Day One, Part I

I was on call in the ICU on my first day of internship. That terrified me. What do I even bring? I didn't know. But I showed up, learned about my patient (we started with just one, so that was reassuring) and rounded with the team, scribbling frantically on my list those things that I thought were important. That's the thing about being an intern. We're responsible for all the details, all the small things, and so I jot down any vague information that might help me overnight: their creatinine or their mental status or their wife's name. I figured that having more information is better than not, which overwhelmed me completely.

After a lecture, we started getting admissions. Luckily, I got the straightforward admissions - two thoracic surgery cases. But after afternoon rounds, I realized being on call is not easy. Suddenly, I inherited ten more patients to worry about. As my co-interns went home, they signed out their patients to me. I learned that interns never have spare time. I would sit down to work on a note, and a nurse would ask me to see a patient or the pharmacy would call about a drug or the lab would alert me to critical results. And though my instinct was to say, "I'm a medical student, let me ask the intern," now I was the intern. Most things I figured out myself, and I always had backup from my resident and fellow.

But then for a two hour span, the resident and fellow were called down to the emergency department to evaluate a potential admission. I scurried about checking on all the patients in the unit, making clinical decisions - albeit small - and recording these faithfully so I could report them. From time to time, I'd page my senior, but for the most part, I was practicing medicine. True, most of it was cookbook - repletion of potassium, administration of lasix, prescription of pain medication - but it was a really new experience. If I wanted something, it would be done. Furthermore, when patients developed new symptoms, I would go to the bedside and evaluate. I would determine whether I needed further workup or whether I could start empiric treatment. Or I would find that I was in over my head and grab my resident. But these decisions were mine to make and that was an immensely liberating and gratifying feeling.