I just finished a week of real internship, as opposed to consults. It’s … I have no words.
My first day, my team was on long call. I got to work around 6:30 AM; we started the day with two patients, discharged them both, and then admitted FIVE. No joke. Plus a stroke code. Plus cross-covering four other services between 4 and 8, when night float arrived. I left the hospital sometime after 10 PM.
I have to say, people were right about the learning curve of internship. Specifically, it’s not really that important if you know the diseases or treatments or anything. I mean, if you do, as an intern, that’s great. But really, the learning curve of internship is systems-based practice. Like how we had to move heaven and earth to get an MRI on my patient with a pacer. Phone calls to attendings, radiology techs, nursing…. at one point I suggested we just overhead page, “Everyone who wants to be involved in Mr. Sherlock Holmes’s MRI, please convene in the radiology suite.”
I’ve also learned, very quickly, not to expect anything. Ever. Think your little old lady can be prepped to go home tomorrow? Ooooh, psych, she spikes a fever! Grumble about overuse of resources when the consultant goes zebra-hunting? Just wait till that silver stain comes back positive.
I do, however, have three med students, who have been incredibly helpful. I try to avoid scutting them out as much as possible. And I love the intermittent moments when I can teach them something of what little I do know. Like when we had reassured ourselves that the aforementioned stroke was not actually a stroke, and we were hurrying back to the ED, I took them through the differential of stroke mimics. And when the med student reported that the computer read Dr. Watson’s EKG as “normal,” I made him fetch the file (we couldn’t figure out how to get the tracing on the EMR) and we went through it, systematically. I don’t think he was that into it, but honestly, if you’re going to be an MD, you had better know how to steer your way around an EKG.