Do not get sick in July. Why? You might die. A recent study published by the Journal of General Internal Medicine reported a 10 percent spike in teaching hospital deaths during the month of July due to medical errors. We call this spike “The July Effect” and we attribute it to the influx of new interns and residents.
Typically, medical students graduate in June and begin their first year of residency training — internship — in July. This group of eager new interns invades the hospital to learn, care for patients, and make medical decisions. One problem. They don’t know what they’re doing.
Like most interns, I arrived with four years of medical school under my belt, an M.D. after my name, and virtually no practical knowledge of medicine. Although I wore the long white coat of a doctor, I kept my pockets packed with condensed medical manuals that we called our “peripheral brains” to make up for the lack of knowledge held in my actual brain. Thank God for these manuals. Otherwise I would have been part of “The July Effect.”
My first night on call. I walk down a dimly lit hallway toward my call room, the only sound the intermittent beeping of a heart monitor. Suddenly, a loud siren rings overhead. A nurse rushes out of a room right in front of me.
“Call a code!” she yells to a secretary. The nurse looks in my direction and asks, “You’re a resident, right? I need you to run this code!”
I look left, right, and behind me.
Gulp. She’s talking to me.
“OK,” I say, hoping that she hasn’t noticed that my voice has leaped an octave.
The truth is, I’ve just finished orientation, which included a course in Advanced Cardiac Life Support, but I have not spent a minute reviewing the manual. Confession: I’m not feeling all that confident.
I rushed with the nurse into the patient’s room. I see on the cardiac monitor that the patient is in ventricular fibrillation, the heart rhythm that immediately precedes death. Squeezing an oxygen mask, a nurse stands above the patient’s head. A second nurse runs medications into an IV.
“What should we do, doctor?”
My mind goes blank. I have absolutely no idea.
I pull out my “peripheral brain,” flip to the section on “ventricular fibrillation.” Aha! Got the treatment. Cardioversion - commonly called electric shocks.
[By cardioversion, I’m using a general term for restoring a heart to its correct rhythm. ]
“Get me the paddles!” I say, my voice rising.
The nurse shoves the paddles into my hands and sets the power to the appropriate level.
“Clear!” I yell, and place the paddles on the patient’s chest.
“STOP!” the nurse screams.
She grabs my hands and moves the paddles to a different spot on the patient’s chest.
One more second and I would have shocked his liver.
“Clear!” I yell again, and press the defibrillation button.
The patient jerks slightly and for an instant the heart monitor goes wild. Then it completely stops. We stand still, staring at the monitor for what seems like minutes, awaiting his new cardiac rhythm.
Beep… beep… beep.
I let out a breath of relief.
Within seconds, several residents enter the room and take over for me. I gladly step aside. I go back to my call room, both exhilarated that I’ve saved a patient’s life and freaking out that I nearly made a mistake would have cost it. I’ve learned my lesson. I pull out my heart book and study it cover-to-cover until dawn.
Everyone - even doctors, especially doctors - have to learn and train in order to become proficient. Interns start out as rookies, not seasoned veterans. Experience takes time.
So if you have to go to a hospital in July, treat the new interns with patience and respect.
Then check with your nurse to make sure they know what they’re doing.
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