Hidden in the Night – a Family medicine Intern speaks

So, I had survived learning the EMR—who knew Epic could be so different between hospitals? I can finally submit an order without suffering palpations every two seconds, and even answering pages without double checking everything with my team. I finally feel like I’m on the way to becoming a fully functional intern! …although, it wasn’t untill my month of nights that I finally felt like I was a doctor. Nights will teach you a few things (:

I remember my first night alone, just like it happened the other day. I received all 4 pagers to hold for the night, and was going to cross-cover 100+ patients at our quaternary care center. Yikes?! I kept telling myself that all I had to do was survive until morning. I was also supposed to be comforted by being able to reach out to the second year covering the ICU if I needed help. 4 weeks later, I experienced multiple codes at night, direct admissions, and escalating care for multiple patients to our stepdown ICU. I reluctantly admitted to myself, that my experience was the most likely influential part of my intern experience so far. During this time, I learned three major things taking care of patients on my own: I had to be confident in my decisions, know my resources, and know when to a call for help.

Confidence takes time to build, but during night shifts you have to be on a fast track. The patients and nurses you interact with overnight will ask you a slew of questions and expect a certain level of certainty. This happened to me in two different notable occasions. The first was when a nurse was concerned about my response to her regarding a patient, and she checked in with her charge nurse for the night. Looking back it was a simple question regarding fluids for a recent KD transplant patient, given my hesitation and likely discomfort with what I eventually learned was a routine question. The second experience was taking out a chest tube (my second one in residency and first one on my own) and a patient remarking on my calmness and ease during the entire procedure. I am still working on being more confident, but these experiences reminded me I should have some faith in myself and teaching I had received to get here.

Resources present themselves in different ways, especially when you are the newest provider on the team. Starting night shifts was a completely different ball game. Most people have been on nights for years with well-established routines then comes an intern trying to find their place. The people who became my friends were the ICU nurse and the charge nurses on the different floor. Not only do they know a lot about what is going on with the patient’s but also they have watched multiple residents advance and are very helpful if you ask them. Talking through different patients at night really showed me how much experience couldn’t be taught and there is no shortcut for it. That along with the use of DynaMed and Uptodate were my saving grace, as I figured things out during these night shifts.

Lastly, knowing your limits is a great asset to have for yourself. Of course they are things we expected to know, but right now there is an over abundance of knowledge that I do not know. At the beginning of my month, I was afraid of asking questions and seeming as if I was not up to par with the rest of my co-residents. I quickly learned it was more important to ask a question once and understand it completely rather than having a fear of other impression of my questions. At night, I didn’t have my team to just bounce ideas off of so I really had to figure out which questions were the most crucial to seeking outside help at night. Overall, I was scared to do nights and I still am. I did manage to make it through my first month but we will see how the It will go when I come back again. Honestly, there is a lot of growth that happens outside your comfort zone or your daily safety net. For now, I am content with being able to sleep at normal hours, see some daylight, and cover a single service. One step at a time. 

-A.M.K, MD

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