Friday, July 26, 2013

My fourth glorious day off

Again, another amazing day. So many hours in the hospital and away from home make you love the time you get to sleep in your bed and hang out in your house even more. Today, I've been on a long walk with Mike & Marley, did 4 loads of laundry, made lunch, did some paperwork, sorted out the budget, and now I'm off to go for a long run in the sun before I go out for dinner with my husband and friends before returning for the last 5 days of the nephrology service.

This week has been so much nicer than the previous ones. The attending rounds quite fast, and I actually have time to see and think about my patients (since I'm only carrying about 6-8 per day instead of 10-12). This means that I've had time to catch a few extra things - like a DVT in one of my patient's upper extremity, investigate a new tremor, investigate a new-onset seizure, and even had time to sit and talk with my patients. I'm not just making sure they don't die, but am actually trying to improve their overall health as well now. I'm managing things better each day, and I'm getting more and more efficient with seeing patients and writing notes and discharges.

Oh and also something pretty significant for today - it's my very FIRST EVER paycheck as a DOCTOR. It felt good when I was awakened by a text alert saying that money has been deposited into my checking account! I almost forgot that I'm getting paid to do this! Not getting paid much, mind you. I'm salaried, but if I worked an hourly wage, I would be earning about $7.54 per hour (assuming a wage increase of time-and-a-half after 40 hours worked in each week). Wait, what's minimum wage again? Oh nevermind, I don't wanna think about it...! I'm just happy as can be to actually have an income from doing something that I love!

So - my first purchase with my paycheck is going to be a new pair of running shoes!!! If only I could pull myself away from my home and get out to shop for them... ;)

5 days left on the nephrology service and I'll be officially finished with my first month of residency!

Thursday, July 18, 2013

Weeks 2-3

After putting in a 68 hour week so far since Sunday, I'm sitting on my patio with a beer in hand reflecting on my life as it is now. I am quickly realizing that the next three years of my life are going to go by in a flash and I will miss out on a million things in my personal life. It's already July 18. I haven't seen my family in weeks. I haven't spent more than 5 minutes with my husband since my last day off, and my work doesn't end when I leave the hospital. I haven't found time to study, all I can do is manage patients and learn by doing. 

I've gotten into a routine for seeing a large number of patients in a short period of time and still giving good care. I start my notes the night before with my plan for the following day. I get into work, put in the vitals and labs for all of my patients, then quickly stop by each room to examine the patient and put my note in the chart. Today I saw 10 patients in 3 hours, and even managed to try my hand at an ABG, diagnose and manage an acute infection, and manage uncontrolled blood pressures during that time. Then I round with the attending for the day and answer loads of pages and phone calls while seeing the patients with the attending and putting in new orders and discharges. It gets a bit crazy and hectic and overwhelming when five people are asking you to do ten different things all at once, but I'm managing. My days are long, longer than I had thought they would be, but I keep a smile on my face the entire time im at work. I do love what I do.

In the past two days, I have seen a few narcotic seekers, and I've denied them meds. It's so much easier to just fill out a script and give the patient what they demand than it is to sit there and talk about why im concerned about prescribing a certain med, but I stand by my principles and look out for my patients'best interests and I've not given in to likely unnecessary narcotics yet.

I'm getting a little annoyed that some nurses treat me with little respect but turn around and flirt with my male colleagues. Not sure if its a jealousy thing or an insecurity or what, but I wish they would be as kind and respectful to me as I try to be to them. Suppose i need to prove myself to them?

My cointerns are amazing. I can't believe how smart they both are and how dedicated, compassionate, and knowledgeable they are. I'm lucky to be with them for my first rotation! 

Tomorrow is my day off! I am so happy I could cry (or I'm so exhausted I could just pass out). 

Sunday, July 7, 2013

S/P First Week of Intern Year

This week has flown by. Seriously. I had one amazing day off (July 4th) that I spent being kind of lazy actually. The rest were spent working my little butt off!

This week has been hectic. I've been carrying 9-12 patients on a daily basis, and our attending rounds began at 8:30 each morning. That means that my 9-12 patients must be seen prior to that, with notes complete, which also means I've been getting up way too freakin' early, man. In by 6, out by 7 most days. Yesterday, I took my first call, and I had the nephrology service's physician phone to address any of our 30+ patients' concerns all day, plus I had my own couple of discharges to do so I was quite busy. The first call I received made my heart skip a beat, but I've been handling the problems fairly well (with help when needed).

I feel like I'm not learning anything because I haven't had the energy to sit and read after work, so I haven't been classically "studying". My senior consoled me by reminding me that I'm passively learning how to care for quite sick nephrology patients by addressing their concerns on a daily basis. I suppose he's right. After one week, I definitely feel like I'm much more competent. There are millions of things I don't know (especially the advanced, more rarely seen stuff), but I'm picking it up. I'm already a lot smarter than I was one week ago...

I really enjoy spending time with my patients each day and being able to advise them on how to manage their chronic illnesses. It is so fulfilling to discharge a patient, happier and healthier than when they arrived!

The attending I've had this week is going off service and I'll be working with someone new tomorrow. I was happily surprised to have been thanked for such a great week and for managing such a large patient-load so effectively, efficiently, and without complications. And he said it with a smile. I'm pretty happy that all of the running around trying to keep from drowning in work has been worthwhile.

Week 1 and nobody died. I'd say we're off to a great start! ;)

Week 2 begins tomorrow with a new attending and our first batch of med students. I'm so excited to teach young, eager, brilliant minds!

Thursday, July 4, 2013

The First Three Days

I've survived the first three days of residency - and, what is more important, so have all of my patients!

It's been crazy.

Day 1: Began with a largely oversized long white coat and introductions to the faculty and staff of the internal medicine department ("Hello, I'm a categorical medicine resident that looks ridiculously out of place in this ginormous white coat"). From there, I had my first clinic day in the morning, so I went to the office and met three new patients over the course of 2 hours. It wouldn't have been that bad had I known how to use the electronic medical records for outpatient services...(fingers crossed, all of the meds I ordered actually went through to the pharmacies intended...). I was given my pager at lunch (officially feeling like an intern). At noon, I had my first lecture before hitting the floors to finish rounding on our 40 patients on the nephrology service. Thankfully, my senior saw and evaluated my patients while I was in clinic (this will never happen again, so every Monday will begin by 5:30am for me!), so I didn't have as many responsibilities in terms of discharges or writing orders. But we did have about 10 new admissions, which kept me and my co-interns barely breathing. The day finally ended after rounds were complete at 6pm and we handed off our patients to the night service at 8. Day 1: 14 hours. About what I had expected.

Day 2: I saw my 9 patients for the first time, wrote notes, and placed a few orders all before 9am. Hectic to say the least. We rounded with our attending until noon, went to lecture, finished rounding by 2 then set off to work on discharges/new admissions/updating patient lists/filling in what we didn't have time to do in the morning. Surprisingly, I was out of the hospital by 6. As I was walking to my car at the end of the day, I thought to myself, "Am I really getting paid to do this?!" The conversion from student to doctor isn't so drastic, aside from being held accountable for the patient. But the work I'm doing mirrors what life was like as a student (except now I'm the one writing the orders). I love this job! Day 2: 12 hours. I'll take that.

Day 3: I was doing so well, seeing all of my patients quickly and feeling a little bit more confident when I realized I had to see 3 new patients along with my list of 8 before rounds started at 9. And it's always during those times that patients decide to talk with you about feeling depressed or making long conversation - not great timing. I did what I could and made my way to rounds at 9:30 (with all patients seen). Definitely feeling more competent and like I can almost handle life as an intern. Finished rounding at noon, went to lecture, then worked on completing some medicaid forms for a patient ("wait, am I really allowed to write on this legal form? Oh, I guess I am a physician now...") and put together discharge orders for patients who are likely to go home on July 4th. We finally had most things finished by 6, when my co-interns and senior resident went home while I stayed behind to take short call. Short call means that from 5-7, an intern takes the service's main phone and handles all patient problems. My heart skipped a beat every time the phone rang (I was praying that no patients would crash on me!), but it turned out to be easier than I thought to answer questions and make clinical decisions on our patients all on my own. Of course if I had questions, I could contact my senior on-call (or my nephro fellow), but I handled it. Day 3: 13 hours.

   -   July 3rd was the fifth year anniversary of meeting my husband, so we went out for dinner and celebrated with one of our left-over bottles of champagne. I fell asleep (passed out from sheer exhaustion) in a chair at 10:30, with a glass of champagne in my hand (which spilled all over my new dress). Life of a physician, eh?

By the third day, I felt like a real intern. There hasn't been any time to read or study, we're just trying our best to keep our heads above water and to keep our patients alive. I'm hoping the service slows down a little so I can actually find some time to study, but I don't think that's going to happen any time soon.

Today's my first day off, and it's already been amazing. I got 10 hours of sleep last night and feel like a new woman! I'm finally going to go for a run (haven't been out since work started July 1st), and we're going to a friend's house for a huge July 4th party later this afternoon. It's nice to be outside of the hospital with regular, healthy people!

3 days down, 362 to go!