More than halfway through

"The intern learns while staffing the hospital. The financial model of the hospital system depends on medical interns' manpower and low salaries"
-eHow.com definition of a medical intern.

Internship year is more than halfway through! In fact there are only 19 weeks and 2 days left of internship, much more than halfway through. :) Predictably, I have a hard time finding the time to blog during this year of 80+ hour work weeks. This has been one of the most exciting but challenging years of my life. I liken it to the first year on a mission: you are excited to get things started, but when you finally get there you realize there is SO MUCH you don't know. Some days I feel completely satisfied when there is a tough problem I am able to figure out with the knowledge i've acquired and think about how fun my life will be with a job that challenges me intellectually every day. Other times I feel overwhelmed by the sheer complexity of the human body and despite my four years of focused medical school learning I have no idea why someone is sick. In those instances I sometimes feel that I am standing on the edge of a pirate ship plank doing the hula hoop with sharks(attorneys) circling in the ocean below waiting for me to make a mistake and fall into their mouths.

If you don't believe in defensive medicine driving up medical costs you are kidding yourself. In every conversation with my supervising doctor, he always makes sure we have done everything we can to "protect ourselves." Every note is written with the scrutiny that if something goes wrong, we will be able to use it to defend ourselves in court. We over test for things that we have a low suspicion for because of potential 1% chance that there is something wrong and we don't test for it, we can get sued. Some argue that this has improved healthcare in America. They say that doctors are being held accountable for their actions. They say doctors no longer get away with bad outcomes. I'm not convinced this is helping. Let me give you an example: a 55 year old male who is a little overweight comes to the emergency room with minor chest pain. EKG's (which test electrical activity of the heart) are normal. The troponins (which is a blood test that measures enzymes in your blood that is elevated when you have a heart attack) are also normal. The chest pain is now better and the man admits to eating a spicy meal that afternoon. He does admit to having chest pain before and has had a negative stress test in the past. Despite the fact that his pain is probably heartburn because this guy is male, older than age 50 and is overweight, he will likely be admitted for a 50,000+ dollar work up to make sure he isn't having a heart attack, including another stress test. After he is admitted the next day his stress test is negative. But sadly he comes down with an infection from a super resistant bug that is only found at the hospital and has to spend a couple of weeks on IV antibiotics at the cost of several hundred dollars a day. Additionally, each night at the hospital costs at least 4000-5000 dollars, not to mention the physician costs, other medications and laboratory tests that will increase the cost of hospitalization. So several hundred thousand dollars and an infection later, we have ruled out definatively this guy is not having a heart attack and protected ourselves against a law suit. But really all this guy needed was reassurance and treatment for heartburn. Unfortunately the ER doc was afraid that if by some small chance this guy really was having a heart attack and he sent him home, he would be like "that one case" where the doctor got sued for several million dollars for "missing" a heart attack because the doctor "should have known" that the guy would go home and have a massive heart attack even though the chest pain event was not even close to normal heart attack chest pain and all the screening tests were negative. Am I making any sense? There are so many reasons for chest pain besides a heart attack, but because of potential lawsuits, almost everyone with chest pain that has a risk factor(being male is a risk factor) is admitted for further testing. Ideally, a good doctor should be able to listen to the nature of the chest pain and then be able to tell if it is a heart attack...but because of "that one case" that presented a little differently no one takes the chance to send the patient home without definative(and expensive) testing. I'm not sure this is better medicine...but what do I know??

I didn't mean to get on that soap box. Oh well. I really wanted this post to be about what my life is like right now in the middle of intership. My day consists of waking up around 430-500am, getting to the hospital between 530-600am, reading the updates overnight and rounding on my patients from 6-8am, attending morning report from 8-9am, rounding with the supervising doctor between 9-12, attending noon conference from 12-1pm, writing orders, notes and answering pages about patients from 1 to 5 or 6pm. On days that I am "on call" I will additionally admit new patients to the hospital and cover for the other interns patients after they leave until 8pm when I sign out to the night float doctor.(I am grateful that 30 hour on call shifts are now gone and 16hrs is the maximum...just changed this year!) When I come home I like to spend as much time with Makenna as possible. Of course I have to study on some nights when I have complicated patients or need to be preparing for my board licensing exam. I also enjoying reading a good non medical book at night from time to time and Im in the middle of "The seven Miracles that saved America." We try to go to bed between 930 and 10pm. Exciting life...I know. Admit that you are jealous. :)

Makenna is 31 weeks along and has been amazing. She has handled pregnancy with such grace. She rarely complains and never lets her "hormones" get out of whack. I have to ask her to slow down sometimes because she wants to do everthing she normally does when she is not pregnant. Her belly most certainly looks pregnant but not the rest of her body. I love to feel the baby kick, and she is super active. The only food Mak has not been able to eat is scrambled eggs. The weirdest craving she had was a combination of pickles and peanut butter cookies at the same time (which gave her a stomach ache and she has not had since). Mak is so good for me because she is a planner and I am not. She has already planned out the delivery of the baby, the first couple of months of her life, our impending move to Texas and I wouldnt be surprised if she has already planned out what the baby will wear on her first date when she is 16! ;) We talk alot about what life will be like in Texas a lot. We enjoy Reno and have made some good friends here. We have a group that we eat sunday dinner with and enjoy playing games afterwards. The Mooney's have been lifesavers and have helped us out a lot. I have one more week of internal medicine wards and then I switch to night float. I have missed alot of church this month due to my work schedule and I really don't like missing church. I have new respect for saints who are faithful but have to work on sunday and will never again judge a person for missing church. That being said, I know it is possible to work all night and still be able to go to church the next day(and give a talk at church), because I have done it. Well, life is good despite the crazy times in which we live. I have a lot of debt, a small salary, live in a one bedroom apartment, drive an old car and work 80+ hours a week. But I couldn't be happier living with my best friend with a baby on the way, seeing different parts of the country and enjoying the journey!