Panda Bear, MD (a feisty young blogger) gives some advice to
new medical interns in his recent post.
Internship, for those of you who may not know, is the first year of
residency training. It is the first time
that a doctor, fresh out of medical school, has responsibility for patient
care. The intern prescribes medications,
performs procedures, writes notes that are part of the medical record, and
generally learns the art of medicine under the careful watch of more senior
Internship is a frightening time for all of us. We’ve studied medicine for 4 years, memorized
ungodly amounts of largely irrelevant material, played “doctor” in third and
fourth year clerkships, but never before have lives actually been put in our hands. We know the expression, “never get sick in
July” because that’s when all the well-intentioned, but generally incompetent
new interns start caring for patients. And so, as Panda describes the experience,
we tremble as we begin the new stage in our careers – applying our medical knowledge
to real life situations, and praying that we don’t kill anybody.
I’ll never forget my first day of internship. I must have drawn the short straw, because
not only was I assigned to the busiest, sickest ward in my hospital (the HIV
and infectious disease unit), but I was on call that day (so I’d be working for
24 hours straight) with the most hated resident in the program (he had a
reputation for treating interns poorly and being arrogant to the nurses). As I reviewed my patient list, I noticed that
the sign out sheet (the paper “baton” of information handed to you by the last
intern who cared for the patients – meant to give you a synopsis of what they
needed) was supremely unhelpful. Chicken
scratch with diagnoses and little check boxes of “to do’s” for me. I was really nervous.
So I began to round on my patients – introducing myself to
each of them, letting them know that I was their new doctor. I figured that even if I couldn’t completely
understand the sign out notes, at least by eye-balling them I’d have an idea of
whether or not they were in imminent danger of coding or some other awful thing
that I figured they’d be trying to do.
My third patient (of 15) was a thin, elderly Hispanic man,
Mr. Santos. He smiled at me when I came
in the door – the kind of lecherous smile that a certain type of man gives to
all women of child bearing age. I
ignored it and introduced myself in a professional manner and began to check
his vital signs. I was listening to his
heart, and I honestly couldn’t hear much of anything. There was a weird very distant beat –
something I wouldn’t expect for such a thin chest. The man himself looked awful, but I really
wasn’t sure why – he just seemed really, really ill.
My pager was going off mercilessly all night. I wondered if this was how the nurses got to
know the characters of their new interns – to test them by paging them for
anything under the sun, tempting us to tip our hand if we had tendencies to be
impatient or disrespectful. But in the
midst of all the “we need you to sign this Tylenol order” pages, there came a
concerning one: “Hey, Mr. Santos doesn’t look good. Better get up here.”
My heart raced as I rushed to his bedside. Yup, he sure didn’t look too good. He was breathing heavily, and had some kind
of fearful expression on his face. I
didn’t really know what to do, so I decided to call the resident in charge
(much as I was loathe to do so, since I knew he would humiliate me for bothering
The resident appeared in a froth – “why are you paging
me? What’s wrong with the patient? Why do you need me here? This better be good!”
“Um… Mr. Santos doesn’t look too good.” I said, frightened
“What do you mean ‘he doesn’t look too good?’ Can you be a little bit more specific” he
said, sarcasm dripping from his tongue.
“Well, I can’t hear his heart and he’s breathing hard.”
“I see,” said the resident, rolling his eyes. He marched off towards the patient’s room,
certain to make an example of me and this case.
I trotted along behind him, hoping I hadn’t been wrong in
paging him – trying to remember the ACLS
protocol from 2 weeks prior.
The resident drew back the curtain around the man’s bed with
one grand sweep of the arm. “Mr. Santos,
how are you doing?” he shouted, as if the man were deaf.
The man was staring at the wall, taking in deep, labored
breaths of air. I saw that the resident
immediately realized that this was serious, and he placed his stethoscope on
the man’s chest.
I approached on the other side of the bed and held his
hand. “Mr. Santos, I’m back, remember
me?” He smiled and looked me straight in
He replied, “Angel.” (in Spanish) Then he let out a deep breath and all was
The resident shook the man, “Mr. Santos? Mr. Santos?!”
There was no response.
“Should I call a code?” I asked sheepishly.
“Nope, he’s DNR,” said the resident.
I was flabbergasted.
“Yep, you just killed your first patient. Welcome to intern year.”
As I thought about his cruel accusation, I was comforted by
the fact that at least, as Mr. Santos released his final breath, he thought he
had seen an angel. Maybe my presence
with him that night did something good… even though I was only a lowly intern.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.