I am 7.7% done with intern year

I was surprised when I divided 1 by 13 in my calculator: it seemed like the number should be much smaller – 2%, maybe. Or 0%. (It feels more like 0%.)

The fact that it was somewhere between 3-to-infinity times larger than what I expected really tells you a lot about 1) how quickly time flies, and 2) my ability to interpret simple fractions.

(Very reassuring to my future patients, I’m sure.)

Anyway, I start inpatient wards on Monday! So I’ll magically go from being deemed capable to juggle the 2-3 patients I had as a Sub-I, to 7-8 patients as an intern. There is no possible way this can go wrong.

I’m relieved to be done with this outpatient rotation, though. It was fun and I may have learned a lot, but I never really felt like I was on anything other than a typical 4th year rotation (albeit, with an attending who was particularly lax about supervision).

Onwards and upwards.

so it begins

Quote of The Day: Oh, Come ON.

Med student: “Hey, Action Potential! Hi! Haha, funny story – I was actually just yelling at you to come over here – but it turned out it wasn’t you I was yelling at, it was actually a 70 year old woman!”

Me: “…”

Co-intern: “That’s not very funny.”

Med student: “No, no – it was! It was really funny!”

Me: “But I don’t want to look 70…”

Med student: “OHHHH, no – no, you don’t!”

Me: “Oh, good. Whew.”

Med student: “It was your hair!”

Me: …..

Med student: “Because you and the old woman had the same haircut!”

Me: …

Med student: “You know, kind of short?”

Co-intern: “Okay, okay, I think she gets it.”

5 Vignettes From My First Intern Clinic

1. Clinic: A Short Play In One Act

Scene: Clinic. Afternoon. 

Kid: Mom, why am I even taking ObscurePsychDrug?

Mom: Honey, you’re not taking ObscurePsychDrug. You’re taking CommonADHDMed. They’re completely different pills.

Me: Very true! You’re taking CommonADHDMed.

Kid: Oh. … so… ObscurePsychDrug ISN’T for ADHD?

Mom: No. It’s for… er… Oh! – the DOCTOR can explain to you what ObscurePsychDrug is for!

Me: *mild panic*

Mom: See, that’s the wonderful thing about visiting a doctor – they can explain all sorts of questions! Even about drugs you don’t take!

Me:

holy shit

Computer: *persistently refuses to allow me to google ObscurePsychDrug*

Computer: *continues to be terrible*

Mom: Okay, son, the doctor is going to explain ObscurePsychDrug to you, so STOP FIDGETING and listen. very. carefully.

*Mom attentively adjusts chair, stares at me in happy expectation*

Me: *prays to the Pediatric God that I’ll be urgently paged to another room*

The Pediatric God: *is not a kind God*

.

Me:i actually don't know what i'm talking about right now

2. My preceptor says I’m “functioning at the level of a January intern” instead of a “July intern”.

(… Is that the best half-compliment I’ve ever received, or is it pathetic and sad?)

there would be no way of knowing

3. Who the hell decided that Epic doesn’t need a “are you sure?” button to permanently sign a note?

I intended to PEND the note. I pend EVERY note before going to the physical exam. I now have a horrible, innacurate note that’s now forever in the system with an apologetic, all-caps, “I’m a stupid intern” addendum. Goddamn it, Epic.

when you make a mistake

4. The nurses like me. That’s something, right?

5. Oh god. I’m a fraud. Don’t ever visit a hospital in July, don’t visit a clinic in July, don’t step outside in July, just draw your shades and lock your doors and stay in bed and pray until this all blows over.

 

Intern Week #1: “… See, now I’m worried you’re not actually joking.”

Outpatient clinic seemed like such a perfect first rotation: Sure, the hours weren’t as cushy as I thought, but who cared? I was seeing patients! Putting in orders! Wearing a long white coat! Not getting too many things horribly wrong!

So of course, Friday morning – as I’m settling in to read some relevant review articles on a makeshift sofa consisting largely of empty cardboard boxes – I get a call from the chief resident.

“So… there’s actually been a… scheduling issue. We need you to move to the inpatient team. Night shift. For the rest of the month.”

huh2

 

Well… so… okay.

Okay then.

That sucks. But… okay! Positive thinking! I’ll adapt! I will rise to the challenge like the flexible, go-getter, team-player I am!

(Read: I sat there, stunned, until it occurred to me that night interns get to wear scrubs.) (I’m a huge fan of anything that qualifies as Socially Acceptable Business Pajamas.)

So: I did some math: I had 3 days to adjust to a 10am – 6pm sleep schedule.

AND I DID IT. Because I am a power intern. Hoo-ah.

(Read: I did it because I really, really like staying up late. Pulling multiple socially acceptable all-nighters until I have the kind of sleep schedule that would have made my parents haul me in to see a doctor myself? SIGN ME UP. The nocturnal train is leaving the station and I am on-board.)

So I shifted my sleep schedule by 4 hours every day this weekend until, this morning, I reviewed all of my inpatient files and I fell blissfully asleep at 10am. My alarm was set for 5:30, 5:45, and 6:00pm. I was ready.

Which – as you can all guess – meant that of course I got a surprise call at 11:30am.

“So… hi. I really, really hate to do this to you… but we’ve had another intern issue. Slight scheduling change.. again: You’re back on outpatient.”

what is this jeez no text

 

“So… we’ll see you at clinic this afternoon?”

 

i quit2

 

The Last Day Of Orientation Pep Talk

Chief Resident: Each patient room has a white-board – make sure that where it says ‘Physician’ you write your attending’s name.

Me: Do we write our own name on there, too? So the patient knows who we are?

Chief Resident: Nope. The patient doesn’t need to know who you are.

Other intern: I thought the nurse said it was critical to have the intern’s name on the white-board…?

Chief Resident: Oh! Haha, I see the confusion. Okay, no – she was talking about the white board at the nurse’s station! The nurses need to know who to call.

Me: Oh. Okay.

Chief Resident: See, one of the questions on the ‘Patient Satisfaction’ survey the hospital uses is ‘Did you know your attending physician’s name?’ – so we have to write it up there so the patients will get that question right. Makes our satisfaction score higher.

Me:   :\

Chief Resident: The rest of the team doesn’t matter, you’re just free labor.

Me:   :(

Pediatric Life Support Training

EXPECTATION:

Instructor: And… begin.

Intern Leader: “Okay, look’s like the patient is in Vfib. You, please charge the defibrillator at 2 J/kg. You, please get vascular access. You two, start chest compressions and ventilation. We’ll shock, then continue with 2 minutes of CPR and reevaluate – if it’s still shockable, we’ll move on to 0.1 mL/kg of epi and charge at 4 J/kg.”

REALITY:

“Wait.. Guys, how does this thing plug in? There’s no plug for the chest pads.”

*10 panicked minutes pass as all interns independently confirm that the defibrillator does not connect to its chest pads in any way recognizable by human sight, touch, hopes, or indeed the very laws of physics*

“Hold on, let me look… I think I saw something, underneath all these cords… wait, no. That’s a lamp. But maybe…”

“IF YOU’RE HERE, WHO’S DOING CHEST COMPRESSIONS?”

“…”

*sound of guiltily resumed chest compressions*

“Let’s just.. let’s just give epi before we lose the patient.”

“Fine. I’ll draw it up while – wait, what’s the weight? “

*sound of drilling*

“GUYS, I GOT VASCULAR ACCESS.”

“… Did you just put a hole in a $1500 mannequin.”

“… for vascular access.”

“This mannequin isn’t supposed to have vascular access!”

“Um, should I still give the epi?”

“YES”

“Oh. Well, we don’t have any.”

Preemptive Yelling

So far, most of our orientation has been “Intro To Our Department!” lectures given by nursing, pharmacy, PT/OT, etc. – which universally consist of the following slides:

  • Who We Are (Names and introductions! Pager numbers!)
  • What We Do (Awesome clinical things!)
  • How You Are Going To Get In Our Way (You suck!)
  • Why You Think It’s Okay To Get In Our Way (It’s because you suck!)
  • How You Can Stop Getting In Our Way (Ask questions, be respectful, and get a degree in our field!)
  • Ha Ha, Just Kidding About That Degree Thing (Not really!)
  • “The End: Hang In There!” with clipart of kitten stuck in tree (Adorable!)

Seriously, someone must have sent out a mass email saying: “Hey! We need to fill some time during intern orientation. Does anyone want to save some time by yelling at the new interns before they start?”

(Either that, or it’s just a temptation no department can resist when they’re staring down the 20 bright, eager faces that will soon be exactly like every other group of 20 bright, eager interns making their July a living hell.

Which… okay, yeah, fair enough.)

Still: it’s just a little disconcerting.

why do you hate me when i show you nothing but love

There’s something at least a little darkly funny about eagerly showing up to an Introduction To Nursing Staff event (Getting to know the nurses! Yes! Hopefully they will like us!) – making small talk, settling in with a nice sandwich…

… only to be told things like “You’re not as smart as you all think you are”, “Remember, we’re a TEAM. You guys never act like we’re a TEAM.” and “At least try to fake some respect in front of the patients.”

classroom reaction

Which… wait, what? That wasn’t us! Those previous interns aren’t in the room! We’re new interns!

Who are you yelling at? Me? My lunch? 

stupid my sandwich is innocent

To be fair, I guess interns actually do shit like that.

And if they’re pre-emptively yelling at us about it, I guess it must happen every year.

So despite my feeling that pre-emptive yelling isn’t exactly going to improve the ‘respect’ situation, I’ll agree that some sort of yelling is definitely going to be deserved eventually.

(But for that, all I can offer is a pre-emptive apology…)

Externally Disoriented At Intern Orientation

Guys. I have internet again! I moved into an apartment that is actually a house, and it now officially has internet, because apparently I am now a real-live functioning adult who can set up utilities, owing to my no longer living in a dormitory.

(Or, indeed, in a city where it’s normal to pay a mortgage-level price for a “studio” so cramped that it feels like a dormitory, Metropolis.)

Anyway, I’m in the middle of intern orientation! If you haven’t been through it yet, just know that it’s a hilarious two week period where you spend your days searching your files for archaic paperwork (do you know where your birth certificate is? Did you screenshot your USMLE scores? What’s your rubella titer?) and spend your nights trying not to think about the absurd totality of your medical ignorance.

On the bright side, you get an ID badge that says “Your Name, M.D.” (which almost makes up for the terrible photo). And a parking space! And a lab coat that no longer hits you at the most awkward and unflattering angle possible!

Great things are afoot, internet.

Anyway, I have a longer blog entry about post-graduation depression that I want to post later, but right now I’m actually feeling pretty good. I’ve met the rest of my intern class and have determined that there’s probably enough other loveable weirdos to make me feel at home – which is all that really matters… right?

Here’s hoping.

Moving On After Graduation (or: The Existential Terror Of The Void)

Before the ceremony, we were all supposed to line up in alphabetical order. But when our Dean called out our names in said order to make sure we all knew how to alphabet (spoiler alert: NOPE), I suddenly knew that she’d skip right over me. And that she’d then pause and look at me all concerned and say, “Oh, hey… you’re not on my list…” and then everyone would know I was a terrible, terrible fraud.

i think it's a mistake

But she actually did read my name: both before the ceremony and (arguably more importantly) during it.

So I guess I’m a doctor now!

I probably need to stop finding this hilarious.

Anyway, in other news, I’m moving to Midwest Metropolis! On Tuesday! And I will be super excited about it just as soon as I’m assured that I won’t be living in a cardboard box.

(Not really joking. I legitimately will be living out of my rental car / cheap motels until I manage to sign a lease – and the rental car is expensive, so…)

excuse me i am homeless

This move entails:

  1. Packing up everything I own.
  2. Realizing I own way too much stuff to fit in a rental van.
  3. Giving away half of my stuff.
  4. Hoping that everything else fits, miraculously, into said rental van.
  5. Driving 7 hours to Midwest Metropolis.
  6. Charming some landlord into giving me a lease ASAP so I can turn in my rental van and stop paying $150 a day for it jesus christ that’s a lot of money
  7. HYPOTHETICAL MOVING SUCCESS.

So far, I’ve gotten as far as Step #4: I’ve rented the van. I’ve packed my stuff. I’m ready and waiting.

I even looked up Craigslist apartment listings! I found one within walking distance of the hospital where a female grad student was looking for a “clean, mature, responsible female grad student or young professional”, and I was like “THAT’S ME. YOU’RE LOOKING FOR ME. HELLO, FUTURE BEST FRIEND.” and sent her a calmer, more subdued, casually disinterested version of that.

But it’s been 10 minutes and she hasn’t replied with an immediate offer so maybe I should diversify my options a little.

And finish packing.

And relearn all of pediatrics before someone accidentally expects me to know something useful.

And say goodbye to everyone in this town I’ve ever loved.

sobbing amidst packed boxes

STAY TUNED.

I’m Not (Yet?) Proud Of Graduating Med School

Sometimes I take a 5 hour bus ride to a different campus. And as bad as “5 hour bus ride” sounds, I actually like these rides: the buses are nice, the route goes through the mountains, it takes me to a nice place where I did all my clinical rotations, it’s usually quiet.

I even go so far as to sit in the front, so the bus driver will personally give a polite “shut up” to anyone in my general vicinity who dares to talk on the phone. (It’s so liberating, being able to sleep on public transit!)

But on Saturday I took my usual 5 hour bus ride and found myself sitting behind this loud, eager old man who would not. stop. talking.

everyone wants you to shut up

The first moment he had a chance, he started engaging the bus driver with questions: “Where’d you get that booster seat?” “Oh? Which Wal-Mart? I’m always looking for a better one! Because – ”  (and here his voice swelled with pride) “I’m a bus driver too!”

And for some reason, I immediately felt guilty for sending “shut up” vibes his way.

They went on to have a 3 hour conversation about the E-17 bus models, the federal regulations, the weird thing that sometimes happens with the steering, the hilarious antics of the county transit supervisor.

That man was so proud of his job. Something about his tone of voice made me not mind the 3 hour conversation that interrupted my nice, quiet bus ride.

Why was I on that bus? To attend a small, unofficial graduation ceremony* for medical school. Because soon, I’m graduating medical school. That’s a thing, apparently. A thing that’s legit happening.

And I don’t feel proud at all.

It’s weird. I feel a lot of other things: sad to leave my friends behind, happy to have a job, irritated about the bureaucratic machine behind my “graduation to-do list”, downright panicked about moving, nostalgic about all the good times and the class bonding…

But I have yet to think “I have an MD! I made it! Good for me!”

Which is pretty stupid, because just this morning I felt proud for getting up at Totally Reasonable O’Clock to attend a mandatory meeting. I was like, “Yes! Look at me! Awake! Facing the day! SOMEBODY GIVE ME AN AWARD.”

error - success

I felt even prouder for taking out the trash last night. I didn’t have to do that! No one was visiting! Look at me, adulting!

Anyway, so I took the bus to the graduation ceremony. And I listened to two bus drivers talk shop for hours. And I somehow wasn’t as annoyed by it as I would normally have been.

You know what? As I’m writing this, I think I’ve realized why I don’t feel “proud”: whenever I pictured myself graduating / becoming a ‘doctor’, I sort of pictured myself as… a doctor. Someone with secret, insider medical knowledge. Someone who can fix people!

But it’s been 4 years, I’m getting that magical “M.D.”, and yet…. nada. In fact, I feel approximately as legit as this guy:

bonafide physician with degree

So how can I walk across the stage and feel the sense of pride when I always pictured that pride being accompanied by… I don’t know… actual doctoriness? Or doctor skills? Or even just general knowledge?

But the clock’s ticking, because after so many graduation celebrations, my actual graduation – For Real Graduation, We Mean It This Time, You’re Wearing A Floppy Hat And Everything – is on Wednesday. And to be honest, I’m still not feeling anything.

Except ‘broke’.

(Seriously, the wizard robes and floppy hat set me back $260. To rent. To RENT.)

(I THOUGHT THIS WAS AMERICA.)