Third Year Reality

This one's for you, Ricky.

1) Sleep deprivation = bad

2) Sleep deprivation + hypotension (i.e. low water intake and prolonged standing) = pre-syncope (i.e. "almost fainting") = really, really bad

3) Do not eat or drink in front of your Attending.

4) Never, ever sit at the table unless you want to get pimped and don't mind power-drunk residents who like telling medical students where their places are.

5) 6:30 pre-rounds are almost as bad as 5 AM ones. Almost.

6) You will hate your white coat. It will irritate your neck because it weighs 15 pounds. Accept the fact that you will not know where things are in your numerous and voluminous pockets, and that patients will immediately ask you how old you are. It's a reflex of theirs. The contents of my 5 coat pockets currently include:
Top pocket: pen, penlight, calipers, highlighter, lip balm, lipstick, hair
elastic, Maxwell's pocket guide, $5
Left anterior pocket: tools (ophthalmoscope, stethoscope, reflex hammer, 128
Hz tuning fork, safety pins/cotton swabs - this obviously depends on your rotation)
Left posterior pocket: patient census, daily progress notes, random research
articles you printed because you were board and the floor printer is free, Case
Files for whatever specialty you're on
Right anterior pocket: Tarascon's pocket pharmacopaeia, 12 cheat cards (normal lab values, abnormal lab values, laminated Folstein Mini-Mental Status Exam, neuro facts, infectious diseases, guide to physical exam), pager, Kleenex, mini bottled water (if you were able to steal one from seminar), pocket notebook for tasks/lists
Right posterior pocket: miscellaneous alcohol wipes, band-aids, house and/or car keys,
granola bar

7) Attendings are lonely people who just want to be loved. They suffer from "Nobody Invites the Boss to Dinner" syndrome. Give 'em an ear and you'll get at least a High Pass.

8) Only present the organ system your team follows. Never include a general medicine issue unless it is a known risk factor for the organ system you are following. On surgery, only discuss pain, bowel movements, urine, and by mouth intake. If you're tired, your report can amount to "Patient is alive this morning."

9) It's hard to remember to call your resident's by their first name. It's really weird to call an Attending by their first name when they tell you to.

10) Eat when you can, sleep when you can, pee when you can. You may be in the business of fixing bodies, but the system likes to pretend that you don't have one.

11) Always follow the senior-most member of the team.

12) You'd think "Spiritual Care" progress notes would be informative. Forget it.

13) Everyone tells you to consider the "psychosocial" axis. No one tells you what to do about it. Calling a psych consult is considered a sign of weakness.

14) No one reads medical students' notes, except other medical students. They are a goldmine of information.

15) No one ever wants to talk to "the family."

16) Never believe what the ER tells you.

17) Always read your own imaging studies and EKGs. You'll often disagree with the "official read."

18) Speaking of...radiologists hate people, but they probably know more about your patient than you do.

19) It's okay to steal juice (or ice cream) from the kitchen when no one is looking.

20) Always bring your own pens! And never let someone "borrow" them. That's it. It's gone.

21) The difference between illness and inflammation is lost on most patients because the symptoms are the same. It is critical to understand this distinction.

22) Always put cancer and vasculitis on your differential.

23) Remember that there are three critical organ systems: lungs, then heart, then brain. (And kidney, if you're feeling fancy.)

24) Inept doctors call consults. At the very least, try to have a basic work-up in place before picking up the phone.

25) To steal from my clerkship director, "Listen to your patient...they're trying to tell you what's wrong with them."