VA Wards

I guess now that I am finishing up my second month, I should write about it. After ICU, I went to wards at the VA. Medicine wards form the foundation for the internal medicine internship year. I once heard that the hospital runs on interns, and here it is true. There are five teams, and in each team, there are two interns, a resident, and often a gaggle of medical students. Each intern takes responsibility for up to ten patients, and each call night (every five days), the interns take up to six new patients. It runs in a pretty standard fashion, similar to the way UCSF operated. Each day, I arrive at around 7 to get sign-out on my patients overnight. I see them all, then work-round with the resident to get all the details squared away. Morning report is at 10, and after that, we have attending rounds to staff all the patients. During the afternoon, I get "work" done: notes, studies, discharges, consults.

On call days, we stay overnight admitting patients. Most patients come in through the ED, though we often get a few ICU transfers as well. As an intern, I work more independently than I did as a medical student, trying to come up with a diagnosis and plan myself. We admit until 2am (or until we cap at 6 new patients each), then tuck the patients in until the morning. During the morning, we staff all the new patients with the attending and a day float resident. The day float resident stays during the post-call day as we scramble to get home by the 30 hour rule. It's a pretty standard structure.