This month, I am working in the emergency department. Most of us see this rotation as a sort of vacation - we only work 15 11-hour shifts in a month, plus our clinic days and didactics...which, for me, means I'll average about 55-60 hour work weeks (compared to my usual 70 hour work weeks). Those extra 10-15 hours off can make a huge difference!
The only downside of the emergency medicine month is that you're working in emergency medicine. While means in reality, I've seen about 10 cases of viral gastroenteritis, a few mild influenza, several people who fell on the ice and bruised their knee/wrist/back, and the random toothache and STD check. In short, not exactly anything I would label an emergency. In fact, I would be surprised to see most of these patients make a visit in to my clinic with these complaints - these are such mundane problems that they in all likelihood wouldn't even see their PCP for these problems. But they show up in the ED. It's so bizarre. I'd much prefer them to be in a clinic with their PCP, not only because of continuity of care and appropriate use of resources and savings of our healthcare dollars, but also because it would actually suit the patients best. The treatments I can give in the ED are vastly different than what I can do in the clinic, such as looking for underlying cause of problem and being able to treat that rather than just stick a bandaid over the wound, so to speak. It's hard to find much job satisfaction in this environment.
Only 3 days into this rotation and I'm already jaded. Despite being a "Vacation Month", I can't wait to be back on the floors and doing what I love again.
Thursday, February 6, 2014
Monday, January 20, 2014
Pulm/CC
This month I'm on the pulmonary service. The patients on this service are mostly consisting of people who were recently in the MICU, so we do have quite a few sick patients that are making their transition from MICU to hospital to LTAC/SNF/ECF/Home. Most of the patients have several chronic illnesses which are near the end-stage. I've sent several patients from the hospital to hospice, and I've sent several from the hospital to LTAC, and a few to home after hospital. One thing I'm learning from this service is the importance of good social workers (I don't know how they do it, honestly...finding a place and dealing with insurance and contacting a million people for a seemingly simple task...). I've also had a fair amount of frustration from the insurance companies.
I have a patient now who was recently shifted out of the MICU after having seizures. He's otherwise relatively healthy, but after an extended stay in the hospital, has lost quite a bit of muscle use. He needs to go to rehab. So I ask the physical therapists to see him, but its a weekend and they're short staffed- it will have to wait until Monday for a full assessment. Until I have that assessment, the social worker can't begin the search for placement upon discharge, as we need PT recommendations for subacute rehab versus acute rehab versus outpatient rehab. Once that's completed by the PT and the social worker submits information to the patient's insurance company. Again, they aren't open on holidays or weekends, so it has to wait. Once the insurance company gets the information, it can take several days for them to make a decision as to whether or not they would pay for the placement. In the meantime, they need daily updated notes and progress notes submitted to them. And before you know it, someone who was ready for discharge ends up sitting in the hospital with no reason for a week. Being someone who hates to waste healthcare dollars, this makes me so upset. Not to mention the fact that NO ONE likes to be in the hospital (and if they do, they must really hate where they live or are malingering or something). I get so frustrated.
Another patient I had came in with a hip fracture. She was completely independent at home prior to her fall, and in unbelievably good health for her age. Unfortunately, she had a complicated hospital course and suffered irreversible anoxic brain injury. For several weeks, the family insisted upon "doing everything in our power" to make things better, which we did. Everything was looking great, but when it came time for discharge, we ran into another hold up. Insurance issues. The patient was improving every day, but this patient ended up staying in hospital for an extra 8 days waiting for approval. While waiting to get out of the hospital for some rehab, she continued to lose muscle strength and ended up getting a mucous plug in her mainstem bronchus which completely made an entire lung nonfunctional. It's easy enough to remove - just a quick bronchoscopy (percussion and drainage was not working) - but it was at this point when the family decided that enough had been done, and it was time to shift our focus from aggressive treatment to comfort care. I'm having troubles coming to terms with this - there was at least a small chance that she could have make a good recovery with intensive physical therapy, but instead we elected to keep her comfortable, which will likely lead to a pneumonia, sepsis, and eventual death. I can understand comfort care with cancer, end stage liver or heart disease...but from weakness? I just can't wrap my head around it...but pneumonia is a leading cause of death in the elderly, and I am sure this is a large reason as to why. I suppose if we did the bronch and removed the plug, it would only happen again and again...which it did during the hospital course...so in a way, why prolong the suffering? It's just hard, my most difficult ethical dilemma of intern year. It just seems so treatable...but the underlying problem could really never be fixed. When I shared this information with the MICU team who cared for her, they were devastated. We all knew that the underlying problem would never be fixed (not likely anyway), but it's still so difficult to see someone we've invested so much of ourselves in to do so poorly.
People constantly tell me how sad oncology is, but I'd take it any day in place of this!
Anyway...I'm officially halfway through intern year! :) :) :) :)
I have a patient now who was recently shifted out of the MICU after having seizures. He's otherwise relatively healthy, but after an extended stay in the hospital, has lost quite a bit of muscle use. He needs to go to rehab. So I ask the physical therapists to see him, but its a weekend and they're short staffed- it will have to wait until Monday for a full assessment. Until I have that assessment, the social worker can't begin the search for placement upon discharge, as we need PT recommendations for subacute rehab versus acute rehab versus outpatient rehab. Once that's completed by the PT and the social worker submits information to the patient's insurance company. Again, they aren't open on holidays or weekends, so it has to wait. Once the insurance company gets the information, it can take several days for them to make a decision as to whether or not they would pay for the placement. In the meantime, they need daily updated notes and progress notes submitted to them. And before you know it, someone who was ready for discharge ends up sitting in the hospital with no reason for a week. Being someone who hates to waste healthcare dollars, this makes me so upset. Not to mention the fact that NO ONE likes to be in the hospital (and if they do, they must really hate where they live or are malingering or something). I get so frustrated.
Another patient I had came in with a hip fracture. She was completely independent at home prior to her fall, and in unbelievably good health for her age. Unfortunately, she had a complicated hospital course and suffered irreversible anoxic brain injury. For several weeks, the family insisted upon "doing everything in our power" to make things better, which we did. Everything was looking great, but when it came time for discharge, we ran into another hold up. Insurance issues. The patient was improving every day, but this patient ended up staying in hospital for an extra 8 days waiting for approval. While waiting to get out of the hospital for some rehab, she continued to lose muscle strength and ended up getting a mucous plug in her mainstem bronchus which completely made an entire lung nonfunctional. It's easy enough to remove - just a quick bronchoscopy (percussion and drainage was not working) - but it was at this point when the family decided that enough had been done, and it was time to shift our focus from aggressive treatment to comfort care. I'm having troubles coming to terms with this - there was at least a small chance that she could have make a good recovery with intensive physical therapy, but instead we elected to keep her comfortable, which will likely lead to a pneumonia, sepsis, and eventual death. I can understand comfort care with cancer, end stage liver or heart disease...but from weakness? I just can't wrap my head around it...but pneumonia is a leading cause of death in the elderly, and I am sure this is a large reason as to why. I suppose if we did the bronch and removed the plug, it would only happen again and again...which it did during the hospital course...so in a way, why prolong the suffering? It's just hard, my most difficult ethical dilemma of intern year. It just seems so treatable...but the underlying problem could really never be fixed. When I shared this information with the MICU team who cared for her, they were devastated. We all knew that the underlying problem would never be fixed (not likely anyway), but it's still so difficult to see someone we've invested so much of ourselves in to do so poorly.
People constantly tell me how sad oncology is, but I'd take it any day in place of this!
Anyway...I'm officially halfway through intern year! :) :) :) :)
Saturday, January 11, 2014
Secret Day Off
Shhhh...!!! Keep it quiet, let me tell you a secret...I have an extra day off this month! Sort of. Because our patient census is reasonable and I worked an extra 6 days, my senior gave me an extra and unexpected day off today. I had no idea what to do all day, so I just kind of watched the day go by. I just got all of my errands done on Wednesday, so I didn't even have laundry to do today. I have no idea what I like to do outside of medicine (aside from running - which I did do today), so I was like a lost kid all day. ("Do I cook? I think I remember that I used to enjoy making things to eat... Should I organize some things? Maybe I'll do my taxes..." )
Something new from this week is that our students have come back on service. I enjoy teaching students, and I have a really interesting patient right now with a disease we don't see often (it's my first time seeing it as well). So when I discovered that one of the students was also going to be seeing that patient, I got excited and started asking him all sorts of questions, trying to help him learn about this interesting case. Instead of seeing an enthusiastic and interested student, I got basically silence and disinterest from him. Imagine someone being dead excited about something they've never experienced before trying to spread that enthusiasm to a wall. That's basically what was happening.
...I guess not everyone gets excited about medicine...I think this guy will find he fits right in with psychiatry, all he is interested in is stories the patients tell. Gosh, I mean, what's wrong with people?! MEDICINE IS AMAZING. duh.
I've had two separate occasions this week of nurses doing their best to report me. First one was a nurse (who I thought liked me!?) who shouted at me for not wearing a gown in a room with influenza. I had to calm her down and remind her that flu is only droplet precautions and that I did have a mask on within 3 feet of the patient. I couldn't believe it; me, who follows every rule all the time and never EVER does anything half assed. Then another nurse gave me trouble for ordering an immunosuppressant for a patient who has been on this medication for YEARS. The only reason I was dosing it myself rather than putting in a standing order was because the nurses kept giving the medication 3 times more frequently than I had ordered, causing the patient to have some undesirable side effects. Rather than slapping that info in her face, I just said to her that the patient has been taking it for a very long time and I'm giving this medication to her just as it has always been prescribed to her, and I had even double checked the dosing with her primary doctor to be sure that we were doing things correctly as well as monitoring her levels of the drug. Seriously. Get off my back!haha But it's kind of nice that they actually communicate these things with me; early in the year, nurses are a female interns worst enemy and it takes a long time for them to even acknowledge your existence. So I suppose this is a step up!
But, on a much brighter note, two NICE things also happened this week...I received a phone call from a nurse asking me to address an issue she had with medications for a patient, which she had been calling about to the other doctors for the previous two days. I was the first one to tell her why we hadn't made the changes she suggested, and she thanked me up and down (and without even mentioning my name, she knew who I was). She was happy to talk to me. I love when we can all work so well together in a team. Seriously love that. The other thing that made me blush happened during rounds. During my pre-rounds, I had spent quite some time with a patient explaining his diagnoses and our treatment plan and what our goals realistically are, etc...so when we went to round with my attending, who also is my program director, he was explaining these same things to the patient. The patient interrupted him and said "yes, I'm aware of all of this. The doctor standing beside you already told me everything you're telling me. You've got a great doctor there" and my program director just smiled, said "I know she is", and shook his hand and walked out of the room. I felt so competent, so much job satisfaction! It's nice to see the extra things I do don't always go unnoticed.
Something new from this week is that our students have come back on service. I enjoy teaching students, and I have a really interesting patient right now with a disease we don't see often (it's my first time seeing it as well). So when I discovered that one of the students was also going to be seeing that patient, I got excited and started asking him all sorts of questions, trying to help him learn about this interesting case. Instead of seeing an enthusiastic and interested student, I got basically silence and disinterest from him. Imagine someone being dead excited about something they've never experienced before trying to spread that enthusiasm to a wall. That's basically what was happening.
...I guess not everyone gets excited about medicine...I think this guy will find he fits right in with psychiatry, all he is interested in is stories the patients tell. Gosh, I mean, what's wrong with people?! MEDICINE IS AMAZING. duh.
I've had two separate occasions this week of nurses doing their best to report me. First one was a nurse (who I thought liked me!?) who shouted at me for not wearing a gown in a room with influenza. I had to calm her down and remind her that flu is only droplet precautions and that I did have a mask on within 3 feet of the patient. I couldn't believe it; me, who follows every rule all the time and never EVER does anything half assed. Then another nurse gave me trouble for ordering an immunosuppressant for a patient who has been on this medication for YEARS. The only reason I was dosing it myself rather than putting in a standing order was because the nurses kept giving the medication 3 times more frequently than I had ordered, causing the patient to have some undesirable side effects. Rather than slapping that info in her face, I just said to her that the patient has been taking it for a very long time and I'm giving this medication to her just as it has always been prescribed to her, and I had even double checked the dosing with her primary doctor to be sure that we were doing things correctly as well as monitoring her levels of the drug. Seriously. Get off my back!haha But it's kind of nice that they actually communicate these things with me; early in the year, nurses are a female interns worst enemy and it takes a long time for them to even acknowledge your existence. So I suppose this is a step up!
But, on a much brighter note, two NICE things also happened this week...I received a phone call from a nurse asking me to address an issue she had with medications for a patient, which she had been calling about to the other doctors for the previous two days. I was the first one to tell her why we hadn't made the changes she suggested, and she thanked me up and down (and without even mentioning my name, she knew who I was). She was happy to talk to me. I love when we can all work so well together in a team. Seriously love that. The other thing that made me blush happened during rounds. During my pre-rounds, I had spent quite some time with a patient explaining his diagnoses and our treatment plan and what our goals realistically are, etc...so when we went to round with my attending, who also is my program director, he was explaining these same things to the patient. The patient interrupted him and said "yes, I'm aware of all of this. The doctor standing beside you already told me everything you're telling me. You've got a great doctor there" and my program director just smiled, said "I know she is", and shook his hand and walked out of the room. I felt so competent, so much job satisfaction! It's nice to see the extra things I do don't always go unnoticed.
Wednesday, January 8, 2014
Happy New Year
Happy new year!
Coming back to work after a short holiday break, I knew I'd be a little less enthusiastic about work than usual. We were working half-staffed, and unlucky for me, my co-intern's flight was delayed a few days. I was doing the work of three interns, and I was also unfortunate enough to have a long winded attending on service. That meant rounds took even longer than normal. After three 15 hour stressful and busy days, it was new years eve. All I could think about that late afternoon was how I could leave the hospital once my work was done, but knowing it wouldn't be any earlier than usual (and likely later than necessary thanks to my attending). I was a little bitter; after all, so many of my friends had the night off to enjoy with their friends while I was stuck working even harder than usual on a service I don't particularly care for. As I grumbled to myself about the new year and how it will undoubtedly repeatedly reflect the same scenario I was in that night, it suddenly dawned on me: some of the patients I was caring for in the hospital are seeing their last new years eve...and they are stuck in a noisy and uncomfortable hospital room to celebrate. I realized that this life I live now is only temporary, and things will get better. I won't be spending every new years eve in hospital. But for the time being, I am privileged to be a part of so many peoples new years eve as they regain their health. I'm the lucky one.
Hoping to keep this positive mentality through the year. I am so fortunate to be in a profession that gives so much satisfaction and allows me to have a real impact on other peoples lives.
Best wishes to all of you for a happy and healthy new year.
Friday, December 27, 2013
A taste of real life
For the Christmas holidays my residency program has a great tradition of allowing all of the residents to take 5 days off for holidays during either the Christmas or new year.while this is amazing to have time off , going back to work is no joke. We work at half staff to make up fr those on break , which is basically twice the work we already do on a daily basis. Today, tho was a common day when all residents work, twice the workers means half the work. I expected an easy day ahead of what will undoubtedly be a rough next 5 days. 14 hours later I realized I was so wrong! The next five days are bound to be considerably worse...
The break was amazing though. It was a glimpse into what real life looks like for most normal people. I had clean clothes and clean house and spent time with my husband and family. I even went shopping twice! I made the mistake of even saying that I actually felt ready to go back to work like I had missed it. Then in a twisted sense of fate, my first day back was unexpectedly long and difficult, as if life was trying to remind me that I can't actually enjoy my own life while helping others lives improve.
Back to the 14 hour days and never doing anything I enjoy outside of medicine. Cheers to intern year!
Monday, December 2, 2013
General Medicine
Woah, where did November go?! Suddenly its December. What happened?!
November was a month filled with general medicine, and December is pretty much the same. I've seen some interesting cases.
Currently on my service are several metastatic colon cancer patients, a few of which we just diagnosed. It can be really frustrating for results to finalize during the holidays; the hospital runs at a bare minimum, only patients with urgent/emergent needs are given priority. So I've been waiting for some results to come up for my patients for a super long time over Thanksgiving. I myself feel anxious about it, even though I am fairly certain of what the results are going to show. I can't imagine how anxious my patients must feel.
Today I sat down and gave the "bad news" talk with a patient and her family. I think most people are in tune with physicians and our work up that they expect the news when they hear it, at least to a small extent. This is especially true if the physicians take time to explain why we are ordering each test we order. For example, if a patient's hemoglobin is low and they are found to be iron deficient and have blood in their stool, we have a high suspician for colon cancer...so we consult GI and get an endoscopy. The patients are aware of why we are doing these things - to rule out colon cancer - so the idea that the diagnosis of cancer is a possibility is there from the start. This makes things a little less unexpected when the report comes back as a mass and biopsy results are pending. Not that it makes hearing that diagnosis any easier, but at least it allows a bit of mental preparation for the patients. Nothing is worse than explaining a poor diagnosis on someone who is completely not suspecting it. That's how I feel anyway...which is probably why I hate strokes and heart attacks and car accidents so much - there's simply no way to prepare for it. We all know we have a chance of those things happening, but no one actually believes it will happen to them. And it is so tragic when it does. But at least for these things, like working up a mass, the patient has time to think about the potential diagnoses and isn't as shocked by the results.
I'm starting to get used to being a doctor. I properly feel like I'm a physician. Once in a while, I am surprised by how quickly I can answer questions or how much I actually know. Believe me, this isn't knowledge that I'm gaining by studying and reading; this is the knowledge and experience I'm getting from working all day every day for the past 5 months. As much as the time commitment can be a drag, there really is no way around it if you want to make good physicians. We've got to be there to experience it all before we're given our wings and allowed to practice medicine without any sort of supervision!
Wednesday is the day when the third year medicine residents will find out if an where they matched into fellowship programs. What an exciting day! Two years from now that will be me...waiting to find out if I matched into an oncology program and where I will spend the next 2-3 years of my continued training...Absolutely crazy to think that will be me in 2 years! I have so much research to do and things to learn before then!! ;)
Still loving my life's calling. Even happier this month because I know I get 5 FULL DAYS OFF for the holidays!!!!!!!!
November was a month filled with general medicine, and December is pretty much the same. I've seen some interesting cases.
Currently on my service are several metastatic colon cancer patients, a few of which we just diagnosed. It can be really frustrating for results to finalize during the holidays; the hospital runs at a bare minimum, only patients with urgent/emergent needs are given priority. So I've been waiting for some results to come up for my patients for a super long time over Thanksgiving. I myself feel anxious about it, even though I am fairly certain of what the results are going to show. I can't imagine how anxious my patients must feel.
Today I sat down and gave the "bad news" talk with a patient and her family. I think most people are in tune with physicians and our work up that they expect the news when they hear it, at least to a small extent. This is especially true if the physicians take time to explain why we are ordering each test we order. For example, if a patient's hemoglobin is low and they are found to be iron deficient and have blood in their stool, we have a high suspician for colon cancer...so we consult GI and get an endoscopy. The patients are aware of why we are doing these things - to rule out colon cancer - so the idea that the diagnosis of cancer is a possibility is there from the start. This makes things a little less unexpected when the report comes back as a mass and biopsy results are pending. Not that it makes hearing that diagnosis any easier, but at least it allows a bit of mental preparation for the patients. Nothing is worse than explaining a poor diagnosis on someone who is completely not suspecting it. That's how I feel anyway...which is probably why I hate strokes and heart attacks and car accidents so much - there's simply no way to prepare for it. We all know we have a chance of those things happening, but no one actually believes it will happen to them. And it is so tragic when it does. But at least for these things, like working up a mass, the patient has time to think about the potential diagnoses and isn't as shocked by the results.
I'm starting to get used to being a doctor. I properly feel like I'm a physician. Once in a while, I am surprised by how quickly I can answer questions or how much I actually know. Believe me, this isn't knowledge that I'm gaining by studying and reading; this is the knowledge and experience I'm getting from working all day every day for the past 5 months. As much as the time commitment can be a drag, there really is no way around it if you want to make good physicians. We've got to be there to experience it all before we're given our wings and allowed to practice medicine without any sort of supervision!
Wednesday is the day when the third year medicine residents will find out if an where they matched into fellowship programs. What an exciting day! Two years from now that will be me...waiting to find out if I matched into an oncology program and where I will spend the next 2-3 years of my continued training...Absolutely crazy to think that will be me in 2 years! I have so much research to do and things to learn before then!! ;)
Still loving my life's calling. Even happier this month because I know I get 5 FULL DAYS OFF for the holidays!!!!!!!!
Wednesday, October 30, 2013
One Night Back on Nights
Time has been just flying by, as always. Suddenly, its the end of October and I'm nearing the start of another rotation. Sadly, I am finishing my time on oncology. It has been an interesting month, and I've seen some very interesting cases and, being the only resident on a busy service, I have been busting my butt trying to do well and shine this month (since it is what I want to do with my life, after all). It's been really great, I'll share more in a later post, but I've had such a great month!!
Tonight I have one pick-up shift as night float. Since I had to find a colleague to cover me while I was away for a wedding, I'm paying him back by working for him tonight. It's not all bad; because of the duty hour restrictions (thank you once again ACGME), I can't work both days AND nights, so I had this morning off from work. And it has been truly unbelievable. The weather was uncharacteristically warm and sunny, with a nice little breeze. I got to spend some time with my husband (that doesn't happen often, let me telll you), and we even went on a *very tiny* 3 mile run together this morning. I needed a half day off, I really did. I'm feeling so much better about being a doctor - I was starting to burn out after only having 3 days off this month (all of which were spent busy at a wedding, which was great but I need one day to just catch up on life you know!). The downside for tonight - the other intern scheduled to work asked me to cover for him as well. So it's just me, watching over the entire hospital. Please, I know that most of my shift will be during Halloween, please please no one crash on me. A nice quiet night is all I am asking for! ;)
Now that I've officially jinxed myself, I best be on my way! Caffeine is a necessity tonight for this 18 hour shift!
Tonight I have one pick-up shift as night float. Since I had to find a colleague to cover me while I was away for a wedding, I'm paying him back by working for him tonight. It's not all bad; because of the duty hour restrictions (thank you once again ACGME), I can't work both days AND nights, so I had this morning off from work. And it has been truly unbelievable. The weather was uncharacteristically warm and sunny, with a nice little breeze. I got to spend some time with my husband (that doesn't happen often, let me telll you), and we even went on a *very tiny* 3 mile run together this morning. I needed a half day off, I really did. I'm feeling so much better about being a doctor - I was starting to burn out after only having 3 days off this month (all of which were spent busy at a wedding, which was great but I need one day to just catch up on life you know!). The downside for tonight - the other intern scheduled to work asked me to cover for him as well. So it's just me, watching over the entire hospital. Please, I know that most of my shift will be during Halloween, please please no one crash on me. A nice quiet night is all I am asking for! ;)
Now that I've officially jinxed myself, I best be on my way! Caffeine is a necessity tonight for this 18 hour shift!
Wednesday, October 9, 2013
Night Float: Recap
After 30 days of living the night life, it feels better than I can say to be among the living again. I feel like September was all just a big dark hole in my life, where I spent it working and getting behind on everything else. For example, just yesterday I was beyond thrilled to have done my first load of laundry in over a month. Of course that means I actually did about 5 loads of laundry in one evening, but it felt amazing to finally have matching clean socks again! And I spent the remainder of the day (after only working 8 hours) on Sunday tidying the house - it hadn't been swept or the floors cleaned since the middle of August. I can't even tell you how good that makes me feel to have a clean house to come home to. I also (please share in my joy with this one) washed my bedsheets last night and slept in a clean room with clean sheets with a clean puppy. Someone might as well have told me I won the lottery, I was so happy! The only downside of all of this is that I do have another night shift this weekend - but it's only one night (and dang it I will sleep part of that night! -please patients don't crash on me).
Just a few generalizations about my experiences on night shift - when you work nights, you never, ever feel good. You always feel tired, like you need to go to bed, or like you just got up from an ill-timed nap, or like you desperately need a nap regardless of the timing. You also feel so disconnected from society – just as people are going to work, you are headed to bed, and just as the kids are getting home from school, you’re trying to wake up again and get ready for another workday. You almost lose touch with reality, because all you know is hospital work and answering urgent patient problems quickly for the entire month (and praying that no one crashes while they're in your care).
Six nights in a row every week for a month can be difficult. On the one day off, all you do is sleep all day (and try to sleep all night). By the second week, I started to lose perspective. I left home with my husband no where to be seen (he works afternoon/evenings), unhappy about never seeing any one, ever. I started to get teary-eyed when I saw other people enjoying life, when I saw other people happy doing things they love, then I started to get mad about it - why should they be out enjoying life? what are they doing that's so important that they deserve to be happy while I'm stuck working every night and dealing with sick people all the time? I started to get annoyed with everything - residents leaving bits of work behind for me to finish every night, patients not receiving adequate pain control all day leaving me to deal with it all night, colleagues that don't communicate well enough with patients throughout the day and leave me to explain their diagnosis and treamtent plans to the patient and their families at night, annoyed at families for visiting after hours and demanding to speak with a physician, patients for having chest pain, patients for dropping blood pressure or spiking a fever (causing me more work), etc etc etc. I know that those things are clear signs of burnout (and are harmful to patient care), so I did my best to acknowledge these frustrations and shortcomings and to overcome them. But as the nights dragged on, it became more difficult to do So by the time you get a day off, you don't want to do anything because youve been forcing yourself to do things you really don't want to do all week long (and will have to do it all week long all over again). It is just so draining. And the responsibilities are huge - if you stop and think about it, I'm the one watching over half of the hospital. Sure, I have backup and seniors I can call, but if things get busy I'll be the one running the show if things start to go downhill. Its a stressful thing hanging over your head all night, which is why I could never sleep at night even when I had time to. I was terrified I would wake up to a code and be so foggy in sleep mode that I wouldn't run it well. So I'd sit at my desk all night, waiting for any important calls. There are some long nights at the edge of your seat.
All in all, it was a fantastic experience. I worked with a phenomenal team, and I got to do so many procedures and I've learned an incredible amount, as well as pumped up my confidence to a totally different level. This is just one way to show that medicine isn't merely about knowledge and compassion, it's about how you can handle the insurmountable pressures and stresses that physicians are faced with everyday without losing your mind.
Just a few generalizations about my experiences on night shift - when you work nights, you never, ever feel good. You always feel tired, like you need to go to bed, or like you just got up from an ill-timed nap, or like you desperately need a nap regardless of the timing. You also feel so disconnected from society – just as people are going to work, you are headed to bed, and just as the kids are getting home from school, you’re trying to wake up again and get ready for another workday. You almost lose touch with reality, because all you know is hospital work and answering urgent patient problems quickly for the entire month (and praying that no one crashes while they're in your care).
Six nights in a row every week for a month can be difficult. On the one day off, all you do is sleep all day (and try to sleep all night). By the second week, I started to lose perspective. I left home with my husband no where to be seen (he works afternoon/evenings), unhappy about never seeing any one, ever. I started to get teary-eyed when I saw other people enjoying life, when I saw other people happy doing things they love, then I started to get mad about it - why should they be out enjoying life? what are they doing that's so important that they deserve to be happy while I'm stuck working every night and dealing with sick people all the time? I started to get annoyed with everything - residents leaving bits of work behind for me to finish every night, patients not receiving adequate pain control all day leaving me to deal with it all night, colleagues that don't communicate well enough with patients throughout the day and leave me to explain their diagnosis and treamtent plans to the patient and their families at night, annoyed at families for visiting after hours and demanding to speak with a physician, patients for having chest pain, patients for dropping blood pressure or spiking a fever (causing me more work), etc etc etc. I know that those things are clear signs of burnout (and are harmful to patient care), so I did my best to acknowledge these frustrations and shortcomings and to overcome them. But as the nights dragged on, it became more difficult to do So by the time you get a day off, you don't want to do anything because youve been forcing yourself to do things you really don't want to do all week long (and will have to do it all week long all over again). It is just so draining. And the responsibilities are huge - if you stop and think about it, I'm the one watching over half of the hospital. Sure, I have backup and seniors I can call, but if things get busy I'll be the one running the show if things start to go downhill. Its a stressful thing hanging over your head all night, which is why I could never sleep at night even when I had time to. I was terrified I would wake up to a code and be so foggy in sleep mode that I wouldn't run it well. So I'd sit at my desk all night, waiting for any important calls. There are some long nights at the edge of your seat.
All in all, it was a fantastic experience. I worked with a phenomenal team, and I got to do so many procedures and I've learned an incredible amount, as well as pumped up my confidence to a totally different level. This is just one way to show that medicine isn't merely about knowledge and compassion, it's about how you can handle the insurmountable pressures and stresses that physicians are faced with everyday without losing your mind.
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!!!!!!
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!)
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!
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!
Sunday, August 18, 2013
Inner City Hospital
I almost can't believe that it's already August 18th, but here we are! I've spent the last 18 days tending to the needs of an inner city, community hospital. Things have been a bit crazy, and I can definitely say that I am so happy to be doing my residency where I am (in an academic institution outside of the urban area). I have seen some crazy things already, and I've become so much wiser in social issues than before.
One of the many major differences in this hospital than the one in which I typically train is that the internists are the primary team for stroke patients. You may recall my serious disinterest I have towards stroke; Honestly, hemorrhagic strokes freak me out and I feel incredible inadequate and insignificant when I care for patients with this problem. It's not that I'm cold hearted or don't like to deal with end of life situations, that is not the case at all. There is just something so terrifying about hemorrhagic strokes...and the fact that we can offer very little management for this problem. I feel so unhelpful, and like such a failure since all I can offer is support, empathy, and compassion.
I have actually a lot of complaints about my current rotation, but I won't bore you with all of that. I'm learning, I have a lot of independence in patient care, and I'm gaining valuable experience. I am not getting much in terms of guidance, feedback, or encouragement, but I'm figuring things out on my own which is definitely reassuring. I surprise myself constantly at some of the things I know, and how quickly and confidently I am managing problems.
I'll be starting on night float in a few short weeks. I can't wait for all of the procedures and responsibility - I'm going to learn so much in such a short time, I am so excited!
Now I just need to find some more time in the day to sleeppppp....
zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz..........................................
One of the many major differences in this hospital than the one in which I typically train is that the internists are the primary team for stroke patients. You may recall my serious disinterest I have towards stroke; Honestly, hemorrhagic strokes freak me out and I feel incredible inadequate and insignificant when I care for patients with this problem. It's not that I'm cold hearted or don't like to deal with end of life situations, that is not the case at all. There is just something so terrifying about hemorrhagic strokes...and the fact that we can offer very little management for this problem. I feel so unhelpful, and like such a failure since all I can offer is support, empathy, and compassion.
I have actually a lot of complaints about my current rotation, but I won't bore you with all of that. I'm learning, I have a lot of independence in patient care, and I'm gaining valuable experience. I am not getting much in terms of guidance, feedback, or encouragement, but I'm figuring things out on my own which is definitely reassuring. I surprise myself constantly at some of the things I know, and how quickly and confidently I am managing problems.
I'll be starting on night float in a few short weeks. I can't wait for all of the procedures and responsibility - I'm going to learn so much in such a short time, I am so excited!
Now I just need to find some more time in the day to sleeppppp....
zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz..........................................
Thursday, August 1, 2013
Month One is Done!
Believe it or not, today is the beginning of August - the beginning of my second rotation. I can't believe how fast it has went, and how much I've grown on the past 31 days. I learned more than I think I realize - work has been so busy and crazy that I haven't had the time to sit and read or test my knowledge in my traditional studious way. I'm learning by doing, trial by fire, and I'm figuring things out better each day.
I had such a brilliant team for my first rotation. I really miss them already... But I know that I have many brilliant colleagues so I'm excited to get to work with so many different people!
This month I am at an urban, middle city hospital. Today I trained on their electronic health record system (which is really intuitive and efficient unlike the one I'm accustomed to). I'm looking forward to having some more autonomy and handling general medical problems, but I'm a bit reluctant to begin. Things are so different and strange that I feel intimidated and overwhelmed. I always get first day jitters, but today has been more obvious than others. I'm finding myself excited for September to get here, when I'm back to my normal hospital (albeit on night float!).
I can't even describe how sad it makes me to realize that it's already August. I can see winter in my mind already, time will pass so quickly it will be here before I realize it. My life is seriously flashing before my eyes. I miss having a life outside of medicine. But I still do love what I do...so I will continue to focus on that and not the fact that I'm dog tired and haven't seen my family in months and haven't had a real conversation with my husband in weeks or cleaned my house properly since June... Moan over.
Fingers crossed for a good month!
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!
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!
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!
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!
Sunday, June 30, 2013
The Night Before Real Life Begins
Hello, loyal friends!
Tomorrow, I will begin my career as an MD. I am a first year resident in Internal Medicine, categorical. I will be spending the next three years of my life learning how to be self-reliant when caring for patients. I am beyond excited to play an active role in the health and well-being of my patients, but I am also quite nervous about all that is to come. I know I'm not alone when I say I feel like I don't know enough to be someone's doctor - but I'm told that what I know is expected of an intern and that I'll learn quickly along the way during the next three years.
Tomorrow begins at 6:30 for patient hand off, when I will be given my very own set of patients (between 4-10 patients each day) to care for during their stay in the hospital. I will be on the nephrology service for the first month - caring for primary and consult patients. I've heard nephro is really busy, which gives me some great opportunities to meet many different people and pathology.
I intend to keep a running journal of my growth, now as an MD, much like I had during my third year of medical school.
I am so excited to care for patients in a meaningful way and to learn so much more, but I am so nervous as well!
But, I guess, ready or not, patients of the world, HERE I COME!!!!!!
Tomorrow, I will begin my career as an MD. I am a first year resident in Internal Medicine, categorical. I will be spending the next three years of my life learning how to be self-reliant when caring for patients. I am beyond excited to play an active role in the health and well-being of my patients, but I am also quite nervous about all that is to come. I know I'm not alone when I say I feel like I don't know enough to be someone's doctor - but I'm told that what I know is expected of an intern and that I'll learn quickly along the way during the next three years.
Tomorrow begins at 6:30 for patient hand off, when I will be given my very own set of patients (between 4-10 patients each day) to care for during their stay in the hospital. I will be on the nephrology service for the first month - caring for primary and consult patients. I've heard nephro is really busy, which gives me some great opportunities to meet many different people and pathology.
I intend to keep a running journal of my growth, now as an MD, much like I had during my third year of medical school.
I am so excited to care for patients in a meaningful way and to learn so much more, but I am so nervous as well!
But, I guess, ready or not, patients of the world, HERE I COME!!!!!!
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