You Can Always Ask for Help…
How I made it through my first night as an intern
Mostly in one piece
July 1. Notorious as the day medical interns start their first day all over America.
There are a lot of jokes, funny videos, sarcastic blog posts, etc. about July 1. Warnings to not get sick in July are rampant.
Gomerblog, a medical-based satire blog similar to The Onion, posted an article about removing July from the calendar. They claimed it would decrease mortality by 3000%.
Look, I remember July 1, 1999 like it was yesterday. 16 years is not enough time to take the tarnish off of that one. I didn’t kill anyone. I didn’t make any serious errors or thoroughly embarrass myself, or earn the moniker 007 (licensed to kill — see first season of Grey’s Anatomy). But I learned the universal surgery resident truth: you can always ask for help, but remember, asking for help is a sign of weakness.
On July 1, some intern had to be on call. As the intern on the Vascular Surgery team, I was that lucky intern. I was just coming off of a week of orientation, learning how to manage cardiac arrest and major trauma. I had my certifications, my MD, and my pager. And not a whole lot else. Maybe some common sense — who can say? Oh, I was supposed to have my second year resident as backup. But he was scrubbed in the OR and not available.
My one piece of luck was that some other poor intern was also on call that night, and they had to cover trauma. So I didn’t have to run to the ED every time a trauma came in.
6:30. We finish rounds, everybody signs out to me, and I am on the floor with several pages of tasks to finish and 70 patients in my care. It was the largest and the sickest surgical service in the hospital. My chief resident wishes me luck and reminds me:
The cardinal rule of Vascular Surgery — if there are any issues: headache, nausea, vomiting, anxiety, difficulty sleeping — they are probably having a heart attack. Even if there are no issues, odds are good they are having a heart attack.
I sign into the computer and start working on all of the tasks signed out to me — mostly checking labs, following up on EKGs, writing orders for admission, getting started on the discharge orders for the following day. Nothing too complicated, unless of course you’ve never seen this computer system before in your life, have never written an order that someone wasn’t co-signing, and don’t even know where they keep the prescription pads.
The nurses take pity on me. No intern ever got through July 1 alive without the nurses, medical assistants, technicians, and unit secretaries looking out for them. Thank God they were there.
The pager starts to go off. It starts off slow, then becomes a steady cadence. I can’t finish a phone call without another page coming in. I get progressively behind, such that the nurses stop paging me and just come find me. I’m struggling to decide whether it is even safe to just give Tylenol, or do a complete fever workup. Whether to increase pain meds, or evaluate the surgical site to make sure there isn’t something more serious. Heartburn medicine, or rule out heart attack? I’m nearly paralyzed with analysis overload.
The senior resident on call must have gotten a call from the nurses, because she comes up and hunts me down. She quickly, with the judgment of 3 more years experience than I have, cuts through the chaff, focuses on the truly emergent issues, and gets me on track. Then she reminds me, you can always ask for help, but asking for help is a sign of weakness.
It takes me something like 15 years to get over that idea.
Carolyn Messere, MD is a former colon and rectal surgeon, who now works with medical professionals to help them be happier and healthier in their careers. You can find her at www.drmessere.com
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