Surviving to day 2

Well, I'm still alive. I didn't die of fear, which was just one of my many fears. The first day, night, and call couldn't come anywhere near the nightmares I had the night prior.

When I arrived at the MICU the first morning, the intern signing out to me said, "You're on call tonight? Good luck with that! I was scared coming onto this rotation as the last one of my intern year, so I can't imagine how you feel. Since you're the one on call today, you get to read all the chest x-rays during radiology rounds this morning. Oh, here's the code pager." At that point, I wasn't sure if I wanted to cry or vomit. I was wondering if I could do both when my co-interns showed up. There was work to be done, and if we focused on that, I found myself slightly calmer.

Anyway, I won't bore with all the details, but I can say that most of what people told me beforehand was true. The nurses and residents did take care of us, and we were well supervised. They made sure we ate. We didn't receive any pages until later in the day when we were more oriented, and the pages I received overnight were fairly simple. My resident and attending assured me they knew it was my first night and were available for questions. The nurses were fantastic and guided me towards what was best for the patient.

It would have been nice if someone told me that the code pager goes off every 12 hours just to test them, but there were no real codes. I heard there was a code in our other training hospital overnight, and the patient died. I wonder how the intern over there is doing.

I managed to get 2 to 3 hours of sleep here and there. While I probably could have had more, I didn't feel comfortable sleeping until I knew there was nothing else for me to do and was completely exhausted. I signed out after rounds late this morning. We have intern conference on Tuesdays, and while I know no one would have blamed me for going home, I went to conference. Intern conference is a support group for my class, and I wanted some intern support. It was nice to see everyone and hear how the first day went for everyone. While I have very supportive friends and family, no one knows what this week is like except for my intern classmates. We'll all get through this year together.

Ah! Baby scrubs!

I find this scary, but I'm keeping the link in case I decide I want to have kids and dress them in personalized scrubs.

Trial by fire?

I received my schedule, and I'm on call in the MICU my first night! Yikes! Since I'm familiar with the computer system and the hospital, it does make sense in a way to have me be the one covering the sickest patients in the hospital instead of one of my new co-interns who doesn't know how to put in computer orders. Perhaps it's best for the program, but I'm not sure if it's best for me and the heartburn I've been having all week.

Here's a selection of responses I've received since finding out about the MICU:

That means the program trusts you! The program coordinator swore up and down that I hadn't done anything to offend her. If the program does trust me, that's great and everything, but I'm not sure what I've done to earn that trust. Remember that I'm interested in primary care. I've never done a MICU rotation, so I'm not exactly reading critical care textbooks in my free time.

Isn't it better to start in the unit to get it out of the way? Well, that's one way of thinking about it, but I know they're thinking, "Better her than me!"

Don't worry the unit nurses are so good. They'll tell you what to do! I hope so because I won't know what to do!

Part of me is excited to start. I definitely didn't want to start on something easy because after all this anticipation I'm ready to dive in with both feet. However, now forced to dive in with both feet, the wading pool (i.e. anything but MICU) looks pretty darn good.

I have to say that my program has done a great job with orientation. A lot of the annoying regulatory paperwork was done online, and we spent a good deal of time meeting each other. We had workshops discussing how to cope with the stresses of intern year, and we practiced procedures on models and cadavers.

A few people commented on how much nicer this week was than med school orientation. People are really interested in getting to know each other, and we have a lot in common. Not only are we all new doctors and interested in internal medicine but we were all drawn to this particular program. I dished with some people over dinner about their thoughts on other programs, and I was surprised that we had the same impressions.

I did purchase a critical care textbook this weekend, but I honestly have so many errands to run this weekend before I start living in the hospital that I doubt I'll get much past the first few pages. I'm honestly scared about Monday. The 8-hour or less orientation days have been exhausting me so my first 30-hour shift will be a bit of a shock to the system. *Taking a deep breath* However, I know that I'll have a lot of support. That's what I love about my program--the emphasis on teamwork. So, wish me luck!

Emotions of Intern Orientation

need to get to sleep because lots more orientation early tomorrow morning, but here's a little bit of what i've been feeling.

exhausting. we had a few visits from the lawyers letting us know how to keep the hospital and ourselves from getting sued, the psychiatrists to let us know that at least 30% of us will become depressed, and a representative from every department you can think of (interpreter services, infection control, parking, security). plus, there were lots of lines to get ID badges, TB tests, fingerprinting (!), pagers, etc. this is all balanced out by many social gatherings to meet the department and each other. however, i've been waking up at 11 am for the last two months, and i'm not used to paying attention to anything or anyone for eight hours a day. is it bad that i'm tired and chugging coffee already?

exciting. i got a little misty eyed when i got my name badge with "MD" written at the end. plus, all of my co-interns seem super cool and down to earth ... so far.

scary. our department chairman said that we are basically the face of the medicine department as we are the primary inpatient caregivers. a visit from the medical student clerkship director reminded us that we are an important part of the teaching apparatus. i recall that my intern on each clerkship was a crucial determinant of whether i had a good learning experience. oh, and now i have to evaluate and grade medical students when i was one just a few weeks ago.

currently reading: the brochures comparing different health and retirement plans. aiya!

Preparing for worst case scenarios

Sorry for the little break. I was a little turned off from writing since my last entry was linked to by some pro-life Canadians. I was angry that some of my words seemed to be taken out of context, but my husband told me he's not surprised because I made abortion sound really gross. Oh well, I'll live and learn. Exciting stuff is happening in my life, so there's lots to write about.

What's my biggest fear about the start of internship? Where to start? ;) Okay, the one that scares me the most is that someone will stop breathing or collapse in front of me and I won't know what to do. You never think you'll need to use CPR, but I was the first doctor-like person to arrive at two codes during my subinternship. Apparently the residency people know about my biggest fear, and maybe that's why they send us to Advanced Cardiac Life Support (ACLS) training right before we start. Our instructor says he loves teaching the two-day course to new interns because we actually pay attention. It was actually a wonderfully practical course with them drilling in the essential steps, medications, and dosages into our brains. We ran through all their scenarios at least two or three times. (What if the heart rhythm is slow but no symptoms? What if the rhythm is fast but there's no pulse? What if you're the only one there? What if it's a child under eight years old?)

I thought that ACLS training was going to be a pain in the butt, especially since it required me to be back in Boston almost a week before hospital orientation. However, I was especially grateful when a few of my new co-interns and I walked into a restaurant this weekend, and a woman had passed out. While we were still too shy to yell, "I'm a doctor," we asked all the right questions. The American Heart Association has come up with some mnemonics that sound idiotic but are pretty helpful if/when you panic. The restaurant people probably thought we were nosy rubberneckers, but we didn't proceed to our table until we were satisfied that she was okay.

In my free time, I feel as if I'm preparing for the end of my life. My friends who are residents are fond of saying, "Are you ready for the worst year of your life?" or "You're not going to have time for that next year!" While I'd like to think that I'll still have time to see my friends and watch So You Think You Can Dance, I am getting my affairs in order. I paid my bills and got my haircut. My husband and I went on a day-long date walking around our beautiful city and splurging on some wonderful meals, and I went out for a night with the girls.

I know my life is going to change in a big way soon. I don't know how big, and I hope to be able to control in some way how much things will be different. We'll see.

This coming week: A full five days of hospital and program orientation plus social events to meet my whole intern class!

Currently reading: Barack Obama's The Audacity of Hope and Mark Bittman's The Minimalist Cooks at Home. I think I'm in love!

a trip down memory lane: the terminations

I've basically spent the last 10 days doing little else besides packing, moving, and unpacking. However, the effort is paying off in our new home actually starting to look like a home. I start my ACLS training next week, so I'm savoring a few more days of waking up at 11 am and spending unlimited time with my husband.

For those of you who haven't been on vacation for two months and are eager to read some more about medical training, the following is an old post about one of the most unforgettable experiences I had during medical school:

when i thought about going to medical school, i never thought i would spend a morning watching people have abortions, but now that i think about it, i really should have been outraged if i didn't.

one of our professors quit her job at a more prestigious medical school because abortions were no longer part of the clinical curriculum there. at my school, they don't make you watch, but the professor made an impassioned argument for observing at least one abortion regardless of what our beliefs are. being pro-choice myself, i initially didn't have any problems with going to the abortion clinic for a few hours, but as the date got closer, i started becoming more and more squeamish. other med students, even ones who were staunchly pro-choice, said that they became nauseated and couldn't stay for more than 30 minutes or so.

it would be hard to find the abortion clinic if you wanted to hurt the people who are there. it's in a normal-looking clinic, and the woman waits in the same waiting room as other clinics. when her name is called, she is brought to a nondescript room in the middle of a nondescript hallway. there are two rooms. someone else has already talked to her about her choices during a previous visit, and surgical abortion is what she's chosen. when she arrives, she changes into a hospital gown and talks to the nurses.

when the physicians walk in, everything is set. most of the women are put under conscious sedation, which means that they were drowsy but still aware of what was going on. they put a speculum in the vagina just like a pap smear and inject the local anesthetic around the cervix. then they slowly insert small rods into the cervix one at a time, increasing the size of the rod to make the cervix dilate. when the cervix is wide enough, they will use suction to evacuate the uterus. if the pregnancy is very early, they can use what looks like a big plastic syringe. by drawing back on the plunger, there's enough of a vacuum to almost empty the uterus. if the woman is further along, they can use a machine to suction. then, they'll take a metal loop and scrape the inside of the uterus to make sure nothing is left (you can feel the gritty texture of the uterus using this tool), and it's done.

the contents of the uterus are brought to another room and put in some water. the doctors sift through the contents with some tweezers, separating out the clots of blood to make sure that all the fetus parts were removed. i saw only first trimester terminations, so nothing i saw was bigger than my pinky. however, you could see a small skull with an eye and a very thin skeleton. they would usually measure the length of the fetus's foot to determine how far along the pregnancy really was. they identify all the major fetus parts to make sure nothing is left in the uterus to cause an infection.

i almost left after three procedures because i felt sick. it wasn't the procedures themselves that bothered me but the sifting through the uterine contents afterwards. the smell, the small, human-like object torn into pieces and then reassembled to make sure we didn't leave an arm or a head in the uterus ...

what were my impressions after seeing twelve surgical abortions in three hours? the physicians i worked with were all very kind, wonderful people, but i was a bit surprised at how business-like they acted. they introduced themselves, were sensitive to the patient's pain, and made sure to be as quick as possible. however, there was no chit chat before the procedure, no connection made between physician and patient, which is very different from most aspects of ob/gyn. i made this comment to a nurse, and she told me that doing abortions day after day, year after year takes a toll on providers. maybe that's how they're able to keep themselves together.

i was also surprised at how fast things went. it was very efficient with almost a factory-feel to it. the physicians were in the room for about 5 minutes. afterwards, the woman would go to recovery for 15 minutes or so and then leave.

in most areas of the world, women only get local anesthesia during this procedure, so only some of the pain is diminished. one woman did not want the drugs that would make her sleepy, and i could tell she was in a lot of pain. she screamed for the whole five minutes while the nurse who usually injects the drugs could only hold her hand.

i only write about this because i doubt any of you will ever see what i saw that day. it didn't change my mind about whether women should be able to have an abortion. i almost left the clinic after a few, but i thought it was important to stay. however difficult it was for me to see these women go through a difficult and traumatic event, it was more difficult for patient. i certainly better appreciated how performing abortions can take its toll on someone--patient and provider. even if you believe in what you do, it must be difficult, and i'm grateful that some people find an inner strength to provide this option to women.

It's been over a year since I spent the morning in the abortion clinic, but I have thought about that time often. For a while I considered going into family medicine or ob/gyn because abortion services can typically be part of that training. However, I wasn't sure if I could be an abortion provider no matter how strong my belief in a woman's right to abortion access. During my interviews, an internal medicine program director told me that one of her trainees learned how to perform abortions during residency, so I guess that door is still open to me.