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My First Cross-Cover Page As An Intern

I had a great conversation with one of the PACU nurses yesterday about the new crop of interns starting in July, and if/how it affects workflow and patient safety. I shared a story about my first cross-cover page as an intern. At the time, it was super stressful, but in hindsight, I find it hilarious. Thought I’d share it with you all. 馃榾聽

Call room
Call room

To briefly set the scene, I was cross-covering inpatients admitted to medical teams overnight. While reading UpToDate (like any good resident), I got my first of many pages that night.聽I felt a surge of adrenaline. Picking up my call-room phone with a slight tremor from a combination of anxiety, fear, excitement, and caffeine, I called the floor nurse back. I was about to be a real doctor… about to make important decisions… about to help someone in need!

Me: “Good evening, this is Rishi the cross-cover聽intern. How can I help?”
Nurse: “Hi doctor. No big deal. The primary team forgot to put PRN (as needed) orders for stool softeners on the patient in bed ***, can you please write something? He says he feels the pain he normally has with constipation.”
Me: “Sure, thanks for calling!”

And then it started. As a medical student, I聽could tell you everything about docusate, Miralax, and Senokot, but now I started to doubt myself. The internal struggle continued to grow. What if there’s a cross-reaction with聽one of their inpatient medications? What if they’re allergic? What if they get super dehydrated… and hypotensive… and then have a stroke or heart attack?聽What if I kill the patient with a stool softener?聽馃槸

I read more about stool softeners through various journals, commercial websites, forums, and UpToDate than – I – ever – imagined. 馃榾

I decided to call the floor nurse back and ask a very simple question:

Me: “What do you all typically give for PRN constipation?”
Nurse:聽“Oh, a dose of Miralax usually works. That’s what [the patient] takes anyways.”

Brilliant! 馃槢

So much of medicine聽hinges on a probability engine. We must be aware of all potential diagnoses, treatments, and consequences, but put things in perspective based on their likelihood in the clinical context.聽Fortunately (knock on wood), I’ve never heard of a stool softener killing anyone. 馃槅

Funny how experience can build confidence. Fast forward three years later, and now I’m making second-to-second decisions about what vasopressors I’ll administer, how I’ll adjust a balanced聽anesthetic, correct a coagulopathy, etc. Despite this,聽I’m still grounded聽by my humble聽beginnings as an intern. 馃檪


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  1. Our system works quite differently. My 1st shift as an intern, I remember being thrown with a friend of mine in an ED consultation room, that’s how ED are in our country anyway: Chaos redefined…. Trauma of all kinds, stroke, MI, acute HF, all sorts of abdominal pain good luck figuring out which one has peritonitis and which has a mild gastroenteritis and is overreacting….

  2. Hahaha this has to be the funniest post I’ve read in a while. “What if I kill the patient with a stool softener?” 馃槀 Good one Doc!


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