Tales from Week One of Doctoring

The first two days were a nice ease-in to what I’ve got in store for the next year, 5 years, and really the rest of my working life. We had double resident coverage so I really never had more than 3 or 4 patients. But when the holiday weekend rolled around? Yeah, I got bodied. At one point I was seeing 8 or 9 patients at once. And a good half of them were pretty damn sick. 

I think the thing I was least prepared for was that now that I’m a resident, some attendings feel little need to get overly involved except with the sickest patients. They have total faith that I either a) know what I’m doing or b) will figure it out on my own. I’m so damn slow because I sweat over whether my Vicodn scripts should be for 5, 7.5, or 10mg of the narcotic portion. Should I only write for 12 or is 24 okay if they have a legitimate pain diagnosis? 

I’ve also learned that I’m the type of doctor who is willing to send people home if they’ve been in our ER for 8 or 9 hours and their pain is gone or their original problem has been more or less fixed even if it was somewhat serious on arrival to our ER. We have some doctors who just want to admit everyone to cover their ass. I think it’s a waste of the patient’s money and possibly taxpayer’s money. I also don’t think every headache needs a spinal tap or that everyone with new numbness deserves a neurology consult. If the head CT was normal and all their bloodwork was normal and the patient now wants to go home? Their numbness wasn’t that severe to begin with, especially when you’re now begging me to go home. 

The winner of the week though was this drunk guy who was threatening to kill everyone in the ER if he didn’t get his methadone (he’s been on for 14 years). He started to try and flip over his bed and then threw a chair at one of our transportation guys. So he bought himself 4 point restraints and some haldol. I went in to talk to him 10 minutes later and he was very sweet and apologetic and asked if we could at least reposition him so his back didn’t ache as much. I told him we couldn’t because it took 4 cops, 2 techs, and 2 nurses to put the restraints on and everyone was worried what would happen if we loosened the restraints. He ended up getting admitted for his blood alcohol level of .37 and his questionable history of shakes/seizures.

It was an exciting week that reassured me that I have much learning to do. I already knew that but it’s different having daily and hourly reminders.

In some ways it wasn’t very different than being a med student.  I don’t know all that much more. It’s not like they handed me an MD and then the dean layed hands on my head and I was suddenly bestowed with all medical knowledge. Although talking with some of the med students rotating through our ER, I do know a little bit more than they do.

 
It’s just that now that I have a long coat and a temporary physician’s license and can sign my own prescriptions and orders without needing a co-signature from a resident or attending, there’s this added sense that I SHOULD know more. You discuss your patient with an attending and they’re like “so what do you want to do?” Sometimes you hit it on the mark, but most times I forget something that should be more obvious to me, or I add something that shouldn’t have mentioned. Or I’ll take a look at the order list and notice that the attending added some medications or tests, which is a bit more embarassing than had they just told me to my face that I had forgotten something and I should order this or that.

I told a friend over the weekend that every day I re-learn that I know very little about this job. I think that should be the mantra of every intern. As long as you know what you don’t know and you’re willing to ask questions and look dumb in front of someone, at some point you’ll be able to do things on your own.