Heading into my last week of general medicine in-patient work as an intern, with one more block of labor and delivery in-patient medicine in June. In-patient rotations are the most taxing simply because they require one to work 6 days a week. I find that generally I end up working 10-12 hours/day during the more chill, out-patient rotations, and 12-13 hours/day during the strenuous in-patient rotations, but the big difference in having a life is that the out patient (aka clinic) rotations are 5 days instead of 6 days per week, which just makes for a happier person. The in-patient rotations however have their perks. I feel more of a sense of control, every morning has a loosely structured schedule, and I get to accomplish my work however I want, I get sign-out (the low-down on what happened for my patients overnight and who got admitted to the team) from the night team, chart review, see my patients, start my notes, while chowing down on some breakfast; all this gets done in the first 3 hours of the day. Then rounding (usually a sitting session – thank GOODNESS! Which is where we discuss the patients, their new labs or radiology reports, and their plan of care with the other team intern, the senior resident, and the attending… and sometimes our awesome clinical pharmacologist and a medical student or two), which takes a pretty variable amount of time depending on how much teaching or tangential talking we do … and the rest of the day disappears in a flurry of random tasks, some big some small, like running up to check an EKG or having a family meeting with the patient and their loved ones, or admitting a new patient from the emergency room, all which I must prioritize to ensure good patient care … and to ensure I don’t stay there till well after my 12 hour allotted shift time, which thankfully really doesn’t happen too often, usually only about once per week by about 1 hour. The day is so busy and usually I do get some time to read or discuss learning points on my own or with my team, and those learning points are always so interesting because they are immediately relevant to what I’m doing and the decisions I have to make (or think I have to make but in reality, the real doctor, the attending, ultimately makes them, but hey I do have some say).
This is in contrast to clinic where I feel I have no control, I have to wait usually at least 20 minutes to see my first patient because it always takes that long for the medical assistant (MA) to screen them, and usually, since I am an intern, I have not even worked with the MA but once or twice so we are not used to each other and things do not flow very efficiently. Then the day goes by quickly, yes, however I continue to feel I have no control over the day’s events, as each patient is a complete mystery, someone new I’ve never seen before, and who may or may not have a host of medical questions for me to address at our 40 minute appointment, which may seem like adequate time, but when you start by taking the first 20 minutes away, then add on trying to have a 5-10 min conversation with your attending in between interviewing, examining and wrapping up with the patient, which may at times require several iterations depending on the attending and how many things they want you to go back into the room to recheck, you are running behind by 30 minutes at a minimum at the end of the day and still have at least an hour’s worth of medical record documentation to do. It’s far more draining than the in-patient work. Perhaps spending more time in the clinic over the next few months will allow me to become more efficient and master the art of clinic flow. Additionally, when second year officially starts, I’ll no longer have to take the extra step of precepting (or presenting my patient and the plan to an attending) except for patients in which I have questions or uncertainties.
Anyway, that about sums up the intern year schedule dynamics. Somehow keeping sane most of the time, Andy-man and Mr. Darcy are ever a source of joy… and then there’s the excitement of expecting…
Yes we’re having another baby! I just passed the big week number 24, also known as “vitality week” since it supposedly marks a statically significant difference in vitality between those who are born prior to verses after this date of gestation. So I suppose I can worry a little less now. I don’t know how to not worry, there is always something new on which to ruminate. Did my water just break, or did i just pee myself? Am I going into labor or is this just what running is going to feel like from now until I give birth? Knowledge on the subject of medicine and health only makes a person paranoid.
But anyway, there is a lot of excitement in the coming July, going to be finished with intern year, and Andy is going to be a big brother! Also, another 3 minutes and it’s Easter, He is RISEN, he is RISEN INDEED, HALLELUJAH !