2 weeks done!

Well I just finished my first 2 weeks of internship, and things have gotten a lot smoother. I've got the hang of the computer system, getting around, knowing what to do, so things are getting more efficient and more manageable.

There is the phenomenon of the "white cloud" and the "black cloud". The white cloud is where you don't get too many patients, your patients don't stay for too long, and therefore the amount of patients you take care of at any one time is less. On the converse, if you have a "black cloud" hanging over you, you're carrying 10-12 patients, and they always seem to stay a long time, so that every 4th night you keep getting more patients, and none are really ever leaving.

I'm fortunate enough to have the white cloud over my head right now, as I have only 3 patients (I had more as a student), but my poor teammate and fellow intern has 11, and its been this way for the last week. I'm probably jinx-ing myself right now by talking about this, but I guess I'm trying to say its not so bad right now. I'm on call tomorrow night, so I'll get up to 6 more, but the hope is that they are not too sick so they don't have to stay in the hospital so long.

There is a hierarchy in medicine. The "attending" physician is the boss, the one responsible for all the decisions. Then there is the "resident", who is in the 2nd or 3rd year of residency, who has experience and reports to the attending. And then the "intern", who is in the 1st year of residency and does a lot of the day-to-day work, while the resident and attending make the important decisions. And then the medical students, who are there to learn the basics of medicine. Usually, the intern is the one to see the patient every single day, and gather all the data. Thus, they actually are the ones that know the patient the best.

I have this one patient, a 19 year old girl who is very sick with Lupus (where the body attacks itself) and TTP (where the body attacks your platelets, making you at risk for heavy bleeding). Her lupus has caused her kidneys to shut down, which has caused her to retain too much fluid, and caused her blood pressure to skyrocket. No matter how many blood pressure meds we gave her, her pressure was still too high. She need to go on dialysis, a machine that acts like artificial kidneys, so it will take away extra fluids and toxins in the body. The "attending" kidney specialist was trying to convince her and her mom that she needed this. However, the attending walks up to me, and tells me that the mother would like to talk to me about dialysis. Huh????????? Me?????? Turns out she trusts my decision more than the kidney expert. So crazy.....and the kidney expert was standing right beside me, so I was pretty nervous to give my opinion with him there. Anyways, she really did need dialysis, so I told her so, and she said, okay, do it. Shows how much influence us "interns" really have, whether we realize it or not. We're the faces they see each day, and just that simple fact of us going in and asking them how they are doing, each morning, seems to make us their doctors. Pretty cool.

Mom, dad, Jenny, Jeff, Amy, and Tyler are all on family vacation in Orlando. Wish I could be with them!!

Nicole is up here with me, and has started her pediatrics rotation in Raleigh. I think she forgot how much she likes working with kids, and is having a really great time. Apparently on Monday there will be a bunch of kids from Belarus coming into their clinic. These are kids who have suffered the effects of the Chernobyl nuclear meltdown in Russia in the 80's. I'll let you know what she finds, should be really fascinating (and sad).

How is everyone doing??

Alan