are you OK?

2:20 Am

Today is my first on call. I could not sleep very well last night because of  the anxiety about today's call. So in the afternoon, I really began to feel drowsy, and my day has not even started yet.

4pm sharp, the day call team passed their pager to me, and my resident told me there were two admissions waiting for us already.

We went down to ER beginning the admission. During then, I got paged from nurses, change over docs, etc. I had to ask my resident about most decisions, luckily he has  been quite patient with me. 

The first on call day for an intern is a real challenge. Today I am the one wearing scrubs and carrying the pager, so everybody frequently asked me, Are you OK? I was really too busy to stop to chat, only a quick Oh Yeah and then kept walking.

10pm, we got a call from psychiatric department, saying they have a patient with multiple medical issues needed to be consulted. While we were talking with the patient, I got another call from the floor, so my resident asked me to go see the patient on the floor and she will meet me there.

Psychiatric ward is a special place, locked everywhere for security reason. I lost my direction when a nurse opened the exit door for me. It was not the way I came in with my resident. I followed the exit sign, but got more confused. Suddenly the door behind me locked down, so did the one in front of me. I was trapped in a 5 meter long hallway, with no phone, no light and I didn't have my cellphone with me.

My pager kept going off, my resident was looking for me, and nurses on the floor needed to talk with me. I kept pounding at the door, screaming like a real psychiatric patient. It's 11pm, and nobody was there. I stood in the dark, too scared to even cry. 

I kept screaming for help and kicked at the door, after seems forever, finally a nurse opened the door. Not until I saw her, did I realize how traumatized I was. I hugged her with all my strength and began to cry really hard. She padded my back softly while I just cried and cried. Finally I collected myself, and said thank you, she asked me " Are you OK", I said yes.

When I finally found my way back, my resident already began to do my notes, she didn't ask where I have been, why I didn't answer pager, instead she just looked up at me and asked "Are you OK?" "Oh, yeah, thank you", I replied with a calm tone and took over the notes. She then smiled.

I guess it is not important what happened, it's I am OK really matters.
 

[tabby]

I am off this weekend. Next week I will have a double call during the night. That's it for all the calls in this block. Actually tomorrow will go to this good dim sum place in Chinatown with my co-residents. Outpatient block weekends are very precious to all of us. (Some are pulled to ward for weekend coverage) We have to have some fun. ;-)

Yes I also feel like having "expressive aphasia in medical English" from time to time. I guess practice is the only remedy for this. During my second patient encounter, I asked the guy to "Change into a gown. Keep your panty on, everything else off" He said to me "You don't say panty to guys, just say underwear". I was really embarrassed. I am sure my notes still sound weird sometimes. Well I guess it takes time to get better.

Once you are used to the system, your previous experience will kick in and you will be in great shape. Trust me.

[落花飄零]

thank you tabby, do you need to work tomorrow? hope not.

the ward month is really a harsh start for me, I am so overwhelmed, just like you said, when i am tired and anxious, i threw away my common sense and my basic knowledge i learned for years.

During the round, my attending asked me quesions which i should've known, but i just paused and could not find answers in my brain, when the resident spoke it out, i felt horrible because i knew it, i just somehow blacked out.

also my presentation was terrible, it was my post call, i didn't know the day is our team's formal rounding day, even pathologists and their residents were there. I could barely remember my patients' name because i admited them at 3am in the morning, god, all i know is they are still alive, hehe. the attending kept interrupting me because i either gave too much detail or missed something important, he did this in very polite way, but i still got very embarrassed, especially when docs from other department were present. all i could think is,oh boy, i screw up hard this time, i am dead.

actually my attending and the pathologist were really kind, they tried very hard to teach me the right way to think, to present, to conclude. it's me, who is not prepared.

when i see other interns speaking and writing fluently while i have to struggle for a short note, that feeling is killing me.

[tabby]

What you feel is quite normal. It's not easy for us to get into a residency program in this country, so it's natural we want to prove ourselves even on the first day. During my first day, I saw one young outpatient with gastritis symptoms and presented to my supervising attending. He asked me what I plan to do. I said we should scope him to rule out ulcer. I didn't know why I was saying that. The attending said for young patient we would just give a trial of meds first. Then I suddenly recalled "for young patient without alarming symptoms, meds first". It's so obvious yet I said the wrong thing. I felt horrible as I was really eager to impress my attending. I came home feeling a bit down. I was worried I didn't leave him a good impression.

The second day I saw 5 patients in one afternoon. At that time I wrote all notes after finishing the patient encounter, which later proved to be a bad strategy. When I presented my last patient of the day to another attending,I was tired and paused a few time during presentation. He said several times "keep it going, keep it going". I felt horrible again thinking I didn't do a good job at all. Yes I felt insecure and was very sensitive to attending's reaction, partly because I am singled out in this program.

I learned my lesson from first two days and changed the way I do things. On my third day I typed notes in computer while asking patient questions. I was must faster in keeping the clinic moving. That day when I presented to my attending about my patients, she said "you are very strong clinically". I was surprised to hear that. It was a great encouragement and I realized me being more relaxed helped a great deal.

Again it's harder to start off with ward. But believe me what you feel is not necessarily what other people think of you. We have disadvantage in language, but past experience gave us the advantage of knowing what to say to a patient or about a patient. This is way more important than how you say it. Don't kick yourself too hard. Just give yourself a few more days and I am sure you will be a great intern.

[warmginger]

落花，我覺得bmw328說的很對，想開一些，放鬆一些， ＂作為一個intern...就要用一個intern的標準來衡量自己＂。我很同情你醫院的路很複雜。我想你肯定不如我迷胡，我在自己住了很多年的地方依舊會迷路，開車時轉了兩個圈以後，就不知道自己從那來的了。不過也都過來了，世界就那麽大，還能掉到地球外麵不成？不過我覺得醫院不對呀，他們應該預先就告訴你密碼或者給你鑰匙。我想你的第二天一定感覺好多了！

[BMW328]

對自己的要求不要太高了，不然容易沮喪和喪失信心。作為一個intern, 尤其是剛開始2，3天的intern，就要用一個intern的標準來衡量自己，不用要求自己跟住院醫生一樣，不用要求自己能夠一下子把已經有的經驗和智慧全部發揮出來，也不用要求自己一定就要比其他的intern要出色，盡管這個可能是你的奮鬥目標，但是語言上的劣勢和環境的不熟悉，注定了你的起跑比別人要慢，承認這個現實，接受這個現實，並且認識到自己的經驗和潛力會幫助自己在第一年的後半段發力趕上他們。接受現實，不急不躁，才是對自己充滿信心的表現。美好的未來在等待著你，堅持！加油！

[落花飄零]

謝謝大家，睡覺起來，看到這麽多留言，眼眶不由得潮濕了。

一直以來，覺得最辛苦的不是學習，工作，而是沒有人能夠分擔憂慮，分享喜悅，似乎作為成人的角色，就應該獨立，堅強，成熟，尤其是自己的職業，別人對我的期待，就是一個冷靜的，理智的，所有的知識都具備了的人，但是很多時候，我不是。這種自我評判與社會期待的差距，對自己的不斷調高標準，而且似乎永遠無法達到的沮喪，才是最痛苦的。

所幸在這裏，我能夠毫無保留地把自己的痛苦，掙紮和恐懼如實記錄下來，在回顧的時候，也給了自己一個重新審視的機會，通過一個字一個字地鍵盤敲擊，把積累了一天的情緒，梳理一下。當然，最重要的是，得到了這裏的朋友們無私的關心，熱情的鼓勵，有時候忙裏偷閑，坐下來瀏覽一下這裏的留言，都會讓我覺得心情好很多。真得謝謝大家。

rx300, 醫院裏手機信號不好，所以我總放在辦公室裏不隨身帶，流水浮萍，醫院的地形我會盡快熟悉起來，謝謝。

wuximm, 謝謝你每次都把這麽寶貴的經驗耐心地寫下來，我已經開始像你說的這麽做了，你前麵的留言我也看了，實在沒時間好好寫回貼，但是你說的話我都記在心裏了，謝謝你。

tabby,你比我出色得多，嗬嗬，我到現在還掙紮在low self esteem的問題中，覺得離標準太遠了，心情有點低落。。。

我不一一回複留言了，還有書要看，覺得很內疚，希望大家不要介意。

[黃大皇]

Just curious about the two doors. Is this a safety hazard? You should sue the hospital!

You will be OK!

[rx300]

1. You may want to ask the secretary for a map of the building. I was very frustrated on my first day of my new job. The building is huge and the hallways, rooms are numbered randomly. To my surprise, the secretary actually had a floorplan for the building and she made a copy for me.

2. You might need a cellphone for emergency. Prepaid plan might be a good choice. Write down your boss's phone number, your friends' phone number as emergency contacts.

Just my 2 cents.

Trust me, things will get better when you get used to your new environment.

[流水浮萍]

Sounds like what's slowing you down are logistical nits, rather than lack of substantive knowledge or clinical experience. The language barrier will become less of an obstacle over time once you become familiar with the medical jargons (or "river pilot" language according to Mark Twain). It seems to me the pressing task is for you to quickly know your way around the hospital to save you from further embarrassment, perhaps by walking around and mapping the various departments that you may frequent while on call.

Am I taking what you wrote all too seriously? Or is your piece literary fiction, in which case I apologize for this condescending post by pointing out the obvious. In any event, I wish you the best of luck and am sure you will excel in any endeavor you are and will be attempting.

[xiaotutu]

Dear Luohua, you have survived in your first chanllenge! You will do better and better! God bless you.

[盈袖2006]

We are here for you too:) HUG

[女孩安然]

啊，是昨天晚上嗎？我看到你登陸移動設備了，怎麽會這樣啊。天~~看了這篇文章，我感動死了，姐姐，加油！！！

[曉風殘月]

看的忍不住的哭，一直哭。

落花，你很幸運碰到那麽多善良好心的同事。我也很有感觸，我們這兒的staff也是這樣，尤其是我導師，還有我們秘書，總是很關心我們的情緒，每每路上碰到都會問are you all right，讓人感覺窩心。落花，讓我們一起加油吧。

[ing]

不想再多表達一次對落花的由衷佩服了，落花，你很了不起。感覺你是在ENJOY這種緊張刺激的生活，盡管有很多的PRESSURE。我把你的BLOG推薦給了我一個正要考執照的同學，他很喜歡，我也相信他會喜歡的，因為，你的文章可以給人一種動力。

[人在異鄉]

很高興我是第一個看到這篇文章的人。看得我眼淚都跟著打轉。