intern year: the beginning

Lets see, after two weeks of orientation, being bombarded with parking passes, computer training's and information that doesn't even make sense to you yet, starting to see pts was a great relief.  Every night was a social extravaganza meeting everyone, getting to know everyone etc.

Starting on Psych was a great intro.  As a third year I started on psych and its just a nice easy transition back into the swing of things.  My first call wasn't even that bad.  I had an excellent third year holding my hand and pretty much pulling half the weight.  The first week and a half was just handp discharge h and p and discharge, virtually all the same day.  In my first few days I met a schizoaffective guy with cellulitis of the hand, Anti social personality disorder traumatic brain injury pt, bipolar manic impulse control guy, druggie who fell asleep naked on the toilet, depressed drug addict, really depressed druggie, borderline chronic painer, psychotic ptsd and it goes on.
  My second day of work my TBI and Manic pt got in a huge physical fight.  There was only one male staff who held down the TBIer and the manic just kept on provoking him, as the TBIer just lunged all over the place.  Finally the TBIer grabbed a cleaning spray bottle and threw it across the length of the hallway, narrowly missing all the interns who cowering behind the gate separating pts from staff.  TBIer and manic each grabbed a mop handle and were trying to beat each other down with it. Meanwhile the nurses are yelling for meds, and continuously paging security, and I am quivering in the corner of the hallway not knowing what to do.  I blinked and my med student ran to the manic's back side and in an aggressive football move swiped the mop handle from the manic pt.  My chief yelled at me to order Haldol 5mg IM, Ativan 5mg IM, Benadryl IM STAT.  It was crazy.  Really.
  Both pts were discharged without a blink of an eye. SO Lesson learned, make sure if you have violent and agitated pts make sure to have strong prns on board before hand.  Must protect you staff and the other patients.
  Everyday I was finishing around noon with all of my work.  And just as I was getting cocky I have been leveled down.  Which is good.  My borderline pt is quite a handful and I am learning to limit set and grow a thicker skin.  She is equivalent to two pts so with an admission of a pt with acute psychosis and disorganization it took forever to get all the work done.  Its good.  I am forced to think and make quick decisions.  Next comes Family Med Wards.