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On a steep learning curve...

...and remembering curve. Last week went pretty well overall. I was very lucky to be surrounded by a lot of helpful and patient people (especially the amazing ER pharmacist) and to share the experience with another intern (a neurology resident from Texas). So many things to remember after a year of thinking about very different things! What antibiotic to use for an uncomplicated urinary tract infection? How to do a complete neurologic exam? How to calculate an anion gap? Plus, how to be the one who makes the decisions? Should I ask the attending about this or should I just do it? 
{the hospital, Burlington, and Lake Champlain}
Friday, I admitted my first patient. Until then, I had been "treating and streeting" everyone (which is not a phrase I've used until this moment, but it's fairly descriptive...so I'll keep it). The admission process was very frustrating. When the patient came in via EMS, I thought, this person is sick. I will need to admit this person. I talked to one attending who said, "Oh, just see how it goes with some fluids and an insulin drip. You may not need to admit him." I thus decided to wait and see...I talked with Megan (the pharmacist), and she helped me calculate the rate for the insulin drip...and Lauren (the nurse), who was very kind and said, "You're the doc," which of course was not helpful (if I'm the doc, who the heck am I supposed to ask for help!?) 

 After a couple of hours of treating this patient, another attending asked me (in an annoyed voice), "So...uh...what's your plan for him then?" And I told him what I had discussed with the first attending...and he replied, "So you think you're going to fix him here? In a few hours? You need to call and admit him. Call the internal medicine team." 

 Call 1: Internal medicine team (they returned my page after I spent several minutes trying to figure out how to complete this daunting task of calling the internal medicine team.) 
Me: Hi. This is Michelle Dorwart. I'm an intern in the ER, and I have a patient to admit
     to your team... (followed by a very thorough description of the patient's case and
     course of treatment in the ER)
Internal Medicine Hospitalist: Oh? Mr. X? Well...I'm looking at his chart right now, and it
     looks like he was last seen by a family medicine doctor, so they will probably want to
     take care of him.
Me: Oh, but he doesn't have a primary care doctor. They just happened to see him
    once...
IMH: You should call family medicine.

 Call 2: Family medicine resident (again, a returned page after several minutes of trying to figure out how to reach the family medicine team--and deciding against texting my fellow family medicine intern who is on the inpatient team now)
Me: (same as above)
Family medicine resident: Oh...well, we actually need to have our attending accept the
     patient before we can do anything, so you will have to call the attending.
Me: What is the attending's name? 
FMR: Dr. (unpronounceable name)
Me: Um...can you spell that?
FMR: Oh...most people call him Dr. Sam
Me: Ok...

 Call 3: Dr. Sam (after several minutes spent trying to figure out who Dr. Sam is) 
Me: (same as above)
Dr. Sam: Oh...he's on an insulin drip? He will need to go to the ICU. You'll have to call
     the ICU team.
Me: Ok... 
(At this time, I began to think that I really would be "fixing" this patient in the ER.)

 Call 4: ICU? (after several minutes trying to figure out how to call the ICU team...especially since there are two ICU's--a SICU (surgical ICU) and a MICU (medical ICU)) 
Me: (same as above) 
ICU intern: So...you're an intern?
Me: Yes.
ICUI: Um...I think you have to talk to our attending? Um...let me ask one of the other
     residents...
(phone is handed to another resident)
Another ICU resident: Uh...yeah. The call actually has to go to our attending...but...you
     can't call our attending. The call has to come from the ER attending. 
Me: Ok...

 I hung up the phone in defeat. And stood up to talk to the attending who already thinks I'm incompetent. He was dictating a note, so I stood awkwardly behind him, waiting for him to finish. He paused the dictation and turned to me with a withering look. I explained the situation, and he made the call, begrudgingly (probably).

 It was frustrating. But...I learned a lot, and when I got home that night, Chris had the following drink waiting for me: 

{sangria with white peaches and fresh raspberries
(from our backyard!)}
All's well that ends well (not only the drink...but the patient is doing well too)!

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Location: Burlington, VT, USA

Comments

  1. kjpJuly 17, 2013 at 4:58 PM

    You're so great! Don't let mean people get you down. You should now feel smug that you did the right thing!

    ReplyDelete

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