The End of Intern Year

Today was the very last day of my intern year, and honestly, it couldn't have come fast enough. After 2 weeks of night float followed by 4 weeks of CCU, I was drained and in desperate need of a break. My license expires tomorrow and won't start again until July 1st, so until then I have a glorious 1-week break which I plan to spend at home with family and friends.

The newest batch of interns arrived this morning to shadow us for a couple of hours to see what their jobs tomorrow would be like. They showed up in their brand new white coats and notepads in hand ready to jot down new information. We were pretty amused to find that of the four new CCU interns, three were named David; we joked that they'd have to be called by their last names to tell them apart. One of the Davids would be taking my spot tomorrow, so I told him a little about each patient and what was going on. The fellows, too, welcomed the interns, and one of them immediately sat down and started teaching them about Swan Ganz catheters, right heart caths, and other things essential to the CCU. It was surprising because he'd never taught my fellow interns and me any of this (we had to figure it out on our own), but I guess with these guys being new to medicine and the CCU they had to learn quickly what was important. Our attendings, too, were interested in meeting the new interns "fresh out of medical school;" when the heart failure attending came by and didn't see the interns anywhere (b/c they were in another patient's room), he wondered where they'd gone.

Unfortunately for the new interns, one of our patients coded right in front of them today. This was a woman in her 60s who had been admitted back in April for an infected pacemaker; the infection had spread to her spine, forming an epidural abscess. During her stay in the CCU, she went into multi-organ failure (intubated, needed dialysis, platelets fell to 19 and only responded to HLA-matched platelets, became jaundiced from a failing liver, etc), and we all knew that her prognosis was very poor. Yet through it all, she never complained; she always smiled when she saw us and (once she was extubated) said she felt all right. When we saw her this morning, she was her usual alert and smiling self, albeit more short of breath than usual. Finally it became obvious that she would need to be reintubated, and I felt sad b/c she'd being doing better.

Then she went into PEA, and half the residents ran into the room to assist in the code. One of the Davids donned gloves, ready to help with compressions, but the fellow told them to stay out of the room. So while half of us stayed in the nurse's station to round with the attendings (and sneaking peeks at the tele monitor all the while), the other half stayed in the room with the patient. Fortunately I knew my patients well enough to present them while my resident (who was post-call, too) was helping with the code. Twice this lady recovered with the help of bicarb and amiodarone and epi, but in the end it wasn't enough. Time of death was shortly before noon.

One of the residents later commented that the interns had looked terrified while all this was going on, and I don't blame them. These were all prelims going into radiology, anesthesiology, or PM&R; they probably haven't done a medicine rotation in many months. I, too, was jittery when presenting to the heart failure attending (who's pretty high up there on the cardiology totem pole), and at one point he said, "Calm down, you've got these guys to replace you, and soon you're going to be the boss of them. Scary thought, isn't it?"

Yes, it definitely was. Although the prospect of being a resident (and being expected to teach interns and med students) was frightening, it's also exciting. What's not to love about limited overnight calls (residents only do 30 hr shifts in the units) and having fewer notes to write per day? On the other hand, now I'm expected to do chart dictations and actually know stuff. It's easier to get away with being stupid as an intern, but as a resident I'll have no excuse. One of the cards fellows already knows I have zero cardiology knowledge, and he's going to be the CCU fellow again in 5 months when I return to CCU as a resident. My only hope is that by then, I'll have gained enough knowledge to be more confident as a resident.