Failing Body

Apparently my body doesn't agree that I should be consistently working out. My knee began to act up a few days ago and is now clicking and rather grinding whenever I do much movement. Bending the knee slightly? Clicks, pops, grinds, and just feels weird.

A month ago my back was acting up and put a small hiatus on weights. Now it looks like I'll have to put a hiatus on my at-home cardio.

Stupid old man body. At least I've lost 5 pounds since residency began...most likely due to not being able to eat while in the ER.

Dickhead Consults

I suck at consulting. But that's OK, because so does every other intern and we're given a sorta pass the first couple days/ weeks. However my consulting is more frequent and a thousand times more annoying since I'm the ER page everyone loathes.

So far I've been able to get all my consults completed, even though I've had to call up to 4 different services for one patient every now and then, but my delivery is weak. Most of the people are fairly nice and allow me the awkward delivery, but a couple have been just dicks.

The other day I had a really bad consult. We have a computer system where we place a consult in and then also ask for the receptionists to page them. This way the resident knows the patient's MRN and something about them before they call back - and is supposed to speed the process up. Supposed to...unless some idiotic intern consults on the wrong patient.

That's right, I sent a computer page for the wrong damn patient. No excuses, even though I had been completely swamped, the patients were 2 doors away from each other, had similar complaints (in fact around this time I was losing track of what patients needed what and what I haddonesincetheywereallsoundingexactlythesame,buttheattendingsweredifferentandthereforethe managementvariedslightly...but I digress), and had almost identical names.

The consult called, asked me some questions, was a mega-dick since we hadn't done a huge amount for a patient who was discharged earlier that day and was back for the same problem (I remember wanting to get snarky with them when they refused to take the MRN and bitterly and patronizingly told me I should have ordered some test, since "I'd think that's something you'd do in the ER, riiiight?"), and said they'd be down. Once there they came to me and told me in front of a large group of attendings, residents, interns, nurses, techs, and patient families that I had consulted on the wrong patient.

"I did? Shoot...sorry about that."

What else could I say? I was wrong, but I still hated the treatment. I need to make sure I'm being more careful about point-and-clicking patient info and orders - it's a good lesson, but the consult's tone and demeanor towards me was upsetting. I was reminded just how low I am in the hospital and honestly resented it. I'm trying to get my head around the system while the crazy ER keeps dumping patients on me when I haven't even seen 3 other patients yet and have 6 more that I'm following up on and I was exhausted. All excuses, all weak, but still, it sucks.

Moving Meat

So I know my experience is purely from the 2 days that I’ve worked, but I’ve got to say that I feel lost.

I don’t think I’ve really helped any of the patients I’ve seen (except those couple lacs I repaired) and have merely shuffled them around to test after test and departments or back to home. Some of it is understandable, but a large part seems hit and miss and very dependent on the attending.

I know there’s a method to the seeming madness, but right now it seems chaotic. And that’s another thing – the patients don’t stop coming. There’s always freaking work to be done no matter how much you try to move your patients up and out. Someone else always comes back to that room and you’re still at full capacity running around like a chicken with its head cut off no matter if it's 6pm or 3am.

Some elements of medicine ring true – like all bleeding stops (even though I had a bleeder for hours that just refused to cease oozing despite varied treatments), so I’m learning as I go and will take away what I can.

First Day

My first real day in residency was interesting. I was not able to get a work out in since we were lectured to for over 2 hours yesterday morning. It was good for those who started that morning – as it decreased their time, but it made it impossible for me to get to the gym with any hopes of a good workout. So I reviewed some items and readied myself.

I arrived early, thinking that it would be good to get my bearings and any patient hand-offs from interns leaving before I was supposed to start. Entering the ED I found what appeared to be confusion. There were lots of people walking around, some running, multiple conversations going on all at once, and a large electronic board with all of the rooms in my section of the ED – all full of varied patients and complaints.

“Well, here it is.” I thought. Introducing myself I was directed to a new patient since there weren’t any interns leaving at that time and began a full half hour before I was scheduled. Gotta remember to get there closer to my actual time.

Overall the day wasn’t too bad. The most vexing item was just trying to understand how to review charts, remembering to develop and follow up on patient care plans, and order things smoothly. I quickly dispatched of my Rx pad and a few other items as the system is completely computerized. I regularly carried 4-5 patients, but as more docs arrived (we had something like 5 interns and 2 attendings) and I attempted to write and discharge notes on several patients at once I found myself to only have 2 towards the end of the night and eventually handed off just one.

We went on diversion for traumas (weird in a level 1 center that receives everything) for some surgical reason – I never did find out why. I do know that the more acute side had 6 traumas or emergencies within 1 hour of each other, so maybe that had something to do with the diversion.

Since I was in the less acute area I got into the swing of things a little more quickly than I’d have thought. I forgot to ask some simple questions, probably due to rust, but for the most part was able to get somewhat used to the idea of being a doctor. A couple times I almost said I was the medical student, but would catch myself just before.

On again today.

Heavy

My white coat is ready - and burdensome. I weighed it today with me wearing it and figured out that it's about 3-4 pounds with everything that's in there. This includes:

- pocket pharmacopeia
- handheld PDA
- Sanford antibiotic guide
- stethoscope
- half-sized pad of ruled paper
- 2 pens
- pager
- OB/Gyn pregnancy wheel (I mean, I'm in the ED after all)
- pen light
- pocket notes guide (though everything's computerized, so I most likely won't need this)
- cell phone
- name badge
- antidiarrhea pills (hey, I get sick to my stomach when I'm really nervous and I'm sure it's coming)

I actually was surprised to see that I couldn't fit in as much into this long coat as I could in me shorter coats. I believe it's the tailoring that restricts the bulkage - more tapered in the back and slimmer appearing than the boxy short coats were.

I'm freaked out, paranoid, scared, nervous, sweaty, and all other sorts of anxious about tomorrow. I have a meeting at 7am, in which they'll take us around, and then I don't start till 11am. I plan on trying to get some time in at the free resident-gym, but we'll see. I may be so stressed that I'll spend most of my morning in the bathroom. Yeah, gross.

Wish me luck...here we go.

Here It Comes

Hearing about a friend’s first day on Trauma Surgery was enough to scare the pants off me. Knowing that she survived, though, was refreshing. In two days I officially begin residency - in the ED, not trauma (thankfully). I’m freaking out a little today - most likely in fits tomorrow.

I’ve gotten my white coat ready, placed all sorts of medical accoutrements within it’s vast pockets, and have procured a set of scrubs. Tomorrow we have some final orientation items and I’ll make sure that all my passwords work, scrub access is open to all machines, and I can find the ED. You know, the basics.

Sorry for the crappy posts recently, but this is taking a lot of time - hopefully better to come.

We Are the Enemy

OMDG has a post about her impression of anesthesia. I'm not surprised by what she took away and have posted already about this process. What did upset me, though, was the resident's take on their job.

I hate to hear anesthetists and anesthesiologists trivialize what they do - either in the preop holding area, on the floors, or in the OR. It continues to create negative impressions of a field that's hardly understood by anyone outside of anesthesia. When you hear someone say that: "You'll be going to sleep while the strong surgeon works." or "I kick back and relax while they operate." you can understand where the perceptions of anesthesia come from and how they keep getting validated.

Being extremely virgin-like in the art of anesthesia delivery I really don't want to try and explain concepts that I'm still unsure about; however, there are times when things run smoothly and it appears that not much is going on, and then there are times when the anesthesia staff are constantly checking labs, running drugs/ fluids/ blood, and keeping the patient stable while the surgeon repairs the defect. I'd find it scary to think that someone who brags about sitting for 5 hours a day would be put in those scenarios - as their mindset lends itself towards adverse outcomes.

Of course, if someone is really napping, playing games, putting their feet up, or trying only to appease the surgeon(s) then they're weak anyway. Unfortunately, the old adage of "You're only as strong as your weakest link" is only too true here.