Don't touch the pancreas

Winter time . . .

2007-12-06T17:50:00.000-08:00

Wow its been awhile . . . I'll sum up my time since I've posted:

November was colorectal. 30 solid days of suck. I loved colorectal as a student, the surgeries were great and the diseases were too. But my month as an intern on colorectal was painful. Very stressed attending, very stressed residents, and sick, obnoxious patients were the standard. Which added together makes for a tough time as the intern. Every mistake that was made came down on my head. Which I'm used to, but the more patients I have, the more mistakes are made. And my census averaged 20 for the first 3 weeks of the month. Twenty notes to write, 20 patients to see and pander to. Great times.

Okay, rant over. December is now. I'm on the laparascopic service, which is better in so many ways. First of all, the surgeries are less involved, so patients usually go home earlier. Second, everyone's happier, so I get yelled at less. And I have time to work out again, which is great. Last month I turned to mush, and I'm still pretty much trying to dig my way out of my non-fitness hole.

It snowed here yesterday. By snow I mean the lightest dusting of frozen stuff, most of which has already melted today. It was nice though. Made it feel like home. And speaking of home, I'm headed there in 2 short weeks. I'm excited, but sad that Dennis cant come with. He has to work. He and Maddie will be here for Christmas. Last weekend we got a tree and decorated. I'll try to take pics when I have more energy.

getting a new hospital perspective

2007-10-05T23:55:00.000-07:00

Well, its a new month and I have a new job in the hospital: I work overnights, covering a multitude of services for the day teams. I have 3 or 4 services on any given night. I also am the intern who responds to all traumas in the ED. Which is good for me, because I haven't had much exposure to trauma and I tend to get a little ADHD when I get into the trauma bay.

Here are the things I love about night float:
1. I get to wear scrubs every day. Actually, all I wear this month is scrubs and pajamas. How's that for fashionable?
2. The hospital is a cool place at night. Things move at a slower pace, and you really get to know staff.
3. Seeing lots of daylight. Its great to wake up when its light out, and get to be outside for a good part of the day.

Here are the things I hate about night float:
1. The inability to do most anything for patients. One of my more senior residents summed it up nicely, when he compared night float intern to a person trying to patch holes in a dam. You're holding your finger over one hole, another finger over another, and just when you think you've got it, a new leak springs. Basically my only job is to make sure patients stay alive through the night. Its also nice if they stay comfortable/stable :)
2. I rarely get to see the BF. We now work opposite schedules, and so our time together is rare. It stinks.
3. I go to sleep when its light out. That's been a little distracting; less so as I start to get exhausted, but still tough. I often wake up at noon freaking out that I'm late for something.

I have so many more thoughts to post, but I really should go do some work (its a slow night but I still have plenty to do). I need to post some pics of scenery plus horse stuff that I've seen lately, so be on the lookout for that!

"If I haven't spent $10,000 by noon, I start to feel a little antsy"

2007-09-25T15:10:00.000-07:00

Only in health care. The above is a quote from one of our trauma surgeons. And its so true. I've never actually tried to add up the cost of all the stuff I order in a day, but its considerable. Probably cheaper now than when I was in the ICU, but still. Labs for all, scans, tests, medications, consults . . . the list is never-ending. Medicine is crazy; every piece of equipment has an extraordinary amount of labor/engineering/technology behind it, plus the fees of the person giving it. It adds up quickly. Take the OR, for example. They charge for OR time by the minute, and although I'm not sure how much the exact amount is, I can assure you its not pennies :) If I think about it too hard I start to feel guilty about how long it takes me to do stuff like suture.

In other news . . . Wow, its been awhile since I've blogged. Its been quite a busy month, despite my being on one of the 'easy' surgery services. My first two weekends were on call, so I logged over 90 hours each week. Last week was lighter, but I was out of energy after working 22 straight days, so it was hard to get my butt to the gym after work. Now, I had last weekend off, and I'm refreshed! What a difference a couple of days of sleeping in makes! Sleeping in for me is now until about 8am (sounds hilarious, but its a weird feeling to wake up when its light out, freak out for a second that you're late for work, then realize its your day off and snuggle back under the covers).

And I've gotten to operate a fair bit. Mostly small breast surgeries, but I've done a couple mastectomies and helped with some implants on the plastic surgery service. Tomorrow I do some melanoma resections. Pretty sweet huh? I'm getting more comfortable in the OR, asking for instruments and knowing what the next step is. And I love the attendings I've been working with, they're so patient and give me great tips for how to improve. Its been overall a very positive experience. A little too much clinic time, but otherwise a good month.

Today was fabulous. Our last OR case cancelled (sad but okay for today), so I got to go home at 4pm! Its funny how a 10-hour day seems short now. Makes me realize how warped my view of life and work is. I probably wouldn't know what to do with myself if I only worked 40 hours a week. Anyhow, this afternoon I had time to work out, walk the dog, pay bills, blog, and I'm on my way to have ice cream with my surgery team. Its great to have time to do more than drive home, see the BF and fall asleep.

Several of you have asked about my BF. He's doing well, loving it here as much as I do (in other words, "It's not terrible"), but meeting people and enjoying his job for now, at least so he says. He's still working on school, but has plenty of time to watch me sleep when we hang out together. I'm not exactly sure how I keep him interested/entertained, since I do sleep so much of the time we're together, but I try not to dwell on that. I think we'll be okay here in VA, and although we might never fall in love with this area, we'll be happier and happier as time goes on.

Finally, the reason I'm here . . .

2007-09-05T17:23:00.000-07:00

I'm on my first general surgery month. Finally. A real team, with a chief, midlevel, and intern (me). My service includes breast and endocrine surgery. That means we take out breast cancers and thyroid nodules and cancers, for the most part. Usually relatively simple procedures, and the patient goes home the same day or stays overnight and goes home the next morning, if all goes well.

And when I say "we" take out nodules and cancers, of course I mean the grand "we." As a team, we look at the case list for the day, and my chief picks the cases she'd like to do. Then, the midlevel picks his cases. If there are any cases left, they go to me. Its sort of like being picked last in dodgeball, but in reverse. At any rate, the other day I got to go to the OR!!! Victory :)

Let me try to explain why I love the OR. First of all, its where surgery generally happens. That's a given. But also its where surgeons feel at HOME. Its where we're in our element, as it were. The OR is full of mini-rituals and very, very anal retentive practices, which is why surgeons are generally type A people. I'll run though the prepping of a patient for surgery for you, step-wise.

1. I go and see the patient in the preop area. All I have to do is say hello, and maybe update his documented History and Physical. The patient also needs to be consented for the procedure, if that hasn't happened before.

2. The patient gets wheeled into the OR suite. We do a TIME OUT, which means we all agree that we're doing the right procedure on the right patient on the right side. The patient then gets moved from their bed to the operating table, a very skinny very hard board that goes up and down and lots of other nifty directions. They pretty much get strapped in, covered VERY BRIEFLY with warm blankets, and anesthesia does their magic to put the patient to sleep. Usually they put an endotracheal tube in to help the patient breathe during the case. They also tape the patients eye's shut to prevent any corneal damage. Squeezy boots are put on their legs to prevent clots from forming during the case.

3. As soon as the patient is asleep, the fun begins. We immediately strip off all those warm blankets, put a catheter in if its a long case, and shave any really hairy body part we're working on. I then use a sterile prep to clean the patient's skin where we'll operate. Usually its betadine, so I'm (carefully) slopping this wet brown stuff all over them. Starting at the middle of the site, and moving outward in a circular motion until my sponge gets dry. Then get a new sponge, reload, and repeat. I do at least 4 runs with scrub, and 2 runs with dye. This shows us where we've prepped once the scrub dries.

4. Then I go to the scrub sink to scrub myself. This is a 5+ minute process of cleaning under my nails, then scrubbing every side of my fingers and hands (5 strokes each side of each finger, 30 on each palm, 20 on the back of the hand, 30 on each side of the arm to the elbow. um, scary that I count this? probably). Then I walk into the OR, careful not to touch anything, and the scrub tech helps me into my gown and gloves. Hopefully I've already put on safety goggles, but usually I forget and get yelled at by the circulating nurse. Once I'm done getting gowned/gloved, I start draping the patient. This is the part where my heart rate goes up, because I don't want to mess the draping up and have to start all over, and get called incompetent. Its very important that the patient stay sterile, so nothing can touch the prepped part except our sterile towels, drapes and instruments.

5. The patient gets fully draped with towels and drapes to cover every single part except the part we operate on. This is key, and its the reason why the OR's not really as grisly as people imagine. Its quite easy to focus on the part in question, and forget you're operating on a full person, in some ways. Keeps the queasiness to a minimum. This is not the case for an operation on the head, where the patient is pretty much in plain view. Anyhow, the draped area is sterile now, and not to be touched by anyone except those who have scrubbed as I described above. Usually this will include the attending surgeon, the assisting intern, a medical student, and the scrub tech. In the room, there is also an anesthesiologist and a circulating nurse, who gets us anything that's not already sitting on the instrument stand.

6. The scrub tech then wheels her stand over, full of fun operative equipment that I'm just starting to learn the names of. Tools sometimes have many names, and include blades, clamps and graspers of all types, and retractors, among other things. A key feature to any case is the Bovie, an electrocautery device that can both cut and coagulate bleeding areas. Also key is the suction. Any med student who has had that job can probably laugh along with me as I fondly remember my first case in the OR: "suck, dammit, suck. I can't see anything. That's better, now try to keep it dry, and suck whenever I'm not in there, okay?"

7. Then the magic happens. The magic first involves staring at the site for what seems like forever, trying to figure out where to make the perfect incision. If I get to decide, my mark usually gets altered once or twice before actually proceeding. The area of choice gets marked with a (sterile) pen, and I ask for the scalpel. "Fifteen blade" is actually what I say. Then I get to make the cut. Either I do okay, and get praise, or I do a bad job, and halfway through the attending screams at me to stop.

And I won't continue boring you with my favorite things, but that's basically how the OR works. And it works that way every time, and there's quite a sense of ritual and exactness about it that makes me happy. Probably because of my borderline OCD.

Here's hoping I get to get back in the OR frequently this month!

a brief guide to medical lingo

2007-08-26T12:38:00.000-07:00

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

2007-08-16T14:34:00.001-07:00

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

2007-08-05T16:24:00.000-07:00

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.

ends of the spectrum

2007-07-26T15:50:00.001-07:00

Yesterday was an amazing day. I knew it was going to be a good day when I went to the scrub machine and got the softest, most amazing pair of scrubs out. They were like wearing flannel pajamas, they were so broken in. Heaven.

Then, I started my day. Did a couple of scopes, did great. I made it into the right colon without help, got polyps out with no trouble, and felt very competent with my flex sigs. Then saw my postop patients. Everything was going great; all my patients were happy and pain-free. My pager only went off when I actually had time to answer it. When I answered it I knew how to deal with the issues that I was called about. Amazing, huh? I felt like my intern year was finally coming together.

Then, the greatest part. I got to go to the OR. The breast and endocrine service didn't have enough residents to cover all of their cases, and so I got to do 2 lumpectomies. And the doc let me do pretty much everything. My knot tying was improved, and I sort of knew what I was doing. All in all, a pretty good day. Oh yeah, and I got to work out, hang out with the puppy, and have a quality dinner with Dennis.

Then, I woke up today. First of all, I woke up 15 minutes before my alarm. Not a big deal, I know, but I really wanted the sleep. I normally wake up 5 minutes before my alarm anyhow, which is odd, but this morning I really wanted those minutes of sleep back. But I got up anyhow, got ready, and headed to work. It was raining, and my hair was extremely frizzy, which should have tipped me off.

It was all downhill from there. On nutrition rounds, I discovered that not one, but two of my ICU patients had died. One had care withdrawn, which I knew was going to happen eventually, but the other was a bit surprising. Another patient who's a favorite of mine fell out of bed, and is now in a C-collar. Worse yet, her PEG got pulled out on the way to the floor, so her belly hurts and she has a new tube in her nose. She was supposed to be discharged today, but obviously that's not happening. She's such a sweet woman, and has been in the hospital so long . . . yech.

And then comes my daily scopes. With the most impatient attending there is. I set up for the scope, and page him. 45 minutes later, he strolls in, gets angry that I can't get the scope into the stomach in the first 1.5 seconds, and takes the scope from me and finishes the procedure. After which, he asks me to dictate, talk to the family, and schedule the patient for surgery. Yay, since I've done so much with this patient, why don't I just operate on them too? That scenerio is repeated twice more for his next two scopes (including the approximately 45 minute wait each time), which pretty much takes up the rest of my day. Meanwhile, I'm getting paged by God and everyone who wants a PEG placed now, or sooner if possible. Geez people. In between I try to get as much work done over the phone as I can, but that's difficult sometimes. Its always easier to get information out of nurses in person anyhow.

Side rant: since I spent approximately 45% of my day waiting for attendings, I reflected on how worthless the time of a resident really is. Our job is completely necessary, and hosptials would not function if we weren't there. But our time is dirt cheap and so everyone could care less how long we wait for them. They figure we'll be here anyway. Which might be true, but doesn't make me feel any better as I'm sitting in the endoscopy suite tapping my Dansko clog against the floor, wishing I could just get on with my work. Meanwhile the pile of things I have to get done before I leave work is increasing exponentially, and I'm stuck without a way to do a lot of them. Its just frustrating.

Back to my story. Once out of endoscopy for the day (it was 3:30pm), I ate my lunch quickly and started to see my 5 new consults. All of them were sick sick people. None of them were going to get better from having a PEG, and at least one of them had a good chance of dying if we tried to put it in. Just depressing. Then I went to see another postop patient, who is generally a very charming woman with end-stage ovarian cancer. She's completely incoherent and twitching. Seizing? Tired? I have no idea, so I page the gyn/onc team. They yell at me for not knowing her exact blood pressure when I call them. A girl just can't get a break.

I try to do what's best for my patients, but sometimes that's hard to figure out, let alone do. This patient, for example. Her tumor grows quickly regardless of her chemo regimen, and she's inoperable for now. Anyone who knows anything about cancer will tell you that's a bad combo. But she and her husband are sure she's going to beat this. I'm equally sure she won't. I hate to be a pessimist, but truly the odds are stacked against her. But a consultant, that's not my place to say. I just make sure the Gtube we put in her is working to decompress her bowel. Which it is, as best as it can.

So that's a little blurb on how my days go. The last couple were most remarkable because they were polar opposites. Most other days fall in between, with a nice mixture of good to offset all of the bad. Through it all I'm learning, which is really the point. And I only have 3 more days of endoscopy left. Although I love endoscopy, I'm ready to move into another area. Everyone is; we're all feeling the stagnant sameness of our current rotation, and we're ready to switch.

more of the same

2007-07-21T14:23:00.001-07:00

I'm finally starting to feel comfortable with endoscopy. I've done probably 40 or 50 scopes, and about 25 PEG tubes. I'm also starting to get to know other residents, nurses and support staff, which helps when I'm trying to get things done for my patients. I finally feel comfortable finding the answer to any problem that arises, which is great. And I'm consistently getting more scopes done without any attending help. Its still lonely without a team, but the nutritionists are great, and I work with them quite a bit. I'm not sure if I mentioned this part, but I also take care of the nutrition needs of all patients who are on tube feeds and TPN. Its a great way to learn how to use nutrition support in the critically ill.

Being on call in the SICU on the weekends has been very, uh, educational. Its tough to come in and cover for a weekend, because I dont know any of the patients. The residents who normally cover the SICU are not surgery residents, and so they're not as interested in the rotation. For example, the ER resident who signed out to me last week left before rounds last weekend, leaving me to present all these new patients to my attending. Luckily he was somewhat understanding, but the chiefs and the fellows who rounded with me beforehand were not. Anyhow, I dealt with more really sick patients. I'm finally starting to feel comfortable with the controlled chaos that is the SICU. I am starting to figure out that there's no need to get stressed out . . . most things, even emergent ones, happen in slow motion. Even codes happen in slow motion. There's still a lot of standing still and thinking involved. And a lot of procedures. I've gotten to put in chest tubes and central lines and arterial lines.

Several people wanted to know when I did my first real surgery, so here it is: I did a lumpectomy and sentinel lymph node biopsy this past week. There was no one else to cover the case, and I didn't have anything urgent going on, so I agreed to head to the outpatient OR and do it. It was a great chance to work on my (sad) suturing and knot-tying skills, and it helped me remember just why I'm here working my butt off in the hospital. I love all the procedures I do in endoscopy, but I really can't wait until I get to operate more.

my life outside the hospital

2007-07-08T08:52:00.001-07:00

Okay, its pretty much nonexistant. But I do sometimes have off work (like this weekend). So here's a quick scoop on the stuff I do when I have time off:

1). I work out. Usually at home, but I have a gym membership too. I've never actually been to that gym, but ah well. Someday I'll check it out. Here's my home gym:

Its a great place to work out. I can pretty much do all of my MBG style workouts, except shuttles. Of course its no Monkey Bar, but I still like it. Milo likes it too; she hangs out there pretty much all day.

2). I Do yardwork. Sort of; I really have no idea what I'm doing. But so far Dennis and I have cleared a large portion of our wooded backyard, and trimmed bushes and trees in the front. Here's some pics of the backyard:

Eventually, we want to do some simple landscaping, and plant grass in the bare patches, and lots of other stuff . . . but for now we're pretty happy just to sit and stare at it. Here's our deck, which we sit on sometimes. I'm convinced that if we had a grill, we'd spend more time out there. That'll come eventually.

3). My house: I'm slowly getting it decorated the way I want. All the furniture we need is pretty much here now, and I made pillows last weekend (very exciting stuff). I have so many ideas for wall art, and other crafts. I just need time to do all of it . . . which honestly I don't have. However, I have two weeks of vacation coming up. Dennis can only get one of those weeks off of work, so the other week I'm going to be home with little to do. I might get some stuff done then. Here's pics of my living room and kitchen:

That blue looks pretty bright in pictures! I like it though.

4). Oh, and I hang out with my intern class a bit on the weekends. We typically go out on Fridays after work. Last Friday it was up to me to pick the spot (right, put the new girl in charge). I kept bringing up places, and Dustin (who's a VA local) would roll his eyes at me. Its pretty hard to know what is a good place to go out to eat or drink if you're new to town. We ended up at this place called Wild Wings, a sports bar that feels sort of like Brats. It was a good time, and we got some of the neurosurgery guys to come out too. They're a fun bunch, although they work even harder than we do, so its hard to get them to do anything outside the hospital.

Yesterday I went over to Kristen's place (another co-intern). She lives in a condo with a pool, so we sat by the pool all afternoon. It was lovely, although it was about 93 degrees. Its been hot the past couple of days, and extremely humid. So humid that it sometimes rains for 15-20 minutes in the afternoon, because it gets so humid it probably has to.

Don't go to the hospital in July . . .

2007-07-02T14:37:00.001-07:00

That's what they say, at least. Everyone is new, and mistakes get made. But so far, I haven't seen anything terrible happen. The nurses know what they should be doing, for the most part, and they keep us new residents out of trouble.

My first night on call was this weekend, and whew. That's all I have to say. It was made doubly hard by the fact that it was in the ICU, and I didn't know any of the patients. The first few hours were pretty laid back. I got called for little things, like patient X needing pain meds or patient Y's hematocrit being too low. Not too bad. I even got to sleep about, uh, 15 minutes.

THEN, at about 2:30 am (perfect timing), things start to go a bit mad. Patient Y is now bleeding profusely from his wound, soaking his dressing and the bed and everything else he can manage to soak with blood. I go try to figure out what's happening. Then I call my chief, who sleepily answers the phone and tells me to 'just bovie the thing.' Hm. Haven't used a Bovie in awhile, and never in a patient's room (the Bovie is electrocautery, that cauterizes bleeding vessels shut. Its used very often in surgery). I go get the portable Bovie and go to town. This only temporarily fixes the problem, but that's all its going to get at this hour.

Just as I'm finishing redressing this guy's wound, Patient Z, who I really haven't heard too much from, tries to die. Repeatedly. I go get a more senior resident to help, and we try to convince this dude that being alive is really the way to be. It has to be bad luck if a patient dies on your first night on call, right? So we finally get this guy to be semi-stable, and I call my chief. He's not too impressed about patient Z either. I start to wonder what its going to take to impress this guy.

Then comes a stream of smaller but still stressful things, including an off-floor code. We respond to codes on surgery patients, because we'll be taking the patient into our ICU. So we got patient C (C for code I guess), who apparently came to our hospital just in time to die. But . . . he didn't actually die until my shift was over. Score!

Then came rounding, and attending rounds. Where the attending doc played "pimp the poor intern who's been on call all night and whose brain is fried from the stress of her first night on call." That game was NOT fun. So, after my first night on call, I left the hospital and cried. I feel better today, after realizing that it is okay that I don't know all the answers, as long as I know where to find them. But I still don't feel qualified enough to have people's lives in my hands. I hope that comes.

Getting into the groove

2007-06-25T16:22:00.000-07:00

cue the Madonna music . . .

Really, though, its a week into intern life and I've finally got a schedule down. It goes something like this:
5am: wake up, walk dog
6:15am: arrive at hospital, change, head to morning report
7:30am: start daily work (scopes, or nutrition rounds)
7:30pm (give or take): get home, walk dog
Then I've got until about 9:30 or so to get my stuff done. My goal every night is to do 30 minutes of reading, 30 minutes of workout, eat dinner, and hang out with the BF and Maddie. It doesn't sound that bad, but I've got to be efficient to get it all done.

I should point out that although 6:15am sounds early to a lot of you, its not early at all to get to work as an intern. That will only happen for me this month. After that, I've got patients to see in the morning before my team gets to the hospital to start their workday. As an endoscopy resident, I'm the only resident on my team, and so I round whenever I want. That's usually in between scopes. And because I don't have any patients to call my own, I don't have to see them super early in the morning, to make sure work gets done for the day. I love it.

But I do miss having a team. It gets a little lonely, and a little scary when I get paged about a problem I have no idea how to handle. But I muddle my way through somehow, and get help when I need it. Like last week, for example, when I was called about a patient who's PEG tube was leaking gastric contents all over her bed. Yummy. Oh, and not just any gastric contents . . . this lady had C. diff, so it stank unbelievably. If I think about it, I can still smell that stuff. Ugh.

Cutting my daily workout from an hour to 30 minutes has been sad. But really its all I can make time for. I sort of count my running around the hospital as a workout too. My endoscopy clinic is on the first floor, the ORs are on the second, and I have patients on floors 3, 4, 5 and 6 at most times. So I'm quite the stair climber.

One more piece of good news: I have vacation in August, so I will be in WI for at least a week. I'll be emailing my demands to see many of you while I'm there. So stay tuned. It sort of stinks to have vacation this early in the year, but I already miss lots of people, and have a family wedding that I didn't want to miss, so I'm glad I got some time off!

finally, some real doctoring . . .

2007-06-20T18:30:00.000-07:00

well, maybe not. Most of my patients aren't the most communicative (especially when gorked out on meds during their procedure). I'm on endoscopy and nutrition service this month. Which is awesome, because its a consult service (meaning you only see other people's patients, so have less rounding in the morning). But its also rough, because I'm the only resident on the service. If I have questions about how things work, I have to call my attendings directly. Which can be intimidating. Plus I don't get to have a team of residents to share work with, which can be a great bonding experience.

Today was mostly endoscopy. I looked at a lot (and I mean a LOT) of colons. Its actually pretty fun, sticking an instrument that oddly resembles a garden hose up someone's you-know-where. I still have no idea how to work the scope, and flounder around a lot without going the right direction, but its still a blast. Sort of startling when you're staring at the colon on a screen, magnified I'm not sure how many times, and some poop comes flying into view. Tomorrow I have some EGD's to do (looking down into the stomach with a scope). Whoo hoo!

And, since I'm starting intern year, what better time to get a dog? I found an adorable one, so I brought her home. Pics are below. She's 5 months old. She came with the name Maddie, and we decided to keep calling her that. In my head her full name is Madison, after my favorite city. But Maddie rolls better off the tongue when she's chewing on something she shouldn't be or chasing the cat. The first day she was very mellow, probably overwhelmed. But now she's pretty much settled in, and loves to get into things that she shouldn't. But she's very lovable :)

The beginning

2007-06-13T10:40:00.001-07:00

Getting handed my pager was probably the wake-up call moment for me. Just like everyone else in line before me, I attached it to my waist and turned it on. Why? I'm not sure; its not as though they were going to page me out of orientation. Then it hit me: I'm now (semi)permanently accessible to the hospital. Eek! They can find me anywhere. The name badge with MD after my name is a little scary too. I don't feel ready to be the go-to person.

I met my intern class yesterday. Its eerily similar to Grey's anatomy: two guys, three girls. I started to draw the parallels, then stopped myself. What am I thinking? They already told us twice: no sexual relationships with patients, no relationships with attendings or other hospital personnel that would "jeapordize the patient relationship." Damn, there goes the drama. So I guess that's where the similarity to the show ends. In reality, I think I'm going to love my fellow general surgery interns; they seem like a great group. We went out to dinner and drinks and had a blast after orientation activities were over.

I also met a bunch of interns in other specialties. Medicine, anesthesia, pediatrics, OB/Gyn, and lots more. It seems like there's a great group of people, which is key when you spend so much time together. Everyone shares a common terror for getting lost in the hospital and for starting on a rotation where the chair of the department is one of your attending physicians. That makes me feel much better about my own worries (which are numerous).