From The Pen of Dr. Mandichak

It has been quite some time since I last wrote and would probably be much much longer if I didn't take a second to scribble a few words now. Last night was my very first overnight call as an internal medicine intern and it certainly didn't disappoint. Before I divulge the memorable happenings, a quick thought regarding being a 3-day old intern. One of the most frustrating aspects of medical school for me was the repeated marginalization. I'll explain. As a medical student you are the lowest person on the totem pole. Heck, even the techs are higher than you because they generally know where the bathrooms are. Even if you are a stellar med student everything you do, and I do mean everything, is checked and re-checked. Every physical exam you perform must be "confirmed" by a superior - the funny thing being residents and attendings generally do more cursory exams - before your clinical findings are believable. By the end of 3rd and beginning of 4th year, I was beyond irritated by this. I know I'm still learning, but don't treat me like I am incompetent.

Somehow, after one receives an oversized, and borderline pretentious, medical degree you can be trusted. Somehow, there is no longer any need for people to question your decision... for you are a doctor and of course you know what your doing. Riiight. Despite the fact that I HATE the being marginalized in med school, I am terrified at the idea that people actually think I know what I'm doing. I find myself craving the marginalization I once despised.

So the highlights of my first overnight call on Acute Cardiology:
1. A well-known congestive heart failure patient at the hospital is admitted for an exacerbation of his CHF yet again. He is affectionately known as "Salty Beans" by the staff because during each of his multiple admissions he cries out, "Dang them salty beans I ate!"

2. Nurse: "Could you come look at Mr. _____ in room 18."
Me and the other intern: "Why whats going on?"
Nurse: "I just need you to look at him."
Us: "Well is it important? We're busy at the moment."
Nurse: "He's got a bloody penis! Just come look, ok?"

He did in fact have a blood coming from his penis. I know those in the medical profession are thinking, "ok a little hematuria, no biggie." Yeah, no. We're talking frank blood oozing out of his penis.

3. I'm called to the bedside to assess a patient with a bloody nose. I find a 75 year old lady with 7 or 8 soaked gaze pads in her lap and another equally as soaked held against her nose. Its been like this for 30 minutes and by the way, she's on a heparin (blood thinner) drip. I order a STAT PTT and its 155, which is 54 over the therapeutic range. The outgoing team forgot to order the PTT to check the level before they left.

Fun times.