Saturday, October 07, 2006

First page...and second.

I've gotten paged before. But never before have I been expected to act as the intern and decide what to do about a patient at 2am. I still remember the conversation, which is good. I had just laid down to sleep (how typical, I'm thinking) when I got the page, and calling the phone number, I rang a nurse who told me that "Mrs. Wright has a diastolic blood pressure of 109, and I rechecked it manually and got 101, and though she's asymptomatic, I'm worried about her."

At this point, I was probably sweating. All of a sudden, I didn't know anything. What the heck is blood pressure anyway? Luckily, I managed to keep my head a little, and asked the question "she's asymptomatic?" despite the fact that the nurse had just answered it. Then I said "I'll come see her."

This has a double purpose. One, it's what we're trained to do, as it's the right thing to do, since you can't make a decision about someone without seeing them. At my level anyway. Two, it allows you the time it takes to walk to the patient's room to think about what you might do.

In my case, it didn't matter. I still had no clue when I reached the bedside, so I gathered some information and paged my resident. Of course, while talking to him on the phone, I felt like a complete idiot, as he rattled off questions I hadn't asked, including basic ones like "what is the ranger her blood pressure has been running?" Mortified, I set the phone down and ran over to grab the patient's chart, and we figured out what to do.

I returned to bed about ten minutes later very angry with myself. I had completely failed to add anything substantive, and had needed to page my resident over a really simple problem.

Half an hour later, I got a chance to redeem myself. I was paged again, on another patient. This time the question was simpler, but I hurried downstairs and clarified medication orders, wrote telemetry orders, and had, in general, a minor success. Very minor.

An hour later, I seriously redeemed myself. I got another page on Mrs. Wright, and this time, I asked the nurse the questions my resident had asked me, then went and saw the patient, and then made a treatment decision on my own. I decided not to page the resident, as I was now comfortable with handling the problem.

It struck me, as I decided it was now too late to go back to bed and I started my morning rounds, that this is probably how most learning takes place as a resident. Seeing an example, and next time, not needing to call.

The end of the story is that my resident was impressed at rounds this morning. I hadn't realized, but I admitted more patients last night than either of the real interns, and I only needed to page the resident once. I feel almost like a doctor.


zhoen said...


Grace said...

What an encouragement. Mad props.

medstudentitis said...

Way to go!

Zwerver said...

I think you're right about how the learning takes place in residency, but also in most everything. Like someone shows you once or twice, then you've got it down, and even nomatter what you KNEW before you had to experience it.

If, on the other hand, you go through experiences and don't learn, you are what we at the City call "a bad hire." Then we fire you :). Luckily I am not at all worried about you!!