Long call

Intern year is infamous for the amount and frequency of long call (overnight) that must be done. While on internal medicine during third year, I have had to work the same schedule as the interns; thus also q4 long call (overnight every 4th night). It's busy, it's tiring, it's frustrating, but it's also when you bond the most with your team and with your patients.

This photo is an example of the night float bonding with an M4 over a shared love of high level mathematics. I was busy bonding with one of my interns over bento boxes and having grown up out west. Later that night I went to visit a patient and his wife, who declared they would be my surrogate grandparents since my family is so far away.

Long call is also exciting as an M3 because it's when you get to do the most. You can get a complete history for your busy intern and then write up the admission paperwork for them. You can follow up on orders to make sure tests and labs are done and interpreted, call consults and be the contact point for the nurses so that you are in the loop on the evolving treatment plans. On cardiology you carry the code pager so when anyone in the hospital goes into cardiac or respiratory arrest you have to drop what you're doing and respond. First person on scene starts chest compressions and let me tell you, a real chest feels nothing like those dummies you learn on.

I really like long call - I like being in the middle of it all. But I can see how 8 months of it would get tiring. Still, 6.5 weeks into 12 weeks of this I'm mostly just pumped. I'm finally in the hospital. Finally working with patients. The last two years I've been impatient to become an M3. Now that I'm finally there, I'm even more impatient to be an intern.

RN vs MD

There is a lot of literature and there are many studies assessing the relationship between doctors and nurses. As a medical student you are told often and early, "don't piss of the nurses." This is sound advice because honestly, you learn a lot from your nurses and they can make your life very frustrating if they so choose. On the other hand, I can already understand some of the frustration that doctors feel. There are those nurses who, for some reason or another, think their accumulated wisdom is more valuable and correct than what goes into the education of an MD. Two recent examples:

1. I was reviewing a rhythm strip on a patient who has an AV nodal arrhythmia. We were concerned the patient was intermittantly having 3rd degree heart block - a rhythm in which the atria no longer communicate with the ventricles, who begin to generate their own "escape/junctional" rhythm. The nurse told me that he couldn't possibly be having an arrhythmia because the interval between the beats was constant. I tried to explain that a junctional rhythm would, in fact, be regular, but would still be an arrhythmia. She proceeded to tell me that after all these years here she knew that, but it still couldn't be an arrhythmia. Um, yes, it could. She insisted it couldn't. I gave up because she clearly wasn't going to change her mind. But honestly... what does she think I've been studying for these last few years? Proper bleaching technique for my white coat?

2. Another patient of mine has been on the floor for two solid weeks getting antibiotics. He's going a little stir crazy and I wanted to let him walk around the hospital courtyard for some fresh air and sunshine. My attending agreed that he was safe to be off telemetry for an hour or so and a walk would be good for him. The nurses overruled us. Apparently, they decided he was too sick to be off telemetry. Excuse me? Since when did nurses get the right to veto physician orders?