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A Day in the Life of a Surgical Intern

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The fluorescent light on the alarm clock reads 4:15AM. I jump out of bed, and with a quick shower, throw on a pair of scrubs and head towards the hospital. I start checking on my first patient at 4:45am. Vital signs and physical exam findings are stable; all his laboratory data is within normal limits. Jot a quick note in the chart and off to see the next patient. After I see everyone it's time to round with the chief resident to come up with each patient's daily plan. After that I pop all the orders into the computer system, discuss the plans with the nurses, and then head off to the operating room for a full day of cases.

For me though the day is still very very young. I'm the intern on call, which means come 5:00pm I'll be covering not only my primary service patients, but also all the surgical floor patients. Floor patients, for the most part, are generally stable, otherwise they'd be in the intensive care unit. However, as the only surgical intern at night I'll be covering the trauma surgery, general surgery, vascular surgery, transplant surgery, and burn surgery patients. Depending on how busy each service is the total number of patients at any given time can be close to fifty or more! In addition, as the intern we staff the 24 hour burn clinic and help the senior level residents "run" any new trauma patients that may come in during the evening or early morning hours. And so the night begins...

The last intern signs out their list of patients. And immediately the pager goes off. It's a new trauma coming by air in 10 minutes. I head towards the trauma bay and throw on the thick heavy lead suit designed to prevent my thyroid, and perhaps more importantly my gonads from feeling the brunt of thousands of xrays that will be hurdled toward our patients, and myself, over the next 12 hours. The patient rolls in... It's a bad one. Car accident, head on, at high speeds. The patient is unresponsive and is quickly intubated. For the moment her blood pressure is fine. And as the intern on call it is my job to wheel her down to the CT scanner and make sure she makes it back up to the trauma bay safely. Fifteen minutes later I've accomplished my goal.

I strip off the heavy lead apron and realize I've missed about six pages. Fortunately, none are particularly urgent. One nurse wants a prescription renewed for pain medication, another wants an order for an abdominal X-ray to verify feeding tube placement. I quickly place the orders.

And then the pager goes off. It's a new patient who is being admitted for a potential liver transplant the following morning. I run up stairs to see him, and just as I'm about to enter his room the pager goes off again... This time it's another trauma coming by ambulance. ETA is 25 minutes. The question at this point is can I get a history from the liver guy, do a physical examination, write the note, then get all the pre-liver transplant orders in before the trauma arrives? You better believe I'm going to try... Part of being an intern is learning how to be as efficient as possible because you never ever know when a break will come for you to catch up on your work.

I jot down a few notes about the new transplant patient. He is fifty years old with end stage liver disease caused by hepatitis C, which he contracted using intravenous drugs. His skin and eyes have the yellow tinge characteristic of a liver failure patient; his belly is swollen giving him the appearance of a human apple, a result of ascitic fluid in his abdominal cavity (aka: "liver sweat"). I get all his information, write the note, and place all the orders just shy of 20 minutes!

I sprint down to the trauma bay, lead-up again, and throw on some gloves just in time for the new trauma to arrive. This one is not so severe. Thirty year old guy who fell of his bicycle after a few hours of binge drinking. Sadly, this is typical of most trauma patients... A few X-rays show a tibial fracture so we call our orthopedics buddy to come check him out and see if he needs surgery.

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Time for a Cliff® bar... I head to the call room to grab it from my back pack, but about half way there the beeper goes off. It's a patient in the burn clinic. She dropped a scalding hot cup of soup on her foot. She has a few blisters, most likely a superficial second degree burn. It will heal well on its own. No need to admit. The nurses debride the wound and give her a tube of antibiotic cream, some pain medications and send her home. Now how about that Cliff® bar...

Not so fast... One of the trauma patients on the 6th floor wants to leave against medical advice. Not that I particularly care when a patient wants to leave the hospital, because ultimately it is one less patient to deal with overnight, but this guy probably needs to stay. He has a pneumothorax, which is a layer of air between the lung and chest wall. He is stable for the moment, but if it were to worsen it could cause his lung to collapse. He needs to stay at least a few days for monitoring.

I head up a few flight of stairs and enter his room. He complains that the food is terrible, his pain is not well controlled, and that he is going to leave right now. I urge him to stay and educate him about the severity of his injury. I also tell him we will get his pain under control. As for the food... Well, I can't make any promises. He actually laughs at the joke, which breaks the tension. He agrees to stay. I write the orders for some additional pain medication, and head back down to the call room. It is now around 11:00pm and my stomach is growling with hunger.

I chow down on my Cliff® bar and log into the computer system and start writing some notes. The pager hasn't gone off for at least a half hour, which is about as quiet as its been all night. Damn! I spoke too soon. It's another trauma. Its a patient who is being transferred from another hospital. He has multiple fractures and some pretty gnarly road rash after losing control of his motorcycle at high speeds. Luckily he was wearing a helmet and doesn't appear to have any head injuries. We stabilize him and write all his orders. He has a couple of lacerations that need to be cleaned out and sutured. I walk the medical student through the procedure. We finish up around 1:00am in the morning.

Just as I'm writing the procedure note, the pager goes off again. One of the kidney transplant patients is short of breath and his oxygen saturation is low. I run up to evaluate him. Sure enough this guy looks like he's in trouble! He is so short of breath that he is able to give only one word answers to my questions, and his oxygen reading is pretty crappy considering he has a face mask blowing pure oxygen into his nose and mouth. I order a STAT chest xray and arterial blood gas test. I page my chief resident and the anesthesia resident to potentially place a breathing tube.

They both arrive within a minute and agree that he needs the breathing tube. After sedating, and paralyzing the patient, the anesthesia resident pops the tube in with no problems and we put him on a ventilator. I transfer him down to the intensive care unit. His chest X-ray looks like he has pulmonary edema (ie: fluid accumulating in his air spaces). We order up some furosemide, which is a medication to help patients pee off extra fluid.

Now that he is in the ICU I've lost jurisdiction, he is now under the control of the ICU resident on call. I give him a synopsis of why the patient was intubated and transferred down to the ICU. It is now 3:30am... I head back to the call room to try and grab a few winks before I sign the patients back over to their primary teams at 6:00am. Just as my head hits the pillow, you guessed it, the pager goes off...

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