Here’s what I wish they had told me when I was in medical school forty years ago.
Your Role on the Internal Medicine Team
You will work in the hospital with a senior resident, two junior residents, a senior medical student, and a couple other morons like yourself. You will be treated like the time sink that you are. The residents will find you irritating because you make work for them. Other students will find you irritating if you know more answers on rounds than they do. Patients will find you irritating because you keep bothering them. Nurses will find you irritating just because.
You must arrive by 7 a.m. to check on your patients and drink the coffee at the nurses’ station before it turns rancid. You will round with your team, write chart notes, and work up new patients. You will not be allowed to see these new patients until the intern, senior resident, consulting resident and his intern and medical student have all had their turns. By then it is 6 p.m., and you will be there till midnight finishing the workup because you have to keep waking the patient up to ask them more questions.
This is the time that the entire team walks around to each patient’s room. First, everyone stands outside the room while the resident asks questions you can’t answer. He will say a few helpful things, like, “I can’t believe you don’t know that!” or “Don’t they teach you guys anything?” or “Do you even know how to open a book?” The residents also will make comments about the patient, such as: “He’s got one foot in the grave and the other swirling down the toilet,” or “When they were passing out synapses, he didn’t get any,” or “She makes beached whales look skinny.” Then the team will enter the patient’s room, smiling as if they are nice people, even though the patient has heard everything.
Helpful tips on rounds:
- Carry a clipboard with the names of your patients next to columns that show lab results, X-ray results, other test results, the orders your resident tells you to write, and the scut he tells you to do. On rounds, you will be asked for the test results you have recorded on your clipboard, but you will not be able to read your writing.
- Do your reading. You will be “pimped” on rounds every day about every aspect of your patient’s diagnosis and treatment, so you should read as much as possible. You will not have time during the day to do this reading. You will not have time after you get home at night to do this reading. Do it anyway.
- Never ask questions. If you ask questions, your resident will assign you to give a presentation on that subject the next day. You will stay up half the night reading and taking notes. By rounds the next day, the resident will have forgotten all about it. He will remember three days later, but you will have forgotten everything you read and won’t be able to find your notes.
A short white coat is required. It identifies you as a medical student who is, by definition, stupid. Your white coat should be clean, but it rarely will be. Under your white coat, you must wear clothes. Preferably ones that don’t smell too bad. Sneakers are forbidden, but if you buy black ones no one will say anything. Women can wear heels if they want but remember that self-inflicted pain is for crazy people. You can be fashionable when you’ve completed your residency in ophthalmology.
Your coat pockets should contain a reflex hammer, tuning fork, safety pin, stethoscope, blood draw tubes, syringes, needles, tourniquets, gauze pads, tape, and gloves. Each of these things will be needed at least once during this rotation, but when that time comes you will not be able to find it. Another student will run off to get the item and return while you are still emptying your pockets.
Washington Manual of Medical Therapeutics. This book is required because it will fit into a pocket of your white coat if you stretch it out far enough. The Washington Manual tells you how to order the correct tests and prescribe the right medicine in the right dosages. When your resident asks you questions on rounds, however, the answer will never be in the Washington Manual. It will be found in Harrison’s Textbook of Internal Medicine. You will want to own this ten-pound, two-thousand-plus-page book because carrying it around will help preserve the muscle tone in your arms, since you no longer have time to work out. You are expected to memorize every page.
At most facilities, you will take call every third or fourth night. You will be assigned a call room to sleep in. You will not get any sleep. You will lie awake worrying that your beeper will go off. It will not go off while you are awake; it will go off precisely thirty minutes after you fall asleep. You will spend the rest of the night correcting orders you messed up and admitting new patients. The day after call, you might be allowed to go home early, like at 6 p.m. In some facilities, you might have night coverage. Your team will go home at 10 p.m. You will stay until midnight finishing all the work you couldn’t get done during the day.
Eat when you get the chance. If you make it to the cafeteria, you will have exactly three minutes before your beeper goes off. If you miss a meal, or several, you probably can find a candy bar in a drawer at the nurses’ station. It will have lint on it and something else that is yellow and sticky. If it looks good to you, you need to work harder to not miss meals.
Life outside the hospital
It is best to inform your family that because of your work schedule, you cannot commit to vacations, childcare, meals, chores, yard work, holidays, car repair, cooking, cleaning, shopping, doctor’s appointments, dentist appointments, teacher conferences, conversations, or funerals. Your time constraints are temporary. You should be able to schedule these events during the two weeks between medical school graduation and the start of residency training. If you still have the same significant other when you graduate from medical school, you are a lucky sucker. Don’t expect that luck to continue through residency.
Welcome to Internal Medicine.