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In residency at OHSU in Family Practice, we work a lot.

On the internal medicine service, we have one third year Family Practice resident and two first year interns. All the other teams are internists. The internists do adult medicine, so they rotate through cardiology, pulmonology, rheumatology, infectious disease, gastroenterology, you get the picture. Meanwhile we do two six week internal medicine rotations on the general medicine service and the rest of the time we are on the obstetrics service, pediatrics, surgery, dermatology, psychology, orthopedics. We are the generalists. Many if not most internal medicine residents do their three year residency and then go on to train in pulmonology, rheumatology, cardiology, infectious disease, gastroenterology, you get the picture. At that point they are a "Fellow", as in "cardiology fellow".

We are a bit behind the eight ball all the time, since every other resident on every other service has done more in their particular arena than we have. Many physicians look down their noses at Family Medicine physicians.

But we get to do everything.

We still have voice pagers. When I am on call for internal medicine as a third year, we have two memorable banner nights. That is, we get eighteen admissions. (What is it with eighteen in my life?). That means nine per intern and I am supposed to write something coherent on all of them. I also have to see them, talk to them and make sure the intern's orders make sense and they haven't missed anything. Sometimes they have.

On one of the nights, a young late 20s guy is shipped to us from an outside hospital. They have been treating him for pneumonia and turns out that it isn't. "His mitral valve has just sort of melted and he's in full on heart failure!" says the intern. "But don't come down, the cardiology fellow is here and cardiothoracic surgery is on the way. You don't need to put anything on the chart, this dude is off our service." Phew.

On the other night, I skip four patients to see the fifth first. My lizard power is fired up. The emergency room resident says that this is a woman with double pneumonia. The line that gets me fired up is a muttered "I think she'll be ok on the floor." I stomp in to the room and say, "Hell no!" She is sitting bolt upright breathing at a rate of about 40. No, no, no, no. Not ok on the floor. I call the Intensive Care Unit resident immediately. "Come get her! Breathing at 40! Septic pulmonary emboli!" I don't have to write a note on that one either, the ICU team roars in and slaps her on a ventilator, which she really needs. I don't know if she lives.

We get something to eat sometime in the night, but it's more sad pizza or yohgurt and an apple. In the morning, we all run around, me to all 17, to have information ready for rounds with the faculty. We will present each patient to the faculty who was home asleep last night. If the faculty is an asshole, they will ask us to name the 15 causes of low potassium or something. If the faculty is in a hurry or is an actual human, they will move right through all 17 and not fuck with us.

Before that, I page the others. Voice pager, remember? "Nutrition rounds, 15 minutes."

Yeah, sounds professional. What it means is BREAKFAST. We meet in the cafeteria and eat like wolves before heading back to the floor.

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