Best new intern stories: let em spill

[opr8n]

1. Nurse calls intern, pt has bowels exposed after an exlap, intern goes to see the patient, writes note saying "bowel and omentum intect and look good, will cont to follow" and dosent call the senior in house

2. Intern admit H&p "pt is without feverishness" ???

3. Intern call upper level b/c medicine resident tried to get intern to see a consult without talking to the chief or attending.
Intern: "so im about to go see this preconsult for nec fasc"
Me: what????
Intern: yeah medicine just wants me to see it to determine if ity actually needs a surgical consult
Me: [shrugs head]

4. Intern see pt in ER with biliary colic, staffed, sent home, f/u for op operation, but intern dictates in A/P: "pt needs emergent operation, will follow up in office"

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[ExtraCrispy]

" Nurse calls intern, pt has bowels exposed after an exlap, intern goes to see the patient, writes note saying "bowel and omentum intect and look good, will cont to follow" and dosent call the senior in house"

Wow. That's horrendous.

Here's one:

Senior resident blind-sided, with fiery attending over his shoulder, with CXR obtained the night prior with honkin' pneumothorax. CXR was ordered by the nurse, never checked by the intern. Nurse ORDERED CXR b/c when chest tube "fell out" the night prior, the intern just "stitched it back into place," without a call to the senior. Fiery attending goes bonkers. Senior resident wants to kill intern.

 

[Winged Scapula]

Please, please tell me that the intern in the 1st post was an off-service, non surgical Prelim. Although frankly, even that's no excuse for not recognizing an evisceration.

That's worse than the nursing assistant who once called me to report some "pink bubbles" on a patient's abdomen. While she didn't recognize small bowel evisceration, at least she CALLED.

 

[opr8n]

Please, please tell me that the intern in the 1st post was an off-service, non surgical Prelim. Although frankly, even that's no excuse for not recognizing an evisceration.

That's worse than the nursing assistant who once called me to report some "pink bubbles" on a patient's abdomen. While she didn't recognize small bowel evisceration, at least she CALLED.

the intern is prelim, but not off service, i know, scarry, he is actually one my service a couple times this year, cant wait!!!

 

[Gfunk6]

That's worse than the nursing assistant who once called me to report some "pink bubbles" on a patient's abdomen. While she didn't recognize small bowel evisceration, at least she CALLED.

Reminds me when I was an MS-IV on my OB-GYN rotation. We were doing a routine post-op check on a pt who had a C/S. Apparently, the pt had been having abdominal pain, some kind of weird discharge from her incision site, as well as low-grade fevers.

So I go in first and take a look and notice that she has those "pink bubbles" that WS mentioned. OK I might have been green but I was pretty sure I was seeing intestines and/or uterus.

So I go back to my attending:

Him: "So how is the pt doing?"
Me: "Well . . . I think I can see her uterus."
Him: "EXCUSE ME!?!?!?"
Me: "Ummmm . . . I'm pretty sure her uterus or intestines are coming out of her incision site."
Him: *Runs in room*

Sure enough it was an intestinal herniation. It was that day I learned what chitlins were . . . my Southern slang wasn't too good.

 

[sponch]

Reminds me when I was an MS-IV on my OB-GYN rotation. We were doing a routine post-op check on a pt who had a C/S. Apparently, the pt had been having abdominal pain, some kind of weird discharge from her incision site, as well as low-grade fevers.

So I go in first and take a look and notice that she has those "pink bubbles" that WS mentioned. OK I might have been green but I was pretty sure I was seeing intestines and/or uterus.

So I go back to my attending:

Him: "So how is the pt doing?"
Me: "Well . . . I think I can see her uterus."
Him: "EXCUSE ME!?!?!?"
Me: "Ummmm . . . I'm pretty sure her uterus or intestines are coming out of her incision site."
Him: *Runs in room*

Sure enough it was an intestinal herniation. It was that day I learned what chitlins were . . . my Southern slang wasn't too good.

afterward, did you point out that fascial dehiscence is due to technical failure 100% of the time?

 

[maxheadroom]

'Tern didn't recognize that an evisceration should be mentioned to the senior resident? Wow! When I was a 'tern we were pretty much expected to talk to the senior resident about EVERYTHING for the first couple of months. Granted, I never told an intern, "If the patient's bowels present themselves, you should let me know," but I really never thought that would be necessary.

BTW, US Surgical suture is total crap. We had a rash of fascial dehiscences when our hospital switched to USS from Ethicon. People had to learn to go up at least one size because the fake Prolene or fake PDS would simply break when the patient coughed. (Yes, people did look to make sure that their knot was still tied and that the bites were adequate)

 

[tussy]

I remember coming in one morning to round and looking in the progress notes of a patients chart and reading an "on call note" that read something like this

"jr. resident on call. Called to assess patient with wound dehiscence. Patient examined. Wound completely opened with exposed small and large bowel. Wound closed at bedside with interuppted 3-0 nylon suture, local with 2%xylocaine, patient tolerated well with no complications. Dr. Intern X PGY1"

We looked and indeed - he had closed the skin over the dehiscence the night before at the bedside and never called his senior. If it wasn't so terrible it would almost be funny.

 

[maxheadroom]

It's like an outbreak of interns just looking at the bowels and not doing anything! I just can't imagine an intern thinking that something like that is OK.

 

[Chronic Student]

I remember coming in one morning to round and looking in the progress notes of a patients chart and reading an "on call note" that read something like this

"jr. resident on call. Called to assess patient with wound dehiscence. Patient examined. Wound completely opened with exposed small and large bowel. Wound closed at bedside with interuppted 3-0 nylon suture, local with 2%xylocaine, patient tolerated well with no complications. Dr. Intern X PGY1"

We looked and indeed - he had closed the skin over the dehiscence the night before at the bedside and never called his senior. If it wasn't so terrible it would almost be funny.

Why not just use staples!

j/k

 

[Plastikos]

'Tern didn't recognize that an evisceration should be mentioned to the senior resident? Wow! When I was a 'tern we were pretty much expected to talk to the senior resident about EVERYTHING for the first couple of months. Granted, I never told an intern, "If the patient's bowels present themselves, you should let me know," but I really never thought that would be necessary.

BTW, US Surgical suture is total crap. We had a rash of fascial dehiscences when our hospital switched to USS from Ethicon. People had to learn to go up at least one size because the fake Prolene or fake PDS would simply break when the patient coughed. (Yes, people did look to make sure that their knot was still tied and that the bites were adequate)

No one ive ever known likes USS suture, its by far a inferior product. Sutures dont hold, they are fragile, ungodly long for most applications (supposedly a selling point), and needles are wimpy...get what u pay for.

 

[maxheadroom]

Ah yes, the needles. Love their "Cosmetic cutting" needles that are as blunt as an ortho intern on the Cardiac service.

 

[Celiac Plexus]

I remember coming in one morning to round and looking in the progress notes of a patients chart and reading an "on call note" that read something like this

"jr. resident on call. Called to assess patient with wound dehiscence. Patient examined. Wound completely opened with exposed small and large bowel. Wound closed at bedside with interuppted 3-0 nylon suture, local with 2%xylocaine, patient tolerated well with no complications. Dr. Intern X PGY1"

We looked and indeed - he had closed the skin over the dehiscence the night before at the bedside and never called his senior. If it wasn't so terrible it would almost be funny.

Skin is the best biological covering after all... It would have been better if the intern had added: "Plan to return to OR in 48 hours for closure of abdomen after resuscitation."

 

[njbmd]

Please, please tell me that the intern in the 1st post was an off-service, non surgical Prelim. Although frankly, even that's no excuse for not recognizing an evisceration.

That's worse than the nursing assistant who once called me to report some "pink bubbles" on a patient's abdomen. While she didn't recognize small bowel evisceration, at least she CALLED.

I received a call for the patient having "snakes in the bed" from one of the nurses. Fortunately, I knew exactly what she meant and headed to bedside.

 

[kaos]

I remember coming in one morning to round and looking in the progress notes of a patients chart and reading an "on call note" that read something like this

"jr. resident on call. Called to assess patient with wound dehiscence. Patient examined. Wound completely opened with exposed small and large bowel. Wound closed at bedside with interuppted 3-0 nylon suture, local with 2%xylocaine, patient tolerated well with no complications. Dr. Intern X PGY1"

We looked and indeed - he had closed the skin over the dehiscence the night before at the bedside and never called his senior. If it wasn't so terrible it would almost be funny.

Oh My GOD! I don't even want to know what the attending said/did!

 

[CTS]

An intern was told to pull out drains after sacral flap. Nephrostomy came out as well.

 

[butterfly0660]

One of our former residents pulled some pacer wires as a PGY-3 and then 10-15 min later had to crack his chest when he coded. After hearing that story I almost peed my pants everytime they sent me to pull pacer wires.

 

[MediCane2006]

Heard this story from the chairman's service from the first couple weeks of the year...


The intern on our chief's service turned off the pager on the first day of internship because "it was going off too much and I couldn't get anything done..."

And on the next day, our chairman called the service pager to round, and she told him to "please call back because I'm just way too busy right now"

 

[smq123]

Heard this story from the chairman's service from the first couple weeks of the year...


The intern on our chief's service turned off the pager on the first day of internship because "it was going off too much and I couldn't get anything done..."

And on the next day, our chairman called the service pager to round, and she told him to "please call back because I'm just way too busy right now"

Wow. I hadn't heard those stories before. She's already famous, it seems.

 

[Castro Viejo]

One of my interns last year...

Put a patient's Foley catheter to wall suction. ("The senior told me to put the drain to suction.")

Cut a JP drain right at the skin and suture closed the skin hole. ("The senior told me to cut it at the skin and pull.")

Placed a TLC into a patient's AV fistula. ("I couldn't get an IV, so I decided to get a central line started, and I placed it into the biggest vein I could find!")

Hooked up a radical neck patient's tube feeds to the neck drain.

You gotta love July.

Now as a fellow, I leave most of the rounding to the Chief on the service. They tend to like it that way and, quite frankly, I don't know how much more grief this old ticker of mine can take before I just keel over and have a massive MI.

Word up.

 

[Winged Scapula]

These are great. And to think I used to believe that no one could have been a worse intern than I (well, ok, I knew of a few exceptions).

Foley to suction? Ouch.

 

[maxheadroom]

One of my interns last year...

Put a patient's Foley catheter to wall suction. ("The senior told me to put the drain to suction.")

Cut a JP drain right at the skin and suture closed the skin hole. ("The senior told me to cut it at the skin and pull.")

Placed a TLC into a patient's AV fistula. ("I couldn't get an IV, so I decided to get a central line started, and I placed it into the biggest vein I could find!")

Hooked up a radical neck patient's tube feeds to the neck drain.

You gotta love July.

Now as a fellow, I leave most of the rounding to the Chief on the service. They tend to like it that way and, quite frankly, I don't know how much more grief this old ticker of mine can take before I just keel over and have a massive MI.

Word up.

Now that's some crazy ****! Holy cow! I mean . . . I'm speechless!

 

[SLUser11]

One of my interns last year...

Put a patient's Foley catheter to wall suction. ("The senior told me to put the drain to suction.")

Cut a JP drain right at the skin and suture closed the skin hole. ("The senior told me to cut it at the skin and pull.")

Placed a TLC into a patient's AV fistula. ("I couldn't get an IV, so I decided to get a central line started, and I placed it into the biggest vein I could find!")

Hooked up a radical neck patient's tube feeds to the neck drain.

Where the hell did you find these guys? Between these stories, and your earlier ones about their work ethics, you have likely experienced the worst interns in the country.

 

[maxheadroom]

Where the hell did you find these guys? Between these stories, and your earlier ones about their work ethics, you have likely experienced the worst interns in the country.

Agreed. Making one of those mistakes could be forgivable. All of those? Sounds like someone needs to rethink their career.

 

[Castro Viejo]

All the same intern?

Fired?

No, unfortunately, not fired. His uncle is the Godfather of the hospital CEO's kid, so this ***** was bulletproof.

Basically the unlucky bastard of a senior resident who took call with this guy had to follow him around ALL night to ensure patient safety. Consequently there were a lot of 3s and 4s who were re-living their internship for a month at a time, Q3 overnight in-house.

 

[Castro Viejo]

Where the hell did you find these guys? Between these stories, and your earlier ones about their work ethics, you have likely experienced the worst interns in the country.

APDS. They almost always come from APDS. Post an ad there looking for undesignated prelims and they come out of the woodwork. We would get about 30 CVs and sets of LORs for every undesignated spot we had.

It was probably our most reliable source for finding warm bodies... Too bad their brains were just cold.

 

[ddmo]

Already painfully dumb students?

 

[SLUser11]

Already painfully dumb students?

Nice.

My first thought was Association for the Placement of Dumb@#ses in Surgery.

 

[Winged Scapula]

What the hell is APDS?

Association for Program Directors in Surgery. http://www.apds.org/

Their web site is probably the best way to find a centralized list of open positions as well as residents looking for positions. Clearly residents of top notch caliber according to CV's stories.

 

[Pir8DeacDoc]

I am only heard about this one from my GF who is a g-surg nurse and one of my buddies who happened to be on call that night.

POD # 0 bastric bypass. Intern is called for gradual decline in UOP and is now 15-20 cc/hr. Intern promptly gives lasix and the patient dumps 300cc. Goes into acute renal failure and obviously becomes more dry than they already were. My friend nearly had a stroke on this kid when he found out about it.

One from my intern year. POD 2 or so gastric bypass. Patient having trouble with nausea that isn't responsive to zofran. Fellow intern of mine attempts to place an NGT to relieve her discomfort. Luckily he wasn't successful. Attending found out about it and threatened his life if the patient had a leak. No leak luckily.

 

[radslooking]

yikes. i have to say, this thread has made me feel a little better about my own intern experience. maybe i wasn't so dumb.

Foley to suction? cutting a JP and sewing up the hole? what person does not know you can't leave plastic nonsterile objects inside a body....hmmmm....

 

[Winged Scapula]

yikes. i have to say, this thread has made me feel a little better about my own intern experience. maybe i wasn't so dumb.

Foley to suction? cutting a JP and sewing up the hole? what person does not know you can't leave plastic nonsterile objects inside a body....hmmmm....

The silastic tubing inside the body should have been placed sterilely in the OR, so that's not really the problem but rather the leavng of a foreign body behind.

We had this problem with a medical student when I was a resident, except that the silastic tubing broke off when he pulled, leaving the white fenestrated portion of the drain behind. He didn't tell anyone and no one found out until the patient returned to the OR.

In his defense, I'm not sure this student had ever seen a drain placed and wasn't sure what it looked like on the inside, so I used that experience to make sure that anyone pulling a drain knew exactly what to expect. Then again, a surgical intern should have known better.

This should be a lesson to all seniors, Chiefs and attendings to be very clear about what you mean. I recall being asked to "crack back" a drain when I was an intern...and I had NO IDEA what that meant and was too scared to ask (because I had a particularly unpleasant few Chiefs).

 

[Castro Viejo]

In his defense, I'm not sure this student had ever seen a drain placed and wasn't sure what it looked like on the inside, so I used that experience to make sure that anyone pulling a drain knew exactly what to expect. Then again, a surgical intern should have known better.

This should be a lesson to all seniors, Chiefs and attendings to be very clear about what you mean. I recall being asked to "crack back" a drain when I was an intern...and I had NO IDEA what that meant and was too scared to ask (because I had a particularly unpleasant few Chiefs).

So the story goes that this intern had never seen a drain before. It was a bad assumption on our part as his seniors and, in my case, his Chief Resident. I suppose that's why most of the crap came down on us and, in particular, me.

I agree with WS. Especially in July we should refrain from using the vernacular of surgery until everyone's on board.

I recently told an intern a few weeks ago to:

"Crack the drain."

He had a puzzled look on his face, so I said:

"Strip the drain."

Still puzzled. OK, so I had to show him what I meant having learned that interns don't necessarily speak the same language.

Cutting the JP at the skin and leaving the white part inside is really no big deal insofar as you discover it prior to discharge and take care of it. It's like suturing up a patient's balls and forgetting to cut the stitch at the end of case. I'm sure we've all done that (OK, maybe not...) and it's not the end of the world, but it's good to take care of these things before they hit the front door.

So we remedied this by making the drain incision slightly larger and fishing out the rest of the drain. No biggie.

 

[radslooking]

well, i guess you have more confidence than i that the JP would be sterile and not contaminated by skin flora. i guess the patients/nurses I deal with dont' seem to keep that site as clean as it should be.

 

[Winged Scapula]

well, i guess you have more confidence than i that the JP would be sterile and not contaminated by skin flora. i guess the patients/nurses I deal with dont' seem to keep that site as clean as it should be.

It has nothing to do with confidence or keeping the wound clean.

As I mentioned, the issue is not with the sterility since as it was described, the wound had been closed and the sterile portion left in the abdominal cavity/subcutaneous tissues. Yes, the wound *might* get infected but there is probably more of a chance of an inflammatory reaction (not infection) due to the long term presence of foreign body than an actual wound infection.

I'm not advocating leaving things behind but *we* do it all the time, sometimes intentionally and sometimes not, and sometimes with a communication to the outside world. These are not always a source of infection. Inflammation does not = infection.

 

[tussy]

Okay - i'm an attending and i don't know what "crack the drain" means. Must be an american thing!!

Not quite an intern story but so funny it deserves telling. A first year med student was shadowing in the OR and the surgeon decided that he should put in a foley catheter. The surgeon walked him thru the procedure and once it was in the surgeon said "now blow up the balloon". the student looked at him with a puzzled look and the surgeon again said "BLOW UP THE BALLOON" so the student put his lips to the end of the foley and blew!!!

 

[maxheadroom]

Okay - i'm an attending and i don't know what "crack the drain" means. Must be an american thing!!

Not sure where that expression comes from . . . I was pretty clueless about it, too.

 

[Winged Scapula]

Re: cracking back the drain

Now, I can see why there may be some confusion because it appears that even Castro and I have different ideas about what this term means.

When I want someone to remove clot, test to see if a closed suction drain is still working, I want them to "strip the drain". This is not the same as "cracking [back] the drain", or not the way I was taught.

I was taught that cracking back the drain means pulling it out a few mm each day, slowly, resuturing it to the skin, to allow for the track behind to close up as the drain was removed. Done for long term drains. Not sure if it works frankly (is there a med student around here who can look that up? ) but this is what I was taught the term meant.

 

[tussy]

We just call that "pulling the drain back". Yes, i've done that, althoguh i don't think there is any evidence to it other than making the surgeon feel better!!! Removing clots we call "stripping the drain" and i don't find it really helps either but makes you feel like you're doing something!!!

There is so much "hocus pocus" surrounding drain care!!!

 

[Lolo08]

LOL. that's hilarious!

Okay - i'm an attending and i don't know what "crack the drain" means. Must be an american thing!!

Not quite an intern story but so funny it deserves telling. A first year med student was shadowing in the OR and the surgeon decided that he should put in a foley catheter. The surgeon walked him thru the procedure and once it was in the surgeon said "now blow up the balloon". the student looked at him with a puzzled look and the surgeon again said "BLOW UP THE BALLOON" so the student put his lips to the end of the foley and blew!!!

 

[Castro Viejo]

Now, I can see why there may be some confusion because it appears that even Castro and I have different ideas about what this term means.

When I want someone to remove clot, test to see if a closed suction drain is still working, I want them to "strip the drain". This is not the same as "cracking [back] the drain", or not the way I was taught.

I was taught that cracking back the drain means pulling it out a few mm each day, slowly, resuturing it to the skin, to allow for the track behind to close up as the drain was removed. Done for long term drains. Not sure if it works frankly (is there a med student around here who can look that up? ) but this is what I was taught the term meant.

Huh. Weird. I was taught crack the drain and strip the drain were the same thing.

For pulling the drain back? We'd simply say "pull the drain back" or "de-vance" the drain.

Stupid jargon.

 

[GoodMonkey]

this year one of our interns admitted someone for their scheduled total hip replacement. apparently the patient had asked "hey, while you're down there, can i you guys do a vasectomy too?" the intern had told the patient we probably could swing it, and wrote in her admission h+P, as part of the plan, "patient desires vasectomy by primary team at time of THA. will discuss with team in morning, added to consent."

when we went by to round the next morning on the preop patient, he was all, "so you're doing the vasectomy, too, right?" my chief about laughed herself out of the room. "sir, your sperm do not come from your hip joint."

 

[Winged Scapula]

Yeah, just what you want to do when putting in a total joint...to be messing around with someone's smegmatic junk. Did the intern actually think the Orthopods were gonna do this little snip or was she thinking Uro would just drop by and fix the guy up?

Why not just consent him for "removal of hardware" for the infection he'll need in a few months?

 

[Castro Viejo]

Yeah, just what you want to do when putting in a total joint...to be messing around with someone's smegmatic junk. Did the intern actually think the Orthopods were gonna do this little snip or was she thinking Uro would just drop by and fix the guy up?

The intern's probably watching too much Gray's Anatomy.

Why not just consent him for "removal of hardware" for the infection he'll need in a few months?

He wanted to have his tubes tied, not to have his junk removed. Ha ha.

 

[Winged Scapula]

The intern's probably watching too much Gray's Anatomy.

WHAT?!! You mean that show isn't realistic?

He wanted to have his tubes tied, not to have his junk removed. Ha ha.

I was talking about his Ortho hardware being removed (as in, I doubt that given all the fear about hardware infection in a total joint you'd want to be doing any other procedures at the same time which might increase that risk), but the shoe fits this scenario as well!

 

[GoodMonkey]

Yeah, just what you want to do when putting in a total joint...to be messing around with someone's smegmatic junk. Did the intern actually think the Orthopods were gonna do this little snip or was she thinking Uro would just drop by and fix the guy up?

i have no idea what she was thinking. i just thought it was hilarious enough that she added "possible vasectomy" to the consent and h+p plan.

my chief told the guy that morning that he'd be just as well off if he did it himself with a butter knife than if she did it after she replaced his hip. he was all, "well, i only want to pay for one operation!" the patient probably just heard the word "surgeon" and thought one-stop-shopping.

 

[Winged Scapula]

i have no idea what she was thinking. i just thought it was hilarious enough that she added "possible vasectomy" to the consent and h+p plan.

Yeah, that WAS pretty funny. Hope someone kept note of that to talk about during her Chief's dinner.

 

[Winged Scapula]

Agreed.

The whole idea is nuts.

Just nuts.

Heh heh...nuts.

 

[GoodMonkey]

Yeah, that WAS pretty funny. Hope someone kept note of that to talk about during her Chief's dinner.

ah, but she's surg prelim

 

[Winged Scapula]

ah, but she's surg prelim

Awww - too bad!