are you OK?

2:20 Am

Today is my first on call. I could not sleep very well last night because of  the anxiety about today's call. So in the afternoon, I really began to feel drowsy, and my day has not even started yet.

4pm sharp, the day call team passed their pager to me, and my resident told me there were two admissions waiting for us already.

We went down to ER beginning the admission. During then, I got paged from nurses, change over docs, etc. I had to ask my resident about most decisions, luckily he has  been quite patient with me. 

The first on call day for an intern is a real challenge. Today I am the one wearing scrubs and carrying the pager, so everybody frequently asked me, Are you OK? I was really too busy to stop to chat, only a quick Oh Yeah and then kept walking.

10pm, we got a call from psychiatric department, saying they have a patient with multiple medical issues needed to be consulted. While we were talking with the patient, I got another call from the floor, so my resident asked me to go see the patient on the floor and she will meet me there.

Psychiatric ward is a special place, locked everywhere for security reason. I lost my direction when a nurse opened the exit door for me. It was not the way I came in with my resident. I followed the exit sign, but got more confused. Suddenly the door behind me locked down, so did the one in front of me. I was trapped in a 5 meter long hallway, with no phone, no light and I didn't have my cellphone with me.

My pager kept going off, my resident was looking for me, and nurses on the floor needed to talk with me. I kept pounding at the door, screaming like a real psychiatric patient. It's 11pm, and nobody was there. I stood in the dark, too scared to even cry. 

I kept screaming for help and kicked at the door, after seems forever, finally a nurse opened the door. Not until I saw her, did I realize how traumatized I was. I hugged her with all my strength and began to cry really hard. She padded my back softly while I just cried and cried. Finally I collected myself, and said thank you, she asked me " Are you OK", I said yes.

When I finally found my way back, my resident already began to do my notes, she didn't ask where I have been, why I didn't answer pager, instead she just looked up at me and asked "Are you OK?" "Oh, yeah, thank you", I replied with a calm tone and took over the notes. She then smiled.

I guess it is not important what happened, it's I am OK really matters.
 

[tabby]

I am off this weekend. Next week I will have a double call during the night. That's it for all the calls in this block. Actually tomorrow will go to this good dim sum place in Chinatown with my co-residents. Outpatient block weekends are very precious to all of us. (Some are pulled to ward for weekend coverage) We have to have some fun. ;-)

Yes I also feel like having "expressive aphasia in medical English" from time to time. I guess practice is the only remedy for this. During my second patient encounter, I asked the guy to "Change into a gown. Keep your panty on, everything else off" He said to me "You don't say panty to guys, just say underwear". I was really embarrassed. I am sure my notes still sound weird sometimes. Well I guess it takes time to get better.

Once you are used to the system, your previous experience will kick in and you will be in great shape. Trust me.

[落花飘零]

thank you tabby, do you need to work tomorrow? hope not.

the ward month is really a harsh start for me, I am so overwhelmed, just like you said, when i am tired and anxious, i threw away my common sense and my basic knowledge i learned for years.

During the round, my attending asked me quesions which i should've known, but i just paused and could not find answers in my brain, when the resident spoke it out, i felt horrible because i knew it, i just somehow blacked out.

also my presentation was terrible, it was my post call, i didn't know the day is our team's formal rounding day, even pathologists and their residents were there. I could barely remember my patients' name because i admited them at 3am in the morning, god, all i know is they are still alive, hehe. the attending kept interrupting me because i either gave too much detail or missed something important, he did this in very polite way, but i still got very embarrassed, especially when docs from other department were present. all i could think is,oh boy, i screw up hard this time, i am dead.

actually my attending and the pathologist were really kind, they tried very hard to teach me the right way to think, to present, to conclude. it's me, who is not prepared.

when i see other interns speaking and writing fluently while i have to struggle for a short note, that feeling is killing me.

[tabby]

What you feel is quite normal. It's not easy for us to get into a residency program in this country, so it's natural we want to prove ourselves even on the first day. During my first day, I saw one young outpatient with gastritis symptoms and presented to my supervising attending. He asked me what I plan to do. I said we should scope him to rule out ulcer. I didn't know why I was saying that. The attending said for young patient we would just give a trial of meds first. Then I suddenly recalled "for young patient without alarming symptoms, meds first". It's so obvious yet I said the wrong thing. I felt horrible as I was really eager to impress my attending. I came home feeling a bit down. I was worried I didn't leave him a good impression.

The second day I saw 5 patients in one afternoon. At that time I wrote all notes after finishing the patient encounter, which later proved to be a bad strategy. When I presented my last patient of the day to another attending,I was tired and paused a few time during presentation. He said several times "keep it going, keep it going". I felt horrible again thinking I didn't do a good job at all. Yes I felt insecure and was very sensitive to attending's reaction, partly because I am singled out in this program.

I learned my lesson from first two days and changed the way I do things. On my third day I typed notes in computer while asking patient questions. I was must faster in keeping the clinic moving. That day when I presented to my attending about my patients, she said "you are very strong clinically". I was surprised to hear that. It was a great encouragement and I realized me being more relaxed helped a great deal.

Again it's harder to start off with ward. But believe me what you feel is not necessarily what other people think of you. We have disadvantage in language, but past experience gave us the advantage of knowing what to say to a patient or about a patient. This is way more important than how you say it. Don't kick yourself too hard. Just give yourself a few more days and I am sure you will be a great intern.

[warmginger]

落花，我觉得bmw328说的很对，想开一些，放松一些， ＂作为一个intern...就要用一个intern的标准来衡量自己＂。我很同情你医院的路很复杂。我想你肯定不如我迷胡，我在自己住了很多年的地方依旧会迷路，开车时转了两个圈以后，就不知道自己从那来的了。不过也都过来了，世界就那么大，还能掉到地球外面不成？不过我觉得医院不对呀，他们应该预先就告诉你密码或者给你钥匙。我想你的第二天一定感觉好多了！

[BMW328]

对自己的要求不要太高了，不然容易沮丧和丧失信心。作为一个intern, 尤其是刚开始2，3天的intern，就要用一个intern的标准来衡量自己，不用要求自己跟住院医生一样，不用要求自己能够一下子把已经有的经验和智慧全部发挥出来，也不用要求自己一定就要比其他的intern要出色，尽管这个可能是你的奋斗目标，但是语言上的劣势和环境的不熟悉，注定了你的起跑比别人要慢，承认这个现实，接受这个现实，并且认识到自己的经验和潜力会帮助自己在第一年的后半段发力赶上他们。接受现实，不急不躁，才是对自己充满信心的表现。美好的未来在等待着你，坚持！加油！

[落花飘零]

谢谢大家，睡觉起来，看到这么多留言，眼眶不由得潮湿了。

一直以来，觉得最辛苦的不是学习，工作，而是没有人能够分担忧虑，分享喜悦，似乎作为成人的角色，就应该独立，坚强，成熟，尤其是自己的职业，别人对我的期待，就是一个冷静的，理智的，所有的知识都具备了的人，但是很多时候，我不是。这种自我评判与社会期待的差距，对自己的不断调高标准，而且似乎永远无法达到的沮丧，才是最痛苦的。

所幸在这里，我能够毫无保留地把自己的痛苦，挣扎和恐惧如实记录下来，在回顾的时候，也给了自己一个重新审视的机会，通过一个字一个字地键盘敲击，把积累了一天的情绪，梳理一下。当然，最重要的是，得到了这里的朋友们无私的关心，热情的鼓励，有时候忙里偷闲，坐下来浏览一下这里的留言，都会让我觉得心情好很多。真得谢谢大家。

rx300, 医院里手机信号不好，所以我总放在办公室里不随身带，流水浮萍，医院的地形我会尽快熟悉起来，谢谢。

wuximm, 谢谢你每次都把这么宝贵的经验耐心地写下来，我已经开始像你说的这么做了，你前面的留言我也看了，实在没时间好好写回贴，但是你说的话我都记在心里了，谢谢你。

tabby,你比我出色得多，呵呵，我到现在还挣扎在low self esteem的问题中，觉得离标准太远了，心情有点低落。。。

我不一一回复留言了，还有书要看，觉得很内疚，希望大家不要介意。

[黄大皇]

Just curious about the two doors. Is this a safety hazard? You should sue the hospital!

You will be OK!

[rx300]

1. You may want to ask the secretary for a map of the building. I was very frustrated on my first day of my new job. The building is huge and the hallways, rooms are numbered randomly. To my surprise, the secretary actually had a floorplan for the building and she made a copy for me.

2. You might need a cellphone for emergency. Prepaid plan might be a good choice. Write down your boss's phone number, your friends' phone number as emergency contacts.

Just my 2 cents.

Trust me, things will get better when you get used to your new environment.

[流水浮萍]

Sounds like what's slowing you down are logistical nits, rather than lack of substantive knowledge or clinical experience. The language barrier will become less of an obstacle over time once you become familiar with the medical jargons (or "river pilot" language according to Mark Twain). It seems to me the pressing task is for you to quickly know your way around the hospital to save you from further embarrassment, perhaps by walking around and mapping the various departments that you may frequent while on call.

Am I taking what you wrote all too seriously? Or is your piece literary fiction, in which case I apologize for this condescending post by pointing out the obvious. In any event, I wish you the best of luck and am sure you will excel in any endeavor you are and will be attempting.

[xiaotutu]

Dear Luohua, you have survived in your first chanllenge! You will do better and better! God bless you.

[盈袖2006]

We are here for you too:) HUG

[女孩安然]

啊，是昨天晚上吗？我看到你登陆移动设备了，怎么会这样啊。天~~看了这篇文章，我感动死了，姐姐，加油！！！

[晓风残月]

看的忍不住的哭，一直哭。

落花，你很幸运碰到那么多善良好心的同事。我也很有感触，我们这儿的staff也是这样，尤其是我导师，还有我们秘书，总是很关心我们的情绪，每每路上碰到都会问are you all right，让人感觉窝心。落花，让我们一起加油吧。

[ing]

不想再多表达一次对落花的由衷佩服了，落花，你很了不起。感觉你是在ENJOY这种紧张刺激的生活，尽管有很多的PRESSURE。我把你的BLOG推荐给了我一个正要考执照的同学，他很喜欢，我也相信他会喜欢的，因为，你的文章可以给人一种动力。

[人在异乡]

很高兴我是第一个看到这篇文章的人。看得我眼泪都跟着打转。