Vacation!!!!!

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2 more days until vacation. What possessed me to go 6 months of my intern year without vacation? We'll never know. But I am two days away from vacation bliss. We're taking the baby skiing - the resorts have daycare so hubby and I can get some much needed R & R. We are renting a house with my parents. Something luxurious and at the center of the town's activities. So excited. In fact, so excited planning my next vacation. Hopefully a Royal Caribbean cruise.

My schedule

Wake up 5am
Coffee
Check email, labs online
Head for the hospital at 5:30
Arrive at the my first patient's bed at 5:45 - usually a ICU patient
See my oncology patients (usually pancytopenic, and sometimes sick)
Round with the attending
See the rest of my patients
Lunch conference
Meet with the resident to go over work-rounds kind of stuff
Procedures, paperwork, etc.
Head home
Read about my patients at home (blogging right now, but this is "me time"... anything I have on my mind, stuff I want to know about
Husband comes home at 5:30
We walk over together to get our son
Make dinner
Play with our child
Laundry, dishes, whatever needs done
Child goes to sleep at 8
Hubby and I are asleep by 9

On call every 4-5 nights. 4-5 days off per month.

Almost done with my second month of wards...

This month...
3 disseminated histo
1 legionella pneumonia with bilateral carotid artery stenosis and a stroke
1 DKA in a previously undiagnosed type II diabetic
1 HIV diarrhea with a K of 2.9 and a Hct of 12
1 bacterial meningitis with mastoiditis requiring otologic and neurosurgical debridement
1 guy on his way to get a liver transplant who started bleeding to death from his periodontal disease; who had an ASD; flown in to our hospital rather than where his liver was waiting

and a bunch of others I can't remember right now...

I am learning a lot and it is slowly becoming less painful. But it still hurts.

Tonight the ladies in the program are having a happy hour get-together. I am leaving the baby with daddy and going. I might even take the bus there.

Oh, and I am losing weight - unintentionally. Hate me if you want to.

Need vacation.... but no breaks until January.

Why I chose internal medicine...

I had a call so good, so hard last night it just makes me giddy. Also makes me want to go back to the hospital to check on my ICU admissions. Bacterial meningitis (worst case the ID doc has ever seen), Bad Pancreatitis, and Bleeding Man at the top of the liver transplant list (who deserves that liver). My Amazing Lymphoma Lady came back too, for a second round of chemo. She won't be neutropenic for at least a week I hope... so time to tend to some really sick people. I learned a lot. I did a lot. And it makes me look forward to going in tomorrow- pretty darn early. Maybe I am an adrenaline junkie.

Medicine wards

Two days in. Two codes. One false alarm. Three procedures.

On call tomorrow. Inherited 6. Discharged 3. 2 to home.

Making faces while doing LP today. Forgot, there is a mirror in the room. Luckily patient is more mature than I am. Unfortunately upper level stepped in before I got the LP. The patient suffered less for it, but I suffered more.

I need to be more confident. It is a tall order because I feel I have very little to base it on.

Came home. Baby is awesome. Laughing. Eating rice and blueberry yogurt. Chasing cat on all fours. Almost ready for that first step. Loves to climb over me and give big open-mouthed kisses.

Attending asks if it is hard to be a mom-intern. Right now it is hard to be an intern. Loving the mom part. At least I have something worthwhile to come home to.

H1N1 has hit the daycare and the hospital...

So far I am not sick, but several of my co-residents have been ill. None of them have taken the recommended SEVEN days off after coming down with it. My little boy seems as healthy as ever... just the sniffles he gets from being a daycare kid (possibly with some super-imposed allergies). Since I am on a pulmonary/critical care elective I am seeing the most amazing H1N1 cases. It has been a wonderful month to reconnect with the family as I have had weekends off, but it has also been a good month for learning. We are in the middle of a major epidemic and it will be an interesting winter season on Internal Medicine wards to say the least. I know it is crazy, but I am actually looking forward to it.

My notes about colic... something all pediatricians should know

My son had a fussy period every day, but it would start at 10am and end at 5pm. Those hours between 4am and 10am were precious. After that, my baby would not sleep unless he was held and rocked while I walked or if I took him for a stroller ride. And he would fuss if he wasn't bathing, sleeping or rocking (while I walked, not sitting - that was not allowed apparently).

And when I say fuss I mean deafening ear-piercing, did-he-watch-the-exorcist-while-I-was-not watching-scream. That is colic. I went to the pediatricians office for some help and basically just bawled my eyes out. His first day of colic he cried 6-8 hours - and he was 2 weeks 6 days old. There might have been a few ok days after that.... but it was pretty bad for awhile. He got a stroller ride every afternoon in January, 2-3 baths per day, and I lost all my baby weight in about 6 weeks and I had gained 40 lbs. Not a weight loss plan I would endorse.

Then starting at 8 weeks I decided to let someone else help with the load - I started going to the YMCA and let them deal with his crabby self every day for 1.5 hours while I walked my worries away. Eventually the colic ended, 2 weeks before he was to start daycare.

I was probably at risk for post-partum depression (strong family history), but having a colicky baby just about put me over. As it does for most people who have colic. It is amazing that baby and I bonded so well given how hard that was. Way harder than internship. Not that I don't have stuff to cry over with that, but at least I get some sleep 4/5 nights instead of 0/5 nights.

September happenings...

I'm on an elective and that is a good thing. Those on wards are looking pretty tired right now. I have a potpourri presentation coming up. My mom is going to watch Luke on Monday night so we can work on it. Yes, I am recruiting help from my hubby. I hate doing presentations. We need to get it done Monday so I can practice it a few times.

Oh, and I got my first art line in. Easier to do when no one is breathing down your neck. My ward months are going to be full of procedures. I can't wait to get to a point where I feel proficient. Until then, just another thing I stress about.

8.5 months

Our child woke us up about 3 times last night and ended up in bed with us until 5am when he decided he had slept enough. Luckily my husband took over until 6am. It is now 7am and he is going to daycare - across the street. Then I am off to a pulmonary elective month. It is a ton of fun. First week was outpatient. The rest is ICU. My first day as a consultant in the ICU was an eye-opening experience, in a good way. More on that to come.

GOLDEN WEEKEND!!

We went to the beach for my first golden weekend in a long time. It was a wonderful trip. I basked in the sunlight (55 spf, of course). I strolled the beach looking for shells. I played with my 8 month old who was in a pretty good mood for most of the trip. I reconnected with my husband. I met minor sports celebrities on the plane on my way back. And I am not too sad to be back... seems vacationing me-style is more work than being on call in the CCU. It is a little hectic trying to get out of town with a baby for just a couple of days. So, I might try to pick a closer getaway next time.

Today, I am on call again. Several of my patients got discharged while I was basking in the sun. The one that remained is getting better; transferred to floor today. I have one admit that is going to the CCU proper- though with every passing minute and every liter of fluid off of him, it makes me wonder if he really needed to go there in the first place. My next one is same story, second verse but hasn't arrived here yet.

I'll probably get some thai food with my husband and child tonight if I am not too busy. So far, I have only had two admissions and it is 5pm. If I get another one soon, that will keep me busy for awhile. For now, it is cold coffee and more reading. Until they call me for orders.

What I've got so far...

CCU service on call... so far (most of my admits will come in late tonight)

1. cute little old lady with pneumonia with afib with rvr (could it be rapid from the infection?)
2. nice middle aged, doctor-fearing guy with hypertension urgency with st depressions in II, III and aVF not resolving now that the blood pressure is down, initial enzymes negative... enzymes pending (oh, and he has refractory hypertension, hypokalemia and metabolic alkalosis)

3 more to cap. There is a chance I won't. Already got 2-3 hour nap in.

I am definitely missing my baby and hubby terribly. I finally got to see them for the first time in a week last night and now I am on call. My husband is with his brother at a baseball game. My baby is with my parents. I am at the hospital, alone, with no resident. Tomorrow we are going to the beach with a friend from my pre-medical school days. We bought an infant life jacket yesterday, along with $100 worth of other crap from Target.

Things good.. well, ok

Hurt my thumb on my first day off in three weeks. It cannot be bent. Plus, it hurts. Not broken. Jammed. Its what I get for being physically active.

Plan to post picture. Someday.

Now post call. Child and hubby out of town. Just me and the cat. Maybe I'll read when I wake up, but my parents promised to feed me. A night alone at home might actually be wonderful.

What I learned today...

Please don't laugh...

The QT interval should be less than half of the RR interval. I know there are some other ways of looking at it, but for the sake of my exploding brain, we are going to keep this simple. I have had several patients with "long QT" and I have had to look up a lot on this.

You cannot give sotalol to someone with long QT, or if they have structural heart disease. I also remember something about haldol and other psych drugs potentially causing long QT syndrome. You can give amiodarone to patients with structural heart disease though. Can you give it if they have long QT? Wish we had a pharmacist on our team this month.

Digoxin slows the heart rate without affecting blood pressure much. It is so funny, because I keep putting patients on this old mostly-forgotten drug. I need to read about it because there are a lot of things to keep in mind while you are using it. And since I am just starting my medical education (med school does not count), I have nothing in my mind and need to fill it up.

It is HARD to find any medical care for the WORKING poor around here. So, even though I am not a huge fan of government run medical care, it is time that someone did something about the fact that I have patients who work 40 hours a week and barely make enough money for basic needs - and they have no health insurance because they are self-employed and not married. But they make too much to get charity clinic. They would pay what they could afford, but I doubt that will be enough to afford a cardiologist. Why do we take care of people who sit on their rears before we take care of those who actually make this country run????? ARGH!

Don't put people on coumadin who can't get their INRs checked. No extra comments needed.

I went to work early, saw my patients and got out of there. My dubin's came in the mail and I am reading it. Maybe I'll take a nap and head back into the hospital this evening once the attendings have had a chance to see my patients.

Planning a break: golden weekend coming in 2 weeks

I am going to use this post to brainstorm ideas for my golden weekend. Its 22-23rd.

Not sure if we can get my parents to watch the baby, but that would be ideal if they were cool with it. I'll just to be brave and ask.

If so, the sky is the limit as far as what we can do. We've got Southwest Airlines passes and it would be great to head for the beach or the mountains.

If we have to stay around here, I would love to go sailing. If we have to bring the child (not a horrible thing by any measure), there is the zoo. Also, we've been doing a bit of renovating and we could get some more stuff from Ikea.

The babe and hubby are headed to Minnesota next weekend. I will finally have a weekend day off and they won't even be here. I can't begin to express how lonely it is without them. My med school buddies are off at programs in other cities and my resident buddies are working. So that leaves my non-medical friends... That or I am going to shop up a storm. Maybe I'll see if I can get some help cleaning our place.

I need to pick a specialty already??

So I went into internal medicine to postpone some decision making. I liked both surgery and medicine, but I thought medicine had more options. Either way, I'd be helping make people better (hopefully) so I didn't feel that much pressure. I am loving the CCU so much that I am teaching my non-medical husband to read EKGs. Where are some med students to teach when you want to? I'm on call tomorrow, a Saturday, and I am hoping I have some admissions so I can actually learn some stuff and get to know some of the attendings. When I started this year I was thinking onc, but I love how much effort has gone into everything we do in cardiology. There have been big controlled double-blinded studies and we actually know what strategies are best. Less guessing. Plus, heart disease is so common that I know I could work almost anywhere when I am through. I need to spend some days in the cath lab, but I have a feeling I'll love it. Just to see such fast improvement will be a cool thing.

Tele monitoring for dummies

I need to learn how to read the incidents on the tele monitor. I have been shown before, but evidently I missed an event. I'm wondering how since I checked it out this morning. Luckily the nurse called me (I'm home)... but that is so frustrating.

On the upside, hubby and I are bonding as I teach him (and myself) how to read EKGs.

Just another update

So, I am in the middle of a 17 day stretch. I thought I had pissed off someone and gotten a horrible schedule... then I found out it is just due to the automatic scheduling they do. Usually someone double checks it, but not last month.

I was really worried about how I would handle it, but I got ZERO admissions last night. What are the odds? This never happened in medical school. Still I'll take it where I can. I had plenty of cross-cover to keep me busy and a patient came into the hospital that I see in clinic. So, I helped take care of her. And I got some sleep. Pretty awesome. Or worrisome. Depends on your perspective.

It was nice to spend some time with the family post call and not be completely zonked. Though, after a nap this afternoon it is going to take some benadryl to get me back on a regular sleep schedule. And I am just one of those people who needs a regular sleep schedule with about 9 hours per night optimally. You MD moms may laugh, but my brain works best with that much and I do whatever I can to achieve that. Basically that means nothing gets done around the house and I am either at work, playing with baby or hanging out with hubby.

Something about mothering

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Little one is a formula fed baby. And like all formula fed babies there is a little concern about the iron in his formula and how it seems to be causing constipation. He is on a lactose free formula. We switched him to that when he was very colicky (6-8 hrs per day of crying) and every time we try to go back we run into problems. I don't really know if he is lactase deficient. You'd think I'd know. But he just seems to do better on the lactose-free formulas. All you pediatricians out there can roll your eyes. No, there are no controlled double-blinded studies to support me. He just gets really crabby every time we switch him back and starts spitting up more.

So, we are in a quest to get him regular and his stools soft. I have even considered miralax, though I am not sure if it can be used in babies. The apple juice does not seem to be doing the trick. Next up, prune juice. And prunes as an afternoon snack. Yummy.

Update...

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Admitted 4. Discharged 1 to heaven. Requested autopsy. First time ever. Family thought over. Charge nurse called me at 5pm post call. Had no sleep despite relatively healthy patients other than other mentioned. 5 codes overnight (not my patients, thank god). Prayed with family. Haven't done that lately.

Something's wrong. Sudden death. Runs in family. EKG not giving up any hints. Need answers.

My post-midnight admissions suck. Hard to get an H&P when I can hardly think. Will get better as it becomes more automatic.

Baby has two little tooth bumps. They haven't poked through yet. Slightly crabbier than normal, but still literally a bundle of joy most of the time. Starting to get those baby thoughts again, but need to give myself at least another year before seriously contemplating another pregnancy. My life is hard enough.

Drinking red bull post call and trying to enjoy time with family.

Unit month starts tomorrow.

17 day stretch...

Well I am in the middle of a 17 day stretch without a day off as I go from wards to CCU. I had a pretty easy call night last time and weekend calls on the wards are pretty darn easy. Plus I just have to admit them and pass them on. CCU is generally a little more difficult because the call is more frequent, but at least I am getting one of my months of that out of the way.

I have had a better experience the last few hours of yesterday and I am hopeful today will go well.

Honey I'm home...

A friend called from a well known relatively malignant east coast program, crying. She says she has cried twice during her month on the wards, feels she knows nothing, that she is going too slow and wishes she had studied more during her fourth year. This girl was very much a go-getter during all of medical school, studied plenty and is definitely as smart as her peers at this program. She has been on her own a lot, getting that autonomy these programs tout, but also been expected to know things she has never learned about. Ah, the life of an intern.

I'll admit, I have cried too. The last time was just two days ago when I lost a patient I had been caring for for a couple of weeks. She had been sick for at least 6 weeks before she came in. She was one of my most complicated patients but she was talking to us, and I hoped we could "fix" her and get her back to her regularly scheduled life. Apparently I was the only one on the team with such hope and I was actually informed by the ophthalmologist that we consulted (before he saw the patient) that he had never known anyone to survive what she had. I kind of scoffed. Really? (That is not what up-to-date says.) Apparently there is no substitute for experience. Of course, at the same time she was dying I had to be in clinic. My senior resident had the day off and luckily he had incredible backup who helped.

Then one of my other patients started seizing (apparently dilantin is not the drug for her - though can she afford Keppra??). I spent 4.5 hours with one patient in clinic due to the inefficiency of the clinic and the fact that the patient needed psychiatry followup which apparently takes 4 hours to get.

A bunch of other stuff also went wrong (including my first bone marrow in front of the attending) and I ended up staying at the hospital until 7:30pm, planning to come back on my "day off." The last two things I did that day were sit with an oncologist telling my patient's family about the treatment for metastatic melanoma to the brain and sitting with my other patient's family just after my other patient had passed.

My senior resident told me to go home, that he would fix anything remaining in the morning. At that point everybody was stable, but I pretty much felt like a complete failure. And to be honest, after reflecting this weekend on it all, I just know I have a lot to learn.

To me friend at her crazy east coast program: you can't be in two places at one time. Do your best. Ask for backup if you think you need it. I am glad the seniors here don't make us feel like wimps for doing that.

I won't have another day off for at least the next 12 days. So... I am not going in today. I'll start early tomorrow and straighten out the rest. Then I'll admit five new patients. At least I get to start fresh with them.

As for my family - we are having a great weekend together. Cooking, shopping, swimming, playing, relaxing. I got my first paycheck. We closed on our condo Thursday. I am so glad I have a family at home to diffuse my stress. Nothing like a happy, smiling, belly-laughing 7 month old to make you realize it is all going to be ok.

My census is one

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And that person is a neurosurgery patient sitting on my medicine service. But, with no major medical problems it isn't hard to check if he is breathing every day, optimize his blood pressure and do some basic medical screening (the man has never seen a doctor). Plus it gives me time to teach. Today I went over the neuro exam with my medical students. Tomorrow we are going to the hematology lab because my co-intern has a patient with a very rare type of leukemia.

Seriously folks. If you are in medicine and reading this you are probably laughing. I am giddy with happiness. We're on call Friday which is generally a very busy call.

Meanwhile I am writing my own guide (based on the others) to a lot of the problems I have encountered as an intern.

Why isn't everything basic I need to know in one place? The answer is that what each person considers a "need to know" "basic" thing is different. I am hoping by the end of this year I will have discovered and tested the answers to many of the common medical problems we see.

P.S. You've got to read http://www.mothersinmedicine.com/.

Hanging in there

Tomorrow I am on call. I discharged a good 66% of my service yesterday. It means I only have two patients going into call. One with a-fib I am learning to rate control (though seems like we are headed toward amiodarone) who I thought would be a 23 hour obs and is turning into a rock. How is that possible? Oh, you people with experience can probably count the ways. And another nice lady with GBS, who though does take up a lot of my time every day, is teaching me a lot about taking care of a patient in the ICU. Plus I got to do my first central line. I loved it. My medical students were quite jealous. I remember being in their shoes. I am staying late, working hard and feel like I am learning little. I am learning how to survive. I also have a big mouth and probably give bad advice to other interns, but they ask me anyway.

So for my only day off this week (at least I get one), we had lunch with some friends, are swimming at my parents house and are having another couple over later. Oh, and I am working on getting date night planned out for Thursdsay night. We haven't had one since I started residency and my husband keeps reminding me.

Post Call & Its 5 O Clock Somewhere

Enjoying a nice glass of chardonnay, thinking about going to pick up my son.

My hubby picked me up from the hospital, nearly 30 hours after he dropped me off. I now know why the 30 hour rule is so frustrating. On one hand it does encourage the medical community to help some interns out the door - at least at my hospital. On the other other hand it is a lot of pressure to try to get everything done the next day. And honestly without the "rule" I might sleep in a little more post-call (when I do get sleep) and take my time in the morning, drink a little coffee, and take care of business in a less hurried manner. As it is, if I have a lot of patients, it is a rush to get everything done.

The next two days will probably (hopefully!) be a picnic in comparison to what I was told in retrospect was a very busy call day. I couldn't rely on my resident for constant advice because he was busy taking care of sick people. Instead I had to come up with solutions on my own. Turns out I was mostly right. I love having a medical student by my side (oh, yeah - they can get coffee, patient charts, take excellent social histories, and read up-to-date to you).

After getting about 2 hours of sleep I should be ready to crash, but I think it is going to take awhile to settle down. No work until 7am tomorrow.

Golden Weekend

3 days into my life as an intern I got a golden weekend. Well, we had a great one which I'll report on later, but I am on call today so no time to chat. Right now I am loving medicine. Baby is doing great. Husband is doing great. And who knows what I will learn today.

Survived first call

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My hubby took himself and the baby to my parents house for dinner. Luke decided to get up extra early, but sounds like they both did well.

He took the baby to daycare today and went to work out. Our anniversary is coming up so he got me flowers and picked me up from the hospital. We stopped for thai on the way home and I ate for the first time in at least 18 hours. It is so easy to forget to eat when you are running around the hospital.

My patients were interesting. I forgot how much I like being on call. I may hate it later, but for the next 4 weeks some upper levels take cross cover. So, I am just on the beginning of a very steep learning curve. It seems like my resident is constantly cleaning up after me. I look forward to the day when I can do it all myself, but I really appreciate the support right now. It is very strange to be called Dr. and introduce myself as Dr. Last Name. Right now I don't mind the pages I get on my night off. Unfortunately there is not much I can do to help from home except tell them to call the on-call resident. I don't know the pager number, sorry. Amazingly the pager operator does. How this all comes to be, I have no idea. I guess it is just one of those things I'll figure out someday.

Oh, and the paperwork is astounding. There is a form for everything. I realized after I woke up from my post-call nap I had forgotten one of the discharge forms. Somehow the patient got discharged anyway. Maybe it was just another thing my resident had to do that I forgot. Only time will tell. But I hope it gets better.

My service includes: Guillan-Barre with Respiratory Failure, Sepsis with Multiorgan Failure, ITP with probable antiphospholipid syndrome, DKA, w/u for Shortness of Breath (new diagnosis emphysema), and Abscess with MRSA bacteremia resolved awaiting SNF placement.

July 1st

I have looked forward to this day. Prepared for it for the last 6 years. And dreaded this day.

I have to say I was pretty useless on the floor. This is not to put myself down, but to remind myself that when I am in charge of the new intern: they are pretty much useless. They are especially useless if they had a baby in 4th year and it has been more than a year since any real clinical experience. I am still learning where everything is in the chart and in the computers. I am still getting access to everything.

I discharged a patient and dictated for the first time. I am not looking forward to reading that report later. It will require a "bit" of editing. The upper levels assure us it will get better.

As for my cute baby: he's great. He was sleeping on my husband's lap when I got home at 5:30. Now he is laughing and playing. I know he'll remind of the good in the world as this year goes by. He also reminds me that every patient of mine is someone's child.

But, I really only survived because others had my back today. I know it is going to be that way for awhile, but I am looking forward to when I can ride without needing the training wheels.

My job

I met my co-interns. One of them has a girl born just one month before me. Some of the residents have kids. Its a pretty family friendly place.

I start on the wards on Wednesday. I'm on call Thursday. And I'll be the intern in the CCU starting next month. Friday morning will be when I have clinic for the rest of the year.

I have a lot of information to process over the weekend. I plan to spend it relaxing though - with my hubby and son. A lasagna is in the oven. And thus begins a year of processed freezer foods since we are both too tired to cook.

Last Days of Freedom

We are heading to a local waterpark today to enjoy our last days of freedom. It is what we did as a medical school class before it started 4 years ago. It is amazing how fast time flies and it seems to get faster the older I get.

Orientation starts tomorrow. We will get our schedules (finally!). Clincal duties start Wednesday. The Chief of Medicine is having a party this weekend. It will be nice to meet my co-interns and residents.

Oh.. the granite people just called (we are remodeling the kitchen) and they are coming TODAY. Not Monday. So, I gotta run!

How do you get geared up for intern year?

I am spending the day cooking chicken, several casseroles, and generally organizing our place. It seems silly to make some food ahead when I wonder if I'll ever have time to cook dinner again. However, I am trying to get the components made so my hubby can just pop stuff in the microwave.

Hubby is coming home to spend the afternoon here and he is taking Thursday off so we can spend the day doing something fun together. These are my last days off. For one of them we plan to leave Luke in daycare and run to the waterpark. It sounds pretty selfish, but I can't think of a better way for me and E to kick back and do something fun.

I've been in definite nesting mode for almost a year now. I guess it is time to see if all my hard work and planning has paid off.

Starting Intern Year as a Physician Mother

Intern year starts later this week. We'll find out our schedules and get acquainted with one another. I graduated from medical school this year, 6 months after having my first child. He's already a daycare kid and it seems to be going well there. I've got a few days to spend with him, organizing our things, and getting ready for the deluge that is coming. Wish me luck. I'm gonna need it.