Oh What A Night: An Interns Guide to Staying Afloat

06 Sep 2018

By Rachael Sundland

As a brand new baby intern, the prospect of starting off with a month of night call feels like someone has just handed you the keys to a cruise ship and asked you to sail across the world. Each night you are faced with the daunting prospect of docking said cruise ship in a teeny-tiny harbor without destroying the marina or killing the passengers.

My first night as an intern was an easy Sunday night. Not much was happening on the floors, everyone was stable and in general it was a pretty straightforward night. And thank God that it was! As the pages began to roll in I realized that I had never put in an order before. So that was step one, figure out where to click to place an order. Step two was much trickier. Could I actually order IV acetaminophen even though there was a shortage? Did I have to check liver enzymes? Why was the person not on acetaminophen already? Was I missing something? With all of these questions swirling around, step two quickly became: see the person you got paged about, text the seniors and ask them what to do. Then Step 3 was, do what they said and move on to the next page.

As the first week went on, I began to settle in and feel more comfortable. Which obviously meant I had stopped checking my blind spots and the ship was about to crash into the harbor. I had my first official experience of being signed out a “no issues for this person overnight, NTD” which actually meant “this patient is going to try to die tonight”. Namely, one small bloody bowel movement turned into two more VERY large ones leading to a precipitous drop in hemoglobin. Meanwhile, I was on the main surgical floor confidently taking care of post-operative checks and pain calls, when I got the gut wrenching text from my chief… “Why aren’t you in step down?!” As I ran to the step down unit I only had one thought, “f**ck, f**ck, f**ck”.  On arrival, I found the entire overnight team already putting in IV lines as I was handed the massive transfusion protocol paper and sent directly to the blood bank. Needless to say my chief was not happy with my initial absence. Fortunately, I was then provided with an opportunity to redeem myself as a newly admitted patient slid down the slippery slope of septic shock, and I was the first to raise the alarm.

This up close and personal experience with being the last person to find out something was happening, when I should have been the first, was startling.  As I was having a breakdown in an empty SICU room the next morning, I had a heart to heart with one of my favorite intensivists. He said to me, “Rachael, you should be excited about last night. Because not only did you get to learn about hemorrhagic shock, but you got to learn about septic shock too!” I decided at this point that every “near miss” was going to be treated as a one time learning opportunity. It is a mistake that can be made one time, and one time only. There are no second chances to miss hemorrhagic shock. The second time, someone may die and that’s on me. But it is okay to make mistakes, and I will miss things and it is something everyone goes through because it is a part of learning and is also the reason we have a team. The important thing is that I learn from these mistakes, realize where my weaknesses lie, and make sure to learn from everything I do, everyday. It’s also imperative that, as an intern, I ask for help whenever I am even a little unclear about what to do in a situation. Honing clinical intuition takes as much time as honing clinical skill and it something that seniors can help guide me to learn, but only if I ask. Learning to drive a car was not easy, and maneuvering this cruise ship is exponentially more difficult, but I wouldn’t have it any other way or with any other co-captains.

Rachael Sundland (@rsundland) hails from Colorado, her educational journey has moved her from St Louis (undergrad), to Atlanta (Emory, Masters in Public Health) and to Grenada for medical school at St George’s University. Now she lives in Brooklyn and is a first year surgical intern at Maimonides Medical Center. During medical school she found her passion for women’s health as a member of her schools chapter of AMWA. She plans to take this passion for women’s health to her new program by participating in fundraising events for breast cancer and other women’s health issues, especially during the month of October. She has also developed a passion for promoting women practitioners in surgery and strengthening the presence of AWS at her institution. In her free time she enjoys sleeping, watching Netflix, doing yoga and playing with her friends dogs.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.


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