The Midnight Menu

| September 11, 2015

Being a medical intern is easy. It’s like riding a bike. Except the bike is on fire, you’re on fire, everything is on fire and you’re in hell. It is for those who have done so, particularly if it was for no other reason than to check a box on your “career to do” list for boards and state licensing requirement, perhaps the most exhilarating and difficult year of your life.

At times the job is relatively easy, like riding a bike. If you have seen one, you do one and then you teach one. After witnessing it, you can place an arterial line or intubate someone, you can teach the fourth year medical student to do the next one. Lots of people, junior residents, senior residents, fellows and attendings tell you what to do – what labs to order, what to watch for, when to call whom and what nurses are more trustworthy than others. There is little thinking involved. Your patients get reduced to 3×5 note cards with problem lists and “to dos” before your shift is over. This was before the 80-hour work week which made it more difficult to define your shift.

One month you may be helping in orthopedic surgery, the next month delivering babies. The 3×5 cards still work as well as they do in the ICU or on the general medicine service. By the end of the month you gain some confidence you learned something without hurting anyone and if you absolutely had to, place a cast or deliver a baby when you rotated off.

Call consisted of at least every third night, assuming no one quit, called in sick or died. My year all three happened. It’s why I was a medicine intern and not the usual transitional intern reserved for those going into radiology, pathology or other specialties other than medicine, ob/gyn, pediatrics or surgery that had their own interns. If you didn’t match in your specialty or couldn’t apply to match in your specialty like pathology or radiology, you did a clinical year, or “transitional” year. One of the medicine interns reportedly “had a nervous breakdown” before the end of the first day of orientation and quit. I filled his slot to make the schedule work. The other transitional interns would pick up the slack in the clinics.

My first call night started July 1, then July 4 again and so on, in the ICU. Thanksgiving night and Christmas Eve. Superbowl, Masters and US Open Sunday. Your life is spent taking care of others. The call room was a pile of dirty linens, scrubs, candy wrappers, soda cans with books strewn all over the place from pocket guides to differential diagnoses to outdated 3-volume reference texts. Unpaid utility bills and residency applications filled the desks.

Post-call you could “sign-out” your patients to the intern relieving you who would spend the night and take over the task of taking care of the patients until 6 AM the next morning when they would be relieved again and post-call. On those days you could get out by 8 AM and have the day to golf or run or sleep before returning at 5 AM the next day. These every third day moments made the year tolerable.

But perhaps what made the entire year actually fun and enjoyable and made you feel like you were not alone was “The Midnight Menu”. Every night at 12 AM the cafeteria would open and serve a mix of late dinner and early breakfast food. Fried chicken, scrambled eggs, grits, bacon, pizza, hot dogs and French toast. It served the “graveyard shift” employees that worked around the clock, anxious visitors and the housestaff.

Around 2 AM interns and residents who could make it would meet in the cafeteria with their EKGs, radiology films (before digital radiology), lab tests, and clinical histories and discuss cases with each other. If your resident was admitting someone from the ER, perhaps you brought a question he/she had to the cafeteria to ask other residents their opinions about management or if we should call our attending. If your resident knew that other residents were available perhaps he/she would take a few minutes for an early morning rendezvous with their significant other somewhere. I wouldn’t say it was at the level of “House of G-D” escapades but we had our moments.

So, over grits and fried chicken we would share our cases, ask questions, consult with colleagues and try to help each other make it through the night and morning. I actually looked forward to The Midnight Menu, not that the grits was all that good but for the comradery and the stories and the chance to learn something new as best one can at 230 in the morning. You could get a neurosurgery, pulmonary or cardiology consult without getting up from the table. Senior residents from other services shared their knowledge with you, making sure to get their digs in when you were going down the wrong path in their opinion.

Within a few hours fellows and attendings from your service would show up again and the cycle of admitting-treating-following-discharging would start all over.

And within a night or two, you would be back to The Midnight Menu.

A few years later, after my internship, due to budget cuts, the cafeteria did not re-open for the third shift employees. No more group house staff gatherings in the cafeteria to bounce cases of off. The visitors, nurses and janitors were provided vending machines.

The interns were left without a central consultation lounge. I think it hurt morale for those who were caught in the transition that year making internship that much more difficult when you are learning how to ride the bike and the bike is on fire.

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