Saturday, September 28, 2013

Nearing the end of Nights

After a 13 day stretch of working 13+ hours per day, I noticed a couple of things:

- I get emotional
- If it's taking me too long to get a procedure complete, my frustration level is through the roof and I quickly convince myself that I am not as skillful as I should be by this point in my career. Even though I'm one of the very few interns who are certified (even several of my seniors aren't as qualified believe it or not), I am frustrated that I'm not as competent as my senior (who is renowned for his skill and ability to perform procedures on the most difficult patients). 
- My attention span is non-existent. 
- After so many hours and days of firing myself to do things I don't particularly care to do, I just can't force myself to do any studying or productive work. 
- I could destroy a full English breakfast. This hunger is ridiculous, I can't believe I haven't gained a ton over the past moth!
- I want to sleep but I have abandoned so many things in my real life that I don't want to waste more time with silly things like sleep. I mean, I have a house to clean, clothes to shop for, a wedding to prepare for, a house to decorate, and a husband to date! And I only have 36 hours before I'm back in work, so I have to use my time well.
- I'm too exhausted to drive home, so I waste time sitting in my car wishing I lived at the hospital (how pathetic is that!).
- I miss wearing clothes. Scrubs just aren't my style, man.
- I have a million thanks I want to tell my senior, but I can't muster up the brain power to make sentences without awkward silences, so the best I could come up with is a good handshake and a "thanks so much for everything". I hope it at least sounded sincere, since I know I wouldn't be half the intern I am today without this senior who has patiently taught me innumerable lessons over the two months we've worked together. 
- I seriously walked all the way out to my car with my night float phone in my pocket effort I realized "hey, I'm not working tonight, I think I need to put this back for my colleague to use tonight..."
- where is my brain? Living in such a fog. Maybe a few hours nap will do me good... :)

Thursday, September 26, 2013

Work, Sleep, Repeat.

Nights on night float is a lot of fun. I'm learning a lot in a short amount of time, I get to see many different patients and only have to manage acute problems and learn from their presentation and disease processes without worrying about completing notes or ensuring that everything I do is properly billable etc. for instance, I recently saw a patient with an acute crisis of scleroderma, with digital infarction. I had literally just studied the morning before, and the last question I answered was regarding initial treatment for acute scleroderma flair, and I had answered it incorrectly (I really had no idea what was the proper management). So when I received sign out of this patient, I was so pleased with myself because I knew how I would manage her overnight. It's one thing to handle the day to day things we see commonly; it's a whole different kind of satisfaction when you can manage a specialist's problem as a mere intern. And now ill never forget - acute digital infarction secondary to scleroderma requires prostacyclin to enhance vasodilation (as well as warm ambient environment and adequate pain control to prevent vasoconstriction). My co-intern was dead impressed with my knowledge - he thought I just knew that off the top of my head. The perks of forcing myself to study after working 13 hours - I look smarter! (Maybe it's because I am getting smarter, but I wouldn't go that far...!).

I love the team I am working with. I am now certified to independently place arterial lines, obtain ABGs, and place internal jugular central lines. That's not bad for only being an intern for less than 3 months. And I keep practicing to develop my skill - there's nothing as valuable as learning from proper experience. My senior is incredible. He's brilliant and he's a patient teacher, so I am really learning so much from him. My whole team is really top notch. I'm so lucky. When I'm working, I am so happy and I'm doing such amazing and rewarding things. But - this is how my life looks:
7:30am: Leave work.
8am: Arrive home, eat breakfast.
8:15am: Go to bed and sleep.
5:15pm: wake up and do something useful for 15 minutes (like clean the dishes or write an email or walk the dog or run a quick mile or two).
5:30pm: Shower and get ready for work.
6:15pm: Drive to work.
6:45pm: Work.
7:30am: Leave work.

Only having 15 minutes a day of "free time" is really starting to wear me down. The worst part is that I haven't spent time with my husband in what feels like a month (it's really only been 3 weeks). I miss my life. But I do still enjoy what I do - I just wish I did a little bit less of it.

Only 4 nights left. I'm actually kind of sad about it!

Monday, September 23, 2013

The Night Life

Well, the very day after I wrote my last post and mentioning that I had been aware and ready for patients to crash, a patient out-of-the-blue crashed on me. I frantically got a call from a nurse, telling me that this patient (who I hardly knew) just had a seizure. I didn't recollect her ever having a seizure in the past, so I immediately went to her room. As I was in the hallway, I heard "Code Blue" called over the intercom, and I immediate knew who this code blue was for - so I ran to the patient's room. I was (terrifyingly) the first physician there, and started running the code until my senior arrived. It was absolutely terrifying inside, but I handled it much better than I thought I would. I found myself calmly asking a few questions and calming ordering a few STAT medications and I saved her from asystole or an arrhythmia. I had never seen atropine given in this situation before, but it was miraculous. The patient went from crashing to improvement within seconds. It was truly amazing.

Aside from the long hours (minimum of 72 hours a week) and odd hours (it's hard to get anything in my life outside of the hospital done during my night shift work), I'm really enjoying night float. Seriously. I'm managing the sickest, most interesting patients in the hospital, and I fill in the gaps the day team leaves behind. I have time to study, which is great, and I am learning so much so quickly. I'm also now certified in arterial lines and internal jugular central lines (which means I can do them without supervision). I can't believe I've been able to do so many procedures in such a small amount of time, but I'm thankful for it. I think I'll be ready for my MICU rotation when that comes up later this year.

Today also happens to be the two-year anniversary of submitting the green card application. Which can only mean one thing - we get to start working on our renewal. Exciting times! (blah!). Only a few more years until the husband is a citizen and we can put all of this work (and money in fees) behind us.

Seven more nights on night float! We're nearly there!!!!!!

Friday, September 6, 2013

Nights on Nights

This month I am working as a night float, covering for the medicine services from 7p to 7a six days a week. It's so different to what a person typically does while on the floors; I don't have to write notes, I don't have a set of designated patients to see, I don't have to do physical exams, I don't diagnose, etc... Instead this is what I do:

1. Assess and treat pain. Like, all night. I find myself wondering how patients survive nights at home, where there isn't a quick access to narcotics to treat their pain. I'm so stringent on prescribing pain meds, so I actually go up and see each patient (as time permits) and then decide whether or not to give anything. I would hate to give a narcotic to a drug seeker as much as I would hate to leave someone in pain without any treatment. It's hard to distinguish that over the phone with a nurse, so I'm doing a bit of extra work running around and addressing pain issues like, all.night.

2. The two words that freak out most nurses: "chest pain". Again, I have to assess patients that complain of that and order a few tests to make sure that there's no myocardial ischemia going on. Things got a bit crazy a few nights ago when I had 5 calls from 5 different nurses for 5 different patients within 5 minutes of each other all complaining of chest pain. That's a bit stressful. Thankfully no one has had anything serious causing their chest pain yet.

3. Parts of the night are pretty (dare I say it) quiet, but its those moments when a patient is crashing that I am in the hospital for. And that's tough. I'm covering for all medicine services (all specialties at the moment, all general services for the end of the month), and my patient load is about 60-70 patients. I can no way know all of them inside-and-out, so when one patient is crashing suddenly, I'm going in pretty blind. That's terrifying. I spend the first parts of my evenings getting to know some of the patients I think may possibly crash, but there are always a few patients that just crash out of nowhere. Thankfully, the patients that have had serious problems overnight were patients I had spent time getting to know through their charts, but I am sure there will be a night or two this month when I am called to handle a serious situation without any significant knowledge of the patient's history. Talk about scary.

4. Going along with the "critical moments", I'd like to add that I am a person who likes to sit and think and not be rushed to make a quick decision. I like to weigh all of my options and choose the best one. In critical moments, there is no luxury of time, and a decision must be made quickly. It's not that I would choose the wrong choice in these circumstances, it's just that I could choose a better choice if given the time to get to understand the patient's history.

5. Procedures. I get to do procedures with the supervision of my senior. A few nights ago I placed my first internal jugular central line under ultrasound guidance (and I got it with my first try!). That's awesome, and such a celebration. But it is so frustrating when you try for a procedure and miss (like I have done with an arterial line this week). It's hard to hit a tiny artery with that needle! ;) I'll get it this week though, don't you worry.

6. All I do is work and sleep. Ok, and I've made time to write on my blog. And sometimes I find time to shower. And I have time to brush my teeth. But anything else - everything else - has been pushed to the side. There just isn't time for me to do the things I enjoy. Yesterday, I saw a few people outside running in the sunshine while I was driving on my way to work and I honestly started to tear up. I wish I had time for those things. But I just don't. I am so tired. I hate it when people use those excuses, and I really never have before, but I'm telling you this whole residency business doesn't leave any room for life. Just ask my husband, he'll tell you in a few more colorful words how he feels about it!

Off to work another 13 hour shift. Living the dream.

(this is day 14 in a row for me, and its my last shift before my day off on saturday. thank god!)

Thursday, September 5, 2013

A Month in the Inner City Hospital

Last month, I worked in an inner city hospital, blocks away from the city's homeless shelter and adjacent to the most crime filled neighborhood in the city. Needless to say, I saw some interesting cases...

A few take away points from this month:

1.) Never underestimate the power of a great social worker. I have so much respect for them. Some of the things they have to deal with and attempt to fix in a social complex is absolutely crazy. I don't know how they do it, but they can always seem to find a way to find cheap or free meds for patients without insurance or money; they find them assistance in other ways, such as transportation to and from appointments and free outreach programs and cheap to free therapy and home health services. I'm so thankful for them - just the thought of trying to solve these social issues makes me want to run far away from the hospital. Thank god for their patience.

2.) Always, always get a tox screen and alcohol level.

3.) DTs and other drug withdrawals are terrifying to witness. I would include in these patient's differential diagnosis "possession by evil spirits", they just go nuts. Really nuts.

4.) There are so many good-hearted people in the world who are in health care for the absolute right reasons. That is so refreshing to see.

5.) Your team can make-or-break the month. Having a strong senior resident makes life so much nicer for an intern. Having a really poor senior resident scares the life out of a brand new intern. For the entire first week, I had so much anxiety and worry over my care given to the patients, because I was fairly certain that my senior (and attending) wasn't even watching over me. For the first time in my life, the patients' lives were completely in my hands. It was terrifying. But I discovered that I can handle that, and that patients were getting better with my treatment plans, and I'm more capable than I thought I was at this point. Not bad for a one-month-old intern.

6.) Patients can refuse to take any responsibility for their health, and will return to the hospital and expect you to patch them back up before you send them home, only for them to return again in a few weeks' time with the same problems needing fixing. That can be such a frustration, especially when you take the time to ensure everything is set out as clearly and easily as possible for the patient and they still remain noncompliant. I have had so many noncompliant patients this month, it can really make you feel jaded and you lose a lot of your professional satisfaction.

All in all, it was a positive experience. The food at the cafeteria was nicer than I'm used to (that's a big deal when you eat in the hospital for breakfast, lunch, and dinner six days a week), and I'm definitely more confident of my abilities. I feel as though I'm more clearly making the transition from student to physician. But I sure am happy to be back at my hospital again!