The Bird in Flight

Sorry no posts in a while, I haven't really touched my camera since residency started... but here's photo of my medpeds intern class of 2010. They're awesome, I love them to death. Anyways, my post is totally unrelated to this picture. ^_^

10 yo HM. Nephrotic syndrome. They say you never forget your first patient. Yet I can’t remember his name for the life of me. I do remember Dr. Opas telling me that 1. He never forgot his first patient and 2. That my job as a doctor was to turn down the air conditioning when the room got cold. I remember the kid was cute, and that he had all the side-effects of cyclosporine like gingival hyperplasia and hirsutism, as Dr. Opas pointed out to me after I matter-of-factly told him that my patient had a normal physical exam. Oops. Screw-up number one…

So I’ve managed to survive my first two months of internship. The first month was pretty easy; after all, there’s really nothing like a nice month of outpatient pediatrics to ease my way into residency. The second month wasn’t nearly as easy. I got to experience my first night on call admitting 5 patients (which is not nearly the crazy censuses of some teaching hospitals, btw) and things frankly started to get confusing. Falling asleep over my paperwork, my pen would continue to move as I would nod off, and first my carefully constructed sentence would start to go to nonsensical words, and finally just pen strokes as my pen would fall out of my hand.

More mistakes happened than I really thought would, as well. Some were minor, such as when a friend of mine sent a patient off to the CT scanner on the wrong date – a big affair only because, well, we don’t have a CT scanner in the women and children’s hospital, and getting a CT involves a quick ambulance ride to the general hospital. Oops. The annoyed look on the faces of the paramedics, patient and her mom were priceless as they came back to the floor from CT, where they were undoubtedly told in a very kind manner that they had arrived on the wrong day.

As for myself, well, I’ve made plenty of mistakes too. Judgment really clouds up under stress. Most involve things like the wrong dosing on a medication (which luckily are checked both by nursing and by the pharmacy prior to administration) or the wrong test (I ordered an xray+contrast study instead of a nuclear medicine study). Just the other day, I confused two patients who had the exact same name and described the wrong patient entirely to our endocrinologist. I ended up having to page him five minutes later and explain how I just told him everything I knew about the wrong patient.

One patient in particular was a much closer call, however. I ordered a load of dilantin on this child, after having reviewed his order log to make sure that he had not already received one. Medication loads are high doses that we use to bring rapidly someone’s blood levels of a medication to therapeutic levels. They really should only be done once. My mistake was that I had forgotten that the patient had already been loaded in the ER, which uses a different order sheet.

So there I was, sitting at this desk and falling asleep when I remembered that this patient had indeed received a load. I debated whether or not it mattered, prudence got the better of me and I told my senior. “I think he already got a dilantin load in the ER…” She snapped out of her half-asleep state and after verifying it on the ER ordering sheet, ran out of the room to see if she could cancel the order. Thankfully the patient had not yet received his medication, and she was able to cancel the order in time, and I did not poison my patient. It’s truly amazing the dumb things I can do.