I've been meaning to post earlier but couldn't get in the right mood at any point before the present time. Week One of internship seems like it was forever ago and I specifically held off going on a blogging rampage under the influence of all the stress and emotion. Afterall, as with revenge, reflection is a dish best served cold. Week Two - the week just gone past - I was reduced to a zombie, working the graveyard night shifts, with little time/energy to do anything but go to work, fall into a deep coma between shifts, wake-up, and return to work on the evening of the same morning that I was just at work! This week I'm on evenings and the dust of novelty is settling; so it seems like a good a time as any other to reflect on the weeks that have been.
So, as I have alluded to, we work on a rotating roster - doing a run of Day (7.30am-6.00pm), Evening (2.00pm-12midnight) or Night (10.30pm-8.30am) shifts. Typically we will do about four of these shifts in a row, then have about three days off before rotating to a different time slot. While it has its advantages (like random days off midweek and the occasional long weekend), I can't say that I'm much a fan of shift work. There is a tendency to become so consumed in your own schedule that making social plans becomes too much of an effort, logistically. Night shift, in particular, is going to take me a while to adjust to. I always considered myself somewhat of a night owl - but I now appreciate the difference between staying up all night watching DVDs or reading a good book; and staying up all night with the expectation that actual work needs to be done and to the same standards/efficiency as if you were working during daylight hours. The fluoro lights help.. a bit.
The Emergency Department (or ED as we call it) at my hospital is a VERY busy place. I did my Emergency Medicine rotation in a small district hospital, with a low admission rate, frequented by the "worried well" who really should have presented to their GP/family doctor instead of coming to the ED. So my preparation for a term in a busy Tertiary Hospital ED was somewhat inadequate. It's growing on me and every shift is less overwhelming than the previous one was. There is a lot of support for the junior doctors of course, at all times, which I am very grateful for. The registrars, consultants, nurses... but mostly from each other. You end up being best buddies with your fellow intern who is on the same run of shifts with you for that week - like you survived war together, or something.
My buddy Daniel and I at about 4.30am on a night shift, trying to keep our spirits up
The work itself depends on where you're placed within the ED. I have only ever been assigned to the Acute Care area thus far, so I can't comment on other areas yet. Acute Care is where all the seriously ill patients are placed for review, assessment and initial management. Most of the patients in this area end up being admitted to the wards so there is a tendency to spend longer taking a thorough medical history, examining, investigating, and really getting to know these patients in anticipation of what will be required criteria by the admitting team in order for them to accept the patient. It's a bit bureaucratic - but you basically have to prove to another medical or surgical team that your patient in ED is sick or interesting enough for them to want to accept them under their care on the wards, because obviously the ED is not an endpoint in itself (despite how it's portrayed on ER!). This is the part that I have found most challenging. I have dealt with just about the entire spectrum of human personalities on trying to refer patients to other teams. Some teams are exceptionally open and inclusive - basically happy to take anyone whom the ED (at our discretion) think needs to be under their care. Other teams refuse to even talk to interns. So you have to be adaptable to whatever response awaits you at the other end of the telephone line. Thick skin and remembering that it's not personal also helps.. a lot. Enough said.
"So, what's the verdict doc?" I hear you asking.. Do I love it, do I hate it? Hmm.. hard to tell. Certainly, even as a distant memory, I wouldn't recall that first week as the happiest in my life. It's tough being the new kid in a new playground - that much I was sort of expecting. One morning I came home after a particularly harsh night shift and, despite being completely and utterly knackered, started frantically researching different medical specialty training programs that allowed for an early exit from the hospital system. I'm going to leave posting on that for a different day because this musing has gone on for long enough. I will admit though that switching to General Practice/Family Medicine was looking very attractive at one point. On the same account, three weeks in, things seem better than they did on Day One. The other thing, I work with doctors and nurses who have been there for years, decades even. That's something to hold onto for now.
Love and Peace until next time...