A friend of mine introduced me to Intern, a recount of a cardiologist’s experience during medical internship. The author, Sandeep Jauhar, trained at New York Hospital–it is now known as NYP-Cornell. While internship is difficult regardless of where you train, his book details many of the experiences that still have gone unfettered by social reform, at least in NYC hospitals. Certainly, the unionized nursing staff in the city makes even basic morning labs and vitals a chore for the house staff, even to this day.

From what I saw as a student in the ivory towers, overnight cross coverage still remains harrowing, with an incessant onslaught of pages, difficult patients, and codes. What this experience amounts to is not only a learned resident, but a tome of unfathomable tales that you’d otherwise imagine only to be fabricated.

On one occasion in his book, Dr. Jauhar describes performing a paracentesis on an ascitic patient. He instructs the patient, with tubing in his peritoneum draining the fluid, to remain still while he checks on another patient outside. When Dr. Jauhar returns, bodily fluid covers the floor. When asked to explain why he moved, the patient stated that someone walked into his room and seized, knocking all of the ascitic fluid bottles over.  Frighteningly enough, that actually happened.

I had cared for an elderly gentleman (86-yr old) when I was a 3rd year medical student. He was bawdy and demented; on several occasions he would ambulate around pantless, and void in the hallways as if he were hoping that someone would slip on his urine.  His behavior was probably not entirely due to age; his brain was ravaged by neurosyphilis. One evening I saw him with a bruised forehead and ecchymotic eye. Had he fallen despite having a sitter? No, it turned out the sitter had punched my patient. I had a helluva time explaining that to my attending in the morning.

I’m relieved that I escaped from the city for internship. At times, however, I wonder whether this rite of passage would have made me a better doctor. It sure would have added to my list of stories I could reminisce over with friends at the bar.  Regardless, I’ll be back soon enough.

medicine medicine

In the spirit of The Office, I considered replicating Michael’s attempt to impress a personalized contribution to society by dunking my face in the newly minted black-top (It was still steaming) in the hospital parking lot.  The thought was short-lived, however; somehow I doubted that fresh black-top is as malleable as wet cement. Nonetheless, it would have been more enjoyable than performing medical research, with comparable results.

medicine humor

As part of my internship requirements, I work in the emergency room triaging patients. The shifts range from 10-12hrs apiece, and it’s surprisingly tolerable. Since I am not an EM categorical resident, I don’t have to triage the trauma patients. That leaves a medley of typical ED presentations along with some less common issues. These include COPD exacerbations, pneumonias, GI bleeders, HIVers, and obstipations. The best part about the ED is that all I have to do is determine whether a patient needs to be admitted or sent home. At the end of the shift, I sign out any pending labs and issues to the next resident, and I leave. No more worries. Since there are always patients waiting to be seen, the shift doesn’t drag along.

The attendings also seem content with their work–several of them noted that the best part of their job is that they rarely exceed 50, even 40 hrs a week! That leaves adequate time outside of the hospital to stay sane. Not bad.

medicine work

I finished the USMLE Step 3 exam today. It was more ungodly than I had imagined. A friend of mine had joked about the progression of these licensing exams: Step 1 – 2 wks of preparation; Step 2 – 2 days of preparation; Step 3 – No. 2 pencil. Well, I didn’t even bring a pencil for the test, since it’s all electronic.

I can now get back to more pressing matters, such as updating this blog! More entries to follow. For those of you who are interested, I’ve made the Anki flashcards for Step 3 available on the downloads page.

medicine usmle

I’m always amazed at the types of food that hospitals serve in their cafeterias. I remember that I once saw a McDonald’s in the basement of one of the teaching hospitals of Baylor. The food court of the Cleveland Clinic (in Cleveland, not to be confused with ones in Abu Dhabi or Florida) also has a McDonald’s, right across from a TexMex stand that serves tasty nachos. Yes, why don’t we serve a 1500 calorie extra value meal to a guy whose family member just had an MI? What a great way to strum up future business in the cath lab!

My current hospital is no different. During my block of night float, I discovered that the cafeteria grill cooked items off menu. Off menu! I liked that. So on the last night of my block, when the only parts of my body that hadn’t been punished were my arteries, I custom ordered a Texas Toast grilled cheese sandwich. Two extra-thick processed slices of white bread painted (yes, painted) with a glistening coat of grease, with FOUR slices of american cheese in the center. Wholesome goodness. They should serve that with a statin.

medicine humor, toon