More Thoughts on Internship
I am still baffled when I think about the internship program I am currently involved with. The General Surgery service truly is insane.
At the end of last week, I was the sole intern for a team that was taking care of TWENTY-SIX patients. What a disservice to the patients I was responsible for, let alone a crazy time for me.
Because of the new “eighty-hour work week” rule that is imposed upon all residents, the General Surgery department at my hospital has decided to crack down on anyone who defies the rule. They are essentially in danger of being closed down, or at least put on probation, because a disgruntled resident recently submitted an anonymous letter to the AOA (American Osteopathic Association) stating in so many words that the surgery residents were being overworked. Now the AOA is keeping a close eye my institution, which is why my chief resident sat all the new interns down at the beginning of our rotation and told us that we MUST work less than 80 hours per week. There were some new rules instituted to help us comply with that concept, one of those being that we are not allowed to come into work before 5 am.
Nonetheless, that poses a problem when I have to see 26 patients before rounds. At 5 am when I walk in the door, I go immediately to the fifth floor. I hide my bag in a certain cupboard of a certain conference room. Then I log on to a computer to check my patient list. I always gasp in horror when I see all the new patients that were added overnight. Then I proceed to rearrange their room numbers. I then spend some time assigning patients to my six students (I have 3 medical students and 3 PA students), making sure that no student has more than a maximum of 4 patients. Finally I go through and check the vitals signs on all 26 of my patients, making sure that none of them were hypotensive or tachycardic or febrile through the night. I check any new labs that I had not checked from the day before (but the AM labs are never ready by then, so I do not even bother to check for those). I make notes of who needs to be replaced with magnesium or who needs another set of AM labs. During that time, the night float person will usually call me to sign out. He spends about 5 minutes telling me about the issues overnight and any new patients that were admitted to our service. I also juggle answering questions from my students and the nurses about their specific patients.
By the time I finish with all of this it is already 6 or 6:15 am! If we are supposed to round at 7 am, I essentially have 45 minutes to see each of my 26 patients. They are usually all spread out over seven or eight units (5100, 5200, 5300, 4100, 4200, 4300, 3100, and 3300), not including the recovery room or the ER. Let’s do the math. If I spend about 30 seconds walking from one room to another and looking for that patient’s chart (which is impossible to do, especially closer to 7 am when the nurse’s change of shift occurs), I spend about 13 minutes simply in transit. Subtracting 13 from 45, I get 32 minutes to take care of 26 patients. Thirty-two minutes divided by 26 patients gives me an average of 1 minute and 13 seconds to look at each patient’s chart, talk to the nurse for that patient, talk to and examine the patient.
Needless to say, that is simply impossible. But that’s how crazy my life is this month.
Two days ago, I started night float. My hours are now 6 pm to 7 am. Friday night was quite busy. My pager never stopped going off. I received about 10 General Surgery consults and one major trauma activation. Fortunately I had two great students, Lisa and Nathan, helping me the entire time. Saturday night was slow until midnight. Then suddenly we had an onslaught of trauma alerts. From midnight until 6 am, there were about 7 or 8 traumas that came in back-to-back. All of the patients were intoxicated with alcohol. Most of them suffered bone fractures. One lady ended up passing away after a severe motor vehicle accident. What a night!
When I got home, I was exhausted. At 9 am I went straight to bed, and I woke up at 4 pm. It feels weird to be sleeping in the middle of the day, but I’m sure I’ll get used to it. By the time my body is adjusted, I’ll be back on the day shift again (This Friday I switch again). Although night float is busy, it is certainly a welcome relief from the insanity of working days. Oh, the joys of general surgery. . . =)
At the end of last week, I was the sole intern for a team that was taking care of TWENTY-SIX patients. What a disservice to the patients I was responsible for, let alone a crazy time for me.
Because of the new “eighty-hour work week” rule that is imposed upon all residents, the General Surgery department at my hospital has decided to crack down on anyone who defies the rule. They are essentially in danger of being closed down, or at least put on probation, because a disgruntled resident recently submitted an anonymous letter to the AOA (American Osteopathic Association) stating in so many words that the surgery residents were being overworked. Now the AOA is keeping a close eye my institution, which is why my chief resident sat all the new interns down at the beginning of our rotation and told us that we MUST work less than 80 hours per week. There were some new rules instituted to help us comply with that concept, one of those being that we are not allowed to come into work before 5 am.
Nonetheless, that poses a problem when I have to see 26 patients before rounds. At 5 am when I walk in the door, I go immediately to the fifth floor. I hide my bag in a certain cupboard of a certain conference room. Then I log on to a computer to check my patient list. I always gasp in horror when I see all the new patients that were added overnight. Then I proceed to rearrange their room numbers. I then spend some time assigning patients to my six students (I have 3 medical students and 3 PA students), making sure that no student has more than a maximum of 4 patients. Finally I go through and check the vitals signs on all 26 of my patients, making sure that none of them were hypotensive or tachycardic or febrile through the night. I check any new labs that I had not checked from the day before (but the AM labs are never ready by then, so I do not even bother to check for those). I make notes of who needs to be replaced with magnesium or who needs another set of AM labs. During that time, the night float person will usually call me to sign out. He spends about 5 minutes telling me about the issues overnight and any new patients that were admitted to our service. I also juggle answering questions from my students and the nurses about their specific patients.
By the time I finish with all of this it is already 6 or 6:15 am! If we are supposed to round at 7 am, I essentially have 45 minutes to see each of my 26 patients. They are usually all spread out over seven or eight units (5100, 5200, 5300, 4100, 4200, 4300, 3100, and 3300), not including the recovery room or the ER. Let’s do the math. If I spend about 30 seconds walking from one room to another and looking for that patient’s chart (which is impossible to do, especially closer to 7 am when the nurse’s change of shift occurs), I spend about 13 minutes simply in transit. Subtracting 13 from 45, I get 32 minutes to take care of 26 patients. Thirty-two minutes divided by 26 patients gives me an average of 1 minute and 13 seconds to look at each patient’s chart, talk to the nurse for that patient, talk to and examine the patient.
Needless to say, that is simply impossible. But that’s how crazy my life is this month.
Two days ago, I started night float. My hours are now 6 pm to 7 am. Friday night was quite busy. My pager never stopped going off. I received about 10 General Surgery consults and one major trauma activation. Fortunately I had two great students, Lisa and Nathan, helping me the entire time. Saturday night was slow until midnight. Then suddenly we had an onslaught of trauma alerts. From midnight until 6 am, there were about 7 or 8 traumas that came in back-to-back. All of the patients were intoxicated with alcohol. Most of them suffered bone fractures. One lady ended up passing away after a severe motor vehicle accident. What a night!
When I got home, I was exhausted. At 9 am I went straight to bed, and I woke up at 4 pm. It feels weird to be sleeping in the middle of the day, but I’m sure I’ll get used to it. By the time my body is adjusted, I’ll be back on the day shift again (This Friday I switch again). Although night float is busy, it is certainly a welcome relief from the insanity of working days. Oh, the joys of general surgery. . . =)
posted by janie and paul =) at 5:13 PM
3 Comments:
hang in there Janie!! The year will be over before you know it!! Ophtho will seem like vacation...
But Janie, Surgery is fun!
eric!-)
Wow!
Well good for you for trudging through all of this.
We are praying for you.
Yamil & Lana Lopez
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