Tonight, my CCU rotation came to an end. I had to say goodbye to the wonderful nurses, residents and fellows who made this rotation as great as it was and as magical to write about. Tomorrow, 7 am sharp, I embark on a new journey on the internal medicine floors. I will be head of a team encompassing one Attending, one Resident (me), two Interns (first year residents), one Sub-Intern/ fourth year med-student (from here on the “Sub-I”), and two third year med-students (a.k.a. “Students”).
To serve the readership yet unfamiliar with the medical hierarchy that governs today’s fine medical establishments I will now take the time to explain this ass-licking stepladder. The understanding of this is essential for our future relationship and so if you have any questions feel free to ask. I will list these from least kissed ass to practically dripping. I think the best way to explain will be to list primary goal of each, secondary goal (if applicable), friends and enemies. It is long; I am sorry for this, but essential for the upcoming month. Let us begin:
1- The Students/ Third Year Med-School Primary goal: To impress Attending and Resident with knowledge we were sure they never had. Secondary goals: To cloud a simple clinical scenario by suggesting that the patient has as many extremely rare diseases as possible, to name a disease the Resident hasn’t heard of and to send out for as many of the most expensive blood tests we have as the Resident allows. Friend: The sub-I, as he is closer to the resident and gets the scoop on their performance thus far. Enemy: Interestingly enough, they are each other’s enemy as they are always being judged comparatively to each other. This undercurrent of hate is masked very well and only Freudian understanding of the subconscious can uncover it.
2- The Sub-I Primary goal: Impress attending, Sub-I’s need recommendation letters for match so they too can be taken advantage of by residency programs and government. Secondary goal: Discharge patients, less patients less work and try not to sound like Student by naming any rare disease. Friend: Intern and Resident, possibly third year but only if they agree to do his blood draws. Enemy: Patients with extremely rare diseases (makes Sub-I extremely uncomfortable as he now has to sound like Student).
3- Intern Primary goal: Discharge patients. Intern will do or say anything to achieve this goal as he/she is usually overworked and would love to have one less annoyance. Secondary goal: Anything that ends in less patients (I cannot stress this enough). Friend: Other interns, amazing bonus point if able to really swing Resident to his “point of view” (often wrong!). Enemies: Patients!!!!
4- Resident Primary goal: To impress Attending and Chief of Medicine while also keeping Intern happy, motivated and feeling that Resident is truly on his side. Secondary goal: Constantly remember that Interns LIE! Again, they do anything to get patients out and Resident must continually double check Intern behind Intern’s back as INTERNS LIE! Friends: The Giants and other Residents. Enemies: Everyone on a certain level as Interns LIE, Sub-I wants information primarily for Student, Student wants to name rare disease and make Resident look bad. To counteract Student, Resident must immediately say “I don’t know that but why don’t you give us a presentation on this tomorrow morning” (Gotcha Ya Bastard!).
5- Attending Primary goal: Come for 2 hours in morning, teach, leave as fast as possible, keep name out of chart so no one knows who to sue later. No Secondary goal. Friend: All. Enemy: No one. Remain completely oblivious to the ass smooching going on a round you. Wipe ass off after morning round.
6- Chief of Medicine Primary Goal: Teach and run Medicine Department. Secondary goal: Absorb all ass kissing, taking it all in as one continuous lick that lasts for many years. Secondary goal: Try to remain seemingly very humble, once in while give a lecture which makes every resident in the room feel like he knows absolutely nothing/ give up his medical license and go back to medical school.
7- The Giants Retired Geniuses, all Ex-Chiefs of prestigious departments who don’t want to stay home because their wives will drive them nuts. We all love them because they help us and they know wayyyyy too much. They’re great!
This is the system within which we all operate. If there are any questions please feel free to ask. Tomorrow, I will do my best to avoid all questions and appease Intern to join my view of things. This will be my greatest chess match yet.