My Initiation Into Second Year

For a few months now I have been anxious about the transition from being an intern to becoming a second year/senior. I just didn't feel like I was ready to handle things on my own, not to mention, teaching an intern who is just as terrified as I am.

This weekend I had the most grueling call I've ever had since internship. Mind you, I am sure a lot of people have had worse, but for me it was enough. I am on the medicine service this month so during the day I was already taking care of the patients I would be taking care of while on call. Our list stood at 17 patients that day. Our call shift starts at 5pm.

Between 4:30 and 5pm, I got called for three different admissions. One was a consult, one was a transfer and one was a direct admit. I took the transfer and my senior went to see the direct admit. I knew I had to work fast because we had to sign out to the senior coming on with me. Luckily the case was simple and I was able to contact the consult and write orders. I ran the case by my attending breifly and rushed to the consult because she needed acute attention. The consult was a little bit more difficult because we sort of had to stabilize the patient and get her heart rate under control, but all in all pretty simple. I felt really confident and thought I handled being on my own great.

My senior was dealing with the direct admit who they called a rapid response on, while I told the oncoming senior about the patients on the list. Patient count: 20. We finished the consult admission and get paged for a 4th admission in the ER: generalized weakness. On the way we get a rapid response to the Cath Lab. Scratching our heads, we wonder, "Isn't there already a cardiologist there?" We get to the rapid response and we weren't needed anymore. My other senior shows up and we start signing out patients and getting updates, when we get a call for a delivery. I head over and deliver the baby with the attending and come back for sign out. For floorwork there was a post-operative note I had to do and we were supposed to do visuals on some of the patients. Food status: still no dinner; time: 8pm.

A little background so you all can understand how timeconsuming everything was that night, is that our attending on call and on the medicine service specializes in geriatrics. She is very particular and wants to know everything about the patient; and you know how older people are GREAT at remembering things. Our 4th admission was a 76 year old lady with generalized weakness. During our evaluation we get called for, not one, but two MORE admissions: Admission #5: 83 year old female with fall and generalized weakness; Admission #6: 75 year old female with abdominal pain/kidney problems. After admission 4 we take a 30 minute break for dinner and decompression. Patient count: 23, Time: 1130pm.

At midnight we had admission 5 and 6 to do still. I figured I would get maybe 2 hours of sleep, at most. During admission 5, we get called for yet ANOTHER admission. Admission 7 was a lady in her 70s or 80s who also fell and also had generalized weakness. This isn't going to get confusing at all! I had to tell myself multiple times to focus because my brain was slowly turning into mush and all the patients were mixing together in my head. We finished seeing the patients and presenting to our attending at around 6:45am. We never had time to do the floorwork that needed to be done. I never did that post-operative note. I had not slept. And patient count was 24.

That morning I had to round on 6 patients and rounds with the attending started at 9am. I took a really crappy 15 minute nap and went to go see them. For some reason my brain wasn't functioning the way I wanted it to and I had to go at lightning speed. At the beggining of rounds with the attending, I felt like I was going to have an anxiety attack. I felt like I didn't know any of the patients and that my presentations were sucking. After the first two presentations of the new admissions, my brain was starting to function again, and rounds weren't so bad after all. I just felt bad leaving so much floorwork for the oncoming team.

At the end of rounds, my attending commended me on a job well done. It felt really good to get that affirmation and at this point, I think I might just be ready to be a second year resident. I just need to get that darned anxiety about rapid responses out of my head!