The first morning, I walked up the drive to the almost overwhelmingly large University Hospital anticipating  the days and weeks ahead of me as intern on the Vascular Surgery service.  I felt as prepared as I could possibly be, having reviewed the patients I was picking up.  It was an exciting, yet somewhat terrifying, morning.  I met my co-intern, Dean, who was going into Urology.  He would have to do two years of General Surgery as part of his residency, unlike me, who would be able to go right to my specialty, Neurosurgery, after the internship year.  We met the senior resident, Marie, with whom we would be working the closest.  She was a tough, no-nonsense surgery resident who exuded confidence and experience.  She knew we were essentially green medical students, and she carefully explained our responsibilities and priorities.  She would spend most of her time assisting in the OR, taking care of the ICU patients and seeing consults; we were to take care of the floor patients and do the admissions, pre-ops and discharges.  We would also assist in the OR when needed.  

As the days went by it quickly became clear that we were basically glorified ward clerks.  Somehow, the service was able to admit patients pre-op for their entire workup, something that would be impossible nowadays because insurance simply would not pay for it.  Our daily routine, after morning rounds, consisted of admitting patients, taking a history and doing a physical exam, and ordering all of the preop studies, including angiograms.  All of this could have theoretically been done on an outpatient basis, but since we were there, the patients were simply admitted, and we did all of the work.    

Meanwhile, we experienced getting task after task assigned to us, compelling us to shuffle the tasks around in order of priority, and to multi-task whenever possible.  One might find oneself at the end of rounds tasked with 3 discharges, 2 admissions and preop workups, 2 central lines to pull, 5 consults to call in, a handful of xrays, cat scans and labs to be ordered, and a diabetic foot ulcer debridement to be done at the bedside.  One also had to check labs, x-rays and any other studies that had been done.  One had to check consult notes, to see what the consulting service was advising us to do.  As one went about these tasks as swiftly as possible, one would have to field questions from the floor nurses, pages from interns on other services regarding patients the Vascular Surgery service was consulted on, and pages from the senior resident in the OR with new tasks to be done.  In the middle of all this, one might be called to go assist on a case on the OR.  Basically all of the tasks were expected to be completed by pm rounds, the time of which varied from late afternoon to mid-evening, depending on when the senior resident was done in the OR. 

To make life more interesting, it turned out that the patients on the Vascular Surgery service were the sickest in the hospital.