I survived my first week of doctorhood! And, more importantly, so did my patients!
During one of our orientation lectures, we were told that as interns, we are “entitled to stupidity.” Despite all that we’ve been doing the past 4 grueling years, no one expects us to know anything right now. Therefore, we should take advantage of this time to ask questions and make mistakes… you know, as long as we don’t kill anybody.
Well, that’s awkward! In any other profession, I feel like “Don’t kill anybody” would be setting the bar pretty low. Granted, outside of medicine, customers generally aren’t dying to begin with; when people walk into a grocery store, they aren’t complaining of chest pain. But I’ve read enough textbooks and passed enough exams to know how not to kill any given patient, don’t you think?!
I changed my mind at about 3AM today.
My first shift covering the hospital’s Medicine service was overnight on a weekend, after a full regular workweek. Having never even pulled a true all-nighter in college or medical school, I had no idea how this would go. At 7PM I showed up to meet my day-shift counterpart. He was holding a handful of lists, and after about 5 minutes of brief introductions, all 25 or so patients on those lists became mine. That was a chilling moment!
I took the lists, and a slow deep breath. I asked, only half-jokingly, “Are you sure you trust me with all your patients?” He said, “Of course I trust you!”
By midnight I had admitted a couple more patients from the ER, written a handful of orders, and successfully fielded several pages from nurses. I’d finally gotten used to introducing myself as “Dr. Meservy,” and I was starting to feel like it too.
At 2AM, my fellow night intern and I were sitting side by side, typing up our notes on the new patients we’d admitted. I was trying to read up in the literature about my patients’ conditions so I could incorporate good reasoning into my notes. I was constantly interrupted by the pager. Neither of us could stop yawning. We agreed that pulling a life-saving all-nighter was just about the craziest thing anybody had ever expected us to do.
Shortly after 3AM, I received 3 consecutive pages from the same nurse. A critical lab value! Something might kill a patient! After calmly telling the nurse that I would call her right back, I ran over to my senior resident and asked, “WHAT ARE WE GONNA DO?!” Together we made a slew of fast decisions that ultimately reversed the danger and stabilized the patient. This was followed by more deep breaths and more note writing.
In the morning, our management was met with both praise and criticism. We did the right thing overall, but we overlooked some minor details and we didn’t meet everyone’s preferences. In the daylight, our little mistakes became blatant. But in the moment, we were scared and tired and didn’t have much time to act. If the situation had been more critical, with less room for error, maybe it would have made the difference between life and death for that person.
This all leaves me wondering, was it in a hospital that they came up with the term “graveyard” shift? Now I know: if somebody were to get killed, this is probably how and why!