Overwhelmed....

As glad as I am not to be an intern anymore, being a resident has its own share of trouble. I'm now working on a heme-onc floor service, a rotation which I'd requested because I'm interested in heme-onc and the attendings on this service are also the program directors for the fellowship program here. If I did well on this rotation, then the attendings would take notice of me and possibly write me a letter of recommendation when time came for me to apply for fellowships. I had just completed a heme-onc floor month at the other hospital, so I thought the transition from one hospital service to another wouldn't be difficult.

Wrong.

This service is notorious for always being capped and being extremely busy, but I had no idea how busy it would be until now. There are new patients being admitted to our service almost every day for chemotherapy, neutropenic fever, etc., so I have to do admissions on days even when I'm not on call. There was one day where we got 3 new admissions before noon, and I already had 13 patients on my service. But the 14-patient cap doesn't really exist for this service. The chemo patients are pretty easy; they come in for chemo for 1-2 days and then leave (it just means more dictations for me to do later on; by the end of this rotation I'll be a pro at dictating). But that also means our census is always fluctuating, and it's hard for me to know everything that's going on with all 14+ patients. Which is bad, because as the resident I'm supposed to know what's going on at all times. Instead it's my sub-I who knows the patients best since she's been on service for 4 weeks and knows more about them than my own intern (who's similarly overwhelmed since this is his first floor month). And now she'll be leaving too, and I'll have a brand new sub-I and MS3 next Monday to train.

Today was especially bad because my intern had clinic this afternoon at the "Bing," the private hospital located 13 miles away (a 1 hr commute during the day), so I was intern-less for the afternoon. At this time I was carrying a grand total of 17 patients; 2 new ones got admitted for chemo in the morning. There would also be 4 patients leaving after completing their chemo, so my med students and I were doing discharge paperwork like crazy. On top of that, one of my patients needed a MICU eval b/c he fell out of bed and was found to have a head bleed (MICU ended up rejecting him b/c of his DNR/DNI status), another one got a last minute ERCP for abdominal pain, etc. There was so much to follow up on I was running around like crazy. My intern, despite having clinic this afternoon, was also on call until 8 pm tonight, so I did 1 admission and 1 accept note for him this afternoon. I felt bad about leaving my med students alone when I had to run to the ER for the admission, but fortunately they did fine. The other heme-onc resident helped out by supervising my MS3 in her first successful ABG, and I rewarded my med students by sending them home at 5 pm (which is "early" for this service; this entire I week I never left work earlier than 5:45 pm)

Then there were 3 direct admissions to my team starting at 5:30 pm, and all of them for nausea/vomiting/sick symptoms. The triage resident told me to do one of them, but by then my intern had returned so I gave the admission to him. Ideally, I was allowed to leave as soon as my intern returned to complete his call, but I stuck around the hospital to help him with floor stuff while he worked on his admission. The problem: he started doing floor stuff instead, and I tried to get him to focus on the admission in order to get him out at 8 pm. By this time it was 7 pm and after the day from hell I was anxious to leave. The triage resident had told me that she would supervise his admission, but around 7:10 pm another resident (who's known to be extremely two-faced) came by and told me, "By the way, triage wants you to supervise your intern's admission."

I was stunned. Never mind that I wasn't even on call today, why were the residents making me stay until 8 pm to supervise my intern's admission? Was it because the patient was going to my team? I wasn't even supposed to BE at the hospital right now! I'd only stayed so that my team would have continuity of care until my intern returned, and now this?! Were they doing this just for the sake of convenience? I did not believe that the triage resident had wanted this; she had apologized for making me stay late until my intern returned. Rather, I think the other resident said this so that he wouldn't have to supervise my intern himself. A part of me wanted to call the triage resident and ask if she really wanted me to stay late to supervise the admission, but then what would that have done to my intern? He was sitting right beside me when I was told to supervise him; if I bailed on him now, then he'd probably think all I cared about was going home rather than help him out. So I didn't argue and agreed to supervise the admission. Even when another resident stopped by and asked if I needed help, I said I'd take care of it since, after all, the patient was going to my team and I needed to know what was going on. I think at the end of the day my intern could tell I was stressed to the max (I was "sighing" a lot more than usual), but he still couldn't sense my urgency to get out on time. We didn't wrap things up until 8:30 pm, at which point I couldn't leave the hospital fast enough. I didn't let myself break until I got home.

I never expected to be on call with my intern like this, and I have my own call in 2 days. That is Q2 call. I should consider myself lucky that residents don't have to do overnight calls except in the units, but I am still extremely stressed, angry and frustrated. I feel like I'm not a good resident since I don't know my patients as well as I should (even consulting residents knew to ask my sub-I for information instead of me), my medicine knowledge is lacking, and I've yet to do well by the attendings. At this rate I don't think I'm in any position to apply for a fellowship this year. If I even want to do a fellowship anymore. I also want to email my chiefs about this, but I don't want to come off as being lazy or weak. *sigh* I don't know what to do anymore.

Just hoping things get better next week.

Being a Resident

I've been a PGY-2 for about 5 days now, and I must say it's been quite a transition from being an intern. Sure, I have fewer notes to write, but there's a greater sense of responsibility that comes with being a resident. My intern is very helpful and hardworking (which is good; I don't know if I can deal well with lazy interns), but I still have to look over his shoulder to make sure things get done right. Yesterday he was on call overnight (and covering night float), so I expected him to be a zombie. When I ran into one of the Drexel attendings, however, she confided that she didn't know what to think of this year's batch of interns. One intern ordered methadone for a patient's pain (when she was already on dilaudid and not a recovering addict). Another called the attending at 3 am asking what dose of kayexalate to give a patient for a K of 6.2. My own intern, to my dismay, told her over the phone that he was "too busy" to take care of something she wanted done as soon as possible. And while I believe that he was busy since he was getting signout from other teams at the time, that's just the wrong thing to say to an attending. I still remember my fellow MSIII's response at Methodist when the attending asked her why she didn't go to the pathology lab to look at a patient's biopsy results as instructed: "I guess I didn't feel motivated to do it." *facepalm* When I told another classmate about my intern's faux pas response, he asked me, "Were we that bad when we were interns?" I'd like to think no, but who knows. -__-

The current batch of interns here at the "Bing" (the private hospital where we rotate through 1-3 months of the year) really do seem overwhelmed. I feel pretty fortunate that I'm now a resident on a service that I did just 3 months ago as an intern; the attendings still remember me and I know how things run. That's not to say I haven't made mistakes; my intern mistakenly told me that a patient's bone marrow biopsy wasn't back and instead of checking the results myself, I took his word for it. Later I found myself in trouble when the attending clearly pointed out that the biopsy results had been noted in the chart. "How long have you been on service?" she'd asked. That was a real FML moment, but makes me more determined to be careful when chartchecking. Clearly it's too soon to believe everything that comes out of the intern's mouth for now; I just hope it gets better by the time med students start. Then I'll have my hands full.