Surgical Internship

You might have noticed I've been busy for the last couple of months. This is because I've started my surgical internship, and when not working, am usually either sleeping or eating. I'm going to endeavor to write more though, because I think important things are going on in the world, and because it's somewhat therapeutic.

I'll tell you first about a day in the life. What does a surgical intern do? Well, pretty much what most interns do in medicine. We are the ones who run the floor, who do the day-to-day stuff that keeps a medical or surgical service running. The work isn't that exciting. We put out fires, do a lot of administrative work, and deal with the moment-to-moment issues with patients admitted to the hospital. But it is important work and necessary to keep the system running.

A day usually starts around 5-6AM, when you show up on the floor and get "sign out", or information on the patients on the service from the person covering them at night. We then start collecting data from the previous day, the vital signs and labs that let us know the status and trends of our patients, and put them together in a list. The list, they say, is life. It becomes the vital piece of reference information the team uses throughout the day to determine what has happened with our patients so far, where they stand now, and what needs to be done in the future. Usually consisting of a few pieces of paper, in tiny print it contains the information we use for rounds that morning, and then use to refer to our plans for the patients on service for the rest of the day.

Rounds are critical. Rounds are when everyone on the team learns what is happening with every patient, we talk to them to hear about any new issues or new complaints, do a physical exam, discuss plans with members of the team and the nurses, write our notes for the day and address acute issues that have come up in the previous night. On surgical services, because the first cases are usually scheduled to start between 7-8AM, rounds have to be efficient and succinct.

Then between 8AM and around 5PM my day is dividing between implementing the plans decided on by the chiefs and attendings during rounds, addressing issues that come up during the day, and hopefully getting into the OR once or twice a day to continue to improve my surgical skills. Internship is mostly about the basics of patient care though, and keeping the service rolling to the patients get better and out the door so a new batch can come in and get treatment.

Around 6PM the night call person usually gets sign out from us, and we endeavor to communicate the critical issues for our patients that need to be addressed during the night, and the problems we anticipate coming up. It's an under-emphasized aspect of hospital medicine, the day-to-day communication that makes sure nothing falls through the cracks and when we try to make the care of patients as seamless as possible, despite the need to hand-off care to the next guy. We are only human after all, and can only keep the plates spinning for so long before we need to eat, sleep, and get cleaned up for the next day's work. During the day you're running from task to task as quick as you can, and I lost about 15 lbs in the first month (unintentionally) from the constant activity and lack of time for meals. Fortunately I can miss the weight. My second month has been a bit calmer and there is free food, so I've stabilized, but I'll start to melt again once I get back on one of the more crushing services.

Every 3-4 days, or just on weekends if there is a night-float system, you have call. This means you start at 6AM and work until about 11AM the next day in a 30-hour marathon shift. At 6PM you pick up a couple of other surgical services you will have to cross-cover overnight. It's brutal, but necessary, and you learn to deal with issues as they come up efficiently, and even more importantly, to ask for help from the covering chiefs when you're out of your level of comfort or expertise. Post-call you sleep for about 12-14 hours and show up the next day at 6AM to start the process all over again. Amazingly, despite these requirements we have to keep our total hours under 80 hours a week on average.

We'll talk some more about what it's like to be a new intern. Specifically, we'll have to talk about the July effect (whether or not it even exists), the 80-hour workweek, and the impact medical reform may have on graduate medical education. It's an exciting time to be in medicine, I can only hope we get past the current noise and nonsense to make some real improvements in how we apply the science of medicine to human health.