a brief guide to medical lingo

I had a recent conversation with a family member that makes me laugh. I told him I was on call, and he replied "oh so you could have gotten called into work." This makes me laugh because, althgough its called CALL, it really means WORK. But most people don't know that.

So right now I'm on q2 call. This means that every 2nd day, or every other day, I'm on call. Call means that I'm the intern carrying the pager, and all patient issues come my way. It in no way means that I'm at home eating bon bons waiting for a question to come from the hospital. Often call means that I'm running around from room to room in the ICU, attending to patients and fixing potentially scary situations before they happen. I also see patients that are done with surgery before they get upstairs to the ICU, because other interns don't always make sure that patient is optimized when they get to me. Case in point: I get a patient from the OR Friday night about 11:30 pm with a blood pressure of 40/20's. Normal is 120/80, and in the ICU I'm happy with 90/60s. At any rate, my call shifts are fairly busy and I generally work the entire time.

That brings me to another vocabulary issue I get over-quizzed about: who's who in the hospital.

ATTENDING: that's the boss. He's the physician who admits patients, operates on them, or oversees their care. In the ICU the attending spends 0-10 minutes in the patient's room PER DAY, depending on how sick they are. They spend more time in consultation with us making sure that the plan on their patients is carried out.

CHIEF: this is the highest ranking resident on a patient's care team. In surgery, this makes them a 4th or 5th year resident. They operate a lot, and generally tell me what they want done and scream when I don't get it done exactly as they'd like. They communicate most directly with attendings.

RESIDENT: anyone with an MD who's not yet board certified. This means that they can't take care of patients without an attending above them, but they generally oversee the patient care for the attending. Therefore, they spend a bit more time with the patient. The most junior resident on the team has the most boring, innane patient work to do. Residents are also called HOUSE OFFICERS.

INTERN: The lucky souls who are always the most junior resident on the team. Intern year is the first year of residency. Interns generally take calls about patients, write notes, enter orders, call consults, admit and discharge patients, paperwork-wise, and basically do all the boring stuff regarding patient care you can think of.

There are a variety of nurses also, but I'm less familiar about them. There are also pharmacists, respiratory therapists, physical therapists and occupational therapists that see patients in the hospital. Not to mention speech pathologists, wound care specialists, dieticians, social workers, and chaplains. And many, many other people that I'm forgetting right now. And everyone wonders why health care is expensive. You basically have a small army of experts working their magic on you to try to get you better.

What else is part of my daily lingo that normal people would ask about?

ROUNDS: This is the act of seeing your patients one after another and writing a note on them. It usually happens in the morning. The goal of this visit is to check and see how their night went, and formulate a plan for the coming day. It involves talking to the nurse, talking with and examining the patient, and gathering labs and vital signs. First, the unlucky med students pre-pre-round on patients. Then the interns get there and pre-round before the team comes in. Then the full team of residents rounds and comes up with a semi-finalized plan of the day. THEN, whenever they have time, the attending comes and rounds on the patients. This can happen with all residents present or not, depending on how much is going on. In the surgery world, all of this happens before 7:30 am because that's when the OR starts. So you can imagine how early those poor med students get there in the morning. Interns too :(. Especially when you have 15+ patients to see and your med students are unreliable.

CODES: These are called on patients that are unresponsive or who's condition is rapidly declining. Sometimes they are quickly resolved, and sometimes they involve intubating (putting a tube in the throat) and shocking heart rhythms. Either way, as an intern, they scare the crap out of you. I've never been the first one to a room when a patient is coding, and I hope I won't pee my pants the first time it happens.

I'm out of energy to type. As an update, I'm still enjoying my time in the SICU (surgical ICU) and I'm learning an incredible amount. As one of my co-residents put it, you either learn what you need to know or you hurt people. So far I've put in central lines, chest tubes and arterial lines. I've done upper endoscopies and bronchoscopies (scopes looking at the stomach and lunge, respectively). I've done bedside wound explorations and wound vaccuum changes. But I'll be happy when this insane schedule is over and I get to move onto a different rotation with 'healthier' patients.

in the bubble

I'm back to work. And my newest post is SICU intern, the oh-so-glamorous position which includes getting shat upon by attendings AND chief residents. And ICU nurses who feel as though they know more than a lowly intern could ever know about anything. Exciting. The good part is, I share this duty with one ER second year resident and an anesthesia 3rd year resident (CA-2 for those who know the lingo). The ER resident is nice but blah, but gets her stuff done without a fuss and is very helpful. The anesthesia resident is the bomb. In fact, the majority of anesthesia residents I've met are similarly awesome. I think its because, with the exception of surgery off-service rotations, their life is pretty sweet. Not that I want to be an anesthesiologist. That's probably because I enjoy being sullen more than they do. But they've got a good thing going, that's for sure.

At any rate, the title of this entry is a tip of the hat to the SICU, where I am 99.9% of my day. In general, I have no idea what's happening in the rest of the hospital, nor is it my job to care. When codes get paged overhead, we get excited for about 0.5 seconds, until we find out that the patient will go to a different ICU. If they're coming to us, then we care, and maybe even run to join in on the fun that is a floor code. Otherwise, we're blissfully content in our 16-bed paradise, doing crazy stuff to sick people all in the name of saving lives. Today the only craziness I indulged in was putting in NGtubes and Dobhoff tubes (they go in the nose and either to the stomach or intestine. Their ultimate destination depends upon the skill of the operator. Today, mine went where they ought to have gone. Whew.) I also got to change a central venous line over a wire, a task that always makes me cringe because I wonder if I'm maintaining sterile technique. I picture the little bacteria marching in through my new contaminated central line and killing the patient. Then I try to block that image out of my brain. The only other fun came when I was busy rounding, and a patient needed to be intubated. I didn't get to do it, but got to help with a bronchoscopy of him later. So all in all, a quiet day in the SICU. Perfect for starting off.

No day here is complete without learning that a patient is even closer to death than previously expected. The SICU is filled with . . . how do I say it . . . generalized badness. Many people make it out alive and well, but some . . . not so much. And the way they go out is grizzly, to say the least. Remind me to tell you the story of Moomba someday. Being just back from vacation, I got the scoop on who did great and who tanked while I was gone. Some were expected, and others were a surprise. Today's new badness was the very large lady who went for a pelvic washout of an abscess that turned out to be fungating uterine cancer. Always a fun thing to tell the family. I'm fairly certain that the SICU is the focal point for extreme badness in medicine. I'm going to have to remind myself of that every day, or I'll start to think that everyone is really really sick with no chance of getting better.

I'm on vacation

and I hate it. Not really, but I want my vacation to start already! I've been off since Aug 1st, and can't leave for WI until Dennis is off work. And I'm doing my best not to spend money on ANYTHING, so I've been pretty bored. I've never been one of those people who does well with nothing to do. I'd rather be at work, quite frankly. At least there are patients to laugh with/at there. I feel like a slacker, sleeping in and watching too much HGTV while all my fellow 'terns work their butts off.

Of course, I'm excited to head back to WI. I miss everybody, and I'm just not comfortable in VA yet. I like my job, and I love my house, and that's about it. People suck at driving here, I know practically nobody, and the people I do know are too busy to hang out with me! I'm sure I'll get more and more comfortable, and everyone I know will get more used to going out despite little or no sleep the night before, but for now its hard.

Today Dennis and I went to the county fair. It was the biggest disappointment! Everything was set up in crappy tents, and I'm used to the tons of animals, activities and other stuff that the Kenosha fair has. This one had maybe 1/4 of that, and far fewer animals. I expected fewer cows, but there were maybe 5 horses and a couple of donkeys. I even brought my camera, to take pics, but was too bummed to do that. Dennis pointed out that it was the last day, and many of them probably went home, but still! It pretty much ruined my day (see how much I have to look forward to here?). So I went home and made some brownies and now I feel better :). Its sad how little there is to do here. Especially when on a budget. Sigh.

At least I've been busying myself with reading for school, so I can continue to answer somewhat intelligently when pimped at morning report. Yep, that's right, I said pimping. Those of you not in medicine: pimping is asking questions of someone under you that you already know the answer to. Its usually done to med students. Except here, where the interns get pimped every morning at about 6:30 am. Nothing like dozing off in your chair at conference, waking up just in time to hear "Dr. Burpees, why don't you tell us the Henche classes of diverticulitis?" Whoo hoo. I'm already looking forward to not being an intern, and I have about 11 months to go.