Stick a Fork in Me...
It's funny. I used to think that the worst month to get get sick would be July. All of the new residents start on July 1st. But now, nearing the end of my first year of residency (or the end of my internship, for all you Americans out there) I no longer think that July is the scariest month to be in hospital... it's June.
In July, we KNOW we're new. We're scared. We feel like we've suddenly been given a massive amount of responsibility that we may or may not deserve. And for the love of God-- we don't want to screw it up. So we're meticulous. And careful. And probably more than a little paranoid. So the first few times the nurse calls for an order in the middle of the night, we'll drag our asses out to the floor to review the patient's chart first. And we'll double-check the dosage. And triple-check the med list and the allergies. And THEN we'll write the order. If a nurse calls and wakes me up because a patient is hypotensive, I'm on my way to assess them before she's hung up the phone. And it's not just the R1's that are like this-- as the R1's in internal medicine take up the lofty title of Senior Medical Resident, literally overnight they are ultimately responsible for the CCU, two wards of inpatient medicine, all consults from emerg, all consults from other services and every code called in the hospital. It's a lot. And rightfully, they're petrified as July 1st draws nearer.
But what a difference a year makes.
Want an order? Are they allergic? Any obvious contraindications? No? Sure, give them Ativan 0.5 mg po qhs prn. I barely even have to wake up anymore. Your patient is hypotensive-- are they stable? Any congestive heart failure? Give them a bolus of fluid and take the pressure again once it's run in. If it's still low, call me back. If a patient is stable I probably won't get out of bed for a systolic less than 85. Apathy? Maybe a little. But I can now do the bread and butter of my job with my eyes closed-- and sometimes, at 4:30am, I do.