“What is that?”. “I’m not sure. Whats that smell?”. “I think, ya, that’s fear alright”. “poke it with something would ya, I’m a little worried”. As the two senior attendings examine the body quivering underneath the desk it slowly turns toward them and peers back with swollen, sunken beety red eyes. Only a few months ago these same eyes carried a sheen that could captivate the hearts of his friends and speak only the most heartfelt optimism to total strangers. Now when these eyes glance at people on the street they tend to walk the other way. For eyes like this could only mean that this person intends to either kill, or has been on a meth binge for the last week. In fact the only people that find interest in these once human eyes are the police.
“Hey its turning over”. “Wait a second,. Jesus Christ! Its an Intern”. “The intern mumbles something that sounds like a phrase somewhere between “feed me”, “help”, “sleep”, or “no more”. The attendings in a unison barrel rolling laugh silence this quivering by grabbing the nearest stack of charts and beating the now feeble minded fool with them. Once the intern is back in his chair they place the blood stained charts in front of him, and bark “Get back to work! And if anyone asks you haven’t been here longer than 80 hours you piece of shit”.
Thankfully I have not yet become the person I describe above. To become something is a journey, a quest, it is a road that first must be traveled. In this so called road trip, the shell of a man I describe above is the destination. I have only just pulled out of the driveway with a full tank of gas and a body full of energy and excitement. Why do I have enthusiasm about the start of such a treacherous path that will inevitably only lead to self destruction? I have no idea.!! Apparently somewhere deep in my subconscious, somewhere between MCAT, USMLE, NRMP and other acronyms that really only spell pain I must have come to accept suffering as part of my being. I mean before diving into what will hopefully be entertaining accounts of intern year lets put a couple things into perspective. For the last decade I’ve gone to school accumulated a theoretical debt of over a quarter of a million dollars( no I don’t have that much debt, I decided I would rather be shot at), sacrificed years of my social and sexual prime in trade for a nice cup of coffee and seven gazzilion hours in a book. Finally in one glorious day a silky hood is placed on me, hands are shaken, congratulations given, and the MD is branded. What is the reward for this? What is the instant gratification? The privilege of working at least 80 hours a week for the next X number of years and making a fraction of minimum wage! All while being knee deep in a malignant egocentric culture that would have any fortune 500 companies human resource department in an uproar. What I would like to do is sit any over achieving 18 year old down that wants to be a doctor and tell them these things. If they still want to go through with it after all that they are either insane, masochistic, or overly idealistic. All of course being values I would admire in anyone!
So lets start out with the question of happens in the hospital in the middle of the night? When all the patients are tucked away and visitors have gone, what then? Could it be that like some Stephen King movie, the doors start to creak open and all creatures of imagination lurch into empty hallways to wreck havoc on whoever falls into their path. Then in a burst of white brilliant light a doctor in a white coat shows up on a white horse sword glimmering overhead to slay to beasts of the night. Well I would soon find out, because my first responsible act as Capt MD was the feared two weeks of intern year known as Night Float.
The set up in this military hospital is like so. During the day there is an internal medicine team that is “on call”. Until 8pm any patients that need to be admitted to a medicine team from the ER are taken up by this team. After 8pm the call team stops taking patients, everyone from the team goes home, but two scared and weary intens stay behind to manage any problems that may arise from any of the existing patients in the hospital. These Hydra slayers where the title of “cross cover”. Also at 8pm an Intern and a second year resident come in to make up the tag team known as night float. Night float basically admits any patients that come into the ER that need to be on a medicine team from 8pm to 7am. So the job of the night float intern, aka “me” is to work with this resident admitting whatever the ER wants to let slip by and make sure they survive the night, in the morning I wrap these patients up like a nice little present and hand them off to another team.
After a few days of trying to beat my circadian rhythm into doing something it clearly does not want to I was ready. As far as first nights go, it probably couldn’t have gone anymore story book wrong. I naturally couldn’t find anything, I some how didn’t have computer access even after doing days worth of training and computer inprocessing. This was of course typical for the military, when I explained my frustration about it the next day I was met with a smile that said “your new to the military, aren’t you?”. Right from the start the night was alive. Two patients were waiting in the ER. My resident thankfully knew his way around the computer system which I think requires an ability to “see the matrix”. Like most people striving for a career in Internal medicine he wasn’t without his quirks. I always enjoy traits about people that at first are annoying and then once the ridiculousness of it is fully appreciated they become amusing. This guy loved the word “player”, not in the pimps and hoes, don’t hate the game kind of sense, but in the “this patient is an ICU player”, or “that doctor over there used to be an army player”, or “the sodium is the main player, and that lab will be an important player”. The only play I played in the game most of the night was my ability to take histories and physicals and scribe them in the time tests biblical format known as the H&P.
For the first 8 hours we got slammed. The patients were typical, Grandmas with chronic obstructive pulmonary disease, alcoholics with liver failure. But they might as well have been snarling hell hounds because when I cut the head off one by admitting them they would somehow grow back in three and the night never died. It would also be an understatement to say that being called doctor was foreign. You see med school is pretend school. You wouldn’t take a 2nd grader that had just finished safety town in the school parking lot and put him on the autobahn with a Ferrari would you? So why is it at night that a bunch of pretend doctors are somehow running a hospital, all the while snickering in the back of their heads thinking “I can’t believe they actually think I’m a doctor. What a bunch of idiots”. At about 3am I said to my resident the player, “I’m thirsty” realizing that we hadn’t stopped for water or pee all night. He apologized admitting that sometimes he ignores his basic bodily functions and keeps pressing. Yes, the things some of us do in the name of self destruction. We took a minor detour between bouncing from one bed to the next in order to get me a 2 ounce cup of water. Around 5am the night started to retreat its fiery red eyes back into it’s cave and the opportunity for food presented which I gladly took.
The last trial of the night was passing these patients off to the team at 7am. I was going to stick around for most of it, but the player told me to duck out early and get my computer access fixed. For each patient that was presented copies of my H&P were passed around the room. This was unexpected, but I should have expected it. See as a med student your H&P is usually ignored, stuffed into the back of the chart to never be seen from again. I wrote 8 H&Ps that night, bear in mind I have not written one in over six months either. As the player presented the first patient I could hardly take watching everyone’s eyes scanning over my notes crippled by spelling, and grammatical errors that a 3rd grader would find hilarious. You see mom and dad, even though I’m a doctor repeating 3rd grade did not help at all! Before my eyes the white coats in the room became darker until they resembled the robes of judges. Pencils became gavels that slammed down and barked out “Idiot”! I quietly slipped out of the room. I found out the next day that the attending physician was “less than impressed with the H&Ps”. Well at least I’m not getting a grade, what are they gonna fire me?