Let's shit on the interns

July in the hospital means one thing: new interns. It's common knowledge that going to the hospital in July is risky business. I know the new interns are here because I can hear the staff complaining. Every third sentence starts, 'Those dumb interns... *sigh*!' To everyone out there bitching about the interns' growing pains, I'd like to say this: STFU!

When I was a new intern, I caught flack from everyone: my attending, my senior, RN's, PCT's, MA's, RT's, EMT's, PT's, OT's, case managers, and even some custodial staff (strangely enough, I never heard a bad word from social work or nutrition...). I discovered one universal truth to being an intern in July: no one has your back.

My intern hell continued until my ICU month. Nurse Battle Axe was taking care of one of my patients. BA had been doing critical care since I was in diapers. The amount of critical care knowledge she would lose in a particularly violent sneeze was still more than I knew. So, when she asked me a question, I assumed it was rhetorical.

"I asked, 'What do you want to do, doctor?'" she repeated. My patient had a blood pressure of 70/30 despite aggressive hydration. I had no clue what to do. So, I sat down and thought about it, and after a little soul searching, I decided to start a pressor.

"Um, can we start dopamine? ... please?"

"Sure, doc!" she replied, and walked into the room, pushed a button on an IV pump, and dopamine was in. BP improved to 90/60. Mission accomplished.

Later, I thought about it, and she must've had the dopamine hung already and the line primed. But she let me make the call. I asked her about it, and she told me, "Dr. ifinding, you know I've always got your back!"

Part of being an intern is painful, and that's just how it is, but it certainly doesn't have to be more painful than it already is. So take it easy on the interns, huh? Or at least don't badmouth them to their face.

This has nothing to do with medicine at all

I am so disappointed that Petrozza lost on "Hell's Kitchen" tonight! I thought it was not right. He was a real gentleman and after the first few episodes, never had a bad service, whereas Christina continually had bad services right up to the end! And Christina's menu was so unimpressive! Sliders? OMFG, I'm not going to a Gordon Ramsay restaurant for mini hamburgers! Not unless it's a black truffle with fois gras hamburger.

But the thing that really got me was the comment at the end by chef Ramsay when he said that Christina had more potential and time, as she was significantly younger. Well, fuck, if you were going to choose Christina anyway, then why bother? Might as well just cut Petrozza a check and let him go home with some dignity. I mean, Christina had food sent back, which alone was enough for previous contestants to lose.

I think ultimately, looking at their menus, Christina's menu did not have much imagination, and really did not excite me whatsoever. Ramsay's restaurants average $100+ for a three course meal. For that price, the food not only has to be excellent, but imaginative. I got a lot more excited by Petrozza's menu, and would be much more likely to eat off of his menu.

It just seems to me more fuel for the 'nice guys finish last' fire. If I was a chef, I wouldn't work for Christina. It would be like having an intern run the medicine service. Personally, I love when I get a seasoned intern on service.

Humble Pie

I think that I'll try to post on a monthly basis. I know, I know, once a MONTH? But right now, that's as fast as I can go! And by the way, I'm taking down my old archives 2002-2004. Sorry! Maybe I'll put up some selected posts as a 'best of' kinda thing?

Every step in the medical education process is a humbling one. There's never a safe moment when medicine won't put you in your place. For me, the most humbling part of my medical education was the application process. I was waitlisted to some, rejected by most. My applicant year was extremely competitive, and some of my rejection letters acknowledged that in other years I would've been accepted, but for circumstance.

I lived in fear of my mailbox. I made a large pile of rejection letters on my desk. I was going to burn them once I got accepted, but after several months, my burning plan was lost in self-pity. Two schools were kind enough to reject me via postcard. I that that was the biggest slap in the face, that my rejection was not worth an envelope.

The interviews were even worse. One interviewer actually told me that I had no business applying to med school, and I shouldn't bother to pursue it any further. Another interview, I forgot my tie of all things. The interviewer took one look at me and didn't bother to listen to a word I said.

So, in early June while I was packing up my apartment and getting ready to move back home, I got an overnight express letter: 'Congratulations! Blah, blah, blah. Sign here!' One of my waitlist schools came through.

Now that I'm further along, it's easy to look back on those times with nostalgia, but it's awfully humbling to know that the only reason I got into medical school was because someone higher up on the list said 'No thanks, I can do better.' Thanks, dude. I really didn't want to move in with my mom.

A laugh

This post is one of the pre-written posts I mentioned earlier. I've been sitting on it for a couple months, trying to tune it up, but at this point, I give up.

Sometimes, laughter is good medicine. Sometimes, when faced with horrible situations, the only way to deal is to throw up your hands and chuckle.

One month on ICU, I had nothing but nightmare calls. My first call I had four patients code in a row, nearly back to back, and all four expired: four emergencies, four families destroyed, four tense situations full of panic and fear, over 80 minutes of sustained adrenaline with no release, on top of an already busy ICU call night full of septic shock and DKA.

Codes are agonizing. Only about 20-30% of in-hospital codes survive 24 hours, so it's a situation that destined to have a bad outcome. When I first started running codes, I did not save anyone through my first twelve. I was ready to quit residency. I should've gotten at least three of them to come back, if only for a day.

And then there's agonal respirations. During the code, it's a good prognostic sign, but after the code? It's probably the most horrifying physiologic response I can imagine. Every now and then you hear about someone coming back after being the code being stopped, but for the most part, agonal respirations are like a knife in the back.

And it's bad enough to have a patient die, but then facing the family is that much worse. It's like tearing your heart out piece by piece. It's always the same. The wife drives in to the hospital at 3 AM, still in her nightgown, sitting patiently at the nurses station with a cup of disgusting coffee which she can barely hold onto. And to have to tell this poor woman that her husband of 40 years is dead? It makes me nauseous just remembering.

There was another resident in the hospital who helped me through some of the codes, and in the morning before checkout, we reminisced about our terrible night. He loved vasopressin because you can't chase it with epi for five to ten minutes, so that's five minutes you can sit back and think. That doesn't sound like a lot of time, but if you're running the code, five minutes is a lifetime.

"Man, I love vasopressin. Five to ten minutes? That's half the code right there! It's Code Blue cruise control!" We both chuckled. Not that there's anything funny about watching four lives slip through your fingers, or telling four families that their loved ones were dead. It's just that when you have no other protection, nothing to hide behind, all you can do to keep going is to laugh. Because laughing is breathing, and on some days, it takes all the effort in the world to take that next breath.

Fin

Lately, I've been writing all my posts on paper and trying to edit them. I've been a little more concerned with my writing style, etc. but I've been discovering that I just don't have anything to say. I'm feeling good about my career and where I am professionally. I just don't have much to say.

And the things I do want to say are all things that I can't talk about for one reason or another. And this is just too restrictive a medium.

Finally, my personal life seems to be more of a concern to me than anything else. I was talking to a resident a while back, and he was telling me that he doesn't have time for his personal life. And from my own experience, I couldn't help but say that you can't just have a professional life. There needs to be some balance. That's something that I'm still missing.

So, for now, I have nothing left to say. And honestly, I was thinking about taking this blog down, but I couldn't do it. I don't know what this blog means to me anymore, so I'm giving it a rest.