder to prevent the next one. So, that's the positive side.
Anyways, I walked out of the hospital today feeling pretty medium about life. I'd screwed up on a number of things and I'd beat myself up pretty good about all of them. But, I'll fix those mistakes and make a whole new set tomorrow. What's really got me feeling iffy is the outcome of my trauma victim from last week. Her heart went to save the life of another little girl who just turned 1 a week and a half ago. She's spent her whole life in this hospital. When she outgrew her NICU crib she moved down to the PICU and now she has a heart that works and will finally be able to see a world outside of the hospital.
That story should give me the warm and fuzzies. Except, I know where that heart came from. I was in the room with the donor when we were trying to save her life. I saw the book that the nurses put together for the grieving parents. It has the little girl's hand and foot prints stamped in it. A nurse and a bereavement counselor sat with the parents and filled in her first words, favorite foods and all her hopes and dreams. And that is all that is left of her. Because even though her heart is beating in another little girl's chest she is still gone.
9/16/10
2 year olds shouldn't die.
It was one of those days where things are amazing and awful all at the same time. Today I took a kid who twenty years ago would have spent his life pooing into a bag and created a brand new rectum for him. He won't even remember this first year of his life when his non-functioning rectum meant that he was dependent on an ostomy. And that was amazing.
Imagine if this kid had grown up with an ostomy. We all know how cruel kids can be. The nicknames would have been awful, and would have haunted him in everything he did. I mean, who would go to prom with the kid that everyone calls "shitbag?" It's nice to think that it would have made him a stronger person, a better person. But that's more often the exception than the rule. Fortunately we don't have to wonder about any of that because we took the ostomy and reconnected it to a newly created, functioning rectum. I can honestly say that I helped make this kids life better.
Unfortunately there is a 2 year old girl lying in our PICU for whom I can not say that. She was ejected from her car seat in a motor vehicle collision and suffered multiple skull and head fractures, she was bleeding into her brain and she was taken to the nearest hospital. A rural hospital. They did CTs of her head and body and intubated her. Then they kept her there for EIGHT hours before sending her to us. Who are we? We are the only level 1 pediatric trauma center in the state. We are where she should have been sent the SECOND she was stable. We should have been notified of her the second she rolled into their emergency department. We would have had her on a chopper and in our trauma bay in an hour.
Instead she was transported to us by ground and that delayed her definitive care by another 3 hours. Do you know what happens when a 2 year old bleeds into their brain for 11 hours? They stop clotting. They start oozing from orifice. Their core temperature drops. They become hypotensive and tachycardic. They become unresponsive. Their pupils dilate. They lose their basic brainstem reflexes. They die. That's what happens. And we all stand there incapable of saving her. All of us, interns, residents, attendings, nurses we try to put in lines and get her blood products and warm her up, and raise her blood pressure and slow her heart rate. We call in ENT, Neurosurgery, Optho because we know our limitations. The pediatric surgery and pediatric critical care attendings do all the procedures because she isn't someone that can afford a resident mistake.
This isn't a learning experience for us. This is a desperate attempt to save someone who can't be saved. Because the thought that this little girl is going to die no matter what we do isn't something any of us can bear to entertain. So the attendings pull out all the stops because at some point they know they are going to have face her parents. And when they do they are going to have to look them in the eye and say "we did all we could."
But none of that is going to change the end result. Right now that little girl is lying in a PICU bed. She is intubated, sedated, paralyzed and receiving enough blood products, fluids and medications to keep her heart beating. But, neurosurgery already told us what none of us want to face. She is brain dead. We're keeping her body alive even though what made her who she was is gone. Someone will talk to her family about her donor status. And maybe some part of her will go to another little girl. Maybe that's a silver lining. But it doesn't change the fact that 2 year olds shouldn't die.
Imagine if this kid had grown up with an ostomy. We all know how cruel kids can be. The nicknames would have been awful, and would have haunted him in everything he did. I mean, who would go to prom with the kid that everyone calls "shitbag?" It's nice to think that it would have made him a stronger person, a better person. But that's more often the exception than the rule. Fortunately we don't have to wonder about any of that because we took the ostomy and reconnected it to a newly created, functioning rectum. I can honestly say that I helped make this kids life better.
Unfortunately there is a 2 year old girl lying in our PICU for whom I can not say that. She was ejected from her car seat in a motor vehicle collision and suffered multiple skull and head fractures, she was bleeding into her brain and she was taken to the nearest hospital. A rural hospital. They did CTs of her head and body and intubated her. Then they kept her there for EIGHT hours before sending her to us. Who are we? We are the only level 1 pediatric trauma center in the state. We are where she should have been sent the SECOND she was stable. We should have been notified of her the second she rolled into their emergency department. We would have had her on a chopper and in our trauma bay in an hour.
Instead she was transported to us by ground and that delayed her definitive care by another 3 hours. Do you know what happens when a 2 year old bleeds into their brain for 11 hours? They stop clotting. They start oozing from orifice. Their core temperature drops. They become hypotensive and tachycardic. They become unresponsive. Their pupils dilate. They lose their basic brainstem reflexes. They die. That's what happens. And we all stand there incapable of saving her. All of us, interns, residents, attendings, nurses we try to put in lines and get her blood products and warm her up, and raise her blood pressure and slow her heart rate. We call in ENT, Neurosurgery, Optho because we know our limitations. The pediatric surgery and pediatric critical care attendings do all the procedures because she isn't someone that can afford a resident mistake.
This isn't a learning experience for us. This is a desperate attempt to save someone who can't be saved. Because the thought that this little girl is going to die no matter what we do isn't something any of us can bear to entertain. So the attendings pull out all the stops because at some point they know they are going to have face her parents. And when they do they are going to have to look them in the eye and say "we did all we could."
But none of that is going to change the end result. Right now that little girl is lying in a PICU bed. She is intubated, sedated, paralyzed and receiving enough blood products, fluids and medications to keep her heart beating. But, neurosurgery already told us what none of us want to face. She is brain dead. We're keeping her body alive even though what made her who she was is gone. Someone will talk to her family about her donor status. And maybe some part of her will go to another little girl. Maybe that's a silver lining. But it doesn't change the fact that 2 year olds shouldn't die.
9/15/10
Blerg
I am very, very tired. I worked for 31 hours. I've been up for about 33. It is so bed time but I just had to drop a couple lines about the events of last night.
So, last night I managed a couple of patients without any hand holding. I made decisions and then called and told my fellow or chief. The sky didn't fall. I didn't do things perfectly or with very much finesse but everyone came out alive and not much worse for the wear. That being said I totally had a break down crying moment this morning. Granted, I'd hit that wall that you always hit when you've been up for too long.
I needed a Chest X-ray on a patient whose chest tube we were planning on pulling that afternoon after we'd water-sealed it the night before (basically taking it off suction). I'd might a slight error in the order. I'd written post-pulling eval instead of pre-pulling. Well, the nurse took it upon herself to cancel the order instead of calling clarifying. So, 9 am rolls around and no CXR. My team is pissed.
So, now I order a stat Chest X-ray, which should happen within 30 minutes. It takes 2 hours. Now, I'm pissed. And somewhere in all that I cray in two different supply closets and the work room with my co-intern (he's going into Ortho) sitting beside me made very uncomfortable by this display of womenly emotion.
Also, that was not an easy call. I was never really completely on top of what I needed to handle. So I had this residual I'm not quite competent enough feeling. Added to my frustrations in managing my sick patients not quite perfectly. And then not being able to get a damn chest x-ray done. I was a ticking time bomb.
Okay, my bed calls. I'll sleep till 4 and then wake up so I can actually get a decent nights sleep tonight. before being back at work at 5 am.
So, last night I managed a couple of patients without any hand holding. I made decisions and then called and told my fellow or chief. The sky didn't fall. I didn't do things perfectly or with very much finesse but everyone came out alive and not much worse for the wear. That being said I totally had a break down crying moment this morning. Granted, I'd hit that wall that you always hit when you've been up for too long.
I needed a Chest X-ray on a patient whose chest tube we were planning on pulling that afternoon after we'd water-sealed it the night before (basically taking it off suction). I'd might a slight error in the order. I'd written post-pulling eval instead of pre-pulling. Well, the nurse took it upon herself to cancel the order instead of calling clarifying. So, 9 am rolls around and no CXR. My team is pissed.
So, now I order a stat Chest X-ray, which should happen within 30 minutes. It takes 2 hours. Now, I'm pissed. And somewhere in all that I cray in two different supply closets and the work room with my co-intern (he's going into Ortho) sitting beside me made very uncomfortable by this display of womenly emotion.
Also, that was not an easy call. I was never really completely on top of what I needed to handle. So I had this residual I'm not quite competent enough feeling. Added to my frustrations in managing my sick patients not quite perfectly. And then not being able to get a damn chest x-ray done. I was a ticking time bomb.
Okay, my bed calls. I'll sleep till 4 and then wake up so I can actually get a decent nights sleep tonight. before being back at work at 5 am.
9/9/10
You can't practice on the patient
So, yesterday was kinda shitty in the OR. Back in December/January I was in the OR all the time as a 4th med student. I got to throw in a couple sutures at the end of a case, suction a little bit, even make a couple tiny incisions. It was pretty sweet and I got pretty good and then I took a long ass vacation from the time I match till the time I started. I drank, I partied, I visited, I traveled. I did not practice my surgical skills or study. It was going to be my last vacation ever and I wanted to take full advantage of it.
I am now regretting this decision. Don't get me wrong. It was the best vacay ever. And I really wouldn't trade it. But, when I get in an OR and I get handed the scalpel or asked to close or any number of tasks I feel clumsy. My hands feel to large and I feel the sweat dripping down my back. Gross, I know but an OR is a hot place. You're wearing a heavy gown, gloves, a mask, a hat, you stand under hot lights and it isn't exactly a stress free environment. Plus, we keep the rooms warm because our parents are open, lying naked on a table. So, yah I get a little sweaty.
Anyways, I know how to do all these things. But the added pressure of being a doctor instead of a med student, not to mention having gone without practice for so long makes things difficult. I can feel myself willing things to go right, willing myself to do it quickly, to do it efficiently. I can feel the attending's eyes on me. I can feel my upper level resident judging me. It's paranoid and insane, I know. But, it's the reality.
Every time I apologize for not being perfect, for not being fast enough, for not knowing the answers my words are brushed away with a simple, "you'll learn." And I know it's supposed to be comforting. But, for some reason that makes it worse. It's like be an awkward teen all over again. Yah, I know it'll get better some day. But, right now it kinda blows and I kinda wish it could be "some day" already.
On top of all of that there is the fact that these skills I'm learning are being learned on a human being. This person that I speak with in the holding area, that I round on every morning, this person that trusts me not to fuck up. Well, interns fuck up. I've been lucky, I haven't as yet. But, I'm not special. It will happen. Most likely it will happen right when I start getting cocky. It's how we are humbled. Because in order to hold your hand out and ask for a knife you have to some amount of hubris. But too much and you get dangerous. It's unfortunate how often it takes a mistake to realize how in over our heads we can get.
I know there are times in the OR when I hold back. Which is very unlike me. But I get into my head and I worry too much about hurting the patient. But that means that I won't learn properly and then when I don't have the luxury of doing these procedures with a safety net things will go badly. Which means, that I have to get out of my head. I have to stop worrying about what the others in the room think, I have to stop envisioning every worst-case scenario happening because of something I do wrong. Not because these things won't or aren't happening. But because dwelling on them makes me a bad surgeon.
I owe it to the patients I am operating on to learn as much as I can from each case. To do that I need to put my own insecurities on hold, keep my ego in check and focus 100% on the task at hand. Single-minded determination is what is required. If I can't do that I don't deserve to operate.
I am now regretting this decision. Don't get me wrong. It was the best vacay ever. And I really wouldn't trade it. But, when I get in an OR and I get handed the scalpel or asked to close or any number of tasks I feel clumsy. My hands feel to large and I feel the sweat dripping down my back. Gross, I know but an OR is a hot place. You're wearing a heavy gown, gloves, a mask, a hat, you stand under hot lights and it isn't exactly a stress free environment. Plus, we keep the rooms warm because our parents are open, lying naked on a table. So, yah I get a little sweaty.
Anyways, I know how to do all these things. But the added pressure of being a doctor instead of a med student, not to mention having gone without practice for so long makes things difficult. I can feel myself willing things to go right, willing myself to do it quickly, to do it efficiently. I can feel the attending's eyes on me. I can feel my upper level resident judging me. It's paranoid and insane, I know. But, it's the reality.
Every time I apologize for not being perfect, for not being fast enough, for not knowing the answers my words are brushed away with a simple, "you'll learn." And I know it's supposed to be comforting. But, for some reason that makes it worse. It's like be an awkward teen all over again. Yah, I know it'll get better some day. But, right now it kinda blows and I kinda wish it could be "some day" already.
On top of all of that there is the fact that these skills I'm learning are being learned on a human being. This person that I speak with in the holding area, that I round on every morning, this person that trusts me not to fuck up. Well, interns fuck up. I've been lucky, I haven't as yet. But, I'm not special. It will happen. Most likely it will happen right when I start getting cocky. It's how we are humbled. Because in order to hold your hand out and ask for a knife you have to some amount of hubris. But too much and you get dangerous. It's unfortunate how often it takes a mistake to realize how in over our heads we can get.
I know there are times in the OR when I hold back. Which is very unlike me. But I get into my head and I worry too much about hurting the patient. But that means that I won't learn properly and then when I don't have the luxury of doing these procedures with a safety net things will go badly. Which means, that I have to get out of my head. I have to stop worrying about what the others in the room think, I have to stop envisioning every worst-case scenario happening because of something I do wrong. Not because these things won't or aren't happening. But because dwelling on them makes me a bad surgeon.
I owe it to the patients I am operating on to learn as much as I can from each case. To do that I need to put my own insecurities on hold, keep my ego in check and focus 100% on the task at hand. Single-minded determination is what is required. If I can't do that I don't deserve to operate.
9/7/10
It's not like I need to see my family
So, this past weekend was labor day and my family get together every year at a lake in Georgia. About 25 aunts, uncles, cousins and my Mom, Dad and Brother. Every year. This year I was working. Because I'm an intern. I guess this is the first casualty of my life choices. I just wonder how many more things I'm going to miss.
My residency is going to be at least 5 years long. I'm assuming that at some point during that time some of my friends will get married, some might have kids. There will probably be school reunions. And family events, I might become an aunt or a godmother. I could be asked to be a bridesmaid. And I'm also willing to bet that I'll be missing out on a lot of those occasions.
On the other hand I am going to be learning how to save lives. So, that's the toss up, I guess.
But, that's what I signed up for. So I'm going to quit my bitching and go to sleep.
My residency is going to be at least 5 years long. I'm assuming that at some point during that time some of my friends will get married, some might have kids. There will probably be school reunions. And family events, I might become an aunt or a godmother. I could be asked to be a bridesmaid. And I'm also willing to bet that I'll be missing out on a lot of those occasions.
On the other hand I am going to be learning how to save lives. So, that's the toss up, I guess.
But, that's what I signed up for. So I'm going to quit my bitching and go to sleep.
9/5/10
Divide and conquer
The thing with being an intern isn't just that the work is hard and demanding. Or that the hours or so long and we're always so tired. The main thing is this overwhelming sense of disconnect. You spend so much time at the hospital and the hours that you aren't there are reserved for sleep, eat, shower and repeat that you have no time for your family or your friends. Maybe this is different if you actually live with someone. But I come home to an empty apartment every night after working anywhere from 10 to 15 hours a day and I just don't have the energy to talk to my parents or even my best friends. Some of whom are actually in the medical field and might be able to relate.
Maybe it's just that I work in such a big university program but I feel the same disconnect amongst my fellow interns. The 20+ of us are split amongst 13 different services and another at an entirely different hospital. If you are lucky you might have one other intern on your service, in addition to a chief or a mid-level resident. You spend a lot of time with your nose to the grind-stone just trying to get everything done without screwing things up too badly. Everyone talks about how your intern class is your support group. Which would be great if I ever saw them. But we just don't see each other that often. And when we do it's not like we have time to sit down for a chat. Even when we sign out to each other (ie, when the on-call intern gets the low-down on all the patients on a particular service from the covering intern) one of us always has an eye on the clock. Either because we're the one that wants to leave and get home or because we're the one covering 4 services and already have so much shit to do it's not even funny.
The uppers tell us that we should take a second during sign out to relay a funny story or two. But there are some days/nights at the end of a shift when you feel so run-down, beaten and just incompetent that you can't bring yourself to make a joke or laugh at one of theirs. And often times you are so wrapped up in your own perceived failures you don't see the same dejection written all over them. Logically we all know that no one is expecting perfection out of any of us. Attendings will be the first to tell us that there is a reason residency is so long. But, we're surgeons for a reason. We hold ourselves to exactingly high standards that have nothing to do with what others expect of us.
I can't speak for all of my fellow interns. But I'm fairly certain that what I'm saying is true to varying degrees for each of them. When I make a mistake, when I ask a stupid question, when I don't know an answer, when I forget to put an order in or any of the hundreds of other tiny mistakes I can make I always feel like I'm letting someone down. Usually the person I've let down is myself as opposed to one of my superiors. I've actually been really lucky in that while most of my chiefs have been exacting they have also been understanding. But that doesn't mean I haven't had my fair share of cries in supplies closets.
For weeks I thought I was the only one with these feelings. But, then a miraculous thing happened. I went for drinks with a couple of the interns in my call pool. The ortho intern walked into the Burn Unit to sign out to me looking like someone had punched her in the gut. And one of the ENT interns who is always so smiley looked like she was about to spit nails. And me, well my chief had to fix all the orders I'd put in on my patients cause I still couldn't figure out the damn order system so I wasn't feeling too great about myself either.
So we get to this bar and order a highball each and a giant plate of french fries. 10 minutes later we're swapping stories about which chief yelled at us. Which attending terrifies us. Which nursing stations drive us crazy. Which patients are the scariest. And somehow all that self-loathing I'd been feeling for days started slipping away. I felt like a new person. It didn't matter that I was screwing up, because these girls were too. Even though all of us that the other was a model intern we were all suffering through the same insecurities.
The funniest thing was that this whole thing only lasted about an hour. We ate, drink, laughed and even got a little teary in over-drive. We were manic in our thrill at having found an outlet for our self-recriminations. Anyone looking at the three of us in our green surgeon's scrubs, with our beepers sitting on the table, would have seen something like a cross between a psychotic episode and an intense cocaine high. There was intensity and desperation in our eyes. We were trying to live out ten different meals filled with gossip and drinks in one evening. We didn't have the time to do this leisurely. All of us had to be up 4 the next morning and it was already nudging closer and closer to 9. None of us wanted to relinquish our precious sleep. But that night I slept like a baby. The recurring nightmares of me screwing up so badly that I got kicked out or someone died didn't wake me up that night. I felt good about myself.
I took this experience from a weeks back to heart and decided to start a weekly intern drinks conference. It's an outlet for all of us. We can get together and share our stories. We can bitch to the only other people who will truly understand what we are going through. And even though that same desperation and mania lingers around us while we do it. It's still the best outlet I can imagine. We've managed to bring the crew together twice in the past few weeks. And of course it's never all of us because there are always those of us on-call. But I genuinely think it's the best thing we can do for ourselves. It's something for us to look forward to. It's a way for us all to feel connected. And most importantly it's a way for us to form a relationship that will go even deeper than just co-interns.
I know that my program doesn't have some nefarious plot to divide and conquer the interns. And I know that we're split throughout all these different services because otherwise their would be no way for the surgery department to function. But, a tiny, tiny part of all of us do feel that this is their master plan. But, our little weekly "intern conference" is the perfect act of civil disobedience.
I know that in ten months when we are all no longer interns we'll look back on all of this fondly. And these people I've worked with all year long will be like family. And in the 5-8 years it takes us to get through our residency together we're going to get even closer and it makes me glad that I have such great people to do it with.
Anecdotally, I recently overheard one of my attendings consulting another attending in another state who had been an intern with him decades ago. I heard his raucous laughter as they aped a chief they had both despised. I heard them discuss another one of their co-interns who had recently fallen ill in hushed and reverent tones. And I heard them pass the care of this particular patient from one to the other the same way the had done all those years ago when they cross-covered for each other as interns.
That little bit of eavesdropping gives me hope.
Maybe it's just that I work in such a big university program but I feel the same disconnect amongst my fellow interns. The 20+ of us are split amongst 13 different services and another at an entirely different hospital. If you are lucky you might have one other intern on your service, in addition to a chief or a mid-level resident. You spend a lot of time with your nose to the grind-stone just trying to get everything done without screwing things up too badly. Everyone talks about how your intern class is your support group. Which would be great if I ever saw them. But we just don't see each other that often. And when we do it's not like we have time to sit down for a chat. Even when we sign out to each other (ie, when the on-call intern gets the low-down on all the patients on a particular service from the covering intern) one of us always has an eye on the clock. Either because we're the one that wants to leave and get home or because we're the one covering 4 services and already have so much shit to do it's not even funny.
The uppers tell us that we should take a second during sign out to relay a funny story or two. But there are some days/nights at the end of a shift when you feel so run-down, beaten and just incompetent that you can't bring yourself to make a joke or laugh at one of theirs. And often times you are so wrapped up in your own perceived failures you don't see the same dejection written all over them. Logically we all know that no one is expecting perfection out of any of us. Attendings will be the first to tell us that there is a reason residency is so long. But, we're surgeons for a reason. We hold ourselves to exactingly high standards that have nothing to do with what others expect of us.
I can't speak for all of my fellow interns. But I'm fairly certain that what I'm saying is true to varying degrees for each of them. When I make a mistake, when I ask a stupid question, when I don't know an answer, when I forget to put an order in or any of the hundreds of other tiny mistakes I can make I always feel like I'm letting someone down. Usually the person I've let down is myself as opposed to one of my superiors. I've actually been really lucky in that while most of my chiefs have been exacting they have also been understanding. But that doesn't mean I haven't had my fair share of cries in supplies closets.
For weeks I thought I was the only one with these feelings. But, then a miraculous thing happened. I went for drinks with a couple of the interns in my call pool. The ortho intern walked into the Burn Unit to sign out to me looking like someone had punched her in the gut. And one of the ENT interns who is always so smiley looked like she was about to spit nails. And me, well my chief had to fix all the orders I'd put in on my patients cause I still couldn't figure out the damn order system so I wasn't feeling too great about myself either.
So we get to this bar and order a highball each and a giant plate of french fries. 10 minutes later we're swapping stories about which chief yelled at us. Which attending terrifies us. Which nursing stations drive us crazy. Which patients are the scariest. And somehow all that self-loathing I'd been feeling for days started slipping away. I felt like a new person. It didn't matter that I was screwing up, because these girls were too. Even though all of us that the other was a model intern we were all suffering through the same insecurities.
The funniest thing was that this whole thing only lasted about an hour. We ate, drink, laughed and even got a little teary in over-drive. We were manic in our thrill at having found an outlet for our self-recriminations. Anyone looking at the three of us in our green surgeon's scrubs, with our beepers sitting on the table, would have seen something like a cross between a psychotic episode and an intense cocaine high. There was intensity and desperation in our eyes. We were trying to live out ten different meals filled with gossip and drinks in one evening. We didn't have the time to do this leisurely. All of us had to be up 4 the next morning and it was already nudging closer and closer to 9. None of us wanted to relinquish our precious sleep. But that night I slept like a baby. The recurring nightmares of me screwing up so badly that I got kicked out or someone died didn't wake me up that night. I felt good about myself.
I took this experience from a weeks back to heart and decided to start a weekly intern drinks conference. It's an outlet for all of us. We can get together and share our stories. We can bitch to the only other people who will truly understand what we are going through. And even though that same desperation and mania lingers around us while we do it. It's still the best outlet I can imagine. We've managed to bring the crew together twice in the past few weeks. And of course it's never all of us because there are always those of us on-call. But I genuinely think it's the best thing we can do for ourselves. It's something for us to look forward to. It's a way for us all to feel connected. And most importantly it's a way for us to form a relationship that will go even deeper than just co-interns.
I know that my program doesn't have some nefarious plot to divide and conquer the interns. And I know that we're split throughout all these different services because otherwise their would be no way for the surgery department to function. But, a tiny, tiny part of all of us do feel that this is their master plan. But, our little weekly "intern conference" is the perfect act of civil disobedience.
I know that in ten months when we are all no longer interns we'll look back on all of this fondly. And these people I've worked with all year long will be like family. And in the 5-8 years it takes us to get through our residency together we're going to get even closer and it makes me glad that I have such great people to do it with.
Anecdotally, I recently overheard one of my attendings consulting another attending in another state who had been an intern with him decades ago. I heard his raucous laughter as they aped a chief they had both despised. I heard them discuss another one of their co-interns who had recently fallen ill in hushed and reverent tones. And I heard them pass the care of this particular patient from one to the other the same way the had done all those years ago when they cross-covered for each other as interns.
That little bit of eavesdropping gives me hope.
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