"What time is it?" I thought as I looked at my phone. Today was the big day. I tried to get some good sleep, but with enthusiasm running through my veins I had once again awoke before my alarm had started to buzz. I was nervous but excited. My new life was soon to begin. A new city, a new hospital, a new set of responsibilities awaited. I was no longer a medical student. I was a doctor, with sick people to take care of. They were relying on me. I had to take a few deep breaths and tell myself to relax.
I was starting on the medicine wards, Team A. My attending was my program director, by chance, I guess. This was adding even more stress to my psyche. I wanted to do well; I didn't want to mess up. I was expected in for morning sign out by the overnight team at 6:00 a.m. As I pulled up to the hospital the sun was just peaking over the horizon. I jumped out of my car and slapped on my freshly ironed white coat. Wow-what a feeling! I had been waiting for this moment for four years and finally it had come. It didn't feel real yet but soon I knew it would.
Huddled together, my new team took sign out from night float. This process was not new to me. While each patient was being presented, I earnestly jotted down the important facts we needed to know. I was assigned four patients and off I went. It suddenly became very real to me. These were my patients. Rounds started sharp at 8:30 a.m. so I had to hustle. Vitals, labs, imaging, H/P's, chart review....I was expected to know my patients. While glaring at the computer, scrolling through a previous note, a hand grabs my shoulder. It was my senior. An enthusiastic PGY-3, with a wealth of knowledge at the tip of his tongue at all times. He was at my interview dinner and I remembered him. "Norm, we have an admission. Let's go, I'll show you how it's done." My eyes enlarged and my senior noticed. "Hey, you will be fine, bed 9 in the ED, check her out and get back to me." I was unsure, but mumbled "OK". I instantly transitioned into hyperdrive and went to see the patient. Full history, full physical, and as I was discussing my plan with the patient my phone started to ring. I apologized to my patient and took the call. "Hey, Dr. Beatty, your patient in room 463, she's constipated, can I give her something?" I was caught off guard, thinking to myself, "What do I say? What can I give her?" I responded, "Colace. Let's try that". Whisking away from the ED I had 32 minutes to see my patients before rounds. One by one I saw my first four patients. They were complicated, but I loved complicated! Acute pancreatitis, cocaine overdose ICU downgrade, end-stage liver disease with hepatic encephalopathy, and COPD exacerbation rounded out the disease pathologies.
Checking my phone, with a pounding chest, I knew it was time for rounds. I rushed to our meeting spot. All the residents were assembling. You could tell everyone was nervous. We exchanged a quick meet-and-greet followed by "Let's start at room 458" proclaimed my senior. Looking quickly down my list I realized that this was indeed my patient. My heart was now pounding even more. I took a deep breath. "Relax, Norm", I thought and off I went with my presentation. "SOAP, SOAP, SOAP", went through the back of my mind as I did my best to adequately present the patient. I wanted to stay structured. After I finished my plan there was a brief moment of silence. I felt like I was going to pass out! Did I do such a horrible job that my PD was left speechless? This is it, I am through. "Well, Norm, for your first presentation I like what you did. You stuck to the pertinent positives and negatives. Good job. Want to go see the patient?" Wahoo! I did it. He liked it.
As we went from room to room that day I couldn't help to think, "I am so glad I chose internal medicine." Every patient was so interesting. The pathologies were so vast. My first day in residency was awesome. This was the type of training I was looking for. This was the foundation I was searching for during medical school. These were the types of patients I wanted to take care of. There was so much to learn and I was nervous just thinking about it but I had made it through my first day. Walking back to my car that afternoon my feet were hurting, my head was aching, and I was exhausted but I didn't care. Pulling away from the parking lot I looked in my rear view glancing back to see the hospital. After today I realized that the next three years of my life would be filled with so much excitement but tomorrow was another day. "Norm, go get some sleep." My senior's words were echoing in my mind. "You're going to need it."
Norman L. Beatty, MD