The Coming Reckoning

Two things right up front:

With that said, I write this post while experiencing a fairly complex, ebbing and flowing mix of trepidation, desperation, apathy, and outright nihilism. These are the emotions of a compromised fourth year student with a willpower wellspring shallower than a lunchbox. When you do nothing for almost three months, your brain atrophies; at this point, all I’m really capable of doing is following the smells of free food and clicking “Yes, I’m Still Watching” on the Netflix popup. This bodes poorly for my ICU rotation starting tomorrow.

My class just finished an ‘intersession week’ where we had a college-style lecture class focused on the health care system. This class was remarkable for two reasons:

  • We almost made it through four years of medical school without even the slightest conception of what health insurance is or how doctors get paid;
  • The health care system in the United States has a worse life expectancy than someone with terminal brain cancer.

I promise this post is not going to be about health care reform, or toxicology for that matter, since it seems you all kind of hate that. It will, however, include numerous humorous photos.

The amusing part about this class – at least as far as the imminent implosion of our system of caring for people can be amusing – is that the vast majority of my classmates had no idea that the Reckoning is coming. As someone with a little background in health policy, the slowly spreading horrified looks on the faces of my peers has been a sight to behold. There’s one graph that is particularly telling:





Actually, just kidding, I know you don’t want to see charts. Instead, here is where our health system is right now:


There are a few key features to notice about this image. The first is that the car and its occupants –the health care system and the people who use it, respectively – are intact and alive. This is a similarity. There are, however, important differences.  The people in the car are terrified beyond all measure and quite certain they are about to die. In contrast, we mostly scroll through Facebook and write angry comments on political posts. The vast majority of us have no idea just how screwed we are, although whatever we dimly perceive through the news is certainly someone else’s fault.

Anyway. To be really simplistic, where we really get into trouble is when the cost of health spending exceeds our ability to pay for it. When exactly this occurs depends on Congress (which is a sentence no one should ever write without irony), but right now we’re slated for oblivion around 2030. I’ll be 42 when this happens:


Anyway. Ball don’t lie, data don’t lie.  Even though I didn’t show you the data.

So let’s talk about my “acting internship” for a minute. I’ll be rotating through the intensive care unit at the local Veterans Hospital, as we talked about before. When you hear in the news that someone is “in critical condition,” they’re usually in the ICU.

I’ve had previous experience in ICUs, most notably when I was told by my supervisor in a formal evaluation, “Worked hard, but Nathan does not have a career in critical care.”

In fact, I chose this rotation.  We’re required to do one of these before graduating, but there’s no acting internship in emergency medicine. I was left looking for something that would prove at least marginally helpful before I got dumped into the real world of actual internship-slash-flying-by-the-seat-of-your-pants for a year. ICU months are the closest imitator of the ER, and the veterans hospital is one of my favorite places despite its aforementioned red tape. I’m actually kind of excited.

The AI, as it’s called, is supposed to serve as a capstone for the training process, as well as to provide you with a closer emulation of what being an intern is actually like. So the AI schedule looks, as closely as possible, like the schedule of the intern for a month. In the ICU, that means long days and overnight call every three nights, where I’ll be the primary caretaker for a big chunk of the entire ICU.

This is pretty different from a normal medical student rotation, where this GIF represents the natural order of things:


If the thought of a fourth year medical student with no meaningful clinical experience since September managing a floor of critically ill people by himself overnight scares you — haha! Imagine actually BEING that student, who is basically pooping his pants just writing this sentence.

I’m sure it’ll be fine, and there will be plenty of supervision around. Maybe. If not, here’s a South Park reference…


Let’s camp for a second on the overnight call thing. According to the course director, I have to take “overnight call” – which, in the ICU, means “stay up all night,” because there’s no such thing as a quiet night in an ICU – every third night.

You are reading the words of a person who never pulled an all-nighter in college because he got too tired. Your author is also a terrible napper who becomes entirely nonfunctional with less than six hours of regular sleep. I get mean, start snapping at people, and my latent nihilistic streak takes over to become my general worldview.

This is usually not a good look for the med student, who is supposed to quietly sit at the bottom of the totem pole and take their licks, not engage in open combat using IV poles with the patient’s nurses.

I’ve been practicing my fencing in preparation. Who needs honors?

One thought on “The Coming Reckoning

  1. ok-take naps whenever possible on the available beds!
    attendings will be available for you if necessary.
    you love the vets and you will probably meet some great people!
    good luck, love,grandma

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