It's November, and the interns are entrenched. The novelty of writing prescriptions and ordering tests has faded. It's dark when we go into the hospital, dark when we emerge.
And by now, interns have become fiercely loyal to our chosen specialties. Most of us have done a rotation or two in our fields, as well as a few off-service months. Hence, I'm hearing unsolicited comments like, "You're in emergency medicine? Here? That is so
not for me. I can't understand how anyone could choose that."
I'm doing floor medicine this month, and while it's a tolerable experience, let me state for the record: It's not for me. The phone calls, the forms, the follow-up with consultants, the incessant paging... All for patients that I rarely even see. No thanks, I'll take my chaotic ED over that, any day of the week, two shifts on Sunday.
But I'm starting to understand how some people could enjoy floor medicine. I keep thinking back to a revealing experience during internship orientation, back in late June.
The hospital-wide orientation itself was a glimpse into the mind of Internal Medicine, since their residents dominate the incoming class. Granted, I wasn't expecting the bonding, team-building, and river-rafting experience of my medical school orientation, but I thought there would be an opportunity to make some friends and learn something useful.
And, sure enough, when I looked at the orientation schedule, I saw several fifteen-minute coffee breaks between lectures on "Filling out Death Certificates" and "How to Spot Suicidal Tendencies and Drug Abuse in Your Colleagues." (Oddly enough, I don't recall meeting anyone during those coffee breaks. I think we all stood quietly, by ourselves.)
At the end of orientation, there was the issue of certification. Hundreds of newly-minted doctors had to prove they were properly vaccinated, properly insured, properly credentialed, that they fit snugly into their white coats and N95 masks, and more. We had to observe up-close demonstrations of blood draws and line placement.
The process was set up in an alley off our hospital's vast lobby, in stations. After lectures got out, we'd visit each station, do whatever was required, and collect a sticker. When our sticker-sheet was complete, we could sign out and begin healing the sick.
Each station was a mob scene. No one's documentation was quite right, no one could understand how the butterfly needle retracted, and everyone could smell through the masks. Most stations were staffed by, shall we say, unsympathetic hospital administrators. At every juncture, there were barriers. The process seemed like it could stretch for hours.
Waiting in line at one station, I noticed a fellow intern's sticker sheet. She already had eight stickers, while I was still on number three or four. She would be done soon -- free to go home and unpack, or enjoy the city. I'd be cooped up in line on a sunny summer day for a good while longer.
We introduced ourselves. It turns out she was a Harvard grad, going into Internal Medicine. "How did you get all those stickers so fast?"
"I cut out of the last lecture early," she said. "Some of the stations were already set up."
"Oh, well," I remarked, "you missed an uplifting talk on persuading families to donate organs."
"That talk wasn't mandatory. This is."
And that orientation experience, to me, was appropriately representative of floor medicine: Obstacles everywhere. A long list of things to check off before you could go home. The patient, a distant abstraction.
I haven't seen that intern again, but I have no doubt that medicine is for her.