A Typical Hospital Day

I'm currently doing my internal medicine rotation.  Internal medicine covers sick people who don't need surgery or aren't there on an emergency, and they can't ambulate in/out of their family doctor's office - they are the sickies.  Think congestive heart failure, heart attack, leukemia, those weird rare diseases that kill you... etc.

Whereas my work cycle in the fire dept. was a 3-day cycle, here at UCI Med Center Internal Medicine it is a five-day cycle.  The difference was, at OFD it was work-off-off.  Now it is work-work-work-work-work with a random day off here and there.  I used to have twenty days off per month.  Now I have four.  What the hell was I thinking?!?!  Well, I guess I might have been thinking that it's priceless to hear someone blame away their syphilis on a wet gym towel and know they are lying sack 'o bleeps.  Or that once someone develops a swollen belly from their boozing, you better say all your last thoughts because they aren't going to be around much longer.  Or that I know definitively how to end a life.  Although I won't use that knowledge, it's powerful stuff.  Those sirens that were Odysseus' temptation?  Sailors didn't throw themselves overboard to listen to them sing silly songs!  The sirens' "song" was actually knowledge - of the past, present, and future.  Knowledge is irresistable.  Many a brave Greek sailor went to their watery deaths trying to attain it.

In any case, this is Day 1 of my 5-day cycle, with an intro to my team:

1.  One attending.

He is the dude who makes the final call on treatments and plans for the patient.  He comes at 9am and leaves at noon, and makes a lot of money.  The 9-noon period is called "rounds" where first the whole team sits in a conference room and debriefs the attending on what new patients we have that day, or what the progress is on continuing patients since the day before.  Then we run around the hospital together, the whole team, so he can examine each patient, one by one.  On any given day in a teaching hospital, there are multiple teams flying in and out of all patient rooms.  It's hilarity to watch.

2.  One 2nd or 3rd year resident (aka "the senior").

She is the dutiful deputy.  She runs things before 9am and after noon, and makes sure everyone's verbal reports to the attending during rounds are delivered smartly, adding clarification or background as needed.  She is there at or before 6:30am and leaves after everyone else.  She coaches the interns on their treatment decisions, orders to nurses, consults with specialists, and teaches medical students in between. 

3.  Two 1st year residents (aka "the interns").

They also get there around 6:30 or before and start examining patients, checking lab values, etc.  They split the patient load in half and have the primary responsibility for the patients.  They consult with the senior throughout the day to keep her informed and bounce ideas off her.  They also babysit lost medical students who need help with menial things.

4.  One 4th year medical student ("the sub-I").

She has already rotated through internal medicine before as a 3rd year, but 4th years have to do a dry-run internship for a month or so (the sub-internship) before they graduate and actually become interns.  Optimally, she carries half the load of the interns, but is primarily responsible for patient treatment decisions just like the interns are.  Of course she consults extensively with the senior, but it's obviously nerve-wracking and hectic for her.  She's not responsible for anyone but herself, but she is the closest to us in experience, so she gives us good little tips and nuggets to help us navigate the behemoth medical system in the hospital.

5.  Finally, the two 3rd year med students.

We just wander around with perplexed looks on our faces.  We never know what we're doing, we just show up when told, and leave when told.  The saddest members of the team.  Don't know anything.  Nurses fart in our general direction, but it's a happy time in the day when unsuspecting family members address us or benevolent attendings introduce us as 'doctor.'  Of course the latter always clarifies that we are "student doctors," but it's still nice to hear!  We come in at 6:30 just like everyone else and write up our paperwork like everyone else, albeit a reduced load, since we're learning and slow at it still, but none of our work counts for anything.  The intern, senior, and attending will all repeat the work done, so we are actually useless on the team; rather we slow everyone else down.  However, we are the only members on the team (and the 4th year too) who are actually paying money to be present, so they have to tolerate us and teach us a thing or two.

Day 1 (long call)

Being "on call" means you admit patients up from the ER, down from the ICU, or from doctors' offices.  You can't just walk into internal medicine and say you want to stay in the hospital; someone has to determine you need to be admitted.  Admitting a patient takes a long time.  You have to go find the patient, spend roughly 30-60 minutes interviewing and examining and looking through the chart to see what's already been done to the patient.  The interview is basically detective work so you can start thinking, "what's wrong with my patient and how can I fix it?"  On long call days, we accept patients from 7am-7pm.  Each team can carry a maximum of 20 patients - eight per intern and four for the sub-I.  Med students generally get one to three patients, and our heads are spinning at that point.  We round with the attending at 9am-noon as usual for our existing patients, but throughout the day, whenever there's another that needs to be admitted, the interns take turns getting assigned.  At noon, there is "noon conference" which is just a fancy way to say "mandatory lecture on whatever and free food to guarantee your attendance."  At 1pm, we go back to work, ordering labs, consulting with specialists, sending patients to get MRIs, talking with family, coordinating with the case worker, calling the family or the convalescent home nurse for background info, etc.  It's an amazing amount of information synthesis that happens all day.  The last long call day I had, by the time I drove home it was midnight, just in time to change, eat, shower, sleep for a few hours, and get up to be back again by 6:30am.  Long call is aptly named!

Tomorrow... Day 2 (post-call)!