As the Internship Wanes

It was a lifetime of 12 short weeks ago that I embarked on this critical care internship. I thought I knew what it would be like, and I was mostly right.

The fact that even in the interview they asked me if I was sure I "wanted to do this", again when they offered the position to me, and a third time when we were at the beginning illustrates the degree of difficulty. The neck snapping uptake onto this learning curve was akin to being rear-ended by an academic semi-truck on a towering bridge--not only do you have to survive the impact, you have to make sure you get propelled down the lane of traffic and not over the side of the bridge into the water. I've always prided myself in some small way on the amount of stuff in my brain; it's what I do, it's my thing. This, however, was the first time where my knowledge, or potential lack thereof, had actual life or death consequences. And I don't mean that in a hyberbolic, grandiose way. I mean that quite, quite literally. Often, if I were to screw up, there simply isn't time or physiologic reserve for the patient to recover.

This is singularly the most difficult thing I've ever done. So far beyond nursing school it's laughable. Easily more intense than the worst day in chiropractic school. The level of performance required on a minute to minute basis leaves me mentally and physically exhausted at the end of each and every shift.

I have assimilated so much knowledge my head hurts and I dream about titrations, QTc's, filling pressures, and cardiac indexes. Yet I'm surrounded by people that possess the same knowledge, at times seemingly disguising the fact that I've learned all that much.

I can tell that I've grown though. It used to be when a preceptor stepped in and made an adjustment to a pump or initiated a therapy, I was simply thankful that there was someone there to make sure the patient got what they needed. Now, it annoys me, because a.) they don't tell me what they've done, potentially making me look like a fool when I get questioned by a physician, b.) because it disrupts my train of thought or plan of care, or c.) because, "It's my patient damnit, and keep your grubby hands to yourself!!", that's why!

To get out of the internship I have to take a drug test tomorrow, and not the pee-in-a-cup kind either. These are the notecards for the drugs I have to know by heart. The test? Not multiple choice, not fill-in-the-blank, but short answer. Many of them I know well because I've used them daily for the past 12 weeks. Some of them I still haven't seen in practice. I have to know class, mechanism of action, preparations--including all concentrations we use, dosing--including initial, titration, max and wean dosing, side effects, nursing actions, as well as surgeon preferences for each drug. But no problem, I got this. *sigh*

Beyond that, I have two more shifts on days, tomorrow and Friday. Then Monday, I head to night shift for 3 shifts with a preceptor to get a feel for how things run on nights.

And then, fin. All done. Completed.

On my own.

And the next new adventures begin...

I love my job.