Colin T. Son, MD


October 27, 2009

The transition from medical student to doctor is a little bit harrowing. You get only a few weeks of orientation -- from sometime after you graduate until July 1, when all interns start their residency -- to learn what you need to know as a new doctor.

To be honest, I did not feel one bit more like a "real doctor" after orientation than before it, and yet here I was setting out into the hospital.

I did get one thing, at least, from my orientation: On my last day, I received a sheet of paper that briefly outlined my responsibilities and daily routine in the surgical intensive care unit, where I was to start my residency.

That single piece of paper also contained a bulleted list of advice. The last bullet read, "Trust your nurses; they know more than you do."

codeblog hosts Grand Rounds
on October 27, 2009.

There's truth to this, which is why I'm so fond of nursing blogs like codeblog.

A resident can learn a lot about how to juggle the unexpected in posts like A Day In The Life, in which a harried nurse describes her morning in a busy hospital ICU:

This is a very, very long post. It details the first 5 hours of a 12 hour shift. Things were especially frustrating on this day...

7:45AM: I have 10 medications due for my comatose patient at 8am. Yesterday, I had problems getting one of those meds from pharmacy. Today I check early -- it's not there!

Nurses know more about the ins and outs of the patient care experience than I am ever likely to be privy to as an intern. Consider this post, Choose Wisely:

[H]er wishes were...explained in great detail in a written document. A document that we had a copy of in her chart. A document that her family readily provided to us.

In the condition she was admitted in, she would need IV fluids, antibiotics, x-rays and tests. She wasn't completely unconscious, but she wasn't very coherent either. Add in her element of dementia, and it was clear that she wasn't able to make decisions.

Her husband came in to see her. He told me that he knew she didn't want any of this. He said that he knew she didn't want life support but that he was her Power of Attorney, and it didn't matter to him -- he was going to ask us to give her one [a feeding tube] anyway.

It was obvious he was grieving and in denial. There was no malice, only a very matter of fact manner. And a deep underlying sadness. It appeared to me that he was simply unable to carry out that which she had painstakingly directed.

I very gingerly tried to get him to tell me why he would go against her wishes, but he wasn't able to give me a straight answer. I could tell that he already missed her so much. I hope she can forgive him.

Codeblog is always original, always revealing, and always educational. This week, for the sixth time, codeblog hosts Grand Rounds. Grand Rounds is a summary of the best from the medical "blogosphere." It features posts from physicians, scientists, and nurses.


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