Yes I am busy but I will continue to post!

Well, I just finished my first week of internship. It was A LOT of hard work, but I think it will get easier. I probably put in about 100 hours of work, and today is my first day off in 8 days. But, working that hard makes these days off sooooooooooo nice.

So far, the thing that has left the biggest impression on me are the patients. I'm on the oncology (cancer) service, and I take care of patients with cancer. Most of them are already diagnosed, and are coming in for scheduled chemo, or some other problem related to their cancer. Some are new diagnoses - people who came in sick, and we suspect that they do have cancer.

One patient I had was a 22 year old girl who has Hodgkin's lymphoma. She had probably been sick for a year or two before being diagnosed. They live out in the boonies of North Carolina, with thick southern accents. Her mom and and her husband were with her. She was admitted to us because she was having pretty bad nausea and vomiting, and couldn't eat or drink. So we gave her some IV fluids and strong nausea medicine, and she responded great and was able to eat the Wendy's her family brought her. I gave them a prescription so they could continue the medicine, but when they were being discharged I could tell she was quiet and sad. The family said they couldn't afford the medicine; if they bought it they couldn't make their house payment. Then this opened the floodgates, of her not wanting to be sick anymore, wondering if its worth all this treatment and being nauseous, that perhaps she could go on without chemo and asked if she would survive without it. At that point, I intervened and sat down and talked with all of them, about their options (the social worker could probably work something out with the meds). I asked if things would be different if she could get her chemo, but not be nauseous, and she said she'd like that a lot, so we determined the most important thing for her was to be able to get the medicine, so that she could carry on. Because we had a plan now, she felt relieved I think.

I felt good about this, and it was one of the things I could do...the complicated medicine, I don't know right now, but as doctors a lot of times the patient doesn't need anything complicated. Just a plan and some reassurance to get them through tough times.

I was proud of myself, but not necessarily for intervening like this. It was because I had been on hour 28 of my 30 hour shift, and I had so many things I had to get done before I left work, and my first thought was that sitting there talking to her was taking up all my time, preventing my from writing progress notes and doing all the little things that are necessary from day to day. But about 30 seconds into the conversation, I realized I should listen to her.

The other very challenging part of residency is this thing called "cross-cover". I stay overnight every 4th night. When I'm there, 3 other interns can leave at 5pm or so, and I watch their patients. And when I'm not there at night, one of the 3 others is there to watch over my patients. You can imagine that when I'm there, I'm watching over all these patients that are very sick, yet I don't even know them. And if something happens to them, my job is to help them get through the night. So, for example, when a patient who is on chemotherapy (and the chemotherapy has weakened their immune system) gets a fever, their blood pressure drops, their heart races, it is very serious because that infection can kill them in hours. So when I get the call from the nurse that patient X is indeed having a "neutropenic fever", I have to immediately run studies on him and order antibiotics, IV fluids, and anything else they need. And then I watch him/her, and pray they make it. No wonder we don't get any sleep.

The working environment here is really great. All of the doctors and nurses and my fellow classmates are really nice, and really helpful, and their computer system is very good, which makes work a lot easier, at least when I finally master it.

I have to say, this past week I have worked the hardest I've ever worked in my life. I knew residency was hard, but man NOTHING prepares you for your first day of residency. You really learn on the fly. There were moments when I thought, "what the hell am I doing here, why did I choose this career, am I cut out for this???!!" That never happened in med school, but it sure as heck happens here. But, it will get better, and each day got better last week for me.

Nicole just arrived today from Atlanta. She'll be staying here for 2 months doing rotations up here, so I am so glad she's finally joined me. We'll be doing some things to our new house - getting a new lawn mower, putting up blinds, working on the lawn, organizing, etc - as well as exploring the area. At least, whenever I have time.

Write back with your thoughts or questions about this whole crazy thing!

I miss all you guys,
Alan