Well, I somehow survived my official first day as an intern. Up until now I carried a partial list, but today I carried the full load of patients. I even managed to get all my work done, albeit 4 hours after most of the other interns left. I try to justify it by saying to myself that I had an unusually tough work load, but I just can’t be sure.
The encouraging thing is that I know that I learn things quickly. The flip side to that is that I almost always seem to flounder in the beginning. I’m not sure if some people are more prepared or somehow manage but I don’t think most people bomb as badly as I do in the beginning.
Today, I did something I really didn’t like doing. There was a patient under my care who was in a severe alcohol abuser, and who actually seemed reasonably motivated to fix himself. He wanted to get into rehab, and I wasted most of the day stalling so that he would have a chance to get in.
It turned out that he couldn’t get into a rehab program directly because there was no space available, so I ended up sending him home. I fully expect that he will relapse once he gets home to his usual environment. I just didn’t feel like I had much choice. I knew that my attending had basically demanded that he be discharged today, and my resident didn’t like him because he apparently made some sexually inappropriate comment to her, so she wasn’t exactly sympathetic to him. Still, I have a nagging feeling that if I kept him in the hospital for another day or to until he could be directly transfered to rehab, he would have a better chance of actually making a recovery. I think he really wanted to recover, and he was clearly disappointed when at the end of the day I had to tell him that there was no space in either of the two places we were looking to try to get him into.
I know that my attending and my resident are speaking from more experience when they basically wrote him off as an alcoholic that will probably die as an alcoholic. Still, I don’t think either of them spent as much time with him as much as I had, and maybe there is a bit of idealism in me that keeps insisting that this patient will be different from the usual crop.
But today, the workload got really high, and I had already spent too much time trying to do the extra thing for this patient. I also know that this discharge was one measuring stick that my attending placed before me, and it was one thing that I didn’t want to fail reaching. So I let him go, and said a quick prayer as I did so. I had to trust that if he really was as motivated as he seemed, he will somehow have to find a way to keep himself sober enough for a few days so that he can get into rehab.
It might have not changed anything in the long run, but I still had to carry the burden of the possibility that it might have.