'Baby Docs' begin a rite of passage Residency: About 23,000 medical school graduates arrived Monday at Hopkins, UM and other teaching hospitals across the country to start their grueling first year of training.

July 07, 1996|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

With stethoscopes slung around their necks and reference books bulging from their starched white coats, they gathered around a conference table at Johns Hopkins Hospital. Within an hour, these newly minted M.D.'s were to meet their first patients.

"The hard part is thinking only a month ago I was a medical student, and now, with no training in between, I'm supposed to be a doctor," said Dr. Ian Krop, 30. One of his cases was a woman his age who has sickle cell anemia. As she grimaced in agony, Krop leaned over her bedside, patting her leg as he tried to reassure her.

It was Monday, July 1, the day 23,000 medical school graduates arrived at Hopkins, the University of Maryland Medical Center and other teaching hospitals across the country to begin the most grueling, intense and, perhaps, most influential phase of their training: their residencies.

The revolution remaking the country's health care system has sent shock waves through residency programs, shifting some training to outpatient settings, creating more primary-care doctors, and reducing residents' hours and even the number of residents.

But in many ways the core remains untouched. A cen-tury-old tradition with roots in Baltimore, the medical residency molds the next generation of physicians. Enduring the first year, or internship, is a rite of passage.

Last week, Krop and his colleagues wrote their first orders. They took medical histories. They did physical exams. They found out how to order X-rays. And they all tried to suppress a gnawing fear that they might kill someone.

The novice doctors worry whether new marriages will survive the strain. They've done bulk shopping, storing frozen food and pasta to last the next several weeks.

Any errands or chores, from banking to fixing something in the house, had to be done by 8 a.m. Monday.

The practice of reporting at midnight has passed, and the -"Baby Docs," as they are sometimes called, are no longer required to wear short white coats, signifying their junior status. But many at Hopkins still do.

First-year residents work 80- to 100-hour weeks.

At Hopkins, interns might get one day off this month. They will have to make quick decisions about a patient's care at 4 a.m., after working as many as 16 hours the previous day. They will grasp the huge implications of social issues, such as loneliness among the elderly.

And they will confront death in many forms, from the potential of a needle prick that could transmit the AIDS virus to the care of someone who is dying.

The Hopkins interns met a 30-year-old man with metastatic brain cancer on their first rounds Monday. His new physician, Dr. Krystn Wagner, confidently shook his hand. They talked a little about the burning sensation he experienced when swallowing. Then Wagner and her colleagues filed out of the room.

Unlike their visits to other patients, this time, as the group walked down the hallway, there was silence.

Across town, another group of interns was experiencing similar feelings.

"You can read about it. You can hear about it. But when you actually have to be on the floor and deal with it, it's different. All of a sudden, it's a real human person in front of you," said Dr. Saidia Shillingford, 24, an intern at the University of Maryland Medical Center who was on call Monday night. She admitted four patients and had to handle problems overnight with several others.

Three hours' sleep

Tuesday morning, after three hours' sleep in a small room at the hospital, Shillingford presented a woman's case to her colleagues.

The senior physician, called the attending, Dr. Herbert Kushner, grilled her:

"How long did she have chest pain?"

"What did they do in the ER?"

"What about the swelling on the neck? Did you find anything?"

Shillingford, bags under her eyes, swallowed and looked down when asked if she had felt the neck.

"I didn't palpate."

Dr. Katherine A. Grundmann, 27, said it took her about two hours to draw blood from a man whose veins were particularly difficult -- only to discover she hadn't put his name on the vial. The lab at Maryland wouldn't accept an unlabeled specimen, and she had to go back to the patient.

The internal medicine residents at Maryland and Hopkins will rotate through several areas, including cardiology, oncology, intensive care and the emergency department. The interns do much of the day-to-day work, but they are backed up by second- and third-year residents. An attending physician, such as Kushner, supervises and instructs all of the residents.

For patients at teaching hospitals, that means a steady parade of physicians.

"Some of these patients have so many doctors they don't know '' what to do," said Sharon Carletti, a Hopkins nurse who has worked with residents for 17 years.

Many patients are discharged just before the July 1 start. That helps residents by reducing their caseloads and enabling them to follow patients from start to finish. Some chronically ill people said they know the routine and prefer to get out before the new physicians arrive.

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