Confessions of an Intern

Week Four

This was the last day of my fourth week on inpatient service. I have to say this weekend has been very interesting. Finished with 90 hours worked in a row. I was definitely slap happy by today. I have been so blessed this month to have had such great experiences with patients and nurses and other residents. I feel I have grown in my confidence and understanding with each patient experience I've had.

Saturday was especially rewarding for me personally. It started with a nurse on the unit that always seemed to be stuck with difficult to handle alcohol withdrawal patients. If you don't know what happens when people go into really nasty withdrawal, look it up. It takes a lot of patience and stamina. She told me that morning how she had been telling a nurse friend of hers about me. She told me that she really liked how I communicated with the nurses and thought I was doing a great job as an intern. She asked her friend if she knew who Dr. D__n was, and she said her friend said no, but asked if this nurse knew the name of the new intern who is really tall, and little bigger, with short hair. She said her friend told her that whoever that was, she was a great intern, really knew her stuff. That was me! I love to hear that!.

Next, I was asked to help with a difficult patient who had hit a nurse. It was an elderly woman who has a lifethreatening illness, and was refusing some of her treatment, but refused to go home. This is a complicated situation. The hospitals need to maximize their efficiency, and if a patient is not doing what needs done for treatment, then there is no point in staying in the hospital, filling a needed room and occupying the staff's time. On the other hand, many of these patients have very real serious illnesses that need specialized care. One thing that I have learned is that everyone is allowed to make bad decisions. With that said, it is our jobs as physicians to help patients make informed decisions. With this particular woman, she had refused to allow the nursing staff to perform the tasks that needed done in order to help her. She has a critical heart condition that required a continuous IV infusion to help her heart work, or she would likely die in a matter of days. This woman needed what I call a 'come to Jesus' talk. This phrase was given to me in my early days of nursing, describing a discussion with someone that would persuade them to make a decision that had to be made.

The nurses and other doctors had all talked to her and tried to get her to comply with what needed done. I let her have a few hours to simmer down and then steeled myself to not let anything negative to get to me, said a silent prayer for grace and understanding, and went in...Her first response was to roll her eyes and say 'What do you want?' I introduced myself, and opened the floor to her to tell me what her understanding of the situation was. She was fixated on the social aspect of the hospital stay: staff always had to come into her room to do things and she wanted to be left alone. She was tired of being bothered. I asked if she knew about her treatment, and her response was that she was being treated fine, she just wanted left alone. After she said her piece, I clarified, asking what she understood about her medical treatment. She did not really seem to understand, or at least that is what she said. I laid it out very carefully for her, telling her the facts and explaining in simple terms how her heart was not working well, and the medicine would allow it to pump better. When I was all done, she said 'I would never refuse medicine that would help me live! No one ever told me what the medicine was for, they just kept bugging me!'

Now, I believe the cardiologist, the many nurses, other residents and doctors all told her something along the lines of what I said. Her response told me she just had not heard the information. Well, that day the nurses were impressed that I did not leave the room to a hail of shouting from the patient, and asked what I did before I was a resident. When they found out I had been a nurse, they all shared a moment and said all doctors should be nurses first. Nurses just understand people better. I agree that my experience in the trenches has been invaluable. The next day, the charge nurse came to me and said she wanted to put my number on speed dial. She said 'I don't know what you told her, but she has let us do everything we need to do and is taking her treatment.' I met the cardiologist (who has a reputation for being mean), introducing myself. He turned to me and said that he had explained the medication to the patient, but did not know what I had said, but thanked me for talking to her. (Score 1 for the intern). I had asked the patient what the heart doctor told her and she shook her head and said he just came into the room listened to her heart, asked how she was doing and left. I believe that. Remember, I'm the fly on the wall nurse that listens to the doctors' talks with patients, then have to interpret what they say once the doctor leaves.

That Saturday, I had a sick patient in the ICU. If you want to meet some territorial nurses, go to the ICU. The unit clerk also has a reputation at our facility for being hateful. She is. However by the end of that day, and her having to page me 30 times on one patient, we had spoken quite a few times. By the way, I returned each page...there were many reasons the nurse had to call me on this patient. I went and wrapped up the day, tidying up this really complicated patient. I had apparently proved myself to them. They were all really friendly and complimentary.

I really enjoyed hearing from all of these people that I worked with what they thought. We all like to be praised. It was more than that though. I feel like it was evidence that I had succeeded. I went into this hoping to be a good, trusted intern. Some people asked if I was a third year, but they were confused, because I was not familiar to them. The staff (my teachers) have all been very good and I enjoyed my time on inpatient service. This is supposed to be one of the hardest rotations of the residency. If this is the case, then I am thoroughly psyched!!!! I loved inpatient medicine!

Here are a few inpatient quotes of the day:

*You can't fix stupid.

*She's so mean she could punch a baby.

*People are allowed to make bad choices.

I'm sure there will be more. These just made me smile. :)