What a week!

If I've been painting a rosy picture of internship, maybe it's because I've been lucky enough to have a few good weeks or maybe a bad day here or there mixed with mostly good days. This week was terrible. Everyday was a nightmare. When I tried to explain my bad days to my husband, he pointed out that nothing really bad (e.g. patient dying, giving someone the wrong drug) happened; I just had long, busy days. The wards are a crazy balancing act, and I'm working on my juggling skills. Our schedules aren't so bad if everything goes according to plan, but some things can really screw up your day:

1. When admitting, all your new patients can come to the floor at the same time. The way we're assigned patients is designed to avoid this. However, patients come from the ER, directly from clinic, transferred from other hospitals, and transferred from the ICU. Although I hear about the patients at neatly spaced intervals, through the mysteries of patient transport, sometimes they all come at once. So, I have to run around and make sure they're all stable and then try and do a quick assessment to put some basic orders in the computer (patients will complain if they don't get dinner, and nurses will complain if there are no orders in the system!). Once they're stable with dinner on the way, I have to figure out what's wrong with my new patients and how I'm going to fix them (or at least what to order to help narrow down the differential).

2. Patients can become unstable. Nothing can destabilize my day like a call that says, "Your patient is having shortness of breath and is desating to the 80s." Yikes! People not being able to deliver oxygen to their organs is really bad, and it requires dropping whatever you were doing (e.g. rounding with the team, writing prescriptions so another patient could catch his 2 pm ambulance to rehab, eating lunch and enjoying a teaching conference, or preparing your signout to leave for the day) and running in that direction. Having been in the MICU, I have some experience with unstable patients, but I also have more patients to take care of. Once the patient's oxygen saturation has gone back up with a face mask, blood has been sent to the lab, the STAT portable chest xray team are on their way, when is it okay for me to resume my other activities? For me, not for a while. The best I can do is park myself at a portable computer outside the patient's room and try to move my other patients along, but it's hard to think about anything else except my patient possibly needing to be moved to the ICU.

3. The absence of a member of your team. I'm fortunate to be on another great team, but when one team member is gone, things can get crazy. Sometimes they're at clinic or have the day off, and in addition to my work, I'm responsible for their patients, too. Double the patients to take care of! Whenever that's going to happen, we try to make sure everyone is "tucked" (e.g. discharge summaries and prescriptions ready for possible discharges, labs ordered, consults called, etc.) but sometimes you can't predict what will happen when you're covering someone else's patients. Also, having a covering attending or resident can throw everything up in the air as he or she can have a different interpretation of events and labs and want to completely change the plan. Of course, they'll say to me, "It's your patient, and your team has a plan. However, I'm not sure why you haven't considered this possibility." Well, when you put it like that, I'd be hard pressed not to go along with their suggestions.

4. Medical students. I absolutely love having medical students and teaching them, but in the crazy juggling act that is my day, finding time for them can be difficult. As I was a student just a few months ago, I remember very well what it was like to be a med student on the wards. I try to get my students out as early as I can although sometimes they insist on staying for some unknown reason. I'll take a few minutes here or there to teach them something (e.g. reading chest xrays or EKG's, going over the differential or workup of a particular problem), but some days the best I can do is try to be a role model of a busy but hopefully intelligent and efficient intern.

What makes these crazy days better? Help from my resident and moral support from my co-interns during the day, and when I come home, a big hug and some understanding from my husband that it'll take me a few minutes to shake off my grouchy mood.

Time to go to the beach, so I can start another week rejuvenated.