The "handbook"

As an intern you’re constantly reminded of how dumb you are. No matter how much you read about a particular patient’s disease, on rounds the attending will most certainly ask you the *one* question you don’t know the answer to.

“This is Ms. Sanchez, she’s a 21 year old Hispanic female who presented to the ED last night complaining of right upper quadrant abdominal pain. This is the second such episode…”

Attending interrupts my perfect, well-rehearsed presentation “so what is your differential diagnosis?”

Huh? What about the rest of the history? Don’t you want to hear my very focused physical exam? And there are lab results to report. I worked *all night* preparing this damn presentation, and he wants to skip all the way down to the differential?

After reciting my (memorized) list of possible diagnoses, he decides to pimp us. I think it made him feel special to demonstrate in front of a group how much more he knows than the rest of us. After a 30 minute discussion, we agree that the patient probably has gallstones. I’m now feeling quite proud, ahead of the game, because I stayed up *all night* reading about cholelithiasis (gallstones) and can basically recite everything there is to know about this disease. I’m gonna show all my fellow interns that I’m smart, that I know my stuff.

“So, Dr. Gilman…,” (bring it on) “can you tell me the name of the person who had the world’s first gallstone?” the attending asks.

What?! You’ve got to be kidding me. Who knows the answer to that, and why is it relevant?

I stare back blankly.

“Anyone?....This is a very basic question. You guys should know this. You call yourselves doctors? How are you gonna effectively treat this disease if you don’t know basic information about the disease?”

Of course there’s some goody-two-shoes intern that actually *does* know the answer…and I end up looking like an ass. On to the next patient (not mine). As were walking down the hall (interns behind the residents, but in front of the medical students) my resident slows down a bit and whispers to me “I should have told you that, he *always* asks the interns that question on rounds.”

Note to self: get a copy of the ‘what the attendings love to ask interns’ handbook. All the reading I did, and all of the *relevant* information I learned went unrecognized because I didn’t have a copy of that handbook.

I was to discover that there were many “handbooks” during residency. Some were more important to have than others.


Me, a doctor?

(note: my name isn't really Dr. Gilman)

“Dr. Gilman?...Dr. Gilman?!!” I glanced around and casually caught the eye of one of the nurses sitting at the nurses station.

“Are you Dr. Gilman?” she asked me.

Me? Oh me!! “Yes, I am Doctor Gilman.”

Starting my internship was a very exciting time. Not only did I get the privilege of wearing the *long* white coat and carrying a pager, I was finally ‘the doctor.’ I think the most difficult part of the transition from sub-I to intern was being called “doctor.” Suddenly you go from lowly medical student…who can’t even get an order carried out by the nurses without a co-signature, to being the first to be called in a full arrest…overnight, literally!!

“Dr. Gilman to CCU, STAT…Dr. Gilman to CCU, STAT!!” My name blared on the hosptialwide communication system.

What tha’ hell?? Why are they calling me?? What am *I* supposed to do? As I arrive to the CCU the (very excellent) RNs are already coding a young man who recently had an MI.

“Hi Doc!!” one of the older, seasoned nurses greeted me. “This guy just bradyed down on us…he’s already intubated, and we started ACLS. What do you want us to do?”

What do *I* want you to do?

Me: “Ahhh, just go ahead and do what you guys usually do…” I tried to sound ‘in control.’

Them: “What drugs do you wanna give? Is atropine okay? We’ve already given one epi.”

Whatever. Just do what you do. Pretend I’m not even here, I wanted to say.

Me: “Yeah, atropine is good. Where’s the resident?” Where the hell is my resident!! Why am I the one first called? I’m the least experienced, alone, in the middle of the night, with the sickest patients. What kind of a system is this? How is this advantageous to anyone that the most na├»ve doctor is the first one called to the unit?

I found that I’d frequently question the medical education system. I wouldn’t have wanted *me* as *my* doctor at that moment. Honestly, in retrospect, I wouldn’t have wanted the resident as my doctor either. Where was the attending? Shouldn’t he be there? You got a bunch of hacks up in the CCU…basically watching a patient die. The attendings? At home, where they typically are at night. If you dare, you can call him/her, wake her from sleep (or otherwise ‘interrupt’ their lives)…but you risk a virtual ass whupping if you do that. Not to mention being branded with a huge scarlet letter ‘S’ for stupid, to be permanently tattooed on your forehead.

It would go something like: “Oh, Dr. Gilman?...yeah…she’s one of our weaker residents…not very confident that girl…requires too much instruction…”

Thankfully the resident arrived seconds after I did…and ran the remainder of the code.