Tales of Survival: The Newly Interned

April 10, 2009

bellevue.jpgBellevue Hospital, the nation’s oldest public hospital and the heart of our residency program, provides unique and unforgettable training for new physicians.  It is probably safe to say that every resident who trains at Bellevue graduates with a lifetime of stories about the experience. “Tales of Survival” was created to convey some of those experiences.

Christopher Tully, MD

My white coat was as white as it would ever be and my pockets were stuffed with all I would ever need, Maxwell, Sanford, Pocket Medicine, Pharmacopia, pens, EKG calipers and, of course, my stethoscope. My pager was smartly positioned on my right hip, jet black, unscuffed and silent. My ID was properly clipped on the left breast pocket, the picture brand new, shiny and smiley. I was ready for my first day at Bellevue on my first day of internship.

My first rotation was on Oncology, a widely perceived tough service to start with consisting of a mishmash of patients with end-stage malignant disease and the end of their fight and others stably receiving cycles of chemotherapy. The day was going about as smoothly as any first day of intern year could go. I was moving methodically slow while everyone else was running at a sprint, but I was still making progress. Everything seemed great, and then it really sped up. It started with a page that my patient was saturating 85% on room air. Then I was in the room examining the patient with my resident. Soon the rapid response was called and the room filled and surrounded me with residents, chiefs, nurses and attendings. I was watching it all with a bit of a dazed stare until everything slowed almost to an immediate stop and suddenly a butterfly needle and ABG syringe were in my hand and my resident looking at me with a sense of urgency. I had probably done three or four ABGs in the past as a 3rd and 4th year medical student, but this felt very different and a bit more intimidating. “Can you do it?” my 3rd year resident inquired. “No problem,” I replied and went for it. I tried. I could feel the artery, it was right there. This 63-year-old man with metastatic non-small cell lung cancer didn’t have enough fat left on his body to hide that artery. I went in at a 45° angle, then higher, then lower, but I could not find the artery. I could feel my temperature rising and everyone watching and although the whole experience lasted only about a minute, I hated it. My resident soon relieved me of my struggle and with a quick poke had bright red blood filling the syringe.

There is nothing about an ABG at Bellevue that is different than any other hospital in the country. It was me. I couldn’t do it. I could try and tell you that the artery was moving under the skin and avoiding my needle, or that I wasn’t used to using a butterfly (we had ABG kits at my medical school), but no, it was me. Of course, while I was wallowing in my failure on the sidelines, the patient was transferred to the step down unit and the room cleared as housestaff filtered back to their abandoned pursuits. I too returned to my previous tasks, disappointed and feeling a bit less ready for my first day as an intern.

So now, six months into my intern year, my white coat has been washed and cleaned multiple times and no longer has that same crispness it did at the start. My pockets carry considerably less, with only a guide or two, my patient list and stethoscope weighing me down. The pager still makes its home on my right hip, but it is considerably more worn and makes a lot more noise. My ID is scratched up, but still properly attached and smiling. And months after my initial fight with the ABG, I watched one early evening as my resident and co-intern both struggled with an ABG on an edematous female patient complaining of shortness of breath. After their multiple failed attempts, I stepped up, gave one quick poke and saw the bright red blood snake rapidly into the curled tubing.

Chirstopher Tully is a first year resident in internal medicine at NYU Medical Center.

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