ends of the spectrum

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 One had care withdrawn, which I knew was going to happen eventually, but the other was a bit surprising.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

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

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 . . .

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

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 . . .

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

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).