Grey's Anatomy

When this show was advertised, I thought "Why would an intern want to watch a show about interns? Especially ones who look like they actually got some sleep." So, despite the hype, I decided against watching it and ended up getting some sleep.

But, a week later, curiosity got the better of me, and I watched the 2nd episode.

Now, the lives of the interns on Grey's Anatomy bear minimal resemblance to our lives. Our hair is never that neat, neither are we as well made-up. Hospital affairs, well, they happen, but very rarely will they be between a consultant and an intern -- we're too far beneath them. And making out in the lift? Please. Interns don't have time to wait for the lifts. Also, there is no way you'd find the consultant sitting by a patient's bedside, having stayed there overnight.

But, the Grey interns are much more put upon than the ones in other medical dramas (ahem... ER, All Saints). Also, to them are delegated the most menial of menial tasks. No operating for them until they've proven themselves, unlike some interns who perform open-heart surgery in the ER waiting room. No, the most they can do is suture in the ER, and that's because none of the "real" surgeons want to do that. Oh yes, and sorting through lab results. That's too low for the "real" surgeons who should be in the operating theatre.

For the idealistic interns in that other medical drama, "internship is all about waiting. You wait and wait and wait, and then, suddenly, a chance comes and you do something that makes a difference in people's lives." Oh no, idealistic TV-land intern, internship is about filling endless stacks of paperwork, taking bloods, putting in iv lines and catheters, reassuring patients, and charting the medications the powers-that-be want your patient to be on. It's about learning how to be a real doctor by observation (with some participation) and hoping that you don't kill anyone along the way.

As for the interns in Grey's Anatomy: "We're interns, we're not meant to be right. And when we are, it comes as a complete shock." Ah, that sounds more like my life.

So, I will continue to watch Grey's Anatomy and suspend my disbelief. After all, the writers have to have some insight into internship, or they wouldn't have produced this conversation:
"As an intern, are you..."
"Terrified? 100% of the time."
"Good. So it's not just me."

Nocturne

Hi it's Anna, night intern. Chest pain? OK, give him some oxygen and one anginine. I'll be there soon. Can I get an ECG done as well. Ta.

Hi it's Anna, night intern. Shortness of breath. Hmm, any history of COAD? OK, turn up her oxygen to 4 litres, give her a neb. I'll be there soon.

Hi it's Anna, night intern. She pulled out her jelco? Is she on antibiotics? *Sigh* Well, it won't hurt her to miss her 2 am dose. I have a chest pain and shortness of breath I need to fix, then I'll come and do the jelco.

Hi it's Anna, night intern. His sats are what? Crap, I don't know anything about BIPAP. Ummm, let me page my registrar and I'll get back to you.

Welcome to my life. I have begun the daunting term that is night cover. Now, night cover means that I am the only intern in the hospital from the hours of 20:30 to 8:30. It means that anything that goes wrong with the patients, I'm the one to call. And if something goes wrong with a patient at 2 am, it usually means they're pretty sick. Well, half the time. The other times, they usually just need some Tylenol written up, or a jelco (iv line) put back in. Or they just need admitting. What strikes fear in the heart of every night intern are those calls for shortness of breath, chest pain, really hihg blood pressure. Actually shortness of breath is the worst, because the patients usually look so ill, you're sure they're going to die on you.

Hello dear, my name is Anna, and I'm the doctor working tonight. Now can you tell me what happened? Did that medicine help you at all? No? OK, we'll try another drug, then shall we? Can I just have a listen to your chest? Deep breath in, and out. Good. And again. Did you have any chest pain at all? No? OK, give her iv hydrocort. OK, dear, just giving you some medicine to help you breath.

Now, being a night intern means that you have to call on all your resources, on all your experiences from med school and as the day intern. Shall I tell you all a secret? All the learning from books over the last 6 years of med school don't mean a thing. You call on experience, not some obscure reference in a half-forgotten pharmacology lecture.

How's her breathing going? You mean the hydrocort didn't touch her? Crap. What are her sats? Hmm, that's not good. I'm gonna call Dylan. How's that man with chest pain going? OK, give him another lot of anginine. Is that his ECG. Ooh, not good. *beep, beep*. Hi it's Anna, someone paged? His sats are still falling, OK, I'll call Dylan.

Now, the night intern isn't totally alone. There's the night medical registrar. His job is to admit and manage the new patients coming in to the emergency department, after they've been worked over by the ED guys.

Hi, has anyone seen my reg? What do you mean he isn't here? Since midnight?! Augh. My patients are trying to die on me and my registrar is asleep. Guess I'll page him....

Hi Dylan, it's Anna, the night intern. Now, a couple of things. You remember the man you sent up on BIPAP? Well, his sats are falling, his conscious state is getting worse and I really don't know anything about BIPAP. The settings? Umm, it's 12 on 5 with 30% O2. OK. And, I have another patient up on the wards. A 75 year old lady with sudden onset shortness of breath, steroid dependent COAD, admitted with query exacerbation of her COAD, query PE. I've given her salbutamol and hydrocort with no effect. Her chest is clear, her sats are falling. She's on 3EB. Ta.

OK, Dylan didn't sound too impressed, he said just change the IPAP to 14. And keep his O2 at 30. And just watch and wait. I need to go back upstairs.

When the intern needs to call the registrar, you know there's a problem. This is when a patient's needs outweigh the intern's expertise.

"Actually, her chest sounds wet. It's not her COAD, she's in APO. Give her some iv frusemide and we'll transfer her down to 1West. Get an ABG, an ECG, and get some venous bloods sent off."

Sometimes, problems that seem insurmountable to an intern, seem so easy for the med reg to fix. But, hey, I've only been a doctor for 8 months, he's been one for 6 years. I suppose I could berate myself for missing a fixable diagnosis and for having gotten distracted by another potential diagnosis. But now is not the time to doubt my abilities, I have other patients to look after, and the sun still hasn't come up.

OK, sir, my name is Anna, and I'm the doctor working tonight. Can you tell me about the chest pain? Is it gone? Good. Now, your ECG has shown that there is something going on with your heart. I need to take some blood tests to confirm this. Yes, I think it might have been a heart attack. Well, I'm going to start you on some aspirin and some blood thinners and tell your doctors in the morning so they can begin some long-term management. If the pain comes back, make sure you tell the nurses and they'll page me.

The last duty for the night intern before heading off is handover. I tell the day interns what happened with their patients in the night, before I go home for some well deserved sleep. And the cycle starts again the next night.

But, because internship is a year of learning...

Hi it's Anna, night intern. Shortness of breath. Any history? OK, turn up his oxygen, get an ECG, and we'll give him some iv frusemide stat.