I had a recent conversation with a family member that makes me laugh. I told him I was on call, and he replied "oh so you could have gotten called into work." This makes me laugh because, althgough its called CALL, it really means WORK. But most people don't know that.
So right now I'm on q2 call. This means that every 2nd day, or every other day, I'm on call. Call means that I'm the intern carrying the pager, and all patient issues come my way. It in no way means that I'm at home eating bon bons waiting for a question to come from the hospital. Often call means that I'm running around from room to room in the ICU, attending to patients and fixing potentially scary situations before they happen. I also see patients that are done with surgery before they get upstairs to the ICU, because other interns don't always make sure that patient is optimized when they get to me. Case in point: I get a patient from the OR Friday night about 11:30 pm with a blood pressure of 40/20's. Normal is 120/80, and in the ICU I'm happy with 90/60s. At any rate, my call shifts are fairly busy and I generally work the entire time.
That brings me to another vocabulary issue I get over-quizzed about: who's who in the hospital.
ATTENDING: that's the boss. He's the physician who admits patients, operates on them, or oversees their care. In the ICU the attending spends 0-10 minutes in the patient's room PER DAY, depending on how sick they are. They spend more time in consultation with us making sure that the plan on their patients is carried out.
CHIEF: this is the highest ranking resident on a patient's care team. In surgery, this makes them a 4th or 5th year resident. They operate a lot, and generally tell me what they want done and scream when I don't get it done exactly as they'd like. They communicate most directly with attendings.
RESIDENT: anyone with an MD who's not yet board certified. This means that they can't take care of patients without an attending above them, but they generally oversee the patient care for the attending. Therefore, they spend a bit more time with the patient. The most junior resident on the team has the most boring, innane patient work to do. Residents are also called HOUSE OFFICERS.
INTERN: The lucky souls who are always the most junior resident on the team. Intern year is the first year of residency. Interns generally take calls about patients, write notes, enter orders, call consults, admit and discharge patients, paperwork-wise, and basically do all the boring stuff regarding patient care you can think of.
There are a variety of nurses also, but I'm less familiar about them. There are also pharmacists, respiratory therapists, physical therapists and occupational therapists that see patients in the hospital. Not to mention speech pathologists, wound care specialists, dieticians, social workers, and chaplains. And many, many other people that I'm forgetting right now. And everyone wonders why health care is expensive. You basically have a small army of experts working their magic on you to try to get you better.
What else is part of my daily lingo that normal people would ask about?
ROUNDS: This is the act of seeing your patients one after another and writing a note on them. It usually happens in the morning. The goal of this visit is to check and see how their night went, and formulate a plan for the coming day. It involves talking to the nurse, talking with and examining the patient, and gathering labs and vital signs. First, the unlucky med students pre-pre-round on patients. Then the interns get there and pre-round before the team comes in. Then the full team of residents rounds and comes up with a semi-finalized plan of the day. THEN, whenever they have time, the attending comes and rounds on the patients. This can happen with all residents present or not, depending on how much is going on. In the surgery world, all of this happens before 7:30 am because that's when the OR starts. So you can imagine how early those poor med students get there in the morning. Interns too :(. Especially when you have 15+ patients to see and your med students are unreliable.
CODES: These are called on patients that are unresponsive or who's condition is rapidly declining. Sometimes they are quickly resolved, and sometimes they involve intubating (putting a tube in the throat) and shocking heart rhythms. Either way, as an intern, they scare the crap out of you. I've never been the first one to a room when a patient is coding, and I hope I won't pee my pants the first time it happens.
I'm out of energy to type. As an update, I'm still enjoying my time in the SICU (surgical ICU) and I'm learning an incredible amount. As one of my co-residents put it, you either learn what you need to know or you hurt people. So far I've put in central lines, chest tubes and arterial lines. I've done upper endoscopies and bronchoscopies (scopes looking at the stomach and lunge, respectively). I've done bedside wound explorations and wound vaccuum changes. But I'll be happy when this insane schedule is over and I get to move onto a different rotation with 'healthier' patients.
Subscribe to:
Post Comments (Atom)
2 comments:
Hey! Thanks for the update on your life and for the lesson. How does the communication on the team work? Do med students round with the interns or before? Then the intern gets their information and talks w/nurses and does their own rounds? Then reports to the residents? How are those workouts going? I think it would be hard to keep them regular, but I hope you're finding a way to keep them there, even a little, for balance!!
hey bbg! My workouts are allright, not as often as I'd like, but I'm still getting 3 good ones in a week. I haven't really posted them, but I alternate standard cardio with monkey-bar type body weight stuff. The cardio I do on days when I'm dead tired, usually post-call, because that doesn't take as much energy. The body power-type workouts I do on my short day or day off, and I try to mix it up. I've been doing a lot of lunges and broad jumps lately. When I'm really dead tired, I do yoga or a hold workout. Just enough to keep me semi-active.
So rounding: the students unofficially round with us interns, just to make sure we're on the same page. Then all residents plus students round together. The intern generally communicates with the nurse better than med students, mostly because the intern gets the calls from the nurse overnight, so he/she knows the new big events firsthand. On rounds, the student will present the patient findings, and the intern just helps out with any additional info that the student forgot.
Communication generally goes to the next level up. Sometimes you skip a person, but usually that's frowned upon. So students get info from interns, interns communicate to residents, and residents will touch base with attendings to make sure everyone's in the loop.
Post a Comment