Archive for June 2006

Don’t bother trying to learn anything

June 25, 2006

I'm recovering from my first full call day in the medical intensive care unit, the MICU. Call in our MICU is a morning-to-morning shift, which means being awake all night, unless you can justify sleeping. It was a relatively quiet night for us, so we got about 5 hours of sleep–a full night's worth, more or less.

I made my first death pronouncement at 10:35 p.m. last night after a family withdrew care from a woman who was only 48 years old. I hadn't taken care of the patient at all; I just pronounced her as practice.

In the middle of the night, I mentioned to my residents that I was going to read about some subject and could present a little summary of what I'd learned to my team in the mornings. They both looked at me as if I were insane. "We don't do that," one said. "You're not in medical school any more," said the other. "Your quality as an intern is measured by your efficiency, not by how much you read. Don't bother trying to learn anything; when you have free time, sleep, eat, or pee. That's the most we can expect you to do."

Maybe I'm still really naive, but this is not an ethic I'm eager to buy into. I guess it might seem reasonable eventually, but for now, I'm going to keep reading.

Signout, by the way, is short for the transfer of information between patient care teams in the hospital. When one team leaves the hospital and another comes in, the old team signs out–or gives signout to–the new team.

First day

June 23, 2006

Today was my first day of residency. In the large, academic medical center where I work, the wards were filled with people like me: kids fresh out of medical school, creases still not washed out of our long white coats, playing with the buttons on our beepers, looking for the bathrooms. For the next year, we will be the interns, and on this first day, we tried to like it. It wasn’t that hard, right? There was a free lunch, and the nurses were really nice to us. Plus, now we have real responsibility. We love responsibility.

It gets easier to be an intern with every year that passes. A few years ago, a national standard was enacted, mandating a maximum-80-hour work week for medical residents with the goal of improving patient care by reducing resident fatigue. This has placed at least a temporal limit on the amount of shit we can take. And although medicine is certainly a conservative field in many ways, the old, patriarchal approach is considered less cool than it used to be. In the setting of a shortage of American medical grads, all but the most popular programs have to work to make themselves attractive to applicants; at mine, for example, we get a free lunch not just on the first day, but every day.

So my first day of my first year of residency—my intern year—was probably less scary for me than it would’ve been twenty, ten, or even five years ago. And although my patients certainly weren’t aware of it, it was much less scary for them, too.

I’ll try to share as much as I can in this space.