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Dear July 1st Medicine Intern,

38819988_mI’ve been wheezing a little bit more over the past few days and I’m worried that my asthma is starting to act up.  I use my Advair regularly, but I’ve been needing my rescue inhaler a little bit more.  I don’t smoke.  My nephew has been sick with a cold; I think that’s what did it.  Do you think it’s safe for me to tough it out at home or should I come to the emergency room and get evaluated?

– Anxious in Atlanta

Dear Anxious,

I can’t believe I’m here!  First day on service, how exciting!  The main reason I became a doctor is so that I could help people.  I picked up my pager at orientation a few days ago.  My own pager, can you believe it?  I can’t wait for my first page!  I can be reached by anyone so that I can do everything in my power to help.  Hooray, my first page!  Hi!  How are you?  This is the medicine intern returning a page!  The patient is upset?  I’m sorry to hear that!  No worries, I’ll take care of it as soon as I can!  Thank you!  Please don’t hesitate to contact me if you have any more issues…  Wow, I can’t believe I’m finally a doctor.  It’s a dream come true.  This is going to be so amazing!

Dear July 1st Medicine Intern,

I’m concerned about all this blood I’m vomiting up.  I’m a construction worker and do a lot of heavy lifting.  A week ago, I threw out my back and have been popping ibuprofen like crazy ever since.  My back feels much better but this morning I had searing pain in my stomach and starting throwing up blood.  Do I have an ulcer?  Should I call an ambulance?

– Bleeding in Baltimore

Dear Bleeding,

It’s hard to believe I’ve already been paged TWENTY times this morning.  But that’s okay!  It just means more people that I can help.  And it’ll be my honor.  What’s that?  What do you mean we’re rounding in twenty minutes?  I haven’t even SEEN everyone!  Dr. Michaels wants notes done already?  That’s SO not gonna… Okay, okay, deep breath.  No problem.  One patient at a time.  Wait, is my pager going off AGAIN?  Shoot!  Yes, this is the medicine intern returning a page.  What do you mean he’s having trouble breathing?  He’s hypoxic?  Oh, that’s not good.  Uh oh.  Ummm, I don’t know actually.  What do you suggest?  Yes, I know I’m a doctor, it’s just that… Wait, let me ask my attending… Uh, wait, where is that floor?  It’s my first time in this hospital, so I’m… I’m a little lost.  Yes, I know that other patient is still upset, I’ll get to it, I’ll get to it…

Dear July 1st Medicine Intern,

My mother has Alzheimer’s disease.  She was diagnosed five years ago.  Over the past year, she keeps getting dehydrated and catching urinary tract infections.  She’s been hospitalized three times in the past two months.  I’m wondering if maybe we should take a different approach.  I met palliative care last time she was here and I’ve thought about it more.  What are your thoughts about comfort care?  Or hospice?  Is that worth considering?

– Curious in Corpus Christi

Dear Curious,

WHAT.  NOW.  Yes?  Sure, whatever.  I’m SO hungry.  It’s 8 PM; I can’t believe I forgot to eat.  Yes?  Sorry, Dr. Michaels, I’ll try to get my notes in as soon as possible, I promise.  I don’t know what’s taking me so long either… Why are these patients so sick?!  And why are they all so… CONSTIPATED?  Yes?  No, I haven’t done any of the discharge orders yet, sorry.  Wow, I’m feeling lightheaded.  Yes, I know that patient is furious, just restrain him, give him Haldol, I don’t care any more.  Did I pee yet?  I feel like I should pee… Ugh, my pager again?  Seriously?  WHEN WILL IT END??  I can’t… I can’t do this.  I’m… having… a nervous… breakdown.  Am I allowed to cry?  I want to cry!  Oh dear, what have I gotten myself into?  What have I done?!  Please, someone, tell my parents I love them…

Dr. Kyle Richter is a July 1st medicine intern at University of Chicago.  His column appears irregularly in poorly-known publications worldwide.  Stay tuned!

Need some more advice?
Ask a 4th-Year Med Student (Who’s Checked Out for the Year)
Ask a Hospitalist
Ask a Surgical Intern, Part 1
Ask a Surgical Intern, Part 2

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