As I mentioned earlier, I'm on my medicine subinternship this month. I am having a blast. I lucked out and got assigned to a pretty unique service that's very supportive. The attendings, nurses and staff have been great teachers and very kind, and I'm with an awesome co-subI. Internal medicine is where I swim.
For those not entrenched in the medical field, the subinternship or "subI" as most medical people call it, is essentially a dress rehearsal for intern year. I know it can't quite compare to the real chaos and demands of internship, but it's a month where we are supposed to think and act like interns. At my hospital, 2 subIs replace one intern, although I'm on a unique service with no residents and only attendings, so the situation is a bit different! On the subI, we take increased responsibility for our patients, place orders (cosigned by an MD of course), and really act as the point person for that patient. At night, my cosub-I, and I split the patient roster and carry 5-7 patients each. Essentially, it's a trial run for the real deal.
Speaking of nights, I'm back to a q4 call schedule. But it's a luxurious q4 call! On call days, we don't have to arrive until noon and then are usually finished by 1 pm (or mid-afternoon if we have post-call class - boo) the next day.
What exactly is q4 call? It's a confusing concept that friends and relatives often struggle to understand. q4 call means we stay overnight on a 24 hour shift every fourth night(q is shorthand for "every" in medicalese - it's Latin, maybe?). Take this example: Say I start work on Monday and I know that my "call day" begins on Wednesday. On Monday and Tuesday, I work normal hours (7 am - 7 pm). On Wed (Day 1 of the cycle), I work from 12 noon to 12 noon on Thursday. On Thursday (Day 2), I'm "post-call" and go home at noon, having spent the prior 24 hours in hospital. On Friday (Day 3), it's a regular 7 am - 7 pm day. Saturday (Day 4) is off. Sunday (back to Day 1) is my call day, so I'm back in the hospital on a 24 hour shift (although this is complicated by the fact that there's usually no additional help on weekends, so we come in at a regular 7 am). Confused yet? Yeah, me too. It works out to be technically less that 80 hours a week, but in reality, I get in by 6:30 am each day to preround and typically don't leave until 7:30 pm at the earliest after signout (where we relay or "sign out" the day's patients to the person staying overnight). On call days, it's 11:30 am to ~1:30 pm the next day after noon conference or class.
The hours are actually way better here than third year at my other hospitals, where call days started at regular times (6:30 am or 7 am) and finished the next day at 1 pm - a true 30 hour shift. How can you be awake that long?? At least during third year, my interns were usually really nice (or maybe I was really annoying!) and sent me to bed as soon as I'd admitted the requisite 1-2 patients. But here, we're really first stop for middle of the night pages (with ample supervision by a night float) so we're up for most of the night. Luckily, each night I've managed to get at least an hour or two of sleep and that helps a lot, but I'll be the first to say that around 2 or 3 am, I am really feeling the lack of sleep. The whole work hour limitations and medical-safety-when-young-doctors-are-sleep-deprived is a whole other debate, perhaps for another post.
In any case, we've been witness to new intern orientation for the last couple days. It's so exciting! A lot of our recent grads are at my current hospital, and it's so exciting to see the new bunch and a bit terrifying to think that's soon to be me. Now just remember not to get sick this month - just kidding :) The interns are really good and there's a lot of support, especially in the July/Aug/Sept when everybody is getting used to their new roles.
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