On call first night of Internship

[glorytaker]

Since there's a topic of interns on call all by themselves without senior residents, I was wondering if anyone knew of interns starting call the first day of internship? If not, when do interns generally start call? Later in the first week or the second week?

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[deleted87716]

Since there's a topic of interns on call all by themselves without senior residents, I was wondering if anyone knew of interns starting call the first day of internship? If not, when do interns generally start call? Later in the first week or the second week?

My first day as an intern was on-call on a Saturday covering peds inpatients. Over 40 sick kids to round on (including hem-onc), none of whom I'd ever seen before. I was also getting paged for admissions during the day. Fortunately, an upper-level resident took care of the admissions for me so I could finish rounding. They met up with me around dinnertime (after I finally finished my notes and sat down for the first time to eat something) to give me the list of new patients that I had to go see after dinner.

As they say, you never have another first day at work. Fortunately.

 

[Solideliquid]

My first day as an intern was on-call on a Saturday covering peds inpatients. Over 40 sick kids to round on (including hem-onc), none of whom I'd ever seen before. I was also getting paged for admissions during the day. Fortunately, an upper-level resident took care of the admissions for me so I could finish rounding. They met up with me around dinnertime (after I finally finished my notes and sat down for the first time to eat something) to give me the list of new patients that I had to go see after dinner.

As they say, you never have another first day at work. Fortunately.

My anxiety level is on the rise...

 

[deleted87716]

My anxiety level is on the rise...

If it helps, I didn't kill anyone.

 

[Smurfette]

Most places (and this varies by specialty too), do have interns taking call right away. It depends on the rotation, of course, but SOMEONE has to be the first intern on call. And all the other interns will want to hear about it since they all are just as worried about their first call too.

Honestly, 9-10 months in now and I can remember certain memorable calls throughout the year....I've had a few doozies....but I can't remember my very first call.

 

[Bobblehead]

Since there's a topic of interns on call all by themselves without senior residents, I was wondering if anyone knew of interns starting call the first day of internship? If not, when do interns generally start call? Later in the first week or the second week?

You may even start in the ICU on call and have one of "those" nights where there are 6 admissions to a 10 bed ICU of which 3 are active GI bleeders, one's too fat for access and then one of the "stable" chronic patients dies in a not-so-pleasant manner.

But once that's over and done with the rest of your year will be fine.

 

[Blade28]

Wait until you get your rotation schedule. Depending on your rotation, you'll probably be on call the first, second, third or fourth day of residency. I was on call the third day. A few of my co-interns were on the very first night.

 

[glorytaker]

That sucks. I'm starting with ICU and I very much do not want to be on call my first night, even second night would be preferrable.

 

[lowbudget]

If it helps, I didn't kill anyone.

Well I tried. But my patient just wouldn't die.

Don't worry. You have millions of years of evolution on your side. Just be calm, be brave, and ask for help when you need it.

 

[Flea girl]

My program told us that since July 1st was on a Sat. this year, one of the interns will be on call before we actually start on the floor .

 

[mysophobe]

Ouch. Got my fingers crossed for ya.

 

[DOtobe]

I was on call my fourth night of internship.

The intern who started on night float started on June 30th, covering all of the floor calls from the hospital. Thank God I didn't have to start with night float.

 

[glorytaker]

So do they give you some sort of quick course on call nights procedures and expectations during orientation or do they just throw you into the fire and expect you to know what to do already?

 

[Blade28]

So do they give you some sort of quick course on call nights procedures and expectations during orientation or do they just throw you into the fire and expect you to know what to do already?

Trial by fire! They just throw you in there.

BTW, awesome avatar!

 

[Trisomy13]

If it helps, I didn't kill anyone.

sounds like a missed opportunity to shorten your list.










(yeah i know. i'm going to hell. it's just humor, folks.)

 

[njbmd]

Since there's a topic of interns on call all by themselves without senior residents, I was wondering if anyone knew of interns starting call the first day of internship? If not, when do interns generally start call? Later in the first week or the second week?

Hi there,
As an intern, I was on call the first night of my internship. There was a chief resident on but I was the first one called. It's isn't all that bad.

njbmd

 

[Solideliquid]

Can anyone give a synopsis of their first night on call? I would very much appreciate it.

Hi there,
As an intern, I was on call the first night of my internship. There was a chief resident on but I was the first one called. It's isn't all that bad.

njbmd

 

[DOtobe]

Can anyone give a synopsis of their first night on call? I would very much appreciate it.

My first night on call was actually great. I was on surgery, and it was the Fourth of July. There was only one OR case (an emergency case) so there wasn't much post-op work to do. (One of the attendings and the chief resident were in the OR while I was doing floor stuff.) I didn't get any cross cover calls over a span of FOUR HOURS at night, so I got to sleep. I even paged myself to check and make sure my pager was working! There wasn't much activity going on in the hospital on the Fourth of July. But when my pager did go off, I got a sick feeling in my stomach before I returned each page... I was so nervous about giving patients morphine...

As an aside, am I the only one who thinks it's odd we can write orders for narcotics while we are in the hospital but can't write prescriptions for them?

 

[Blade28]

As an aside, am I the only one who thinks it's odd we can write orders for narcotics while we are in the hospital but can't write prescriptions for them?

Odd...we just use our program's instutitional DEA license to write scripts for Vicodin, Percocet, Lortab, etc.

 

[teamdick]

My first night on call (gen surg) received sign out from the other surgical teams including cross coverage for neurosurgery and ent at about 5-6 pm. Of course it was also my first day, so I now had 60 patients that I didn't know. Spent most of the evening having one transferred to SICU because he was becoming septic with labile bp, tachycardia, altered mental status. Didn't have dinner. Was up until probably around 1 or 2 am just doing simple things, med order here and there, blood culture here and there. Slept until about 515 am. AM rounds around 530. Whew! 15 more minutes and i'm free, pager goes off. "Pt not responsive." Don't even know who the patient is. Was not on any of my lists, apparently was admitted overnight but the admitting resident (who i had yet to meet) never told me about her. She has labored breathing borderline BP and a fingerstick > 600. Call 2nd year (who I met only because we ran into eachother in the call room). He comes, next thing I know patient is intubated and we're starting a central line and transferring the patient to the unit. Later find out, she had gangrenous bowel. Covering the floor again two months later to find same patient has finally made it out the unit minus some 2 feet of bowel, but was eventually discharged to rehab.

Don't worry. You'll nearly mess your pants the first time, but a month later I was running my own codes in the sicu.

 

[glorytaker]

Trial by fire! They just throw you in there.

BTW, awesome avatar!

So I take it you pretty much are going to end up calling the senior resident... Great. The program I got into is starting up and only has 5 second year residents and 20 Interns (all 25 are incoming).

 

[sophiejane]

Don't worry. You have millions of years of evolution on your side. Just be calm, be brave, and ask for help when you need it.

This is awesome. I'm going to print it and keep it in my coat!

 

[Finally M3]

Man some of y'all were lucky; I was on call my first day as an intern...in the ICU. Good times!

I would highly recommend ICU as your first rotation; after that, everything is cake: you get VERY familiar with the gestalt of a crashing patient, and conversely, who isn't crashing with whom you can dink and dunk around with labs and such.

At the same time, you also get to test the limits of your ACLS training...

 

[DOtobe]

Odd...we just use our program's instutitional DEA license to write scripts for Vicodin, Percocet, Lortab, etc.

For some reason our hospital won't give us the institutional DEA until our third year of residency...I don't understand why. So it's always a pain to discharge people because you have to track down a third year to write you that Vicodin script before the pt can go home.

 

[tega]

My first night on call (gen surg) received sign out from the other surgical teams including cross coverage for neurosurgery and ent at about 5-6 pm. Of course it was also my first day, so I now had 60 patients that I didn't know. Spent most of the evening having one transferred to SICU because he was becoming septic with labile bp, tachycardia, altered mental status. Didn't have dinner. Was up until probably around 1 or 2 am just doing simple things, med order here and there, blood culture here and there. Slept until about 515 am. AM rounds around 530. Whew! 15 more minutes and i'm free, pager goes off. "Pt not responsive." Don't even know who the patient is. Was not on any of my lists, apparently was admitted overnight but the admitting resident (who i had yet to meet) never told me about her. She has labored breathing borderline BP and a fingerstick > 600. Call 2nd year (who I met only because we ran into eachother in the call room). He comes, next thing I know patient is intubated and we're starting a central line and transferring the patient to the unit. Later find out, she had gangrenous bowel. Covering the floor again two months later to find same patient has finally made it out the unit minus some 2 feet of bowel, but was eventually discharged to rehab.

Don't worry. You'll nearly mess your pants the first time, but a month later I was running my own codes in the sicu.

Thank god i start with ortho....hopefully im only getting floor calls for pain/fever

 

[zippy81]

Relevant coverstory on Time magazine this week "What Scares Doctors About Hospitals". Goes on to say July is the time to avoid hospitals with the new crop of interns starting out. Didn't read the entire article just the synopsis on cnn.com

 

[Solideliquid]

How about some good Dos and Don'ts for the first few nights on call. Especially IM inpatient call.

 

[Annette]

First, don't panic. There should always be someone you can call for help. Most of the nurses have been through numerous new interns. They are not going to let you kill the patients. If a nurse asks you if you really want to do that, pay attention. If you aren't certain about a drug or a dose, you can always call the pharmacist (can be very helpful people).

If you see a patient, write a note! It doesn't have to be long. "CTSP (called to see patient) for fever. Pt has temp of 39, bp 140/50 hr 78, rr 14. Lungs are clear, no purulent drainage from would. Pt does not appear toxic. Blood cultures, UA (urine analysis) and culture, and CXR ordered. Abx not changed. Senior resident informed." When the do-do hits the fan (as it invariably will), you have documentation to back you up that you did your job. It also lets the people taking care of the patient know what happened overnight, in case you forget about it in sign over.

Try to stock your locker with snacks. The cafeteria is always closed when you have a chance to eat.

Don't plan on having time to study on call. There will be times when you will have plenty of time, but never when you are counting on it.

Realize that not all your patients will make it through the night. Everyone has to die at some time. Don't take responsibility for things you have no control over.

Why are you all worrying about this now? There will be plenty of time to go through the pain of internship next year. You should be enjoying yourselves while you still can!

 

[Blade28]

That's some great advice, Annette!

 

[Orange Julius]

If you see a patient, write a note! It doesn't have to be long. "CTSP (called to see patient) for fever. Pt has temp of 39, bp 140/50 hr 78, rr 14. Lungs are clear, no purulent drainage from would. Pt does not appear toxic. Blood cultures, UA (urine analysis) and culture, and CXR ordered. Abx not changed. Senior resident informed." When the do-do hits the fan (as it invariably will), you have documentation to back you up that you did your job. It also lets the people taking care of the patient know what happened overnight, in case you forget about it in sign over.

The rest of the advise is solid. But this is a little impractical. Maybe in a hospital where the charts are all paper. But otherwise this would be a real PITA.

 

[deleted87716]

The rest of the advise is solid. But this is a little impractical. Maybe in a hospital where the charts are all paper. But otherwise this would be a real PITA.

Are you kidding me? Documenting what you do is part of your job. Someday, it will very likely save your a$$. Don't start forming bad habits right out of the chute.

 

[Orange Julius]

Are you kidding me? Documenting what you do is part of your job. Someday, it will very likely save your a$$. Don't start forming bad habits right out of the chute.

No one writes a note every time they take a look at a patient.

 

[Blade28]

The rest of the advise is solid. But this is a little impractical. Maybe in a hospital where the charts are all paper. But otherwise this would be a real PITA.

I write notes like this whenever I'm called to see the pt for anything significant - wound dehis, fever, CP, SOB, hematemesis, low O2 sat, hypotensive, etc. I'll also document any long discussions with the pt and their family, ESPECIALLY if it's heated and the family is upset about something.

I'll especially make sure to do all this when it's a cross-cover patient.

 

[alhkim]

I was on-call my very first day of IM internship...it really ended up OK, but I was a wreck during the day. I only had three pts that carried over from the previous intern's service, but it took me 6 hrs to write notes on them since I had no clue how to use our computer system, figure out where the charts were, etc, etc. Then I had 5 pts to admit and it was already nearing 3pm. I was ready to drop bricks all over the place since I figured, well if it took me about 2 hrs for pts that were already here with the workup in progress, it just may take me another 20 hrs to work up these new pts. I had a great resident that helped me out alot, and post-call (I'm intentionally leaving out the numerous panic/i'm ready to quit attacks inbetween), I felt pretty comfortable in the hospital. There really isn't anything like being thrown into the fire to learn how to do something....

 

[Gauss]

1st day was ER and 1st patient was suspected meningitis - I hadn't even gotten sign out and already was gloving up for an LP

 

[ears]

From another thread about the first day of internship...

My first day of internship I was on-call in the MICU. I got one lady in the morning, who had been resuscitated after a cardiac arrest. Her family agreed to withdraw care, and she died in the late afternoon. I had another lady who was resuscitated after an arrest; it seems like she had some kind of vascular catastrophe somewhere, and she died in the early evening. It turns out there's a lot of paperwork for people who die on you like that, especially when they haven't been in the hospital for 24 hours.

Then in the evening, I got a bolus of three patients: one lady with hyponatremia (110), which turned out to be psychogenic. I did the world's worst H&P on her, and basically ignored her. I got a shambles from a rehab: chronically trached, chronically infected, chronically almost no mental status. Just sorting through all of his issues and entering his orders took forever.

And I got one post-op urology patient (who due to a vagary of the system, is cared for overnight by the MICU team, which is to say, me). She turned out to be really, really sick. The blood samples we got kept coming back hemolyzed, and it took a long time to figure out that it was because she was hemolyzing intravascularly. She went into hyperkalemic arrest at 4am or so, and died after a forty-five minute code. That was a whole bunch of paperwork, too.

I was still working on the sequelae of all of that when the team showed up to round at 7am. I left at around 10am after rounds to go home, and I wanted to quit medicine; I thought I just wouldn't be able to do it. I went home and slept and felt somewhat better. I came in the day after that, and talked to my residents and the ICU attending, and was encouraged by them. That helped a lot, too.

The shambles guy died in the unit a week later. The hyponatremia lady is fine, I guess; I've wondered whether I should warn her that she's the only one of my five admissions who survived the month.

I've never had another night that was anywhere near as difficult, both because that was an unusually hard night and because I'm smarter and more experienced now. I still feel bad about the hyperkalemic arrest. If I was only a couple of weeks smarter, I might have prevented her death that night. I wouldn't have made a lot of difference; her prognosis was terrible. But letting one's patient die in hyperkalemic arrest is just bad form.

I know this: I'm a better doctor for that day. (But I sure wouldn't want to go through it again. )

I've had a great rest of the year; I like being a doc, even as an intern. But that first night was something else. Remember: everyone gets Kayexalate (ha, ha, only serious).

 

[Solideliquid]

From another thread about the first day of internship...



I've had a great rest of the year; I like being a doc, even as an intern. But that first night was something else. Remember: everyone gets Kayexalate (ha, ha, only serious).

Which specialty are you in?

 

[Poety]

From another thread about the first day of internship...



I've had a great rest of the year; I like being a doc, even as an intern. But that first night was something else. Remember: everyone gets Kayexalate (ha, ha, only serious).

Jeezuz, if I had that kindofa night, "I" might go into cardiac arrest

 

[deleted87716]

No one writes a note every time they take a look at a patient.

I'm not talking about a page-long H&P, just a quick jotting down of what you did (SOAP format optional.) Hey, it's your butt, not mine. Just remember, "If it wasn't written, it wasn't done."

 

[8744]

No one writes a note every time they take a look at a patient.

I do. On the other hand if the nurse call me to ask if so-and-so can have some tylenol I don't necessarily run up to the floor, examine the patient, and write a note. But if I get called for anything remotely wierd that requires that I see the patient you'd better believe I jot a quick note in the chart.

It takes two minutes. "Patient febrile. Temp 39.2. Resting comfortably without subjective complaints. Lungs CTAB. Heart RRR w/o m/g/r. Blood, Urine cx drawn this AM so did not repeat. No change to current ABX. Will inform team in AM," or something to that effect.

CYA. Then nobody will phone you and say, "Hey, the nurse told you that Mr. Smith had a fever at 2 AM. Did you do anything about it?

 

[deleted87716]

if the nurse call me to ask if so-and-so can have some tylenol I don't necessarily run up to the floor, examine the patient, and write a note.

No, of course not. You'll end up having to sign off on the verbal order later anyway.

 

[Tater]

I think I might almost want to be on call the first night...might as well get it over with. I imagine that the incumbent students turned residents will get stuck with the first call though, as they're obviously more familiar with the hospital.


At my school, the residents got repeatedly yelled at for not writing notes when they saw patients (when called to bedside, or for any adverse events). At least at my institution, its not so much a "good idea" as an absolute requirement.