So it’s been approximately 3 months since my last post on my own website.  Naturally I have been very busy with Internship.  So far I have done Inpatient medicine, ICU/CCU, Family Medicine Inpatient, Emergency Medicine, Pediatrics Clinic, Pediatrics Wards and now Inpatient Surgery.  Naturally with this comes alot of overnight call.  So many of you are wondering what internship is like, I’ll give you a brief run down.

The Hours

Generally you work 75-80 hours a week.  How you approach this limit depends on the amount of call you take.  On ICU rotation, I took 2 overnight calls a week, which is an automatic 60 hours (30 each call because they keep you till noon the next day most of the time).   However during the days not on call, I worked from 6am to 1pm which helps keep the hours low.  Plus you get an average of 1 day off a week.   On other rotations, like pediatrics, my schedule was very erratic.  One week I took call every third day and then finished the week by being on call Friday night and all day Sunday.  Yep, I did 60 hours over a weekend, it sucked.    Other rotations like Family Medicine inpatient, I had 2 weekends off, but I worked 12-14 hours monday-friday.   Thus it should be said that the hours vary but they always find a way during your internship year to get you near that magic 80 hours mark.    At my program, they do adhere to the 80 hour rule fairly well which is nice, but not all programs are like that.

What does it feel like to be an Intern?

During my 3rd year of medical school, I felt like I didn’t know anything and it was scary.  During my 4th year of medical school, I thought I was the man and knew everything!   Your first day of internship you realize that you know nothing again and all of a sudden, everything you do matters.  You can sign orders, sign notes, write scripts…the whole nine yards.   You often feel alone during internship but you always have some sort of backup in the way of a senior resident or attending physician you can call if you have a question about something going on with a patient. 

At times, you feel excited!  It’s like “Wow, I made it thru school and I’m a doctor, it’s really happening!” and other times you are like “Holy crap, what the hell did I get myself into?”  So naturally there are good days and bad.   When someone passes away, you cannot help but feel a little sad.  You are euphoric when you realize that you are post call on a Friday but have Saturday and Sunday off meaning a partial three day weekend!  But most of the time, particularly in the winter months like now, I feel depressed.  Depressed for a few reasons:  Stressing out about future rotations, knowing that I’ve got a rough month of inpatient internal medicine coming up; Not being able to spend alot of time with my wife; Being sleep deprived all the time; Gaining weight due to poor eating/constant stress/exercise habits; The knowledge that there is no end in sight to working 80 hours a week for the next few months; and the lingering thought that you can and will be treated poorly by nursing staff or malignant attending physicians (though I have not experienced much of that luckily) Overall, you desperately cling to the knowledge that residency too, shall eventually pass.

On the other hand, I really enjoy working with the physicians in my family practice program.  They really care about the residents and take time to teach us and get to know us as people.   The problem with internship year is that we see our family medicine faculty two months out of the year and 1/2 a day a week for continuity clinic the rest of the time.   I think life gets better as a senior resident, or so I am told.  Our program was just reviewed by the Residency Review Committee and received a full 5 years of accreditation, which is the maximum a program can get.  Naturally, our Family medicine residency program at Carilion Clinic is doing something right.  Glad to be on board something good.

Increasing Knowledge

I realize I am getting better daily.  Sometimes I don’t feel that way.  Heck, oftentimes I feel like a complete n00b however I am picking up on alot of things.  Some knowledge I acquired during medical school that did not make sense to be at the time really came together for me after actually managing patients on the floor.  It really does help to learn by doing.  There is something about knowing you are ultimately responsible for your knowledge base that seems to make your mind “figure” things out easier.   There’s a constant pressure too.  When you do attending rounds in the mornings and present your patients and their plans, you always have this nervous pit in your stomach, however that is how you learn best and at times you are able to have an epiphany during the discussion.    I do alot of reading, and usually keep a book in my jacket pocket at all times.  Mainly due to the knowledge that I will be taking my step 3 board exam to get my permanent license in the next couple months.  As a Family Physician, I am now faced with the reality that I have to know a little bit of everything and have a broad knowledge base.  I am further reminded of this truth every time I am in continuity clinic.  Like this week, I will see someone for rib pain that will need a follow up rib series (x-ray) and then 20 minutes later will do a pap smear and pelvic examination on someone who may have Polycystic Ovarian Syndrome.  Very broad knowledge base means I will be reading alot.   Did I mention I keep a stack of books by the toliet?  My wife gets a kick out of it

What is being on Call Like?

In one word: Scary.  When you are on call, you carry a pager.  You often times have a call room with a cot and sometimes a TV and a computer to enter orders in on.  Many times you get soft calls like “Mr. So-and-so can’t sleep, can you give him something for sleep?” and so you order some Ambien or some Trazodone.  Other times you’ll get a call because a patient is in pain or has vomited.  In the worse case scenarios your code blue pager goes off or you get called because a patient’s respiratory status is worsening.  At those times, you get your butt out of bed and see the patient immediately.  If things are bad you call the ICU and arrange for transfer for higher level of care.  If you are in the ICU, you intervene and call your senior resident immediately.  (always call your senior resident for ANYTHING bad). 

Admittedly, it’s tough getting out of bed and running to see a patient.   Everything is fuzzy under the flourescent lights but your adrenaline kicks in after a few seconds and you are going at full blast.    I often worry about missing pages but have not slept thru a page thus far.  Still I sleep very light on call nights and so the sleep you get (if any) is very low quality sleep.  When I was on pediatrics, I never slept more than an hour at a time.

What is the the worst thing about being on call?  Overnight Admissions.  Normally you get called to the ER to see a new patient.  Many of these overnight admissions are soft admissions (meaning that the patient really didn’t need to be admitted to the hospital in most cases) but all admissions being warranted or not need a complete history and physical.  Doing a decent H&P and writing admission orders on a patient takes a minimum of 45 minutes to do correctly, and in worse case scenarios, up to 2 hours.  Keep in mind you are still getting paged every so often during these admissions for other patients.  Thus, get 5 admissions overnight and you are talking about a very fragmented (if not non-existant) sleep pattern.   By far though, the absolute worse part of being on call is working the next day and presenting on rounds.  While you are sleep deprived you have to present the people you admitted overnight to your team and your attending physician who often pimps (read: asks multiple medical questions to increase your medical knowledge, make you look stupid or a combination of both) you and turns you to dust.  Why?  Because after sleeping a total of 15 minutes overnight, your brain does not work well which means you cannot recall as much medical knowledge during the next day.  Still this is the way interns have been trained year after year so learning to function in a chronically sleep deprived state is a skill every Intern needs.  Am I good at it?  Let’s just say I’ve gotten better over time.

Still, you do learn during your time on call because it is just you and a book making medical decisions based on what you know.  And if you don’t know? You call someone and ask or look it up yourself till you find the right answer.  I one time got to put in three internal jugular central lines in one call night in the ICU because we had two patients in septic shock and one surgical pt go into cardiogenic shock all within a 4 hour period.  That’s what you call on the job training.

What is the pay like?

Average Intern pay is about $9.46/hour.  Yes you read that right.  I am lucky though, my program is good to me and so I get $10.39/hour.   Are you shocked?  Don’t be

Do you have a life outside of Internship?

Yes but not much of one.  You see, residency completely engulfs your being for 3-5 years.  However, it’s really accurate to say that once you become a physician, that forever defines who you are.   But I still find time to take my wife out to eat or occasionally goto a concert with my wife.  We go out to eat with friends from school and work.  Our families do come to visit also which is a plus!    When I am not reading or catching up on paperwork, you can find me on Xbox Live under gamertag RichieTruxillo playing some Call of Duty 4 or Gears of War 2.  And of course I still play World of Warcraft on Dragonblight server (alliance) though I am severely lagging behind my guildmates who are all level 80.  (I have a 73 hunter and a 70 paladin and a 60 DK).  I was hopeful to goto the gym (we get a free gym membership) my first month when I was working 9-5 everyday during our introduction month, however that went right out the window when I started working in the wards and in the Internsive Care Unit.  It takes 18 minutes to get to the gym so by the time you get there and back, you have burned 2 and a half hours.  Normally I have a total of 3 and a half hours of free time when I get home in the evenings before I have to goto bed assuming I am not on call.    Again, I hear that life gets better next year so I am desperately clinging to that still ;)  Actually life is supposed to get a little bit better after next month (all the call months will be over) and I will be definitely looking forward to it. 

With all of that said…

So, with all of that said, please forgive me if my website has not been updated in awhile.   I have been kept extremely busy!  However, I am clinging to the knowledge that after next month’s beatdown, I will have a smidgen more free time to learn and live life a bit more.  Until that time, please say a prayer for me to continue this journey with my sanity and health intact!   And I’ve still got that sense of humor in me, just haven’t been able to sit down and write music and do stuff like I want to.  Anyways, thanks for reading this wall of text and best of wishes to you!  And next time you think your job sucks, remember the poor Intern and what he goes through.  Suddenly, your job won’t seem quite as bad