Yes, I mean it. There is just ONE MOST IMPORTANT THING to know as an intern. I could wax philosophic about not putting off D/C summaries (really, when there's 10, it's just going to cause you MORE dyspepsia), the perils of the hospital cafeteria (The Intern 15 is real, usually due to carbohydrates and increased stress) and the importance of the Red Book
that should be in every medicine intern's coat... but if I could teach you just one thing "Errrmmmmmm" would be it.
"Errrmmmmm" is the name I've given to that odd little feeling that sits in the middle of your chest, makes you purse you lips and give pause. The medicine version of Jiminy Cricket, it is the thing that will guide you out of bad situations time and time again.
Things that have made me go "Errrmmmmm"
-A patient who we were seeing on GI for likely sepsis from a bad gallbladder and the nurse who was standing outside looking flummoxed and saying "Her breathing is a little slow now, I paged the attending, but he's not answering"
(End result: Septic shock in the unit from bad gallbladder and some dead gut to go with it.)
-Seeing ritalin ordered on a patient with hemorrhagic stroke in the previous month. (BP found to be 167/92)
-A patient in the clinic whose daughter - the nurse, calls in saying "she just won't stay awake today. I'm really worried!" (Sent to the ER, found to have a hemoglobin of 7.)
"Errrmmmm" should always be met with sending it up the ladder. Although you are Super Intern, and you can do it - you're still just an intern. Know when to run something by your upper level, know when to find out who is on call for the ICU. Some people call it "loading the boat" so that when the ship goes down, they're not alone - a grim way to look at it, but when the crap does contact the fan, I find vast amounts of comfort in not being alone.