My First Night on Call (as a med student)

Thursday, July 7, 2005 (Internal Medicine Rotation, Day #3)

Medicine heirarchy is as follows: lowest on the totem poll is the 3rd year rotating student (me) followed by any 4th yrs, the intern (first year MD), the resident, and finally the "attending." the attending is some grand poo bah of medicine or something. Each totem poll represents a "team" that is assigned certain patients to admit, follow, treat, and ultimately discharge. I like my team. I work
closely with an intern named Jane who has been very patient with my ignorance and inexperience.

Yesterday was my first day "on call" which means our team picks up all the new patients. We got there early and immediately started seeing the new patients. By 8am, i was already exhausted. remember, it's already been a long week for me at this point. By lunch, I could barely hold my eyes open anymore. All I wanted to do was find a corner of the hospital where nobody could find me and go to sleep. I
knew I would snap out of it if I could get over the initial hump, and sure enough, by early afternoon I was cruising!

Around 9am the sirens started going off. i had heard vague reports of another terrorist attack in europe, so at first I wondered if something had happened in america too. "Code Red! Code Red!" turns out, it was only a tornado. "move away from the windows" and continue on. I never saw it, but the skies were BLACK. I don't know if it was just a warning or if it really touched down.

By 8pm we were really humming. Seeing patients left and right. I wasn't tired anymore. By midnight, I was hungry, so the team sent me out to find some food. Everything was closed except sonic. I took orders and brought the food back. While I was getting out an old black man who looked homeless came limping over... "oh no" I thought, "another homeless bum looking for money." I live in downtown dallas
and my school/hospital and the VA where I'm currently assigned are all in very bad parts of town. At first I ignored him, because I didn't want to deal with it. But then I realized he was limping very badly so I watched him walk towards my car. His legs were pretty deformed, and he was carrying a bag of ice. I rolled down my window and he said, "I'm SO sorry to ask you, but my legs don't work, and this
restaurant is nice enough to give me ice because my refrigerator don't work. but my house is far, and it hurts to walk that far. could you please give me a ride?" Ofcourse I did, and while doing so I learned he had been afflicted with polio when he was very young. His house was several miles away. He doesn't have a car, so he walks everywhere on those polio legs. I was glad I could do something to help, since
all day I had felt like a burden to my team. I was also reminded of what a blessing health is. just being able to run and play as a child... something he never had.

I brought the food back to the hospital and it was gross. we all thought so. Then we went back to some patients to draw blood, put in iv's, etcetera. One of our patients was an old medic from the vietnam way. while my intern was putting an iv in his neck, i was talking to him. he couldn't talk too well, because he had much of his mouth removed thanks to mouth cancer. he was very sick, and in a lot of
pain. he told me he had wanted to become a doctor, an anethesiologist after vietnam, but fell into trouble while he was in college. now here he was, laying in a bed, in pain, barely able to get himself to the bathroom, with doctors trying to put an iv in his neck, telling his story to a med student at 1 in the morning. Soon we were done seeing patients, but we still had a lot of paperwork to do.

By about 2:30am, I decided I wanted to try to find the "call room" which is a bunk bed for students/doctors that want to crash for a short time while they're on call. I knew I would have to get up early to finish my paperwork and check on my patients before rounds, but I was tired. I wandered the desserted halls of the hospital trying to find it. I walked past the surgical icu. several families had made
makeshift cots out of couch pillows and blankets. It was obvious they were waiting for somebody in their family to come out of emergency surgery. A middle-aged, blue-collar looking man was pacing the hall. I nodded as I walked past him, looking for my bunk bed. Eventually, I found the room, but I needed a code to get in, and since nobody had given me one, I decided I would have to go back to my work room and
crash on the couch. I was slightly frustrated at how tired I was, how late it was, how i hadn't seen anybody i really loved in days, and how I was looking at 2 hours of sleep on an old couch before starting all over again tomorrow. Walking back through the hall I again passed the surgical icu. The same man was standing there, but this time he was different. He tried to hide his face from me and I noticed that tears were streaming down his cheeks. I walked back to my couch, took off
my shoes, set my alarm for 5am, and went to sleep under the flourescent light.

5am came and I launched out of bed groggily and in disbelief at how much I would have to get done in a short period of time. The attending was coming and I needed to orally present one of our patients. An oral presentation is when we tell the entire history of the patient and what we think the diagnoses could be, and how we think he should be treated. It's easy for an experienced doctor, but for a
know-nothing 3rd year student, it's hard. I brushed my teeth and got back to work.

Without blinking it was already 7:30 and the attending was here. I presented, and everybody else presented as well. I knew I was a little disjointed, but I didn't think it was terrible. Not bad for my first time--or so I thought. After presentations, the attending went with the whole team to visit each patient. This took several hours.

After "rounding" the attending asked he other student and me to come to his office. He totally laid into us on our presentations, said they were "terrible." At first I wasn't offended, but by lunch time, after the offense had settled in a little, I was pretty ticked. I had worked my tail off all night, took 2 hours to sleep, and some
doctor who's been practicing medicine for years tells me I suck? Thanks for the help!

Well, by 3pm I was finally done with my responsibilities and free to
leave for the day. That's over 33 straight hours at the hospital.
Tomorrow morning at 5:30am I'll be back there.