medical school, a day in the life

let me start by saying, i do love med school. i really do. but that being said, i can understand why, when i told my father i was going into medicine, all he said was, "are you sure?"

here is a generalization of what happened to me on my first weekend of work as a fourth year. i was working as a junior intern in internal medicine.

so it saturday, we meet at 7:30am for morning report. the night float ppl tell us the patients that they admitted overnight and we go over briefly the patients we are already carrying. my team is down to one resident, one intern, one JI (me) and one third year medical student. normally there are two residents and two interns.

so we then split up and go see our patients, make sure they are doing okay, write new orders, whatever. that goes pretty well. 1pm rolls around and i go grab lunch for the team. we at least get to eat before our code pagers go off. this one poor patient then precedes to code 4 times that day. best part of the first code was the intern and i are first to arrive, making him the one in charge of the code. he told me later he nearly crapped his pants. luckily our resident showed up about 1 minute later.

we then directly get paged down to the ER for new admissions to the floor. we are only down there for 2 mins before the code pager goes off AGAIN. i tell my resident to go, and the third year and i will start the admission. normally, not a big deal.

oh no. we are about to go in the room, and we notice the light is off. why is this? oh, the ER nurses say, this lady came in going nuts. she is currently in 4 point restraints, has a mask over her face cause she had been spitting at ppl, and has been sedated with IM haldol, and STILL is only just calming down. greeeeaaaat. so me and this third year, who has been in the wards literally one week and her eyes are just super wide hearing all this, go into the room to talk to what will be my new patient.

i flip the lights on. its quite a sight. this woman is completely disheveled, nearly nude, and tied down with her hands above her head and a respiratory mask over her face. she then speaks the only words she ever said to me, which was, "take this damn mask off my face." when i politely declined, citing her prior history of spitting, she would not talk to me anymore.

i tried for 5 solid minutes to get her to tell me what had happened, give me any medical history, tell me where she lived. nothing. i guess i should be thankful the haldol kicked in. seeing she was finally sedated, we quickly got her to get a head CT without contrast to rule out bleeds. all we knew about her was she was found down in the street, and her UDS was positive for cocaine.

lovely.

anyway, i get as much info as i can, and we admit her for 23 hour observation. we dictate the information we get from patients, and its called a history and physical. when i did it, it was rather short.

chief complaint: found down in street, unresponsive, given two of narcan, became combative. now uncooperative.

history of present illness: unobtainable

review of systems: unobtainable

past medical history: unobtainable

surgical history: unobtainable

medications: unobtainable

you get the idea.

i had another patient i wound up admitting, but she was a bounceback, so even tho i did the H&P, she went to another team. long story short, by this time it was nearly 10pm. i was tired, but i learned a lot.

no real point to this, but needless to say, after working on a saturday for nearly 15 hours for free, you really have to like medicine, to do medicine.

[HIPAA - this could one of a hundred patients in my city and no names were used!]