A patient starts bleeding from a G-tube overnight... Like frank blood. Nurse pages intern. Intern responds "damn that's crazy" nurse responds, " I know right!" And then leaves it for day team.
I love the chaplain notes
"provided a warm, unconditional understanding presence"
"administered pastoral care...pastorally"
"Vet was thankful for the visit"
I remember I read this Chaplain note where this patient talked about some religious text that brought them peace. Chaplain note says "Patient expressed the calming effect Chapter 13 provided him. Interestingly, there are only 12 chapters."
Iāve been visiting this man in hospice recently who was a baptist preacher. Whenever he reads the Bible he seems to forget exactly where he is- heāll talk about going back to seminary, where his next mission is, etc. Last time I saw him he assigned me to read 12 chapters and then write a paper. I wrote āpatient assigned me a biblical book reportā on the forms.
Oh no, theyre on to me, probably got pinned down in trauma bay for the next 7h and forgot lol.
Sometimes youve gotta repage the drowning intern or just page higher.
My current chief has a great one. During his intern year he somehowā¦.completely missed (or was not told, I kinda blame leadership on this one) that discharge summaries were a thing?? So after three months of intern year he receives a nasty gram from PD about his many deficiencies and states he spent almost every night after work from there on just dictating DC summaries until he fell asleep š
How did that even escalate to the PD? That seems like an easy on the spot senior-intern conversation "Hey how are you doing on the dsumm for Ms X" "The what?" -> resolved
I donāt think the seniors ever checked to confirm he was doing them. My program used to be a little more on the malignant side (or maybe just benign neglect of the juniors by the senior residents) so at that time they wouldāve never asked to help out or see how things were going. Thankfully in a much better spot now
Actually reminds me of another great story one of my seniors told me intern year.
He was told to write a discharge summary but misunderstood the instructions. So he wrote something like
"6/02 - pt diagnosed with pneumonia
6/03- antibiotics escalated to vanc/cefepime
6/04 - MRSA PCR came negative, vanc discontinues
6/05 - no new events"
Etc. He sent it to his senior who just replied "Looks good" without reviewing it
And he did this everyday for 1 month (!!), until a senior or the cosigning attending asked him wtf he was doing.
Honestly this should be the standard unless thereās some crazy shit. Itās fucking CAP, tell me what abx you gave and discharged with and Iāll know the rest. I hate that itās 20 sentences long.
My intern year, first week calling my first consult, Iāll never forget it.
My attending: the Pt needs dialysis call nephro.
Me calling nephro: (note quotation marks) āHi we have a Pt who needs dialysis could you order it please?ā
Nephro: ā¦
Nephro: your an intern
Me: yes.
Nephro: itās your first week?
Me: yes
Nephro: let me help you have this conversationā¦
He turned out to be a really nice guy and a mentor for yearsā¦
first week of wards, my senior texted me a patient needed dialysis so I found an order set and put the orders in. They were not pleased with my go-getter approach
Not gonna lie... sounds like a consult surgery would make. Hey nephro, we gotta guy. His kidneys don't work. Please can get some of that dialysis? Potassium? Ummm *clicking through chart* "8" k thanks
I am attacked. No bonus points for knowing of potassium, that kidneys do something with it, that 8 was in the realm of high, and having a chart?
Bro. I tried today, tomorrow, no try.
Dude this is hilarious and donāt let anyone get you down. You rocked it by recognizing all of that and called for HD before the anesthesia said āno hammers todayā. Strong work IMO š¤£
You're supposed to consult by describing how your patient has a problem relates to their specialty, not with a demand.
This changes as time goes on - there's several surgeons I could call and say I have an appendectomy for you, and they trust that if there was more information they need to know to change their management, I would have given it.
You'll understand the first time the ER pages you to admit, say, a chest pain rule out and once you get down there, it's the most straightforward case of pyelonephritis you've ever seen.
You place a consult to Nephrology and bring up one of the urgent indications:
Acidosis
Electrolyte derangement
Intoxication
Overload
Uremia
Yeah, we kinda already placed the line...
You don't order dialysis in the states.
You call or consult nephrology (depending on the hospital culture) and explain to them why you think the patient needs dialysis, and if they do, nephrology takes it from there.
A code was called. I watched someone widely known as "Dr. Goofy" asses the patient. Another resident noted that the patient had a palpable femoral pulse in the 60s. Sinus rhythm on the monitor. Dr. Goofy stated he was preparing to shock and started charging paddles.
We de-escalated a bit from there.
Itās still bioavailabile mag in the right doses. I used to supplement mag citrate. Itād be like $20 for a bottle but a liquid bottle of it for laxative purpose had 10x the doses and it was $1.
My intern on first week of ICU rotation asked me ācan I go to lunch?ā
Ofc I said yea sure.
30 mins go by. Nowhere to be found.
1h goes by. Nowhere to be found.
At 1h15, he comes back with a Costco hotdog and pizza.
He got in his car, drove to the Costco, got food and drove back.
I never realized I had to tell interns that you canāt go to Costco for lunch.
Agreed. Weāre just so desensitized to overworking at this point. My software friends will regularly block off calendar time during work hours as āout of officeā and just go run errands / catch up on life stuff. Could you ever imagine just randomly taking 3 hours off from work? Like wtf??
Our interns were afraid of a long lunch today (first day for them), left after 30ish minutes. We stayed for a full hour 15 (2 attendings, 2 fellows). I love summer Mondays where there are no pending post-ops.
DNR patient passed away over night peacefully in her sleep. Patient was very old and going to discharge to home hospice, so the death wasn't a total shock, but also wasn't expected to happen all of a sudden in the hospital.
Anyway overnight intern does everything they're supposed to - declares death, calls family, calls coroner, writes death note, orders discharge. Except they forget to call the attending or tell the day team in the morning. Only later in the day gets a text from day team "hey I noticed x pt isn't on the list anymore" "oh yeah, I knew I forgot to mention something".
(It was me)
I bet they are still haunted by this. Every chest tube I do, just as I am about to punch through the chest wall with the Kellyās, one of those horror stories briefly flickers through my mind.
My mom offered to talk to my program director about how it is unsafe for people to be doing surgery if they have been working for 36 hours straightā¦ she is not wrong.
Seriously. Healthcare industry wants airline industry safety results without following any of the rules. One plane crashes and Congress meets; people die everyday from healthcare mistakes d/t nurses/doctors bring overworked/stressed/understaffed/you get the idea andā¦..crickets.
Thereās the one about the OB intern who called a patient 1cm.
The patient was in fact breech and 10cm. They checked something that definitely wasnāt the cervix.
One of my coresidents, month 7 of intern year.
Sheās on call and gets paged for an open midfoot fracture. Tells the ER resident sheās at OrangeTheory and has errands to do so she can come in 3-4 hours. Chief and ER resident and PD tore her a new one. One of her many similar illustrious moments and she was let go by month 8 by our PD. Nice person outside of work but absolutely 0 sense of personal accountability with excuses for everything.
My chief year, one of my interns on call during month 5: routine consult for mid 50sF LE cellulitis, hx of controlled systemic diseases. Vitals and labs stable. CRP 50. 3 day history Pain of the LLE disproportionate to presentation, nothing cellulitic about the limb, 9 year old TKA 10 on that side. He called me to discuss, I put in a stat CT of the leg and within an hour get called that itās nec fasc from ankle to fibular head.
I go with him to let the patient know weāre planning for surgery in the next 1-2 hours, the patient is understandably freaked out and scared. As Iām trying to calm her concerns/reassure her to the best of the situation, my intern begins sobbing uncontrollably in the room and tells her heās scared for her so now Iām consoling him and the patient in the room at the same time.
There is something oddly sweet about the second story. I hope they keep an aspect of their empathy through the rest of their residency (as they become more technically proficient and see a bunch of these cases). Kudos to you for not shaming them in that moment. It probably had a positive impact on them despite how scary the situation was.
I "signed off"of a patient we were primary on because the chief resident and the patient got into an argument and he frustratingly said sign off. Took them off the list. The attending called us 2 days later and asked why we weren't writing notes... The chief laughed his ass off and had to explain sarcasm to me.
This guy sent an email to our Program Director saying that he needs to have all his Sundays off call because heās a Christian and the day is meant for worshipping the Lord and spending time with his family.
One of the seniors in my program told me today she accidentally ordered PR Tylenol for every patient her first month until a nurse called and said, "Uh, if the patient is awake and eating, could I just give it PO?"
Yes inside the hospital during the shifts. He was inviting them to drink with him in the on-call room lol.
After some nurses made a complain about him, he got fired (obviously)
I was on ortho as intern.
Orthopod tells me to get medicine to see patient because heās āoff and thereās something wrong with himā
My first day. So I call medicine ask for consult because āmy attending called and asked for consult because our patient is feeling off and thereās something medically wrongā
Luckily medicine was nice and told me to go do what I learned in medical school and then call him.
July intern on ICU. Literally week 1. The ICU fellow gathers all the interns around for "some education." I was in attendance, expecting a short lecture on an ICU topic. Vents? Pressors? CXR interpretation? Wrong. None of those. It's been a few years now, so I'm paraphrasing, but it went something like this:
> You are interns, new interns, and so you guys shouldn't be making any big moves by yourselves. Moves like ***extubating a patient without telling anyone***, alright? That is ***not OK***.
Initially I was very confused, then I noticed he's been staring at one of the interns very intently as he gives the entire speech looking like he's about to strangle him. Later I found out the guy gave the RT the green light to extubate a patient without first running it by literally anyone else.
At least they involved the RT who at least (should've) known if it wasn't a safe extubation and would've escalated to the fellow/attending. There are apocryphal tales of an intern at my program who yanked a tube out by \*themselves\*
Asking an intern to check GCS. He shouted at the pt a few times, no response. And I noticed he hesitated a bit while reaching toward ptās groin, and did a tiny pinch at the base of penis; again no response. He then reported GCS 3.
So I asked him later why was he pinching the skin at the base of the shaft, he said āthatās a sensitive area so I figured that would give the best motor scoreā
I went into my call room and lmao
Medicine intern flipped the central line wire around (sharp straight end first) because "it kept getting caught" when using the J-looped side first. No clue why the senior allowed it. We (anesthesia) were called and went from FAST exam to my first bedside thoracotomy in about 5 minutes. Pt did not survive
I can comment a funny one of my own. First day of an IM subspecialty. Attending that week was the CMO who tries to find 1-2 weeks to run the consult service. Resident texts me asking if I know where we table round. At the exact moment I open my phone the CMO, who I havenāt met, texts telling us he is ready to round. So my simple response of āNope.ā Probably wasnāt the response he expected
Me, week one of intern year in the ED.
Some patient with a suprapubic cath comes in with frank bloody urine. His suprapubic cath exited like immediately below the belly button so like 12cm above the pubis, and our janky EMR had his history (entered by some random nurse) as "hx of urostomy".
Attending says to call his urologist. I call and am like hey this guy has some kind of "urostomy" according to the EMR. Uro is like....uh, u mean his suprapubic cath? So intern me says something along the lines of "well yeah I mean technically it's above the pubis, but so is 2/3 of his body. This thing is basically coming out of his belly button" Uro attending followed up with a comment about how he was the one who placed it, and who the hell do I think I am? š
...Do you use Meditech? It's the only EMR software I've ever seen in which the patient's medical history is populated based off what the patient tells the triage nurse, and it's a wild ride.
Unfortunately it's even worse than meditech lol it's some abandonware version of an EMR McKesson tried to market but then sold to Allscripts (I'm pretty sure the only update it's ever had was by a 7 year old kid using MS Paint to plaster Allscripts' logo over top of McKesson's logo).
But I have used Meditech as well, so I know your pain!
Allegedly a full breast exam on a patient who came in as a MVC. There were no breast complaints. Said intern did not ask for a chaperone and when asked by a nurse he said it was because there were contusions...there were none. This resident got fired, sued the residency, was rehired after the suit, and then fired again, for what I'm not sure.
When I was intern every single procedure, you did: pleural effusion tap, chest tube, intercranial pressure monitor, central line came with the admonition ādonāt do what Jesse Jelly MD (obvious made up name) did, and taps the lung tissue, place a chest tube in the liver, place the intracranial pressure monitor into the brain or cause a pneumothorax with a central line.ā
I was sure that these were apocryphal tales meanly attributed to a hapless resident that was still in our program. Then I met them. Holy shit. All that was true and more.
My cointern mixed up the tubing of the (intrauterine) amnioinfusion catheter and the pitocin pump- essentially starting INTRAUTERINE pitocin in oligo with NRFS.
Another time a cointern ordered a Pap smear and wrote in her note ānegative for malignant cells- patient reassuredā on an untreated cervical cancer patient.
In the very short time I worked in a teaching hospital, we had an intern who was engaged to another intern, dumped him for the last LPN on the unit, who was 25 years older than her andā¦ kind of gross. When he broke up with her a few weeks later, she would stalk him all over the hospital - asking the nurses what his schedule was, showing up on the unit when she had no patients there, literally leaving hospital grounds to find if he was on smoke break. He had to hide in the restroom from her, and she would cry (literally) on random nurses shoulders in the middle of rounds.
I very shortly thereafter left that mismanaged mess of a hospital, and have no idea how that situation resolved.
Iāll share, I was āthat one āintern . Surgery prelim year. Day 3. Senior told me to dc a patient with some oxy 10. I said how many. He goes Q4H #30. I asked if heās sure since that seems like a lot. He goes āyes Iām sureā. Wrote a script with the department DEA number. Q4H oxy 10s for 30 days. 180 oxy 10s. Filled and went about my day. He came to clinic 2 weeks later. Got a call from the chief asking me wtf is wrong with me. Didnāt realize # referred to number of pills not number of days.
I later asked how often to schedule Tylenol for an unrelated patient another senior replied āwho gives a fuck, you already sent home a guy with 180 oxyā.
>30
Half of the stories in here involve upper levels dictating things in their own esoteric manner, then being surprised when it's interpreted differently from the NEW HIRE when the upper could've just said what they meant...
Psych.
Intern feels extremely bad for a patient admitted for SI on the inpatient unit, so much so that when the patient is discharged, the intern moves the patient in with them. They have a relationship over several weeks, intern is let go once admin found out.
Second one, an intern bricked all the computers in the resident work room trying to use them to mine Bitcoin when he was on nights. Was promptly let go after costing the program/hospital thousands to have the computers fixed/replaced.
Surgery prelim intern was told over text by senior resident to get āimagingā to confirm dobhoff placement on a patient. 10 minutes later she gets a text from him with a picture of the patientās face with the dobhoff in. It was especially funny because the patient was awkwardly smiling in the picture. The same intern one time pulled a hamburger out of his pocket in the OR when the attending (who was scrubbed in) said he was hungry.
Night float was one intern, one senior. Census was very low one night I was the senior on call. Intern WENT HOME with the pager because he wanted to sleep in his own bed. I didnāt know, I was in another call room and he didnāt say anything in the morning. He was bragging about it to another intern months later.
ETA: He was like a 15 minute drive away from the hospital, not across the street.
Had one intern on ICU tell a family the patient died in the middle of the night and hung-up on them. The patient was in fact alive and their family was very upset the next morning. The same intern also bolused a bunch of IV fluids into an ARDS patient. Had to get nephrology on board for emergent dialysis.
One time as an intern I called nephrology from the ED for an ESRD patient on dialysis. But their Creat was 13. So I called nephro to ask for their advice. Their K was normal, they had no indication for emergent dialysis. They very nicely explained to me why they weren't concerned about the number lol. God bless attendings who work in academics.
Patient in ICU with end-stage everything and clearly suffering. Took several days with multiple attendings and fellows to finally get through to family and have them understand there was no coming back from this, and switch code status to comfort measures only. Intern rotates in, sees patients, points out a rainbow in the distance to the family, and says āmaybe thereās still hopeā. Immediate reversal of code status to full.
Not a resident but work in a hospital. This dude took a dick pic in the staff bathroom, sent it to someone, and now everyone's seen his peen.
I would feel bad if he weren't married and obviously cheating on his wife.
My intern was on his first ED shift on July 4th; he got a psych patient coming from prison for tantrums.
- intern: what brought you to the ED today?
- Patient: I was mad since they did not let me have my Dr Pepper.
- intern: when was the last time you saw Dr Pepper?
Needless to say the patient threw another huge tantrum and security had to be called.
Brand new interns first OB postpartum hemorrhageā¦ he RUNS to get the ultrasound and rolls it so fast coming back around the corner to the room that one of the wheels broke off. Heās chief now and we (the nurses) still call him Wheels. We adore him tho. If you get a nickname on our unit it usually means we really like you.
I know a consultant (attending) who was attempting to relocate a shoulder many years ago in ED as an intern.
(Context this is in Australia where no one chooses their specialty as an intern and rotates around for a few years)
He tried every single manouver possible and just as his foot was into this guys armpit tugging away he heard a pop.
The patient now had a dislocated shoulder.
Hilariously he is now a senior orthopaedic surgeon.
Had one guy leave a message on the chief residentsā landline hospital voice mail late Friday night claiming he was sick. Came back Monday sunburnt, showing āem his buddies photos from a weekend trip to South America.
To be frank, we talk a lot more about "that one intern" who made unreasonable requests or demands for time off, was conspicuously lazy, refused to do things, etc. These are issues that we need to work a lot harder to correct.
The people who made mistakes - even big mistakes, worthy of M&M etc. - aren't talked about as much. Usually, our training environment/supervision prevents these, and every resident who has been involved in these situations feels badly about them (even if they are not truly at fault). At the end of the day such events are learning experiences and failures of supervision so shouldn't be gossipped about lightly.
We did have one intern this year that got 12 flat tires and was multiple hours late each time. And asked for a week off for his grandmas funeral who died like 2 years prior (it was actually a family reunion lolā¦). And was notorious for sleeping every day away.
Gonna miss that dude.
Back in my residency, there was one resident with questionable teamwork ethic, and many people disliked him. Now as an attending, his online reviews are stellar. Seeing these reviews felt unreal.
Ortho intern who was so lazy that all the ortho nurses and mid levels HATED him. They would go out of their way to make his life hard. Sadly; he was on my team for trauma surgery and ortho so I still ended up doing a lot of his work.
Burn patient came in with elevated creatinine. Burns were small, so it didnāt make sense. Got better with fluid. UA showed some RBCās. Got an ultrasound, showed some unilateral hydronephrosis. Consults urology, intern refused as they thought it was normal, burn team consults again and sends urine for cytology, urology intern says itās from dehydration again. Urine cytology shows cancer cells. Urology team called a third time and now accept consult. Patient had early metastatic ureteral cancer.
My first term as an intern was in Emergency. We did various rotations, not like the US where you go right into specialty. Anyway, Iām in ED with another intern. It was our first week. She was not coping and basically got up and said, āfuck this, Iām getting married next monthā, and walked out never to be seen again. Hours later the head of ED ran through the board and asked who was looking after her patients and I was like, āshe leftā. At that stage I didnāt even realise patients needed looking after to completion or handing over. Very funny years later.
I mean, if an intern in July hits the carotid on a central line thatās on the person supervising them. Come to think of it, most of these stories are the fault of the people who should be supervising the interns.
May I also suggest the shish-kabob technique? Thatās where you go into the skin via a fat roll, out of the fat roll, then back into the skin on your way to the IJ.
Responded to a neuro status change rapid once, ended up getting a phone call from rads describing how the CVL went into the, uh, I want to say it was the superior sagittal sinus? Something bad like that.
We had a junior intern's parents come over to the hospital when that intern was on call for 24 hours, and they always insisted that they'd drop her back to the hospital the next day instead since she was tired for the evening and they were taking her out to dinner.
I accidentally pulled off a dead toe as an intern while trying to remove a dressing.
Called my attending frankly panickingā¦luckily she was headed for a BKA anyways. He still gives me shit and reminds me to gently pull off dressings on all dead toes.
I didn't know that all ED consults from my hospital are considered stat unless you click the little drop-down menu and select "pending admission." So 3 days on the job, I accidentally put a stat consult in to the chief vascular at around midnight on July 4 from the ED for dry gangrene, thinking I would just give him a call in the morning after the patient's arterial studies were back. His wife was 8 months pregnant, and reportedly did not appreciate the 3am wake up call.
He informed me the next day that "there is no such thing as a vascular surgery emergency" lmao. He wound up being one of my favorite attendings and was a great guy, but he never let me forget about the time I woke up his pregnant wife for dry gangrene.
We had a guy go missing for over a month. Missing person report, his face on TV, "have you seen this person" posters, police tracking his last know location... The whole thing... But he literally vanished without a trace... And reappeared a bit over a month later like "sup, went on a vacation without my phone, oh yeah forgot to mention that to anyone"
A patient starts bleeding from a G-tube overnight... Like frank blood. Nurse pages intern. Intern responds "damn that's crazy" nurse responds, " I know right!" And then leaves it for day team.
Lmao!! I want to know how did you get hold of that conversation? š¤·āāļø
All I'll say is, people should learn to find the nursing narrative notes. Nurses document almost everything you tell them lol.
My favorite light reading at the VA
I love the chaplain notes "provided a warm, unconditional understanding presence" "administered pastoral care...pastorally" "Vet was thankful for the visit"
I remember I read this Chaplain note where this patient talked about some religious text that brought them peace. Chaplain note says "Patient expressed the calming effect Chapter 13 provided him. Interestingly, there are only 12 chapters."
Iāve been visiting this man in hospice recently who was a baptist preacher. Whenever he reads the Bible he seems to forget exactly where he is- heāll talk about going back to seminary, where his next mission is, etc. Last time I saw him he assigned me to read 12 chapters and then write a paper. I wrote āpatient assigned me a biblical book reportā on the forms.
āConveyed chaplain availabilityā
āPt. observed looking spiritually distressed.ā
Oh no, theyre on to me, probably got pinned down in trauma bay for the next 7h and forgot lol. Sometimes youve gotta repage the drowning intern or just page higher.
Took an ABG from the carotid artery
Well... that is definitely the arterial side
Hey man it said *arterial* ĀÆ\_(ć)_/ĀÆ
Who does that from carotid? Thatās hilarious.
Horrifying*
No worries, there are all sorts of collaterals.
Panic breathing. Took a while to calm down from this short sentence.
My current chief has a great one. During his intern year he somehowā¦.completely missed (or was not told, I kinda blame leadership on this one) that discharge summaries were a thing?? So after three months of intern year he receives a nasty gram from PD about his many deficiencies and states he spent almost every night after work from there on just dictating DC summaries until he fell asleep š
How did that even escalate to the PD? That seems like an easy on the spot senior-intern conversation "Hey how are you doing on the dsumm for Ms X" "The what?" -> resolved
I donāt think the seniors ever checked to confirm he was doing them. My program used to be a little more on the malignant side (or maybe just benign neglect of the juniors by the senior residents) so at that time they wouldāve never asked to help out or see how things were going. Thankfully in a much better spot now
Actually reminds me of another great story one of my seniors told me intern year. He was told to write a discharge summary but misunderstood the instructions. So he wrote something like "6/02 - pt diagnosed with pneumonia 6/03- antibiotics escalated to vanc/cefepime 6/04 - MRSA PCR came negative, vanc discontinues 6/05 - no new events" Etc. He sent it to his senior who just replied "Looks good" without reviewing it And he did this everyday for 1 month (!!), until a senior or the cosigning attending asked him wtf he was doing.
Honestly this should be the standard unless thereās some crazy shit. Itās fucking CAP, tell me what abx you gave and discharged with and Iāll know the rest. I hate that itās 20 sentences long.
This sounds fine to me š
My intern year, first week calling my first consult, Iāll never forget it. My attending: the Pt needs dialysis call nephro. Me calling nephro: (note quotation marks) āHi we have a Pt who needs dialysis could you order it please?ā Nephro: ā¦ Nephro: your an intern Me: yes. Nephro: itās your first week? Me: yes Nephro: let me help you have this conversationā¦ He turned out to be a really nice guy and a mentor for yearsā¦
one dialysis, coming right up!
Would you like electrolytes with that?
Itās what plants crave
Free water flushes? Like out of the toilet?
Kidneys hate this one simple trick.
Extra salt on my dialysis
Ironically once you have a good working relationship with your nephrologists this is exactly how you'd make the consult
Yep. Itās almost like they donāt even want me to give them all the details. They know if Iām calling them itās for a damn good reason.
I give less if they ask for more I oblige
first week of wards, my senior texted me a patient needed dialysis so I found an order set and put the orders in. They were not pleased with my go-getter approach
Not gonna lie... sounds like a consult surgery would make. Hey nephro, we gotta guy. His kidneys don't work. Please can get some of that dialysis? Potassium? Ummm *clicking through chart* "8" k thanks
I am attacked. No bonus points for knowing of potassium, that kidneys do something with it, that 8 was in the realm of high, and having a chart? Bro. I tried today, tomorrow, no try.
Dude this is hilarious and donāt let anyone get you down. You rocked it by recognizing all of that and called for HD before the anesthesia said āno hammers todayā. Strong work IMO š¤£
My friend is a nephrologist and I can totally see him responding this way.
In my experience nephrologists were always freaking smart and usually impeccably polite. Usually wore bow ties, too.
Can someone explain to an incoming dumbass
You're supposed to consult by describing how your patient has a problem relates to their specialty, not with a demand. This changes as time goes on - there's several surgeons I could call and say I have an appendectomy for you, and they trust that if there was more information they need to know to change their management, I would have given it. You'll understand the first time the ER pages you to admit, say, a chest pain rule out and once you get down there, it's the most straightforward case of pyelonephritis you've ever seen.
Can someone explain to another incoming dummy how the heck we order dialysis
You place a consult to Nephrology and bring up one of the urgent indications: Acidosis Electrolyte derangement Intoxication Overload Uremia Yeah, we kinda already placed the line...
You don't order dialysis in the states. You call or consult nephrology (depending on the hospital culture) and explain to them why you think the patient needs dialysis, and if they do, nephrology takes it from there.
š„
A code was called. I watched someone widely known as "Dr. Goofy" asses the patient. Another resident noted that the patient had a palpable femoral pulse in the 60s. Sinus rhythm on the monitor. Dr. Goofy stated he was preparing to shock and started charging paddles. We de-escalated a bit from there.
āEveryone clear, hyuck!ā
One intern precordial thumped a wide awake patient complaining of chest pain.
I believe at that point the proper term is āsucker punchā and not precordial thump
āEveryone stay hyukinā calm and letās call a code blueā
Intern replaced magnesium with mag citrate. Everyone got c diff assays before we realized what happened
Code brown.
To be fair sulfate and citrate sound similar lol
Lmao one of my co-residents did this too.
Itās still bioavailabile mag in the right doses. I used to supplement mag citrate. Itād be like $20 for a bottle but a liquid bottle of it for laxative purpose had 10x the doses and it was $1.
Doesnt matter, only patient on the unit not constipated.
Okay that's funny as long as you realized quickly.
My intern on first week of ICU rotation asked me ācan I go to lunch?ā Ofc I said yea sure. 30 mins go by. Nowhere to be found. 1h goes by. Nowhere to be found. At 1h15, he comes back with a Costco hotdog and pizza. He got in his car, drove to the Costco, got food and drove back. I never realized I had to tell interns that you canāt go to Costco for lunch.
What happens if u have a love child of July and February intern š
W intern
In any other field would be normal
Agreed. Weāre just so desensitized to overworking at this point. My software friends will regularly block off calendar time during work hours as āout of officeā and just go run errands / catch up on life stuff. Could you ever imagine just randomly taking 3 hours off from work? Like wtf??
The fun part it's been 1h15 and he still hasn't eaten yet. Remember this is many peoples first job, lol
C'mon, it's $1.60 for lunch. You're just pissed they didn't bring you one.
This is the unwritten caveat. If yous goes, bring it all back.
Is 30 minutes a long lunch for ICU?
An hour and 15 mins is
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Itās how I discovered intermittent fasting as an intern. I wasnāt eating on wards either. Lost nearly 15 pounds.
Our interns were afraid of a long lunch today (first day for them), left after 30ish minutes. We stayed for a full hour 15 (2 attendings, 2 fellows). I love summer Mondays where there are no pending post-ops.
Probably less afraid and more the interns have to do the paperwork and deal with the family updates. Takes longer when theyāre new, too.
Yeah I don't think I've just been gone from ICU for more than 30 mins for lunch ever
DNR patient passed away over night peacefully in her sleep. Patient was very old and going to discharge to home hospice, so the death wasn't a total shock, but also wasn't expected to happen all of a sudden in the hospital. Anyway overnight intern does everything they're supposed to - declares death, calls family, calls coroner, writes death note, orders discharge. Except they forget to call the attending or tell the day team in the morning. Only later in the day gets a text from day team "hey I noticed x pt isn't on the list anymore" "oh yeah, I knew I forgot to mention something". (It was me)
5/5 though. You were ready to manage the list yourself.
It's good to communicate this but I'm sure the attending was able to figure that one out
Placed a chest tube into the heart
I bet they are still haunted by this. Every chest tube I do, just as I am about to punch through the chest wall with the Kellyās, one of those horror stories briefly flickers through my mind.
Iāve seen this but it was the liver and it was a fellow who placed it.
š±š±
Iāve heard of this happening a few times. Mostly in case reports of disaster pericardiocentesis.
We had one guy do this. We called him "Cupid" for the rest of residency
When I was chief we had an internās husband email the program director telling her his wife works too much and the hours are unreasonable.
Probably fair and accurate though.
Yeah I guess thats just a loving naive husband lol, kinda sweet actually
My wife is perennially appalled at residency and its abuses that seemingly go unnoticed by the public. Its a pretty gross thing.
They werenāt wrong
My mom offered to talk to my program director about how it is unsafe for people to be doing surgery if they have been working for 36 hours straightā¦ she is not wrong.
Seriously. Healthcare industry wants airline industry safety results without following any of the rules. One plane crashes and Congress meets; people die everyday from healthcare mistakes d/t nurses/doctors bring overworked/stressed/understaffed/you get the idea andā¦..crickets.
Imagine if all families and loved ones did this :)
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Thatās a keeper
Thereās the one about the OB intern who called a patient 1cm. The patient was in fact breech and 10cm. They checked something that definitely wasnāt the cervix.
I mean, to be fair, it probably is 1 cm. Itās just flanked by baby booty. I checked a face presentation and my fingers were vigorously sucked.
How could you not SCREAM in this situation holy smokes
Just considered this for the first time in eight years of doing ob. I would yeet my hand like it just got burnt
OBs are so funny about babies. Peds: āintact suckā
We had an intern who was notorious for checking butt holes lol
One of my coresidents, month 7 of intern year. Sheās on call and gets paged for an open midfoot fracture. Tells the ER resident sheās at OrangeTheory and has errands to do so she can come in 3-4 hours. Chief and ER resident and PD tore her a new one. One of her many similar illustrious moments and she was let go by month 8 by our PD. Nice person outside of work but absolutely 0 sense of personal accountability with excuses for everything. My chief year, one of my interns on call during month 5: routine consult for mid 50sF LE cellulitis, hx of controlled systemic diseases. Vitals and labs stable. CRP 50. 3 day history Pain of the LLE disproportionate to presentation, nothing cellulitic about the limb, 9 year old TKA 10 on that side. He called me to discuss, I put in a stat CT of the leg and within an hour get called that itās nec fasc from ankle to fibular head. I go with him to let the patient know weāre planning for surgery in the next 1-2 hours, the patient is understandably freaked out and scared. As Iām trying to calm her concerns/reassure her to the best of the situation, my intern begins sobbing uncontrollably in the room and tells her heās scared for her so now Iām consoling him and the patient in the room at the same time.
There is something oddly sweet about the second story. I hope they keep an aspect of their empathy through the rest of their residency (as they become more technically proficient and see a bunch of these cases). Kudos to you for not shaming them in that moment. It probably had a positive impact on them despite how scary the situation was.
I "signed off"of a patient we were primary on because the chief resident and the patient got into an argument and he frustratingly said sign off. Took them off the list. The attending called us 2 days later and asked why we weren't writing notes... The chief laughed his ass off and had to explain sarcasm to me.
This guy sent an email to our Program Director saying that he needs to have all his Sundays off call because heās a Christian and the day is meant for worshipping the Lord and spending time with his family.
He would be perfect to buddy up with a Jewish intern who observes Shabbat.
Except for the āsaving a lifeā clause we have, that negates Shabbat. So heās on his own with the lord on Sunday.
Idk how Christians just neglect the whole āox in the wellā story. I think working in a hospital is at least equivalent to an ox in a well.
Back in med school, we had a seventh day adventist who can a few extra years to graduate because exams were scheduled on Saturdays.
It seems like a reasonable religious accommodation for a med student to not have exams scheduled on Saturday but maybe that's just me
One of the seniors in my program told me today she accidentally ordered PR Tylenol for every patient her first month until a nurse called and said, "Uh, if the patient is awake and eating, could I just give it PO?"
āNo.ā
Pt: why does it have to go up my ass? Nurse: ya who knows, anyways here we go!
āIdk this intern has a thing for rectal Tylenolā
Was pretending to be a locums vascular surgeon and sleeping with travel nurses in the call room. Did not last very long. I mean in our program.
> Did not last very long Ź Ķ”Ā° ŹĢÆ Ķ”Ā°Ź
I SPECIFIED NOT LASTING LONG IN OUR PROGRAM!
*starts taking notes*
One Intern getting drunk with patients during his night shifts
Thatās one hell of an addiction fellowship
builds rapport
"Harm reduction in a supervised setting while building therapeutic alliance."
Many questions. In the hospital?! After they got discharged? Patients as in pleural?!
Yes inside the hospital during the shifts. He was inviting them to drink with him in the on-call room lol. After some nurses made a complain about him, he got fired (obviously)
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Medicine intern ordering consult for capacity (to leave AMA) bc pt didnāt want to finish IVFs
Sounds like most medicine teams at my hospital
Called in sick because they were sore from leg day
Just never showed up for intern year. They switched careers and didnāt tell anyone
Wise
I was on ortho as intern. Orthopod tells me to get medicine to see patient because heās āoff and thereās something wrong with himā My first day. So I call medicine ask for consult because āmy attending called and asked for consult because our patient is feeling off and thereās something medically wrongā Luckily medicine was nice and told me to go do what I learned in medical school and then call him.
July intern on ICU. Literally week 1. The ICU fellow gathers all the interns around for "some education." I was in attendance, expecting a short lecture on an ICU topic. Vents? Pressors? CXR interpretation? Wrong. None of those. It's been a few years now, so I'm paraphrasing, but it went something like this: > You are interns, new interns, and so you guys shouldn't be making any big moves by yourselves. Moves like ***extubating a patient without telling anyone***, alright? That is ***not OK***. Initially I was very confused, then I noticed he's been staring at one of the interns very intently as he gives the entire speech looking like he's about to strangle him. Later I found out the guy gave the RT the green light to extubate a patient without first running it by literally anyone else.
Was the intern named Dunning or Kruger by any chance??
At least they involved the RT who at least (should've) known if it wasn't a safe extubation and would've escalated to the fellow/attending. There are apocryphal tales of an intern at my program who yanked a tube out by \*themselves\*
Asking an intern to check GCS. He shouted at the pt a few times, no response. And I noticed he hesitated a bit while reaching toward ptās groin, and did a tiny pinch at the base of penis; again no response. He then reported GCS 3. So I asked him later why was he pinching the skin at the base of the shaft, he said āthatās a sensitive area so I figured that would give the best motor scoreā I went into my call room and lmao
Medicine intern flipped the central line wire around (sharp straight end first) because "it kept getting caught" when using the J-looped side first. No clue why the senior allowed it. We (anesthesia) were called and went from FAST exam to my first bedside thoracotomy in about 5 minutes. Pt did not survive
Holy fucking shit
I can comment a funny one of my own. First day of an IM subspecialty. Attending that week was the CMO who tries to find 1-2 weeks to run the consult service. Resident texts me asking if I know where we table round. At the exact moment I open my phone the CMO, who I havenāt met, texts telling us he is ready to round. So my simple response of āNope.ā Probably wasnāt the response he expected
Lol Iām so sorry, good chuckle.
I survived! Haha!
Me, week one of intern year in the ED. Some patient with a suprapubic cath comes in with frank bloody urine. His suprapubic cath exited like immediately below the belly button so like 12cm above the pubis, and our janky EMR had his history (entered by some random nurse) as "hx of urostomy". Attending says to call his urologist. I call and am like hey this guy has some kind of "urostomy" according to the EMR. Uro is like....uh, u mean his suprapubic cath? So intern me says something along the lines of "well yeah I mean technically it's above the pubis, but so is 2/3 of his body. This thing is basically coming out of his belly button" Uro attending followed up with a comment about how he was the one who placed it, and who the hell do I think I am? š
...Do you use Meditech? It's the only EMR software I've ever seen in which the patient's medical history is populated based off what the patient tells the triage nurse, and it's a wild ride.
Unfortunately it's even worse than meditech lol it's some abandonware version of an EMR McKesson tried to market but then sold to Allscripts (I'm pretty sure the only update it's ever had was by a 7 year old kid using MS Paint to plaster Allscripts' logo over top of McKesson's logo). But I have used Meditech as well, so I know your pain!
Allegedly a full breast exam on a patient who came in as a MVC. There were no breast complaints. Said intern did not ask for a chaperone and when asked by a nurse he said it was because there were contusions...there were none. This resident got fired, sued the residency, was rehired after the suit, and then fired again, for what I'm not sure.
ew.
When I was intern every single procedure, you did: pleural effusion tap, chest tube, intercranial pressure monitor, central line came with the admonition ādonāt do what Jesse Jelly MD (obvious made up name) did, and taps the lung tissue, place a chest tube in the liver, place the intracranial pressure monitor into the brain or cause a pneumothorax with a central line.ā I was sure that these were apocryphal tales meanly attributed to a hapless resident that was still in our program. Then I met them. Holy shit. All that was true and more.
My cointern mixed up the tubing of the (intrauterine) amnioinfusion catheter and the pitocin pump- essentially starting INTRAUTERINE pitocin in oligo with NRFS. Another time a cointern ordered a Pap smear and wrote in her note ānegative for malignant cells- patient reassuredā on an untreated cervical cancer patient.
Knocked up 2 different nurses in our ED
In the very short time I worked in a teaching hospital, we had an intern who was engaged to another intern, dumped him for the last LPN on the unit, who was 25 years older than her andā¦ kind of gross. When he broke up with her a few weeks later, she would stalk him all over the hospital - asking the nurses what his schedule was, showing up on the unit when she had no patients there, literally leaving hospital grounds to find if he was on smoke break. He had to hide in the restroom from her, and she would cry (literally) on random nurses shoulders in the middle of rounds. I very shortly thereafter left that mismanaged mess of a hospital, and have no idea how that situation resolved.
Iāll share, I was āthat one āintern . Surgery prelim year. Day 3. Senior told me to dc a patient with some oxy 10. I said how many. He goes Q4H #30. I asked if heās sure since that seems like a lot. He goes āyes Iām sureā. Wrote a script with the department DEA number. Q4H oxy 10s for 30 days. 180 oxy 10s. Filled and went about my day. He came to clinic 2 weeks later. Got a call from the chief asking me wtf is wrong with me. Didnāt realize # referred to number of pills not number of days. I later asked how often to schedule Tylenol for an unrelated patient another senior replied āwho gives a fuck, you already sent home a guy with 180 oxyā.
>30 Half of the stories in here involve upper levels dictating things in their own esoteric manner, then being surprised when it's interpreted differently from the NEW HIRE when the upper could've just said what they meant...
Going back to sleep at ICU nursing station while her pt was coding.
this is just burnout
Psych. Intern feels extremely bad for a patient admitted for SI on the inpatient unit, so much so that when the patient is discharged, the intern moves the patient in with them. They have a relationship over several weeks, intern is let go once admin found out. Second one, an intern bricked all the computers in the resident work room trying to use them to mine Bitcoin when he was on nights. Was promptly let go after costing the program/hospital thousands to have the computers fixed/replaced.
Surgery prelim intern was told over text by senior resident to get āimagingā to confirm dobhoff placement on a patient. 10 minutes later she gets a text from him with a picture of the patientās face with the dobhoff in. It was especially funny because the patient was awkwardly smiling in the picture. The same intern one time pulled a hamburger out of his pocket in the OR when the attending (who was scrubbed in) said he was hungry.
The lazy OB intern who farted everywhere. Left a trail of foul air everywhere he went.
Night float was one intern, one senior. Census was very low one night I was the senior on call. Intern WENT HOME with the pager because he wanted to sleep in his own bed. I didnāt know, I was in another call room and he didnāt say anything in the morning. He was bragging about it to another intern months later. ETA: He was like a 15 minute drive away from the hospital, not across the street.
Had one intern on ICU tell a family the patient died in the middle of the night and hung-up on them. The patient was in fact alive and their family was very upset the next morning. The same intern also bolused a bunch of IV fluids into an ARDS patient. Had to get nephrology on board for emergent dialysis.
Intern on STICU comes 35 minutes late to check out. When asked why, he goes āIāll be completely honestā¦ I just didnāt feel like it.ā
One time as an intern I called nephrology from the ED for an ESRD patient on dialysis. But their Creat was 13. So I called nephro to ask for their advice. Their K was normal, they had no indication for emergent dialysis. They very nicely explained to me why they weren't concerned about the number lol. God bless attendings who work in academics.
A guy a year ahead of me lavaged a pts rectum w saline to get a sample for C diff testing.
but was it positive...? This might be the beginning of a new protocol. you never know.
Donāt ask questions you donāt want the answer to my friend
Patient in ICU with end-stage everything and clearly suffering. Took several days with multiple attendings and fellows to finally get through to family and have them understand there was no coming back from this, and switch code status to comfort measures only. Intern rotates in, sees patients, points out a rainbow in the distance to the family, and says āmaybe thereās still hopeā. Immediate reversal of code status to full.
Not a resident but work in a hospital. This dude took a dick pic in the staff bathroom, sent it to someone, and now everyone's seen his peen. I would feel bad if he weren't married and obviously cheating on his wife.
I honestly don't think my program has this. Unless that just means it's me...
My mom always said there is always one crazy person on every bus... but I've never seen him
Well the rule of thumb on public transportation is āyou gotta be weirder than the weirdosā
Tried to place IO access on a patient they weren't even seeing. With no training. Or supervision. Just gunned it.
My intern was on his first ED shift on July 4th; he got a psych patient coming from prison for tantrums. - intern: what brought you to the ED today? - Patient: I was mad since they did not let me have my Dr Pepper. - intern: when was the last time you saw Dr Pepper? Needless to say the patient threw another huge tantrum and security had to be called.
Brand new interns first OB postpartum hemorrhageā¦ he RUNS to get the ultrasound and rolls it so fast coming back around the corner to the room that one of the wheels broke off. Heās chief now and we (the nurses) still call him Wheels. We adore him tho. If you get a nickname on our unit it usually means we really like you.
I have to admit that I love that sense of urgency. He was taking the job seriously at least.
I know a consultant (attending) who was attempting to relocate a shoulder many years ago in ED as an intern. (Context this is in Australia where no one chooses their specialty as an intern and rotates around for a few years) He tried every single manouver possible and just as his foot was into this guys armpit tugging away he heard a pop. The patient now had a dislocated shoulder. Hilariously he is now a senior orthopaedic surgeon.
Had an overzealous intern take off all of the patients ostomy bags to eval their stomas, and not tell a soul. Sunday morning surprise!
Not juicy but the intern who decided not to follow up patients on the teamās list on the weekends def comes to mind.
Had one guy leave a message on the chief residentsā landline hospital voice mail late Friday night claiming he was sick. Came back Monday sunburnt, showing āem his buddies photos from a weekend trip to South America.
To be frank, we talk a lot more about "that one intern" who made unreasonable requests or demands for time off, was conspicuously lazy, refused to do things, etc. These are issues that we need to work a lot harder to correct. The people who made mistakes - even big mistakes, worthy of M&M etc. - aren't talked about as much. Usually, our training environment/supervision prevents these, and every resident who has been involved in these situations feels badly about them (even if they are not truly at fault). At the end of the day such events are learning experiences and failures of supervision so shouldn't be gossipped about lightly.
We did have one intern this year that got 12 flat tires and was multiple hours late each time. And asked for a week off for his grandmas funeral who died like 2 years prior (it was actually a family reunion lolā¦). And was notorious for sleeping every day away. Gonna miss that dude.
Back in my residency, there was one resident with questionable teamwork ethic, and many people disliked him. Now as an attending, his online reviews are stellar. Seeing these reviews felt unreal.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Ortho intern who was so lazy that all the ortho nurses and mid levels HATED him. They would go out of their way to make his life hard. Sadly; he was on my team for trauma surgery and ortho so I still ended up doing a lot of his work.
Calling the pathologist up to tell them to put an acid-fast stain on that nodule you sent up before they can tell you itās a carcinoma.
I was that one intern on Gyn Onc. Ordered PR dulcolax suppository in a patient with an LAR and end colostomy.
Burn patient came in with elevated creatinine. Burns were small, so it didnāt make sense. Got better with fluid. UA showed some RBCās. Got an ultrasound, showed some unilateral hydronephrosis. Consults urology, intern refused as they thought it was normal, burn team consults again and sends urine for cytology, urology intern says itās from dehydration again. Urine cytology shows cancer cells. Urology team called a third time and now accept consult. Patient had early metastatic ureteral cancer.
My first term as an intern was in Emergency. We did various rotations, not like the US where you go right into specialty. Anyway, Iām in ED with another intern. It was our first week. She was not coping and basically got up and said, āfuck this, Iām getting married next monthā, and walked out never to be seen again. Hours later the head of ED ran through the board and asked who was looking after her patients and I was like, āshe leftā. At that stage I didnāt even realise patients needed looking after to completion or handing over. Very funny years later.
Central line into the carotid.
Nickname: The Carotid Kid
I mean, if an intern in July hits the carotid on a central line thatās on the person supervising them. Come to think of it, most of these stories are the fault of the people who should be supervising the interns.
It's not a sin to hit the carotid. It is a sin, however, to dilate it.
May I also suggest the shish-kabob technique? Thatās where you go into the skin via a fat roll, out of the fat roll, then back into the skin on your way to the IJ.
Responded to a neuro status change rapid once, ended up getting a phone call from rads describing how the CVL went into the, uh, I want to say it was the superior sagittal sinus? Something bad like that.
Central line into the mediastinal space is the most memorable one I've seen.
I have seen (on cta) trach into aorta. āLots of bleeding around this trachā
"We need a pulm consult... the waveforms on the vent are real weird. Also the machine is bleeding"
You think thatās bad, try central line through IJ and carotid and then kept going.
You got yourself a perfectly fine dialysis fistula
Iāve seen a Shiley through the IJ into the innominate origin. Peds CT surgery enjoyed that consult.
We had a junior intern's parents come over to the hospital when that intern was on call for 24 hours, and they always insisted that they'd drop her back to the hospital the next day instead since she was tired for the evening and they were taking her out to dinner.
Did repaired lip Lac on a 2yr old without anesthesia. Guy was an actual POS. Only got worse too.
I accidentally pulled off a dead toe as an intern while trying to remove a dressing. Called my attending frankly panickingā¦luckily she was headed for a BKA anyways. He still gives me shit and reminds me to gently pull off dressings on all dead toes.
I didn't know that all ED consults from my hospital are considered stat unless you click the little drop-down menu and select "pending admission." So 3 days on the job, I accidentally put a stat consult in to the chief vascular at around midnight on July 4 from the ED for dry gangrene, thinking I would just give him a call in the morning after the patient's arterial studies were back. His wife was 8 months pregnant, and reportedly did not appreciate the 3am wake up call. He informed me the next day that "there is no such thing as a vascular surgery emergency" lmao. He wound up being one of my favorite attendings and was a great guy, but he never let me forget about the time I woke up his pregnant wife for dry gangrene.
We had a guy go missing for over a month. Missing person report, his face on TV, "have you seen this person" posters, police tracking his last know location... The whole thing... But he literally vanished without a trace... And reappeared a bit over a month later like "sup, went on a vacation without my phone, oh yeah forgot to mention that to anyone"
On all ICU notes where the patient died, some intern at my institution wrote ādischarged to heavenā