Intern year

[lvspro]

Sucks!!! Please tell me it gets better next year.

Note, see attending, f/u on note, look up new results, see fellow, f/u on new results, document new results, discuss those god damn results ad nauseum until every single possible diagnosis that could ever be possible is ruled out with the fellow, and then find the attending to do the same thing again, lick everyones nuts, then consult people who are fellows in other fields so they can do the same thing over, and over, and over again until everyone is standing around happily stroked off that their profession is the most precise, or exact, or demanding, or smartest bunch that has ever graced the planet, and then give the patient steroids, or metoprolol, or albuterol nebs, scatter in a rectal here, a disimpaction there, and voila, your'e an IM intern.
Did I forget to mention summarizing all above crap in the form of a dictation at discharge?


I'll trade this for the 3 300lb heads that dude was griping about any day.


That was my gripe for the day. Either way though, I still like what I'm doing, so don't let my cynicism fool you.

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[VolatileAgent]

you ever watched a medicine resident at a code? it's pretty damn funny.

 

[swpm]

Sucks!!! Please tell me it gets better next year.

It gets better.

Did I forget to mention summarizing all above crap in the form of a dictation at discharge?

Well, you forgot to mention the incalculable joy of admitting your 4th gomer of the night at 3 AM. (One of whom is a readmit you'd discharged 3 days earlier after a week of frantic social work to find him a bed in a gomer home.) That's job satisfaction, baby. Makin' a difference.

Anyone who can tolerate internal medicine has a superhuman threshold for futility and pain ... and my utmost respect. I am so glad someone does it. Those guys rule.

But thank god it's not me.

 

[VentdependenT]

GOMERS rock man.

I remember walking into the ER and almost vomiting from a horrendous stench my intern year. I looked at the ER team and they just pointed towards the direction of the putrid eminence and said "that one is yours."

Dudes foot was hanging on by a THREAD. All stanky mrsa mush. Full blown alzhiemers with only the ability to drool.

 

[Monty Python]

Dudes foot was hanging on by a THREAD. All stanky mrsa mush. Full blown alzhiemers with only the ability to drool.

An acquaintance/surgeon intentionally avoids the gym. He says he hopes to drop dead of a massive MI in his 60s, rather than slowly rot away wearing a diaper.

JPP: I'm speaking of JI, at Touro. Please tell him he STILL has my Thunderbirds tape.

 

[The_Sensei]

I'll trade this for the 3 300lb heads that dude was griping about any day.

FYI, I wasn't griping..........merely explaining my night on call. You on the other hand, are griping my friend.

 

[lvspro]

FYI, I wasn't griping..........merely explaining my night on call. You on the other hand, are griping my friend.

Point taken, and yes, as I indicated, that was my gripe.

As a testament to my gripe, and someone elses response, I had to go see a dood that was found "swimming in a pool of feces, and urine" as documented by ems, this AM at 0400. The funny thing is, some crap SW went to his house just 2 days ago, and found it to be "in clean, and livable condition w/Mr XXXX able to ambulate, and conduct his ADL's w/o assistance." I find it odd that the reason for the initial call was "I needed help getting up from my bed to my wheel chair," yet he was able to conduct his ADL's just 2 days prior in a **** and span apartment. Turns out that the landlord complained about this dude relieving himself everywhere except the toilet a cuppla mo's ago too.

Either way, he turned out to be pretty interesting... after a good powerwashing, P-afib C RVR, PE, T2 Dissecting aneurysm... pretty much open up harrisons, and read the index kinda guy. Good sats, Stable by CT-surg, cardizem drip to PO, off to the floor for some schmuck to dictate, yeehah. I love the ICU

 

[lvspro]

you ever watched a medicine resident at a code? it's pretty damn funny.

By far one of the most impotent things I've witnessed yet... in fact I've had the privelage of observing this painful event 2x. Poor saps would be exposed if they ever were to have to run a code in a non-hospital setting.

 

[hermione]

My internship is at an FP program. Its only December, and I'm already counting down the interminable days left until I never have to do another f-ing ER admit again. I just thank the almighty powers that be that come July, I'll be out of this god forsaken hell of primary care, while my classmates will just be starting at pgy 2s. And to add to my own personal hell...I get continuity clinic twice a week. In the ghetto. Talk about HELL ON EARTH. Last week I cleaned earwax out of a schizophrenic guy's ears, then rocked in the corner, crying. Anesthesia is going to be my own personal nirvana after this...one more year and my cheif complaint would be the same as 85% of the patients I seem to admit...."I NEED DETOX".

 

[VentdependenT]

You know, the atypical antipsychotics may help you through these difficult times. Soon primary care will be in your shadown and you my friend, shall be a consultant.

MS-MAIDS! You'll find out what that means come july next year. You'll also get a centerfold of a dragger anesthesia machine in the full nude. Vaporizers gleaming in the sun...pistons and bellows jiggling...and bright shiney knobs just begging to be twisted.

 

[cchoukal]

I was one of those guys that really liked my intern year. We do a lot of ICU months, limited amounts a floor, and a month of ENT doing trachs and scopes. In any case, I liked the ICU and cardiology so much, I actually entertained the notion of switching to IM. I mean, I'm a talker and a thinker and all that and I thought maybe that fit my personality better. Well, I'm 6 months into my CA1 year and holy $hit am I glad I stuck with it. I was on call Christmas day and got worked pretty hard, and all day I kept thinking to myself, "The worst day on anesthsia call is STILL better than the best day I had on [insert intern rotation here]." I go to the floor and units to pre-op patients, post-op patients, and intubate them in codes and what-not and see the inane busy work and social work and clerical work and the futility of some of it and feel really good about my choice. Sure there's a lot of paperwork in anesthesia, and sure, sometimes you have to take $hit from an irritated surgeon, but, man, it really is better.

 

[lvspro]

My internship is at an FP program. Its only December, and I'm already counting down the interminable days left until I never have to do another f-ing ER admit again. I just thank the almighty powers that be that come July, I'll be out of this god forsaken hell of primary care, while my classmates will just be starting at pgy 2s. And to add to my own personal hell...I get continuity clinic twice a week. In the ghetto. Talk about HELL ON EARTH. Last week I cleaned earwax out of a schizophrenic guy's ears, then rocked in the corner, crying. Anesthesia is going to be my own personal nirvana after this...one more year and my cheif complaint would be the same as 85% of the patients I seem to admit...."I NEED DETOX".

Speaking of which, have you noticed how wonderful alcoholic beverages are at the end of a week that has an open weekend day? It's amazing how easy scotch goes down these days.

 

[lvspro]

I was one of those guys that really liked my intern year.

By far, this is the least heterosexual statement I've ever heard. Apparently being tied to a board and flogged is an attractive way to spend a year for some people.

 

[hermione]

Speaking of which, have you noticed how wonderful alcoholic beverages are at the end of a week that has an open weekend day? It's amazing how easy scotch goes down these days.

Guess I forgot to mention I'm also 24 weeks pregnant...no scotch for me...(the baby prefers tequilla anyway...) This has got to be as close to hell as one ever gets...

 

[Steel_City]

The most annoying thing about my internship is having to write admission notes AND having to dictate an H and P on THE SAME PATIENT. This is so redundant and I can't honestly find a purpose to this (except when it's 2 AM and the dictation won't be back by morning).

I especially love it when the patient is on 25 home meds and they are all chicken-scratched on a post-it.

 

[cloud9]

The most annoying thing about my internship is having to write admission notes AND having to dictate an H and P on THE SAME PATIENT. This is so redundant and I can't honestly find a purpose to this (except when it's 2 AM and the dictation won't be back by morning).

I especially love it when the patient is on 25 home meds and they are all chicken-scratched on a post-it.

Do you all have the "home medication reconciliation form"? A form that lists all the medications a patient is on at home (the nurses are supposed to fill it out) and whether you want to continue the meds in the hospital. The home meds are listed in the H&P, this form, and the orders for admission (whatever meds you continue). Basically you have to write the same info three times...the SAME info THREE f'in times (at 4am). Then at D/C you write in the D/C summary the D/C meds, you have to dictate the D/C summary (with meds) write any prescriptions (seems like people always need all twenty meds refilled) and indicate on this form if the meds at admit are the same, changed or stopped. Again, the same info THREE times (four if you count the dictation). Ridiculous.

 

[Trisomy13]

Do you all have the "home medication reconciliation form"? A form that lists all the medications a patient is on at home (the nurses are supposed to fill it out) and whether you want to continue the meds in the hospital. The home meds are listed in the H&P, this form, and the orders for admission (whatever meds you continue). Basically you have to write the same info three times...the SAME info THREE f'in times (at 4am). Then at D/C you write in the D/C summary the D/C meds, you have to dictate the D/C summary (with meds) write any prescriptions (seems like people always need all twenty meds refilled) and indicate on this form if the meds at admit are the same, changed or stopped. Again, the same info THREE times (four if you count the dictation). Ridiculous.

we have the "reconcile meds" business here.

but all i can say is...

1 month of floor medicine, finished in September. thank eff'n god.

we're halfway there folks.

 

[hermione]

Half way...yeah...but, I don't know if I can stand 6 more months of replacing electolytes and ruling out MIs. I can't imaging any instance where I could care ANY LESS about anything besides someone's Mag level. Its causing actual physical pain at this point....And watching my team get all worked up about it...oh god, it hurts, it HURTS....

 

[Trisomy13]

I start a month of Neurology tomorrow and when the senior said "be sure to review your neuro exam" I threw up in my mouth a little.

 

[hermione]

I start a month of Neurology tomorrow and when the senior said "be sure to review your neuro exam" I threw up in my mouth a little.

Classic.

My idea of a neuro exam (unless the cc is something obviously neuro...like stroke etc) is talking to the patient. If they don't seem gomer like...
Neuro-grossly intact, no defecits noted.

Neuro exam. Seriously. Real, actual, physical pain. 10/10.

 

[Trisomy13]

I justify it as being a chance to actually wield a hammer and hit patients. Oops. Gotta check that reflex again. And again. And again.

And if lunch includes garlic, we're testing CN I.

 

[Laurel123]

Yeah its hell, but the crazy thing is that I look back on it fondly now. I think I tend to block out the misery.

My favorites:
- families that drop off their 80 year old demented grandmas at the ER and stick around to tell the ER docs a couple things but by the time they page the medicine team it is midnight and the family has left and can't be contacted.

- Rule out MI's on the 25 year old histrionic drama queens with chest pain and palpitations.

- examining the retina and having to get my face way too close to patients' face.

- Rectal exams.

- the smells.

 

[lvspro]

MS-MAIDS! You'll find out what that means come july next year. You'll also get a centerfold of a dragger anesthesia machine in the full nude. Vaporizers gleaming in the sun...pistons and bellows jiggling...and bright shiney knobs just begging to be twisted.

I was post call one night a few weeks back, and hopping on to an elevator to go up to the floors to finish a dictation when I had the honor of sharing my ride with a brand new one still wrapped up and everything. I still remember my exhaustion being masked by the warm fuzzies I was getting just standing next to the thing. Getting into the OR and taking the wheel on one of those rigs in a few months is going to be my own personal nirvana.