A Day in the Life of a Doctor in Training
This is a piece I wrote about Internship (that one year of training before taking the board exams) during my rotation in Internal Medicine circa March to April 2002.
It’s five o’clock in the morning but that’s the latest time I can get up from bed. I’m going on overnight duty at the hospital as part of my internship training—the so-called “last step” prior to becoming a licensed physician. I get up, rush through my morning rituals and gulp down breakfast before battling the early morning traffic of Metro Manila. By 6:25 AM, I am out of breath, and running towards my post. I have to be there by 6:30 AM so that the intern who was on duty last night can take a quick shower and come back before 7:00AM which is when the day truly begins.
I spend the day attending to the needs of the patients in my assigned ward. I enter each room, ask them how they were last night and inquire if they need anything. I read the patients’ charts to check if there are new orders that I need to carry out. I recheck a patient’s blood pressure after a nurse tells me it seems a bit high. I talk to the patient a little bit and learn that he just came from walking around the halls. That would explain the slightly increased blood pressure. I reassure the patient and tell him I will check on him again in 30 minutes. I go back to the nurses’ station and reassure the nurse as well. By 8:30AM, consultants are starting to arrive one by one. I accompany them and update them on their patients. They talk to the patients and I get a glimpse on how to improve my bedside manners. I resolve to copy the methods I admire. They quiz me about their patient’s illness. I answer their questions as best as I can but I still end up with tons of reading assignments: some are asked by the consultants themselves; others I impose upon myself. As soon as the consultants leave, I reread the orders they wrote down and I carry out the ones I have to do myself. I then go back and check on my patient’s blood pressure. Thankfully, it went down to his usual level after some rest.
By the time it is 2:00PM, I have a new admission in my ward. I go to the patient and interview her. I ask what brought her to the hospital. We chat a little while about her concerns. I try to allay her fears. I do a physical exam and then thank her for her cooperativeness. I tell her we will take good care of her. She smiles at me and I leave the room. By 4:00 PM, I have admitted six new patients to my ward and discharged five. My writing hand aches from writing countless patient summaries and admitting histories. By 4:30 PM, all interns go to the top floor of the hospital. It is time for our “endorsement rounds.” If we are lucky, we will be done in two hours. We talk about all the cases admitted to our service in all the wards. The interns going off duty tell us which tests have to be done during night and which patients to watch closely. We learn that our favorite patient on the third floor may pass away any time soon. His prostate cancer has spread to his entire body. His brain is already affected and he no longer responds to his family. They weep silently at his bedside.
Around 5:30PM, we pass by a vending machine. I feel my stomach rumble and realize that my last meal was breakfast this morning. I pray that the rounds will end soon so that I may get a quick bite before I develop a bleeding ulcer. I have missed many meals lately. There is just so much to be done and so little time. We hear a “mayday” call on the hospital intercom. We all break out running towards the fourth floor. It is our patient who recently gave birth. Sadly, she has an inoperable heart condition and her recent pregnancy has made it worse. The resident intubates the patient while I start chest compression. I soon tire and get replaced by another intern. After 15 minutes, the patient is revived. She gets hooked to a mechanical ventilator and a cardiac monitor. We talk to the family and explain the situation. Admission to the intensive care unit is suggested. The monitor shows a flat line. We start chest compression again. We revive her after 20 minutes but she crashes again after 5 minutes. We repeat the whole sequence 4 more times in ward. As soon as we revive her, we hurriedly transfer her to the intensive care unit. Once she’s there, she again goes into cardiac arrest. This time we are no longer able to revive her despite 45 minutes of chest compression, ambubagging, drugs, and defibrillators. The battle so valiantly fought was lost. I suppose there’s no fighting the will of God even if you try so hard and so long. I make a silent prayer for her soul.
It is 7:00PM when we finish rounds. The other interns finally get to go home. I run to the vending machine to get myself mineral water and cookies. My co-intern on duty gets a cup of coffee and chips. I receive a call from another ward. My co-intern also gets a call. We part. I eat on the way. When I get there, I learn that I have to reinsert an intravenous line. I wash my hands, enter the patient room and insert the IV. I get several similar calls from other wards. My feet begin to ache. I wonder why we cannot wear rubber shoes on nights like these. At 9:00 PM, I get a call on my mobile phone. It is the other interns on duty asking if we would like to have dinner delivered. We agree then go back to walking around the wards, checking on patients’ complaints.
At 11:00 PM, things settle down a bit. My co-intern and I have dinner (or should it officially be called “lunch”?) but we both fail to finish eating. We have somehow lost our appetites and have another “mayday” call in the ward. The patient is revived after 18 minutes and gets transferred to the intensive care unit. I begin to have back pains. I have lost count of how many “maydays” we have attended to today. I go to another ward to check on another patient’s intravenous line.
I later sit in the call room and somehow fall asleep. I hear a ringing sound and sit up. It is my pager. One of my patients is complaining of rashes according to the nurses. I look at the time. It is 2 o’clock in the morning. My co-intern is sleeping peacefully in the lower bunk of the double deck bed in the call room. I get up and go to the patient’s room. He says he felt oily scaly rashes on his scalp and behind his ears. I look at them. He says he has had them before. I tell him it is nothing to worry about. It is just seborrheic dermatitis—“dandruff” for short. He seems relieved. I ask if he would like a dermatologic consult. He agrees. I tell him, we will inform his attending physician first thing in the morning. It isn’t an urgent problem. He smiles his thanks and promptly goes back to sleep. I begin to envy him and wonder if I should have myself admitted so I can get a good night’s sleep. I smile at how weird I have become in the early hours of the morning. I go back to the nurses station and write a short note on the chart. I tell the nurse my diagnosis. She smiles in an embarrassed manner. I tell her it’s okay. At least the patient can sleep reassured.
I get back to the call room and see the bed empty, the blanket tossed to the side rather haphazardly. I guess that my co-intern got a call. I lie down but as soon as my head hits the pillow, the telephone rings. It is another ward informing me they need orders so that they can hook up new IV fluids. I ask how much IV fluid is left and the rate of infusion. I make the calculations in my head. The fluids are still enough for 6 more hours. I ask if I can just pass by the wards at 6:00 AM. I am really exhausted and would like a few hours shuteye but I don’t tell the nurse that. Everyone seems to think that doctors do not need to sleep nor eat. She agrees. I thank God silently.
As I turn around in bed, I get a glimpse of the wall clock, it is already 4:00 AM. I close my eyes. The next thing I know, the alarm on my mobile phone has gone off. It is 6:00 AM. I rush through the wards giving orders to IV fluids. At 6:30 AM, I back at the call room. Thankfully my reliver has arrived. I tell her what things need to be done in the next 30 minutes. I rush to the bathroom and take a quick shower.
By 7:00 AM, I am back at my post. I hear my stomach grumble. I realize that I haven’t had breakfast. Luckily, the nurses at my ward are ordering breakfast from a fastfood joint. I join them. My day starts again. I do practically the same things except that I can actually leave the hospital to have lunch from 12:00 to 1:00 PM. I end up sleeping in the call room instead. I wake up at 10 minutes to one and realize that it is my turn to present the case at the emergency room conference. I rummage through my bag and find my transparencies. Thankfully, I prepared for the conference last week. I get through the conference without making a fool of myself despite being half-asleep the whole time. I thank my lucky stars. I get back to the ward and do the same things as yesterday. By 4:30 PM it’s time for rounds again. We get lucky today and are done by 6:00 PM. I gather my things and take a taxi home. I say hi to my parents. My mom tells me she made my favorite for dinner. I smile and tell her I will just take a bath.
I go to my room and decide to lie down for a while. When I wake up, it’s already 5:00 AM. I guess I must have missed dinner. I have my dinner for breakfast instead. Another day has begun.
It’s five o’clock in the morning but that’s the latest time I can get up from bed. I’m going on overnight duty at the hospital as part of my internship training—the so-called “last step” prior to becoming a licensed physician. I get up, rush through my morning rituals and gulp down breakfast before battling the early morning traffic of Metro Manila. By 6:25 AM, I am out of breath, and running towards my post. I have to be there by 6:30 AM so that the intern who was on duty last night can take a quick shower and come back before 7:00AM which is when the day truly begins.
I spend the day attending to the needs of the patients in my assigned ward. I enter each room, ask them how they were last night and inquire if they need anything. I read the patients’ charts to check if there are new orders that I need to carry out. I recheck a patient’s blood pressure after a nurse tells me it seems a bit high. I talk to the patient a little bit and learn that he just came from walking around the halls. That would explain the slightly increased blood pressure. I reassure the patient and tell him I will check on him again in 30 minutes. I go back to the nurses’ station and reassure the nurse as well. By 8:30AM, consultants are starting to arrive one by one. I accompany them and update them on their patients. They talk to the patients and I get a glimpse on how to improve my bedside manners. I resolve to copy the methods I admire. They quiz me about their patient’s illness. I answer their questions as best as I can but I still end up with tons of reading assignments: some are asked by the consultants themselves; others I impose upon myself. As soon as the consultants leave, I reread the orders they wrote down and I carry out the ones I have to do myself. I then go back and check on my patient’s blood pressure. Thankfully, it went down to his usual level after some rest.
By the time it is 2:00PM, I have a new admission in my ward. I go to the patient and interview her. I ask what brought her to the hospital. We chat a little while about her concerns. I try to allay her fears. I do a physical exam and then thank her for her cooperativeness. I tell her we will take good care of her. She smiles at me and I leave the room. By 4:00 PM, I have admitted six new patients to my ward and discharged five. My writing hand aches from writing countless patient summaries and admitting histories. By 4:30 PM, all interns go to the top floor of the hospital. It is time for our “endorsement rounds.” If we are lucky, we will be done in two hours. We talk about all the cases admitted to our service in all the wards. The interns going off duty tell us which tests have to be done during night and which patients to watch closely. We learn that our favorite patient on the third floor may pass away any time soon. His prostate cancer has spread to his entire body. His brain is already affected and he no longer responds to his family. They weep silently at his bedside.
Around 5:30PM, we pass by a vending machine. I feel my stomach rumble and realize that my last meal was breakfast this morning. I pray that the rounds will end soon so that I may get a quick bite before I develop a bleeding ulcer. I have missed many meals lately. There is just so much to be done and so little time. We hear a “mayday” call on the hospital intercom. We all break out running towards the fourth floor. It is our patient who recently gave birth. Sadly, she has an inoperable heart condition and her recent pregnancy has made it worse. The resident intubates the patient while I start chest compression. I soon tire and get replaced by another intern. After 15 minutes, the patient is revived. She gets hooked to a mechanical ventilator and a cardiac monitor. We talk to the family and explain the situation. Admission to the intensive care unit is suggested. The monitor shows a flat line. We start chest compression again. We revive her after 20 minutes but she crashes again after 5 minutes. We repeat the whole sequence 4 more times in ward. As soon as we revive her, we hurriedly transfer her to the intensive care unit. Once she’s there, she again goes into cardiac arrest. This time we are no longer able to revive her despite 45 minutes of chest compression, ambubagging, drugs, and defibrillators. The battle so valiantly fought was lost. I suppose there’s no fighting the will of God even if you try so hard and so long. I make a silent prayer for her soul.
It is 7:00PM when we finish rounds. The other interns finally get to go home. I run to the vending machine to get myself mineral water and cookies. My co-intern on duty gets a cup of coffee and chips. I receive a call from another ward. My co-intern also gets a call. We part. I eat on the way. When I get there, I learn that I have to reinsert an intravenous line. I wash my hands, enter the patient room and insert the IV. I get several similar calls from other wards. My feet begin to ache. I wonder why we cannot wear rubber shoes on nights like these. At 9:00 PM, I get a call on my mobile phone. It is the other interns on duty asking if we would like to have dinner delivered. We agree then go back to walking around the wards, checking on patients’ complaints.
At 11:00 PM, things settle down a bit. My co-intern and I have dinner (or should it officially be called “lunch”?) but we both fail to finish eating. We have somehow lost our appetites and have another “mayday” call in the ward. The patient is revived after 18 minutes and gets transferred to the intensive care unit. I begin to have back pains. I have lost count of how many “maydays” we have attended to today. I go to another ward to check on another patient’s intravenous line.
I later sit in the call room and somehow fall asleep. I hear a ringing sound and sit up. It is my pager. One of my patients is complaining of rashes according to the nurses. I look at the time. It is 2 o’clock in the morning. My co-intern is sleeping peacefully in the lower bunk of the double deck bed in the call room. I get up and go to the patient’s room. He says he felt oily scaly rashes on his scalp and behind his ears. I look at them. He says he has had them before. I tell him it is nothing to worry about. It is just seborrheic dermatitis—“dandruff” for short. He seems relieved. I ask if he would like a dermatologic consult. He agrees. I tell him, we will inform his attending physician first thing in the morning. It isn’t an urgent problem. He smiles his thanks and promptly goes back to sleep. I begin to envy him and wonder if I should have myself admitted so I can get a good night’s sleep. I smile at how weird I have become in the early hours of the morning. I go back to the nurses station and write a short note on the chart. I tell the nurse my diagnosis. She smiles in an embarrassed manner. I tell her it’s okay. At least the patient can sleep reassured.
I get back to the call room and see the bed empty, the blanket tossed to the side rather haphazardly. I guess that my co-intern got a call. I lie down but as soon as my head hits the pillow, the telephone rings. It is another ward informing me they need orders so that they can hook up new IV fluids. I ask how much IV fluid is left and the rate of infusion. I make the calculations in my head. The fluids are still enough for 6 more hours. I ask if I can just pass by the wards at 6:00 AM. I am really exhausted and would like a few hours shuteye but I don’t tell the nurse that. Everyone seems to think that doctors do not need to sleep nor eat. She agrees. I thank God silently.
As I turn around in bed, I get a glimpse of the wall clock, it is already 4:00 AM. I close my eyes. The next thing I know, the alarm on my mobile phone has gone off. It is 6:00 AM. I rush through the wards giving orders to IV fluids. At 6:30 AM, I back at the call room. Thankfully my reliver has arrived. I tell her what things need to be done in the next 30 minutes. I rush to the bathroom and take a quick shower.
By 7:00 AM, I am back at my post. I hear my stomach grumble. I realize that I haven’t had breakfast. Luckily, the nurses at my ward are ordering breakfast from a fastfood joint. I join them. My day starts again. I do practically the same things except that I can actually leave the hospital to have lunch from 12:00 to 1:00 PM. I end up sleeping in the call room instead. I wake up at 10 minutes to one and realize that it is my turn to present the case at the emergency room conference. I rummage through my bag and find my transparencies. Thankfully, I prepared for the conference last week. I get through the conference without making a fool of myself despite being half-asleep the whole time. I thank my lucky stars. I get back to the ward and do the same things as yesterday. By 4:30 PM it’s time for rounds again. We get lucky today and are done by 6:00 PM. I gather my things and take a taxi home. I say hi to my parents. My mom tells me she made my favorite for dinner. I smile and tell her I will just take a bath.
I go to my room and decide to lie down for a while. When I wake up, it’s already 5:00 AM. I guess I must have missed dinner. I have my dinner for breakfast instead. Another day has begun.
posted by fay gloria @ 7:30 AM
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