So I have finished my first week of work as a brand new intern on the Medical ICU floor. Wow! I must say that it was a tiring and eventful week. Here are some snippets.
My first day of work was Saturday (6/24/06). On weekends, there are no “rounds,” so my co-intern and I basically took care of patients, wrote progress notes, and tried to do our best to keep our critically ill patients alive.
On Sunday, I managed to experience my first code blue as an intern. My senior resident was not around to run the code, so my co-intern and I were left to fend for ourselves. Fortunately another senior resident was available to help us out.
Later that day, my senior resident told me to hold a “family meeting” with members of the family of a critically ill patient. She had suffered from a massive left cerebral artery stroke, which caused significant edema in the cerebral cortex, causing a 1.7 cm midline shift. The patient was minimally responsive and had quite a poor prognosis. I had only met that patient that very morning, as that patient had been transferred to our hospital from another facility the day before. Now I was now being expected to tell the family about all that I knew about the patient, her condition, and her prognosis. I braced myself for the encounter, and I breathed a prayer to heaven that He would give me the right words to say. A security officer led me to the conference room, and he warned me that there were a lot of family members in there. I was shocked to find that there were more than 30 individuals packed into one small room – the entire family of the elderly Hispanic lady. I proceeded to talk to them about what I knew…and about what I didn’t yet know. I answered their questions as best as I could, and I let them know that at this point we could not give them a definite prognosis. Although I did not have all the answers, I did my best to clarify what our plans were. At the end I asked them if they had any faith background, and when they shared that they were Catholic I asked if they would like for me to offer a word of prayer for them and their loved one. They agreed. After the prayer, I left the room, and the nurse later reported to me that the mood changed one hundred and eighty degrees after we prayed. Before the prayer, they were tense and stressed and angry with the other hospital that failed to give their loved one the appropriate timely treatment that they had expected. After the prayer, they were reconciling with one another and hugging each other. I just thank God that He gave me that opportunity to pray with that family at that critical moment of their lives.
On Monday, I failed to make it to Morning Report. We are supposed to attend these daily morning meetings at 8:30 am with the department of internal medicine. However, there were so many patients to look after that I could not make it to the meeting. One of the senior residents basically chewed me and my co-intern out for not showing up. We apologized and told him we would try to make it to the other meetings. So far, I have only made it to one Morning Report. I realize that I am at risk of failing this rotation if I do not attend 70% of these meetings, but it would have been impossible for me to attend these meetings and take care of all my patients, as our service was overloaded with an extremely large number of complicated patients.
Later that day, I heard some fabulous news. We were getting medical students! I had thought that we would be without medical students for a whole week! But that news totally made my day.
I tried to get my long white coat from the linen department. The shipment was not coming in until Wednesday. I got so tired of carrying a million and one things in my single left breast pocket in my scrubs, so I decided to go down and try to check out a loaner white coat. However, there were no loaners available in my size (34). I finally decided that a large lab coat would be better than no white coat. So on Tuesday, I went down to get whatever I could fish for. They had a size 42 for me. I rolled up my sleeves three times, and I was essentially “swimming” in my coat,…but at least I had somewhere to put my handy dandy pocket reference guides.
On Tuesday I attempted to do a central line. Interestingly in all my years in medical school I had never had the opportunity to place one before. One of the senior residents who was guiding me through it yelled at me for making a wrong move. *sigh* That was quite the disaster. Nonetheless, we ended up getting the central line in successfully after all, and the patient did quite well afterwards.
On Thursday, I attempted to do a lumbar puncture. Another transitional year resident was attempting to guide me through it. Somehow, she managed to show me an incorrect position for where to place the needle. We were way too low in the spine. After several attempts on my part, and after several attempts on her part, we finally called over one of the senior ER residents to help out. He got it after only one try. The poor patient was in tears by that time. *sigh* That was another disaster, but I suppose this is all part of the learning process.
After counting up my hours, I realized that in six days I worked a grand total of 89 hours this week. If I continue down this path, I will be in violation of the ACGME requirements for an 80 hour work week. But at least the worst is over. I now have learned how the charts work, how to get labs and radiology images on the computers, how to phone in for the radiologists’ reports, how to transfer patients, how to make patients "DNR," etc. In one week I have learned how to manage fever, cough, nausea, vomiting, gas, sore throats, hypocalcemia, hypomagnesemia, hypophosphatemia, hypokalcemia, acute coronary syndrome, diabetic ketoacidosis, gastrointestinal bleeding, septic shock, pneumonia, acute pancreatits, and alcohol withdrawal.
Today (7/2/06), I witnessed my first “terminal wean.” An 85 year old Caucasian male, who had been admitted for a massive cerebral hemorrhage, was essentially being supported on the ventilator. He had a very poor prognosis, and the family was made aware of the situation. The entire family finally made the decision to make him a “DNR,” (Do Not Resuscitate). So today, for the first time in my life, I watched a patient pass away before my very eyes. The nurse made the patient comfortable with a morphine and versed drip. Then, I watched the respiratory therapist take out the endotracheal tube and detach the ventilator from the patient. After a few minutes, the patient’s lips began to turn blue, and his face turned an eerie ash-white hue. The monitors were turned off inside the patient’s room, where a few family members insisted on watching their loved one pass away, but the monitor outside in the nurse’s station remained turned on.
After a few minutes, I stepped outside to take a look at what was transpiring on the monitor. It took a total of 10 minutes for the patient’s heart to stop beating. It was a weird feeling to watch the monitor portray a “countdown” of the patient’s oxygen saturation – which went from 100% to 99% to 98%...all the way down to 0 – and to see the heartbeat become an asystolic line. The family was happy that their loved one was able to pass away comfortably, without showing any signs of gasping for breath or pain or discomfort.
I must say that this experience was a strange one. It made me remember that life is so fragile. At any moment in our lives, we must be ready to have our breath taken away. We must be right with the Lord at all times. We must reconsecrate ourselves to Him at every moment. For it is a sure thing that our lives here on earth will come to an end. But if we lay up our treasures in heaven, we can look forward to an life of everlasting joy with our loving God in heaven.
What a week. I’m pooped. I will write some more of my adventures as an intern some other time. Good night!
This afternoon, Paul and I decided to join the Advent HOPE Sabbath School group for a hike at the Palos Verdes Estates Beach. It was quite a long drive out there from Loma Linda, but the weather was perfect and it was absolutely gorgeous.
Paul, Freddie, Jane, and me