Saturday, May 29, 2004

how to be a good little scutmonkey

The hospital is freezing today. I look at the babies in their isolettes and I get jealous. Why can't I have a temperature and humidity controlled pod in which to tool around? You put your hands through the little ports on the side and it's like a rainforest in there. Mmmm, tropical. Lucky babies.

After today, I only have two working weeks left of my intern year (I'm on vacation for two weeks before that), so in the spirit of my ten great truths about being a third-year med student, I decided to share some tips on how to be a good intern. Or if not a "good" intern, at least one who survives until the following July.

(except for the "without really trying" part)

1.) Be nice to the nurses. This tip is number one because it is the single most important pearl to know going into your intern year. As much as we like to think that we're the little workforce that makes the hospital run, it's nursing that keeps this damn place from falling apart. Learn from your nurses. Be nice to your nurses. Understand why they might be annyoyed with you sometimes. (Imagine being a nurse for 25 years in the same unit, and every July, a troupe of wet-behind the ears interns comes flopping in, without a clue, but somehow they're the ones giving you orders? Lord.) I mean, there are definitely some mean nurses, just like there are some mean doctors, but there's nothing that goes farther than kissing up to nursing. Sometimes, they even give you snacks from the patient pantry! Also, remember than an angry nurse is a one-way ticket to a miserable call night.

2.) Find a special pen. You have no idea how much happiness having the right pen will bring you. If you think that sounds really pretty sad, welcome to your new life. It's the little things that brighten your day. Remember, choose a pen that you like, but that you won't cry if you lose. (Or if someone STEALS it from you. Hello, 8 South ward clerk!) Also, remember that with a extra-fine point pen, you can fit even more microscopic scribbles onto a single sheet of paper!

3.) Develop a system. This is something that you can't really plan ahead of time, it will just have to develop over the first few weeks or months of your intern year. How will you organize your day? What kind a rhythm will you get into? How will you prioritize the top one hundred of your one hundred gajillion tasks? Everyone knows the check-boxes. But everyone has their own little subsytem within the checkboxes. Mine is especially neurotic, involving two different colors of highlighter, two different colors of pen, and an elaborate binder full of old scut sheets for archival purposes, to look up the telephone number of that one social work agency in the Bronx that I called last January, or the medical record number for the patient I treated three weeks ago with rotavirus. You will all have your own systems. Just don't steal mine, or you're DEAD. (Just kidding. I would be flattered if anyone stole my organization system, but then I realize no one ever would, because they're SANE.)

4.) Admit that you're dumb. And I mean that in the nicest possible way. The reason that you keep feeling like the stupidest fuck-up in the entire hospital is because you probably are. Hey, I was there. I ordered a unit of blood for a 3 kilo baby my first week of internship, for chrissake. But the more you admit how much you don't know, the more you'll be able to learn, and the more people will be willing to teach you.

5.) Have no pride. This is somewhat related to item 3, but slightly different. Self-depracation is the key, the KEY, to getting anything done in the hospital. It's strange, but true. Let go of all your ego. Practice saying the following:

"I'm wrong." (Even if you know you're right.)
"I'm sorry." (Even if you're really not sorry.)
"My mistake." (Even if it totally wasn't.)
"You're right." (Even if they're so, so NOT.)

You have to be able to say these words without choking. Put some feeling into it! It's hard, but it will get you what you want in the end. So many disagreements in medicine are ego battles, turf wars, pissing contests. Just roll over, belly up, and surrender. When there's no more fight to be had, then you end up getting what you want.

I need you to come up to put this bronchiolitic kid on CPAP. He's breathing at 78 and retracting to his spine, and his sats have dropped into the 80s!

No! I won't! You guys always call me at 3am and I'm fed up! I'll bet this kid isn't even sick! Also, you're a stupid intern and you suck!

You're right. You've been around the hospital much longer than I have and seen many more bronchilitics. I'm probably just overreacting. But could you come over and check him out with me? Maybe I could learn something from watching you.

I'll be there in two minutes.

And bring the CPAP machine with you, OK?

6.) Don't get too task-oriented. This is a tough one. So much of internship is receiving and carrying out orders that it's hard not to just zoom through your day check-check-checking all your boxes like an obedient little robot. But if you can, stop and think about what you're doing. Does the plan make sense? Does this kid really need this lab test? Is this really the best medication choice? Just because the attending told me to do it, does that mean it's really the right thing to do? Remember, you're not just an automaton. You're a doctor, for chrissake! (Insert impressive music and swelling of pride in the chest here.)

7.) Dress up once in a while. This sounds a little silly, but for real, it makes a difference. Even if it's a month where you could get by wearing scrubs all day every day. Even if you have to spend ten extra minutes getting ready that you could have been sleeping. Wear some makeup, if you're into that kind of thing. I mean, don't get all Tammy Faye Baker on our asses, but it feels good to look good sometimes, and not just like some dried-up work drone.

8.) Don't forget to read. I'm kind of a hypocrite for including this as one of the tips, because this has been a tricky one for me. If there's one thing that I don't want to do when I leave the hospital after a long day, it's flip open The New England Journal of Medicine. Work is work and free time is free time. But reading is important, and so I've been forcing myself to do it more. Mostly out of fear, though, that I'm going to be horrible and stupid as a senior and not have any wisdom to impart.

9.) Use the "I'm just an intern" excuse. Don't be afraid, it's not a cop-out. You are just an intern! And using the excuse will smooth over all sins. Well, not all, but many. Harness the pity! Anyway, you'll never be able use it again, so you might as well milk it for all its worth. Ride that line into the ground, friends.

10.) Don't forget to have a life. Have a non-medical hobby. Camp out at Borders and read comic books for an evening. Go out with your friends and have a beer, even if you're really tired and you're on call Q2 for the next few days. You'll be glad. Well, most of the time. I wasn't glad when I went over to Tammy's house for her fancy-pants dinner party and lost my wallet on the train and then had one glass of wine too many (read: I drank a glass and a half) and when I woke up at 4:45am for work the next day knowing that I would be in the hospital for the next 27 hours, I wished I was DEAD. But wallet-loss aside, it was a fun evening, so there you go.

Closing in on the end of my internship. Almost one year later, I'm a little bit smarter, a lot more tired, and ready for round two. Bring it, bitches.

Currently reading: Workbook in Practical Neonatology. Written by our department chair. He said after rounds this morning that I should drop by his office and speak with him about a career in Neonatology. I just may take him up on that.

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