The End of Intern Year

The clock is ticking slowly today. I mentally checked out awhile ago and am just going through the motions at this point. There are a few things to follow up on, a nice signout sheet to make for the incoming resident, and I am done.

I headed over to Starbucks at lunch time to buy myself a little treat for my last day. There was quite a line snaking out the door, so I settled in for a wait. As we crept up a bit I was standing in front of the pastry display. All of a sudden there was a crash and a plate of coffee cake that had been balanced on top of another coffee cake display fell off its perch and lodged itself precariously against the edge of the display case.

One piece of coffee cake got stuck with the top edge of the plate bisecting it in half. That piece of cake started to stretch, and stretch, and stretch. Gravity was pulling it towards a free fall to the bottom of the display case and it was holding on with all of its might. It literally took a couple of minutes for that cake to stretch itself to the point of breaking. When it finally fell the people in line around me and I all started laughing. "That was the most exciting thing I have seen all day," said the elderly woman behind me. "But maybe that tells you something about the kind of life I lead."

Perhaps. But the trajectory of that coffee cake pretty much sums up these last few hours for me: a very slow march to the moment when intern year will plummet into the repository of past life experiences, where it will sit like a smushed piece of coffee cake against the glass, bruised yet visible, and certainly not forgotten.

One Day + One Hour to Go

Could it really be about to end?!??

4 Days To Go

My medical school buddies are all done with their intern years. Congratulations everyone! But me... I still have 4 more days to go, including today. This is what I get for having an extra week off last June to chill out and unpack from my move while all of my friends were already busting their butts in the hospital.

But there is one perk to this "extra week." Yesterday I started to realize that I was getting some strange calls and requests that did not make much sense. A couple of the callers seemed completely lost. Suddenly I realized that I was talking to new interns and that I sounded like I really knew what I was talking about. I was actually able to teach someone something! What a new concept. Perhaps I could get to like this second year resident role. I won't jump ahead of myself here, but I am going to try to enjoy my last 4 days of being a "super" intern.

That Light Is Getting Brighter...

I saw a flier directing people to the "New Resident and Fellow" orientation today. This is my last full week of the year. 6 more days to go. And it could not be coming soon enough. Not that my current rotation is so horrible, but I am just done. So done. So very done.

I had a moment last week where I realized the year really needed to end. I was at home after work and I went to grab a container of yogurt-covered raisins out of the pantry. The lid was not fully on the container and all of the yogurt raisins (we're taling at least 100 in the nealy full package) cascaded down to the floor and rolled everywhere. I laughed my ass off until I almost cried. Mrs. Lone Coyote looked at me and was like, "what is going on?" I could not stop laughing. Finally, I was like "this is the best thing that has happened today." It truly was.

When the highlight of your days is watching white candies bounce onto the floor, you know it is time for the year to end.

Beware of Popsicles

This one really takes the cake for strange calls. Courtesy of an attending:

Clinician: Hi, I have sort of a strange request.
Lab resident: Okay.
Clinician: Can you run a creatinine on a popsicle?
Lab resident: What?
Clinician: Can you run a creatinine on a popsicle?
Lab resident: Uhhhh...
Clinician: I know this sounds really weird, but we have this patient who thinks that the neighbor is trying to poison her kids by feeding them urine popsicles. We thought if we could run the test on the popsicle, we could prove that it is not urine.
Lab resident: Sorry, no, we aren't doing that.

T - 13 Days

The end of the year is getting closer and closer. Yet it seems so far....

Anyway, in honor of my last call night of the year tonight, I thought I would start posting some of my favorite call moments of the year. Some of them I have experienced, and some of them were other's tales of woe. Hopefully, they will be entertaining.

Tissue is the Issue

Caller: Hi, is this pathology?
LC: Yes it is.
Caller: Do you do biopsies?
LC: We do FNAs.
Caller: FNAs?
LC: Fine needle aspirations?
Caller: Is that a biopsy?
LC: Uh, not exactly. It's a needle biopsy. We run a small needle through the mass and draw up cells for cytologic examination.
Caller: (accusatory) That's not a biopsy!
LC: Yes, it's not a traditional tissue biopsy.
Caller: (Raising the voice level) But you're pathology. You're supposed to do biopsies. Isn't that what you do all day?
LC: Well, we do look at tissue sections. But generally someone else gets them for us.
Caller: (Yelling) Well, what am I supposed to do now?
LC: I suggest you call IR or surgery depending on what you are trying to biopsy. What kind of mass does yur patient have?
Caller: :::hangs up:::

A Little Tip From Your Friendly On-Call Lab Resident

I know you sometimes may be frustrated when we tell you that a certain volume is required to run a test. Really, we are not telling you we cannot do the test just for our own sadistic pleasures. Sometimes we literally cannot set a test up if you submit the specimen improperly. And, no, you cannot combine samples from past draws to achieve the desired volume. Sorry, I am going to have to say no that one.

Staircase Blues

The main stairwell in my hospital was very poorly designed. It is very narrow and accomodates about two average-sized people across its width. In the day and age of Americans of increasing body size, this type of design can be very problematic. One person moving slowly up or down the stairs can cause a massive back-up in both directions if no one can get around him. Around the floor that the cafeteria is on near lunchtime there are routinely traffic jams.

Additionally, at each floor the doors to the floor open outwards into the stairwell. Did I mention the door are heavy metal firedoors with no windows? And the landings are tiny? This means that as you are coming up or down you always have to be on the lookout not to get wacked in the face by someone swinging open a door.

So if you work at the hospital one would think that you get used to staying as close to the railing as possible, moving quickly, and swinging wide to avoid doors. One would think you would also learn that you have to walk single file behind your colleagues so as not to block traffic or have a collision with someone running up or down the stairs on the other side. But I guess that would be too much to ask for. Every trip on the stairs is an adventure, so I have started to categorize some of the staff stairwell behavior that never ceases to amaze me.

"The white herd" - this would be an entire team clad in white coats, usually Medicine, rounding in the stairwell. This involves standing around, often outside the radiology floor on the tiny landing, arguing some point of clinical minutiae and being incredulous when people are trying to squeeze by them.

"Best friends" - this involves a group of nurses and other hospital staff, usually female and on the way to lunch. They slowly move in a flock taking up the entire stairwell and preventing anyone from passing in either direction.

"Important people" - can usually be seen leaving the surgical floors and moving very rapidly. They tend to move in pairs and are never single file. Get out of their way, especially if they are headed for the cafeteria, because they might trample you.

"I hate my job" - these people move very, very slowly, especially if they are returning from break. Often they can be heard on their cells complaining about "that girl" or "that guy" on their floor or how unfair it is that they got their lunch at X time today instead of Y time. If you get stuck behind one and there is tons of traffic the other way, expect to be climbing stairs for awhile.

"Passive aggressive" - a subset of "important people" who run up behind you on the stairs even if it is clear things are moving slowly. They may even step on your heel not realizing that tailgating doesn't move traffic along.

"Door monsters" - usually late middle-aged folk who always swing the door open quickly and nearly take you out. "Oh, I'm sorry," they say sweetly as if after working here for 20+ years they do not realize the doors can take people out on the stairs all the time.

More to come, I am sure, as I continue to take the stairs.

28 Days to Go

Now that I have made it to June, I am finally allowing myself to begin an official countdown to the end of this year. Unlike many of my friends, I do not get a week off at the end of "intern" year and will just roll from one service to the next to un-ceremoniously start my 2nd year.

Currently, I am doling out blood products for patients. Blood Banking is its own field within pathology and it is pretty complex. It goes way beyond ABO and criteria cut-offs for issuing products. There is a ton of medicine here, more than I have done most of the year. Some of the more difficult cases are actually fairly interesting. Most of my day is spent writing up transfusion reactions. Blood products are not benign and in some cases we all need to be sure that we have a good reason for giving products and are not just treating a number. Luckily, most of the reactions are the garden-variety allergic reactions which are unpleasant for the patient but not life-threatening. Then there are the badder actor--hemolytic reactions, TRALI, TACO. They do happen.

In other news, it looks like health care reford is coming to center stage in Washington. If you are interested in health policy, check out this piece by Atul Gawande.