Volume 199 - Issue 2
Internship: a journey of wrong turns and coloured forms
Author: Rachel L Jones Lumby
Med J Aust 2013; 199 (2): 134-135. || doi: 10.5694/mja13.10231
Published online: 22 July 2013
Published online: 22 July 2013
Trying to keep a firm hold on things in a fraught initial weekDiving out of bed at 5.00 am on Monday, I shower and preen like it’s my Year 12 formal, dressing with purpose in my carefully selected outfit. By 6.45 am, the ruminations on why one would be stupid enough to choose medicine as a career have begun. “Imposter syndrome” has set in. I could have been ...
Trying to keep a firm hold on things in a fraught initial week
Diving out of bed at 5.00 am on Monday, I shower and preen like it’s my Year 12 formal, dressing with purpose in my carefully selected outfit. By 6.45 am, the ruminations on why one would be stupid enough to choose medicine as a career have begun. “Imposter syndrome” has set in. I could have been an accountant, a town planner, anything at all. Why medicine? I’m not cut out for it. I’ve fooled them for 5 years and now I’ll be found out. Why didn’t anyone intervene? I’m a humanities graduate for goodness sake. What do I know about medicine? I should have been content waxing lyrical about Foucault and reading Kafka.
My logical brain interrupts my stream of consciousness and reminds me of one inalienable truth: I am of the obsessional species. You know the sort: forms crushes on teachers, doesn’t like to step on cracks in the footpath, keeps their socks pulled up evenly and has a penchant for sniffing new textbooks. Of course I chose medicine.
I arrive at the hospital at 7.15 am, endure my “nervous diuresis” — managing two trips to the bathroom by 7.45 am — and set about enthusiastically greeting everyone on the ward. I sit briefly at the nurses station and survey my new domain. The busy surgical ward is like a scene from myriad movies, where a door opens into a microcosm of activity — machines bleeping, people walking with purpose, deep in conversation, knowing exactly their desired destination. A woman glides past with a group of fresh-faced graduate nurses, who are trailing her like hatchlings, struggling to keep up as she momentarily gesticulates towards multiple rooms and nooks before moving on. Three impeccably dressed men with greying temples and serious haircuts breeze past with manila folders. Administrators, I conclude. I become aware that I am the only person sitting and looking purposeless. The maintenance man fiddles with a faulty computer screen, ward rounds float past, phones ring and are answered, patients on trolleys are wheeled by. Time to look busy.
Throughout the morning, I fumble my way through drug chart rewrites, often writing “paracetamol” as “paracetomol”, and repeatedly turn left into the dirty utility room, instead of right into the doctors office. I am somewhat buoyed by an interaction with a medical registrar, in which I think I engage in coherent, intelligent dialogue regarding a patient with an increasing oxygen requirement. My triumph is short-lived upon catching a glimpse of my reflection in the window. I have blue skin-marking pen smudged on my face.
By 2.00 pm, my hopes to appear professional and in control have been dashed. Perhaps I feel this wound more keenly, given that my shortcomings thus far do not involve medical knowledge. In truth, I have not made any clinical decisions at all. I am lacking in far more observable core competencies. I cannot graciously balance patient charts in one hand while writing with the other “no I don’t know if bed 12 has a ‘theatre passport’” and “yes, I will check with my registrar”. In essence, the administration of medicine, rather than medicine itself, has unmasked me. I thought my undoing would be complex clinical issues, not my inability to work the photocopier.
Later that day, I agree to “cover” (from theatre) the day procedure unit for an hour, while the ward house medical officer (HMO) attends a meeting. (As my learned readers no doubt know, the important medical skill of “covering” is found in textbooks under chapters titled “How to be in two places at once” and “Astral travel for the novice”. The discerning reader might like to contact Hogwarts for access to these texts.)
As I, Ineptus internis, diligently hold the retractor for Mr Consultus maximus, the theatre attendant reads out the bleeping message on my pager: “cld u pls sign red form for bed 29 g’scope, due theatre now. thx”.
Scuttling to the ward between patients, with scrub pants one step away from falling off, my assessment of the situation leads to the following conclusions:
this is another unit’s patient
don’t know what the “red form” is
don’t know if an intern should be signing it
have obviously taken a wrong turn as am now in a boiler room.
On my eventual return to the ward, the nurses quickly grasp that this red-faced intern has absolutely no idea of her own name at this point, let alone how to fix the problem. Sensing my unease, one of the nurses helpfully suggests: “Perhaps you should call your reg?” I am definitely not going to call my reg about a form, I think to myself. Consequently, this flustered almost pants-less junior decides to call the intern support officer (ISO).
The ISO sympathetically listens to my tale of woe. He is an outgoing intern, riding high, having achieved the dizzying heights of HMO2 status. His job is to be a non-threatening, on-call support person. He is the point of contact for all the logistical issues you are too embarrassed to discuss with your registrar. He is cool, calm, collected and knowledgeable; basically, everything that I’m not.
He sounds like a proper doctor, a doctor with a firm tie on his scrub pants.
He gives me some advice. I sign the red form. The patient gets their gastroscopy. I go back to ineptly holding the retractor for C. maximus. Crisis averted.
A year later, with multiple red-form-signing experiences under my belt, I find myself acting as ISO to the new group of interns at my health service. It is 6.00 pm on the first day of the new intern year, and I am about to begin my shift. The ruminations begin. Why on earth did I want to do this? What do I know about supporting the new interns? There are far superior HMOs to choose from. Why didn’t anyone stop me? “Harrison’s Harry” or one of the other intern superstars should be doing this job.
The proverbial short straw in the chaotic first week of internship is the dreaded “cover shift”. The intern has paddled hard to keep their head above water throughout the day. By 6.00 pm, the bombardment of stimuli, cacophony of requests and a lack of sustenance for 12 hours have overwhelmed the senses and dropped the blood sugar. They are battered and bruised, bearing the wounds of ward work and the welts of the newly initiated. With a mountain of their own unit’s paperwork left to do, they now find themselves the sole covering doctor for surgical or medical units. Somewhat sadistically, this 6.00 pm rock-bottom hypoglycaemic state coincides with a dearth of senior doctors on the wards. Cue the ISO.
“Hi, thanks for taking my call, I’m really stuck, they’re asking me about a blue form, I don’t know what to do.”
“The light blue or the navy blue?”, I ask.
“Ummm, I’m not sure. If I had to guess, I’d say it’s more of a teal.”
“Oh the teal! Yes, the teal is a real doozy.”
I listen to the tale of woe. I am cool, calm, collected and knowledgeable. I know all about the different coloured forms. I am riding high, having reached the dizzying heights of HMO2. I give advice. The teal form issue is resolved. Crisis averted.
As I hang up the phone, I realise something: I sound like a proper doctor, a doctor with a firm tie on my scrub pants.