These are some of the things I've learned after my first week as an Internal Medicine intern on the MICU. Nothing to do with politics because really this is all I've had time for in the past week.
Things I've learned so far on my first week (2 days of 30-hour call):
- When placing a central line, don't ever let go of the wire.
- Check your dosages twice before you check them again.
- In the event of a code, take a deep breath and go by the algorithm.
- Common things, believe it or not, really are common. Except for the rare thing that will kill you. That's common too.
- Always have a low threshold for seeing the patient. Then when you're there, put in the PRN order so the nurses will stop calling you.
- Don't let go of that wire, I said.
- One incredibly hot nurse is the mental equivalent of several cups of strong coffee in terms of your productivity late at night or early in the morning.
- You can make up time by not eating, but you'll always, always regret it later.
- Don't worry about being tired. If something important happens, you'll wake up.
- Except when you don't wake up enough and make stupid decisions. That's why you double-check your dosages and go by algorithms.
- The simplest answer is usually right.
- A complicated answer is usually the sum of a bunch of simple answers.
- Despite the cut of her scrubs that reveal her amazing rack, that nurse really isn't interested in your stupid intern ass.
- Are you still holding onto that wire?
- You can never have enough information. Except if it's information that you already knew, didn't need, or didn't want to know.
- Make a list of things to do and go with it.
- The two most important words in the English language: PAY ATTENTION.
- As long as the patient is breathing, peeing, and pooping, he's probably all right. Your job is to keep him that way.
- Sleep isn't for the weak. It's for the brutally efficient.
- That wire's very important. Lose that wire and we kill you.
- Hypereosinophilic syndrome is best treated with Gleevec. IVIg is also a possibility, unless the intern suggests it, in which case it must be referred to a consultant for a final decision.
- That automatic cuff is probably wrong.
- That nurse's manual cuff is also probably wrong.
- The blood pressure you just got (which was what the automatic cuff and manual cuff got) is probably the right one and you should consider giving a bolus right about now.
- There are no stupid pages to your resident; there are only stupid interns.
- In septic shock, bolus fluids are a better choice than maintenance fluids. You can totally run fifteen liters into a guy and still be halfway there. Just don't forget that what goes in, must come out.
- Tired of holding that wire yet?
- By your 30th hour awake, you may notice your thoughts process a little differently. To be specific: they process more slowly. This is usually not a problem unless you are the person running the code.
- If you find yourself running a code, page your resident. This is usually the best call to make.
- That third can of Red Bull probably doesn't taste so good for a reason. Can you really die of caffeine poisoning?
- You are not expected to read extensively on this rotation. You are expected, however, to be up to date on the latest protocols, diagnostic modalities, treatment outcomes, and other pertinent facts related to your patients' disorders.
- Even if that incredibly hot nurse isn't interested in you, sexual fantasies are always an acceptable way to stay awake in the wee hours of the morning.
- The resident is always right. Except when the fellow is right. Except when the staff is right. Get used to it.
- The sexual fantasies you were just having about that hot nurse were just totally erased by your 300 lb. patient spitting up on you. That kind of thing tends to happen around here.
- What do you mean, you haven't looked at the chest films yet?
- Remember that doing nothing is sometimes an acceptable answer. Lots of times, even.
- That smudge on the chest film is more than likely a figment of your imagination. Unless of course the staff reads it and it suddenly becomes real.
- All good diagnostic and treatment ideas go through the same process of being thought up, dismissed, forgotten, and remembered at two in the morning.
- The on-call radiologist really isn't.
- It's always easier to calculate things like your net output, anion gaps, free water deficits and things right when you get the labs back, instead of, say, when presenting in front of your team.
- You will make mistakes. These are inevitable. The key is to keep the consequences of your mistakes from overwhelming the consequences of your good decisions. You can therefore make one really good decision and probably feel free to fuck up the rest of the night.
- That being said: Do. Not. Fuck. Up.
- That hot nurse gets to leave hours before you do, to go home to have sex with her boyfriend who, no doubt, works less than you and probably gets laid more than you. Isn't medicine fun?
- You can let go of the wire now. No really, you can.