The Adventures of Medical Internship

NIGHT FLOAT

So for the past two weeks, I’ve been working thirteen-hour night shifts at the hospital (7PM-8AM). I’ve worked the night shift before (granted, it was 11PM-7AM) so it didn’t take me long to adjust to being nocturnal. I’m not saying it was fun, however, since my eating schedule was all of out of wack and I ended up losing five pounds. Sleeping during the day wasn’t really an issue for me, but the complete lack of social contact (except for everyone at the hospital, of course) was kind of depressing. I hardly saw the hubs and my pets and it really started to wear me down. I never had any time for anything else but eating, sleeping, and working, so I’m glad it’s finally over. I had Saturday nights off and I pretty much spent them eating, sleeping, and watching Supernatural, since I had no motivation for anything else. I don’t know how people do this forever.

Anywho, I had a few adventures worth talking about. Hopefully they’re as interesting to you as they were to me!

I pronounce you…dead.

I was called to pronounce a woman dead on my very first night. A nurse phoned me and said, “Hi doc, Ms. Such and Such has passed away.” I sat there for a minute and all I could come up with was a dumbfounded, “Huh?” and she laughed and said, “Can you pronounce her?” and I was like “OH! Okay then, be right there.”

I had never pronounced a person dead before but I’d seen it done. I walked over to the nurse’s station in the hospice unit and they were like “Heeeeey, new intern! Let us help you!” And they did, tremendously. I filled out the appropriate paperwork before I entered the room, finding Ms. Such and Such’s (let’s call her Ms. S) three bleary-eyed daughters at the bedside. Apparently, she’d already been dead for an hour. I introduced myself and expressed how sorry I was for their loss. Ms. S had metatastic lung cancer and died peacefully in her hospital bed. I asked her daughters if they wanted to step out, but they wanted to watch me pronounce her. So I did.

Of course, having an audience made me a little nervous. When I pronounce a person dead, I usually start with the benign things, like listening to her heart, lungs, observing to see if her chest rises and falls, checking her carotid and radial pulses. Then I move onto the neurological exam—check if her pupils respond to light, rub a piece of gauze against her eyes to see if she blinks, open her eyes and turn her head to see whether she tracks me or not, pinch her fingernail really hard to see if she responds to pain. Technically, we’re supposed to try to make her gag, but I spared her daughters of that. Once I was through, I pronounced her dead at such and such a time, expressed my condolences to her family again, then I was off.

I’m sure I’ll be doing this plenty more times throughout the year.

Bleeding out of orifices you never want to bleed out of.

Also on my first night, a woman had been admitted for a GI bleed (colonic) and the bleeding vessel decided to rupture at 2AM. Let’s just say that when I walked into her room the scene wasn’t the least bit pretty—there was blood EVERYWHERE. Her vitals were stable but I decided to transfuse her and ship her to the ICU since the bleeding wouldn’t stop. She ended up having the vessel embolized (or sealed off) by interventional radiology (hell yeah, radiology!). Yay for saving lives and all that. 🙂

Electrical Malfunction

There’s something about nightfall that makes everyone’s heart go into abnormal rhythms. I swear I saw EVERY type of arrhythmia during the night shift. The first one I had to deal with was a supraventricular tachycardia (or SVT), where the heart rate can get upwards of 200 beats per minute and the person can feel their heart trying to slam its way out of their chest. They get dizzy, nauseous, and they feel like they’re going to die. The problem is that they can, ‘cause when your heart is beating fast enough it doesn’t have time to fill up with blood and you can easily lose perfusion to your organs (especially your brain). So you can imagine when I received my first call about this, I had to check my own damn pulse, lol. I ran up there, found this fairly young woman in total panic, but her blood pressure was good. So I hit her with adenosine, a drug that literally resets your heart rhythm by stopping the electrical conduction momentarily. It usually works like a charm, but the problem is the patient can feel it too. And if this lady thought she was dying before, imagine how she felt when her heart stilled in her chest for a full three seconds. I talked her through it, held her hand and told her to keep looking at me. I asked her to tell me about her family, trying to distract her as it was happening. She did just fine and her heart rate dropped back down into the 80s. I put her on a Cardizem (a conduction stabilizer) drip to keep it from happening again until Cardiology saw her in the morning.

Whew! I was a pro after that. 😛

CODE BLUE: Cardiac Arrest

About midway through my rotation, another intern, Siv, and I were sitting in the cafeteria at 7AM having breakfast. It was nearing the end of my shift and I was getting ready to sign out to the day team. On night float, we carry around three pagers—your own pager, the code pager, and the night coverage pager. Usually the night coverage pager is the one that goes off every five minutes during my shift. So as I was devouring my egg and cheese sandwich, my code pager erupted and I nearly spewed out my food. The text page read: “CARDIAC ARREST IN THE ICU”. Siv and I exchanged horrified glances and we bolted out of our seats and headed for the stairs. The ICU is on the top floor, so we had to hurl ourselves up four flights before we burst into the ICU. A few members of the ICU team had already arrived, and one of their seniors had taken charge, so Siv and I jumped in and started doing compressions on the guy.

As I was slamming on this elderly guy’s chest for two straight minutes (can I express how absolutely exhausting that is?), I finally took a good look at him. He was intubated (meaning he had a breathing tube down his throat) and there was black fluid coming out of his mouth. Blood was spilling from between his legs as the nurse kept her hand on his femoral pulse, and I’m like “What the hell happened to this guy?!”. Apparently, he’d arrested at home and fell into a glass table; one of the shards sliced his femoral vessels open (not sure which, likely the vein or else he would’ve bled to death before he even reached the hospital). Talk about bad luck! The paramedics revived him in the field then he coded again when they arrived in the ER. They revived him again, then he went to straight to the OR to repair the laceration. As soon as he arrived in the ICU, he coded again, and that’s why we were there.

We slammed him with adrenaline (and several other drugs I’ll spare you from) to try to get his heart pumping on its own. He didn’t have a pulse so we couldn’t shock his heart into a normal rhythm. We didn’t stop for a full 35 minutes, me and Siv alternating compressions, feeling his ribs crack beneath our hands. It was absolutely awful. No matter what we did, no matter how hard we tried, the third time definitely wasn’t the charm. His family showed up during the last five minutes, and they burst into tears, collapsing onto the floor and crying in anguish. The trauma surgeon finally ordered us to cease, knowing that even if we managed to revive him, he would be utterly braindead. I left the hospital feeling sick and numb and couldn’t sleep for a long time afterwards.

I knew I’d experience this sooner or later, but no matter how much you prepare for it, it still hits you pretty hard. I’m hoping the next one will have a happier ending, but unfortunately, those tend to be rare.

So all in all, it’s been a pretty crazy past few weeks! Forgive me if I haven’t been very active. I hope everyone’s well and I’ll try to catch up with you all over the week. I’m on radiology elective for the next two weeks (and I have the next two weekends off!) so the break is well needed. And besides, it’s RADIOLOGY. How can I not love that? 😀

Until next time…

The Adventures of Medical Internship

WEEK ONE: BLS, ACLS, LMNOP…

This is it! I’m a real doctor! A REAL DOCTOR.

Right.

The program I’m part of provides housing (FREE housing) so hubby and I moved in this past weekend. The apartment buildings are old and a little decrepit, but they’re clean for the most part, and ya know, it’s free. But moving from a full kitchen to one the size of a box has proved complicated and I’m still trying to figure out where I want everything. Otherwise, the apartment is fairly big and just right for us and we’re settled in (for the most part). My furry children adjusted fine and they’re already cruising through the place like they own it.

Monday was the first day of orientation and we got to know the staff and our co-interns. Everyone is awesome here and they come from all over the world. Two of my classmates are in the program with me (both prelims as well), so it’s nice to have familiar faces. The other interns are friendly and sociable (most of them are categorical residents—they plan to go into internal medicine (IM) and will have a three year residency), and our Chief Residents (basically fourth year IM residents and our bosses) are really chill. The chairman of the department invited us over to his house for a big welcome party and we had a great time.

The chairman was actually my senior attending for a week when I rotated in the MICU and he has an interesting personality. I don’t want to say he’s condescending, cause he’s not, but he has this way of looking at you that makes you feel small and uncomfortable. I immediately thought he disliked me (and even more so when I corrected him about jugular venous waveforms after rounds one day), but apparently, everyone feels this way about him. He’s not particularly nice, but he’s respectful and generous. At the party, I found that he hadn’t changed one bit.

Hubby blended in just fine, chatting away and finding common ground with a bunch of doctors he’d never met. I never cease to be amazed by how he can instantly connect with people and make friends. I can’t help but envy him sometimes. 😉

Throughout the week, we all went out to bars and got to know each other. One of the prelims from last year had come out with us (which speaks volumes about the program when a prelim comes back to say hello) and I squeezed as much information out of him as possible. There were a few drunken adventures but everyone survived intact. 😛

Anywho, we had to go through BLS (Basic Life Support) and ACLS (Advanced Cardiac Life Support) training. BLS was easy (CPR, which consists of thirty compressions and two breaths over and over again until the person wakes up or until you can shock them into consciousness with an AED or automated external defibrillator) but ACLS was a little more complicated. ACLS is really BLS with medications (epinephrine or adrenaline, vasopressin (similar to epinephrine), and amiodarone (which regulates an irregular heartbeat)) and a six-member code team. We ran a few mock codes (i.e. when a person goes into cardiac or respiratory arrest), and we did pretty well for our first run. Granted, the codes were on mannequins, so it wasn’t true to life, but it was good practice. The nurse who trained us is pretty hardcore, really sassy and fun. I hope when I have my first code, she’ll be there to help me.

We had endless hours of computer training to the point where my eyes were bleeding and I couldn’t stop fidgeting in my seat. It was torture, I tell you…TORTURE.

Friday was our official first day and I’m assigned to the health clinic for the next week and a half. The clinic is recently renovated and really wonderful. They serve the poor population and most patients are Spanish speaking. I was really excited to start and have patients all to myself. They gave us business cards with our names on it and I was like, whoa! Shit’s getting real! They assigned me two brand new patients (the last one cancelled) and I was like this every time I entered the patient’s rooms:

My first patient was pretty complicated (of course). She was a middle-aged female (who hardly went to the doctor) and she’d unintentionally lost forty pounds since January with intermittent fevers and worsening diarrhea since she’d come back from Peru (travelled Dec-Feb). I’m like, seriously?! This is the first time you’re seeing a doctor for this?! (I assure you, this will be a recurring theme). Usually, when it comes to weight loss that severe, we think cancer, but the diarrhea made me think it’s more likely infectious. The intermittent fevers made me think she has malaria (she took no preventative meds before her travels), so it’s likely she has multiple parasites. This isn’t common at all, so it was a crazy first case to have. I’m screening her for all possibilities (malignant and infectious) and I’ll see her again next week, so we’ll see what happens!

My second patient was a sweet middle-aged woman who just needed a physical and wanted to establish care since she had no medical insurance previously and hadn’t seen a doctor in years as well. I gotta admit, I left the clinic yesterday feeling pretty happy and accomplished, knowing I’d helped them both and would be taking care of them in the future.

So yeah, right now I have ALL THE FEELS, and I’m glad I’m here. Not to mention, I have the next two weekends off, so amen to that!