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.