Welcome to internship

On July 2, 2007 I started my Pediatrics residency. I left my new home in San Antonio and headed up to the lovely little town of Killeen, about 2 hours north. For the next month, I'll be working in the nursery at Ft. Hood, Texas. It's one of the largest Army bases in the country, and supposedly has so many deliveries it's known as a "baby factory". So it should be a good experience. This transition to residency is very strange. One day you're a medical student, the next day you're a doctor. You feel like you're somebody important, walking around in your long white coat and stamping orders... but then you realize you know NOTHING. It's very humbling.

Thursday night was my first 24-hour shift. This is what doctors refer to as being "on call". When you're in residency, this means you are physically at the hospital, and usually awake (you can sneek in cat naps if things are slow, but this is only if you're lucky). Staff physicians, who have completed their residencies, usually pull call from home. They have their pagers on and must be within a certain distance of the hospital... but until I finish residency, I will know nothing of "home call". Rather, I will always have "in-house call". Interns are on a regular call schedule, and this can be highly variable. At best, you may have a rotation that doesn't require call at all. At worst, you may end up being on call every three nights (we call this "Q3" in the medical world). Right now I'm on an average of Q5 calls (every five nights).

My first call was quite eventful. In fact, I will probably never forget it. It started off pretty laid-back. There was one new delivery, but it was a healthy term baby so we weren't even called to the delivery. My attending (the staff physician) and I decided to eat dinner and then go do this baby's physical. After seeing the baby, writing notes, and ordering some labs and meds, we decided to try and get some sleep. Then things got crazy. The nursery pager kept going off - one delivery after another. The ICU called me a number of times about our diabetic patient. Our little jaundiced baby had a ridiculously high potassium level - which I assumed was a lab error since she looked great. And then at 3:30 in the morning we got a page for another delivery. "We need Peds in Delivery Room 2 for a 22-weeker." I was blurry-eyed and sleepy, so I said "Okay, we'll be right down." After hanging up the phone, I realized what I had just heard. I immediately called back. "Did you say 22 weeks??" "Yes, 22." WOW. (For non-medical people, 22 weeks gestational age is not considered viable.) Shocked, I hung up the phone, grabbed my attending, and we ran down to the delivery room. There must have been about 20 people in there. I saw this young mother lying there about to have her baby, with a very concerned-looking husband nearby. The nurses were standing by the warmer, ready to receive the baby. She came out quickly, and was immediately placed on the warmer. Her body was lifeless, she didn't utter a single cry. I listened for a heartbeat - my stethescope covered her entire chest - and I heard one, faint and slow. The next 10 minutes were horribly surreal. My attending walked over to the parents and explained the situation to them - the baby was just too young, the outcome would be poor even with the best efforts, and any attempt at a full resuscitation would basically be futile. She told them what the medical opinion was, but reassured them that the ultimate decision was theirs. I can't imagine what that moment must have been like for them. It was agonizing for me just to watch - how much more painful was it for them to go through it?? They ended up deciding to let the baby go. And after some coaxing, they agreed to hold her. The nurses wrapped her up in blankets and placed an oversized knit cap on her head, her tiny face peeking out. Four hours later, her heart finally stopped beating.

My first night on call I saw a baby girl die. Welcome to internship.