There is a saying in medicine “Don’t get sick in July.” The reason for this is the newly minted Medical Doctors are now being unleashed in unsuspecting patients. These fine young men and women have finished their four year course of medical education, many graduated with high grades, some graduated with the highest temperatures in their classes. Nevertheless they all earned the honorific of “Medical Doctor”. Even though they have spent considerable time in hospitals, especially in their third and fourth years, they have never been unsupervised before. They will still be supervised during their residency, but will be allowed to make some decisions. Let me clarify that a bit. Residency can be anywhere between three and five years depending on the specialty. Actually, I met a couple of young men not too long ago who were in seven year programs for cardiothoracic surgery. That included two years of a research Fellowship, but still it’s a long time.

Back to my story. Interns, also known as Post Graduate Year 1 (PGY1) are particularly amusing because of their geeky combination of inexperience and lots of book knowledge. This first year is crucial because in addition to being virtual slaves to upper level resdidents and attending physicians, they are learning how to interact with real live (or dead) patients. Thus they get the unglamorous jobs such as manual disimpaction, giving patients bad news, explaining and getting permission for unpleasant (for the patient) procedures, and last, but certainly not least, learning to deal with wise ass paramedics who not only have been in EMS longer than the interns have been alive, but are mostly older than the interns parents.

Which of course is where I come in, of course. All of the following stories are true, I witnessed or was involved in all of them. They are not all from the current July, which still has enough time to yield more gems.

It was a long and hot shift. My partner at the time was going through a divorce, in law school, and splitting child care of his two young children with his soon to be ex-wife. She was a nurse and worked full time, plus was hunting for husband # 2, so both of their schedules were tight. As a result my partner hated late trips, which if you work in EMS, is a big issue. He was still a good medic, he just wanted to move calls along. OK, I kept an eye on that just to make sure we didn’t make any career limiting mistakes, but I helped to the extent I could.

One day we had a late call, which by our definition is pretty much anything within the last hour of our shift. Depending on the circumstances we might finish the call and get back right at the end of our shift, or we could run over. Which didn’t bother me because the overtime was good, but was a serious problem for my partner who had every second of his day planned out.

I forget the details of the call, but the patient ended up in the resuscitation room of one of the local EDs and my partner gave report. Then another couple of doctors wandered in (this drives us nuts) and asked for report again. My ever patient partner rolled his eyes, but gave a complete report for the second time. He then walked out to the desk area and started to write his report. As he started to fill in the various boxes, blank spaces, and narrative an eager young intern made the mistake of walking in and asking my partner for report one more time. Three was one too many and my partner lit into him, in essence telling him that we were way to busy to be doing continuous shows just because some lazy intern couldn’t be bothered to show up when the team was called. The intern just stood there slack jawed.

My partner finished the report and we were heading towards the ambulance bay and home when the intern chased us down the hall. Apparently one of the senior residents had told him that he couldn’t let the “ambulance drivers” get away with talking to him like that. After all, he was a graduate of the best medical school known to mankind. So, he decided to “straighten us out”.

We were just about to the double doors to freedom when he caught up to us. “Can I talk to you boys for a minute?” Boys? “What?” was my partner’s response. Whereupon the young intern started to explain to us how the system worked. Only he was cut short by my partner telling him in no uncertain terms  that we KNEW how the system worked and that between us we had about 40 years of EMS experience. To which our not quite getting it friend replied, “Well I’m pretty experienced too.” Which left my partner, but not me, speechless.

“Sorry son, but your time as a candy striper doesn’t count as medical experience. Now, if you’ll excuse us, we’re leaving.”

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We were working up a patient in Congestive Heart Failure (CHF). Her presentation was such that she didn’t appear to be seriously ill yet and we decided that some Oxygen, an IV, and nitroglycerin would fix her up nicely. Which we did up in her apartment, in a building which had an elevator. We got all of that done and went down to the ambulance to start out to the hospital. It couldn’t have taken us more than five minutes to go from the door of her apartment to the door of the ambulance. In that brief time, the patient deteriorated acutely, which was not in our plan of the day. So, we decided that she would benefit from quick application of CPAP. We applied the CPAP, put on the ETCO2, put on the O2 saturation probe, and did all of the other things we do for Congestive Heart Failure patients. The patient responded nicely and by the time we got to the hospital was back to the cheerful, not too sick patient we had first seen. Nice work, if I do say so myself. It was my turn to give report, so I did. Name, age, sex, complaint, history, medications, allergies, treatment and result. Very, very straightforward. I couldn’t guess how many times I’ve done that over the years.

I walked out of the resuscitation room to start my report. An eager young resident followed me out and politely asked if she could ask me a question. As she was eager, young, cute, and polite, I said sure.

“Did you get a room air O2 sat before you put her on CPAP?”

So help me, I laughed in her face.

“No, it’s really important.”

Through my peals of laughter, “No it isn’t.”

I looked up from my laughing fit to see my supervisor standing in the desk area. He just put his forehead in his hand and walked away. The attending physician was also there, but he just chuckled and turned away. Later on I saw him and told him I felt bad and should apologize to the young lady. “No, she’s got to learn how to deal with you guys.”, was his reply.

I still felt a little bit bad though.

A week later another intern at another hospital asked me the same question. I managed to control my laughter this time. I still didn’t have an answer other than “We don’t bother with that.”, but still not laughing at the doctor is an improvement.

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Another CHF patient. Nice lady in her early 70s, but with a very complex medical history. Hypertension, Diabetes, severe cardiac disease (with stents), and to top it all off, Psoriasis. She was pretty sick and we weren’t worried about that, in fact, I barely noticed it and gave it absolutely no thought. Once again CPAP saved the day and by the time we got to the hospital she was looking pretty good, or as good as she ever did. Because she was on CPAP and our CPAP units, nice as they are, use a lot of O2 we were routed right back to the resuscitation area. I gave report, the same type of report as in the story above. I walked out to the desk area to start writing my report. Once again a cute young intern (different one) followed me out.

“Uh, did you guys notice that flaky stuff on her skin?”

“Yeah, sort of.”

“Did you put any cream or anything on her chest?”

Eyebrows knitted in confusion, “Uh, no, we don’t do that sort of thing.”

She walked away, but apparently my answer didn’t satisfy her. Yeah, I’ve once again left a woman unsatisfied.

A few minutes later my paramedic student came up to me and recounted the following. I didn’t hear this, since I was busy working on my report, but I don’t think he would make this up. In fact, I don’t think he COULD make it up.

“Do you know what that intern just asked me?”

“No, what did she ask you?”

“She wanted to know if the patient was so diaphoretic that we threw salt on her chest to dry her up.”

“What did you tell her?”

“Nothing, I couldn’t think of anything to say to that.”

I could see that. It takes a salty old hand like me to suggest that we only use Speedi Dry or in a pinch kitty litter, but never salt because it cause hypertension.

The same student related another gem to me later in the week, but I can’t remember it off hand. I’ll see if I can get in touch with him and if I can I’ll update the post.

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Yeah, don’t get sick in July.