Pretty fucking badass!
- Everybody will leave work no later than 5pm. Working late sucks.
- Keggers will be held every Friday night after work, attendance is optional.
- Rounds start at 11 am, and then end at noon. Lunch is important, and fuck getting up early.
- Gym Time: I like my residents and medical students to be in shape, but I really don’t give two shits if you’re fat and dumpy. 9-11am is the designated gym time, but you can do it whenever it’s most convenient for you. As long as you get your work done, work out whenever. If you hate working out, do what you want to do instead.
- Once your work is done, it’s time to go home. Don’t ask for permission, just leave.
- Business attire in the hospital is stupid. Wear scrubs on my service if you like. If you want to pimp your nicest suit, I don’t give a fuck.
- Saturday and Sunday are off limits for the hospital, I hire hospitalists to take care of that kind of shit. If you want to work on Saturday and Sunday, go for it.
- Residents and students will spend at least 20% of their working time working on personal projects. Entrepreneurism is encouraged.
- Residents and students will be expected to take at least one nap per day. I don’t care when you take it.
- World of Warcraft and XBOX games (including, but not limited to, Call of Duty 4) will be played on a daily basis. If you’re not into this sort of thing, go do whatever it is that you like.
- Anyone that is determined by me, to be a “gunner”, has to complete the following for time: [Run 1 mile, 100 pull-ups, 200 sit-ups, 300 squats, Run 1 mile], all while wearing a 25 pound weight vest. Any time greater than 35 minutes earns the “gunner” a week of doing nothing but scut work, digital rectal exams and manual disimpactions.
Let’s have some fun!
- That look you get from your chief resident or that “serious” attending.
- The way that “common” people look at you in your white coat.
- That family you just spoke with and explained why their dear Aunt Marie probably won’t live through the night.
- It’s 5 AM and your patient is asleep. “Excuse me, Mr. Jones. Sorry to wake you. I need to just listen to your heart and ask you a few questions and then you can go back to sleep. Have you passed gas or had a bowel movement since I last saw you?”
- Rounds at 8:30 PM. After all, you only came into work at 5:30 AM this morning. No biggie.
- I’m paying $150,000 in tuition for four years (including living expenses) so I can come into work for 12 hours on Saturday. God, I rule.
- You’ve been up for 36 hours on call and you still have a conference to attend in 4 hours. Hey, complaining is a sign of weakness.
Wow, medicine really is serious business.
The following is a guest post by getunconscious. Thanks for the submission!
This is just a little something I wrote based on my experiences; I’m at the end of my third year and going into Pathology. I love your blog and just thought you might like it, I wrote it with your theory that medical school is hell in mind.
The Nine Circles of Medical School (read: Hell)
The Circles of Hell
Third Year introduces the medical student to the nine circles of Hell. The circles in third year occur for each individual in no particular order but it is easily determined that some are far worse than others, though they all represent varying degrees of torment and misery for medical students, house officers, and patients alike. Each circle’s house staff are punished in a fashion fitting their personality, and mean-spirited personalities predominate more and more as one descends through the circles. People who were foolish enough to enroll in medical school but realized before it was too late how punishing clinical medicine is end up in Purgatory, this is to say, Pathology and Radiology. Those in Hell are the M.D. graduates who cling to the notion that patient care is a rewarding endeavor.
“Abandon all hope, ye who enter here.”
First Circle: Outpatient Clinic
Here reside the well patients, who need only a brief check-up. Here also reside the not so sick. These patients are ambulatory and one only has to spend 20 minutes to diagnose and treat a simple problem, or follow up on management of one or more chronic conditions. Thus, the medical students are not punished in an active sense, but rather grieve only the occasional walking personality disorder patient. This is the most benign of the 9 circles, and very frequently is even rewarding.
Beyond the first circle, all the others involve overt punishment of the medical student. They may be grouped into 3 categories (similar to Danteâ€™s incontinence, violence and fraud). The first involves basic care of the inpatient and is the least punishing. The second involves care of the very ill, and the third and lowest level of hell involves active interventions that require one to scrub in.
Second Circle: Psychiatric Hospital
The psychiatric hospital represents the most benign form of inpatient rotation. Though students may be occasionally screamed at by the mentally ill, there is usually no physical exam required and rounds move quickly. A good assessment and plan is something like, â€œAssessment: patient still crazy. Plan: go up on the anti-psychotic du jour.â€ Psych attendings are rarely if ever mean and tend to have entertaining and wacky personalities. Best of all, one can be done for the day in less than 6 hours.
Third Circle: Consult Service
The consult service is usually a subspecialty like infectious disease, cardiology, rheumatology, neurology, etc. This is the highest level of hell that involves being in a regular hospital. While consult services are plagued by a relatively unpredictable schedule (primary teams can call whenever), they are not burdened with overall responsibility for the patient. They deal only in one specific area, and while they may follow up, they do not take call and often do not accept consults after 5 pm. As they are almost always a specialty service, they do not have to deal directly with management of the patientâ€™s comorbidities, a definite added advantage.
Fourth Circle: Pediatric Floor
In the fourth circle, one is part of the â€œprimary team,â€ meaning that this team bears the ultimate responsibility for the patient and must deal with the patientâ€™s multiple problems. In pediatrics, the patients frequently only have one diagnosis, which is an acute diagnosis, and little past medical history. In addition, the attendings and house staff are considerably nicer than those on medicine. The patients, being mostly cute little kids, are intrinsically more likeable. For these reasons, if one must be on a primary team and suffer the scourge of overnight call, pediatric floor is the least punishing.
Fifth Circle: Medical Floor
In theory, this is the same as pediatric floor, only for adults. However, there are several reasons why the medical floor is a lower level of hell. The patients often have many, many medical problems that must all be managed in concert. The history and physical is thus quite a burdensome endeavor and includes a significant amount of past medical history. In addition, the patients themselves may be combative and non-compliant. Not infrequently they are demented and cannot give a good history. While pediatric patients may not be able to give a history, the parent can give a very detailed history in 90% of cases. In addition to the patients, the culture of internal medicine is not near as friendly and welcoming as that of pediatrics. Though medicine attendings may not be overtly mean and yelling at people, they often have a giant stick up the butt and are never satisfied with anyoneâ€™s presentations or fund of knowledge. Add to this the 4 hours of rounding each day and it is self-evident that medicine floor is truly the 5th circle of hell.
Sixth Circle: Emergency Room
In the emergency room, one is constantly assaulted by an unending barrage of patients, ranging from the scarily critically ill to the very frustrating patient who just wants to ask for Vicodin or has a cold and didnâ€™t feel like waiting until the next day to be seen by primary care. Thus, one is condemned to feeling either panicked or irritated 100% of the time. With ER patients, there is no winning. In addition, ER nurses are famously mean to everyone, not just students, but residents and attendings as well. Then there are the services to which ER tries to admit patients. When ER calls a service to admit a patient to their floor, the intern on call WILL be pissed, no matter how legitimate the admission. ER house staff have to burn off this frustration somehow, and will often take it out on the defenseless medical student.
Seventh Circle: Intensive Care Unit
The intensive care unit houses the sickest patients in the hospital, and many will expire here. In order to even be admitted to an ICU one has to be more or less trying to die. Thus the first thing that you will notice upon entering the ICU is an eerie stillness. Patients are all obtunded and hooked up to many, many machines and tubes. Here the medical student will often rapidly spiral into depression. Withdrawal of care occurs on a regular basis. When the ICU is not depressing, it is anxiety provoking, as patients code on a daily basis here. The ICU is the lowest level of hell that does not involve the torture of scrubbing in.
Eighth Circle: Operating Room
The operating room punishes the medical student in a very ritualistic, unforgiving fashion. First, the student engages in a ritual reminiscent of Lady MacBethâ€”scrubbing in. This involves rubbing each side of each finger 10-15 times with harsh iodine soap. One must wash in a precise fashion from distal to proximal and rinse in the same fashion. Then entering the OR without touching anything the towel is used to dry the hands in a similar regimented way (careful! The air above your shoulders is â€œcontaminatedâ€ so donâ€™t put your hands up too high!). Afterwards, the gown and gloves are donned and the student is hereafter confined in his own little prison, unable to touch anything except the operating table. Once (s)he is standing in the proper location (usually one where the operation is difficult or impossible to see), the student must remain motionless for the duration of the operation, often more than 4 hours. In some cases the student may have to retract this whole time. Thus the main form of punishment in this level of hell is immobility and inability to eat, drink, pee, or itch. One often sees only through a fog, as splash guarded masks are employed to add to the punishment, despite the fact that in non-trauma cases there is virtually no risk of any splash. The student is usually interrogated at some point by the attending and/or house staff on medical facts, most commonly anatomy, but this is a much less severe form of punishment than the complete imprisonment of being scrubbed in.
Ninth Circle: Labor