My first call as an intern began at 7:30AM. I started out feeling optimistic, even sort of looking forward to it. Ha.
My spirits started to fall when I got my first admission of the night. It was a Russian-speaking guy on dialysis who had chest pain and shortness of breath. Because he spoke no English at all, we called for the translator, who took about an hour to show up.
Me: “How are you feeling, sir?”
Russian patient: [string of Russian]
Me: “What did he say?”
Translator: “I don’t know.”
Russian patient: “Nyet!”
Apparently, because he didn’t have his false teeth, he had become unintelligible and even the translator couldn’t understand him. It was kind of a challenging situation. We got him into dialysis and hoped for the best.
My second patient of the night was a homeless, alcoholic, heroin addict with hepatitis C. He also had chest pain and shortness of breath. I noticed when I was examining him that he had a heart murmur, which I mentioned when I presented my H&P to my resident Susan. She went in to examine him herself:
Susan [accusingly]: “OH MY GOD, this guy has a HUGE systolic ejection murmur.”
Me: “Yeah, I mentioned—”
Susan: “This is the LOUDEST MURMUR I’VE EVER HEARD. You could hear it in the hallway.”
I got another patient at that point, a diabetic guy with diplopia (double vision). After examining the patient, I decided that he had a lateral rectus muscle palsy, probably caused by an infarct to the sixth cranial nerve. I thought I was totally clever figuring out the diagnosis and started feeling somewhat confident in myself.
Me: “I think the patient has a cranial nerve VI palsy.”
Susan: “Yeah, that’s REALLY OBVIOUS.”
I admitted one more patient, which gave me a total of four for the night. The other intern only admitted two patients and the sub-intern admitted two, but I didn’t get any chance to pat myself on the back, thanks to continual disparaging remarks from Susan.
Susan: “Man, I am so tired. I forgot what it was like not to get sleep during call.”
Me: “You usually get sleep during call?”
Susan: “The interns I had before you were really good.”
Well, gee, thanks. It was only my second freaking day.
My confidence dropped to about zero at some point during the night. I kept getting paged about questions on my patients that I had no idea how to answer. I knew they were easy questions, but I just didn’t know the answers. I kept paging Susan to ask her, and I could tell she wasn’t happy with me. It got to a point where if the question wasn't all that important, I just made something up. Some questions I got:
"Doctor, your patient's blood sugar is 62 but she's NPO for a biopsy. What should we do?" Uh....
"Doctor, your patient's blood sugar is 405. What should we do?" Uh....
"Doctor, your patient's BP is up to 195/82. Do you want to do something about that?" Uh....
"Doctor, you wrote for an ADA diet, but you didn't say how many calories. How many calories do you want?" Uh....
By around 3AM, I wanted to strangle anyone who called me "Doctor." I still felt ridiculous returning my pages as "Dr. McFizz" and it also felt ridiculous that nurses who knew about 100 times as much as I did kept saying, "Doctor, what do you want me to do?" (If you are a nurse reading this, please just tell the poor interns on their first call what to do. You know that you know.)
I found some comfort in eating massive amounts of junk food. During the call, I ate a big bag of Doritos, cracker jacks, gummy worms, and a giant bottle of Coca Cola. I felt sickened by how much junk I ate. Yet the moment of putting the food into my mouth gave me just a tiny jolt of pleasure in my otherwise miserable existence.
At about 5ish AM, we finished our admissions for the night. I hadn’t slept at all but I was oddly awake. It was probably all the adrenaline.
Susan: “We’ve got some time before you need to pre-round. Why don’t you go sleep for an hour?”
Me: “Nah, I’m sure my pager will go off and just wake me up right away.”
Susan: “If you have an opportunity to sleep, you should take it.”
So I set off trying to find the call rooms. They were in some hidden, undisclosed location, and I failed to find them. I finally went to the resident lounge and lay down on the couch. I dozed off eventually and woke up about two minutes later when my pager went off.
I may not have felt tired, but my brain was definitely sluggish. When Susan asked me to order a transthoracic echo (TTE) on a patient, I went to the file cabinet of forms to order the echo.
Me [opening file cabinet] “What the hell was I looking for again?”
I checked my notes and remembered I was looking for the echo form.
Me: [after searching for a couple of minutes] “Damn, what was I looking for again?”
I did eventually, miraculously find the form. Of course, it couldn’t be that easy. I couldn't figure out what box to check to just get a normal TTE. The options seemed to all be words I didn’t understand. I checked the wrong box, naturally, and when Susan found out, she acted like I was the biggest idiot in the world. I maintain, years later, that there was no way for me to have figured out how to fill out that form on my own.
My organization paid off somewhat. I made checklists of everything, so I couldn't forget to do anything. Our attending even commented that I was very organized. Of course, I was a little jealous of everyone who seemed to remember everything about their patients on zero sleep and no checklists. My co-intern never wrote anything down. I don’t even think he had a pen.
I managed to get out of the hospital by 1:30 (30 hours), which was a bit of a miracle. The cross cover sign-out guy was really nice and he was like, "Go home! Enjoy your night and get some sleep!"