Welcome to the ER

My first rotation of the intern year is emergency medicine, a rotation that is required for all DOs in this state. My program director, whose wife is a DO, is more familiar with the DO regulations than I am and made sure every DO in the intern class got a month of ER. Very thoughtful and considerate of him. My first day of ER was memorable in that shortly after my shift I overheard a group of nurses talking about how Michael Jackson died. I thought it was a bad joke at first, since Farrah Fawcett had passed away just earlier that day, but as it turned out it wasn't.

Medicine interns work eight hour shifts in 3 time slots: 7am-3pm, 3pm-11pm, and 11pm-7am. At 7am and 11pm the attendings, residents, and interns round on all the patients before the attendings ending their shifts sign out to the ones who are just starting their shifts. In rounds, we present our patient in one sentence, usually stating the name, age, chief complaint, and pertinent labs and other tests. Sometimes the attendings will take time to teach a bit during rounds, but not often (especially if they're in a hurry to go home). Whenever I end my shift, I have to sign out to the EM intern who's worked the fewest hours so far. The EM interns work 10 hour shifts: 7am-5pm, 2pm-midnight, and 9pm-7am. So if I get off at 11pm, I sign out to the 9pm intern. I rarely ever leave at exactly 3pm/11pm/7am, though; I often run an hour or so over.

We don't get to choose our schedules. I can work 3 days and then get the next 2-3 days off, or else I can work 2 days and get 2 off, it varies every time. I also learned to bring all my meals with me to work since there really isn't much time to go to the cafeteria when there are patients to see (not to mention the cafeteria is expensive). The EM attendings treat the medicine interns all right, but clearly favor the EM interns more. Any procedures in the ER go to the EM interns and residents, and medicine interns never attend the traumas. While the EM team is working on a GSW victim who's bleeding out, I'm still writing notes or seeing patients. As for introducing myself as "Dr.____," I'm getting the hang of it, but sometimes I still say my first name during my introduction.

On a side note, I like wearing a long white coat =)

Orientation Week

This whole week has passed by in a blur. The first three days was general Graduate Medical Education (GME) orientation, in which we received on handbook and went over topics that applied to all residents (i.e. resident fatigue, culture awareness, etc). I did get to meet several other people within the medicine department (one of whom lives in my apartment building), but I didn't really get to know my colleagues until the last two days of orientation, which were strictly IM-focused. We met the four chief residents, who gave various presentations about how to take good notes and explained call systems and schedules to us. I had originally lamented that I had not gotten a heme-onc elective like I wanted, but I learned today that the wards I've been assigned to have a heme-onc emphasis so I'll still get to see cancer patients on the floors. That's good.

My first rotation of the year is ER, which is required for all DO interns in order to get the internship approved by the AOA (the program director's wife is a DO so he knows all about the requirements for internship approval, which I think is a good thing). Prelims also take a month of ER, so I got tired of explaining after a while that I had to take ER because I was a DO, not because I was prelim. Shifts are 7 am- 3pm, 3pm-11pm, and 11pm-7am. The June schedule is out and so far I have one 3-11 shift next Thursday and then two 7am-3pm shifts next weekend. Yes, I don't get a weekend, but that means my weekdays are mostly free. I'm just glad I'm not starting on the floors or on the graveyard shift, though I'm sure that'll come next month.

The intern class has 42 categoricals and 18 prelims. On Friday night all of us went to a bar/grill downtown called McGillin's for dinner and free beer/wine. I hung out with some of the same girls I'd been sitting in orientation with for the last few days, but I met several new people as well. When the EtOH was flowing, everyone was super friendly. One Asian guy clearly had way too much to drink (red face) and fortunately lived within walking distance of the club. A few guys who attended Drexel for med school also told me about cheap Chinatown-based buses that run to NYC or DC every day and said that if I ever wanted to visit those two cities, those buses would take me to the respective Chinatowns in each city. It takes 2-3 hrs, but is cheaper. Some of them are already making plans to visit the city every free weekend, but I know almost nothing about New York so I'm not as brave.

This morning we had a little procedures workshop to learn how to insert central lines (subclavian, IJ, and femoral). "Who in here has put in a central line?" asked one of the attendings. There were 7 of us in the room, and I was the only one who raised my hand. No surprise, since I'd done an ICU rotation and 3 of the students were prelims (rads and gas). Two others were SGU students, and I don't know how their rotations work. My biggest problem is inserting the needle in the right place, so when asked if I was proficient, I said no. I hadn't put in a line since last September, but it's really one of those things you don't forget completely. We practiced on a dummy mannequin with "soft tissue," and I think I did okay. For now.

Time To Say Goodbye

Last night I discovered on Facebook (of all places) that one of my former orchestra directors is currently on hospice at All Saints. To say I was floored would be an understatement, yet I shouldn't have been surprised. She was diagnosed with stage IV colon cancer 28 months ago (normally I'd say two years but this was the number my former private lesson teacher told me when I called her for more information), and last week her health took a turn for the worse. The person on Facebook who posted the info about her told me that she probably had days left, which, again, shouldn't have been a surprise. I'd spent a month in geriatrics; I knew that most people who enter hospice care usually pass away within a few days. But still...this was my teacher. She had always been so strong and aged well, despite being close to 70 when I graduated from high school. And she was dying.

I called All Saints and they transferred my call to her room. Her voice was weak and she spoke slowly, but she still remembered me after all these years. "Teachers don't forget," she said. "You were very special." That brought tears to my eyes, and I had to try really hard not to cry while speaking to her on the phone. I told her that I'd played my violin in college, that I went to medical school and am now living on the east coast doing my residency in internal medicine with an interest in heme/onc. I told her about meeting up with my best friend, who was one of her favorite students, two months ago in New York, and said that we were both thinking of her. She said she was flattered that I thought of her, and I said there was no way I could forget. Before medical school, and before college, orchestra was my whole life. Music was one of the few things I thought I excelled in, and part of it I owed to all my directors. Including her.

I didn't want to keep her talking for fear that she needed rest. After we said goodbye I realized there was so much I forgot to tell her, but at the very least she knows I'm thinking about her. I then called my private lesson teacher for the first time in 7 years (amazing how I still remember her phone number) to ask for more information, since she and my former director were very close to each other. Knowing that I was now a doctor, she left nothing out in telling me how my director's illness had progressed since the diagnosis. I asked if there was any pain, and fortunately she said no. "There was never any pain," she said. For that I'm extremely grateful. I just don't know how to say goodbye.

New Beginning

I've been in Philadelphia for almost a week now, and I'm finally starting to settle down in my new home. My apartment, which was frightfully bare when I first moved in (I didn't bring any of my own furniture), now looks much homier with a bed, TV plus stand, square table and chair, a floor lamp, and a sofa bed (which I bought from Ikea and built all by myself; that was an accomplishment on my part). There's a lot of furniture I'd love to buy, but can't because I'd be responsible for moving it and there's only so much I can carry at one time. My place looks like a mess because I still haven't unpacked about 50% of my stuff. No place to put it. Eventually I might build a bookcase for the rest of my junk, but for now, it's staying in the crates.

Last week I had 3 days of EMR training. The first day's EMR was for the main hospital, Hahnemann (henceforth called HUH), which uses something that looks a lot like DOS but is still workable. The other two days dealed with an EMR system used in the clinics. Everyone had to pass the first class before they could proceed to the next class. There were about 15-20 of us in the first class, but on the second day, there were only four of us (me included) who were ready to take the second class; the others had failed (in this case, "fail" = less than 90). I don't think I passed the second class (in which we had to fill out an office note, write orders, assign tasks, etc), but hopefully I won't have to retake it again.

Also to prepare for the winter ahead, I drove to an Ugg outlet store in New Jersey (about 90 min away) and bought a pair of Ugg boots. Now, I would never even think of getting Uggs at home, but the good thing about PA and NJ is that shoes and clothes are tax-free. And my boots, which have a retail value of $180, only cost me $109. Not too shabby.

Orientation starts tomorrow, and I'll also be tested in the practical portion of the BCLS/ACLS. I'm not worried about BCLS, but the online ACLS class I'm taking is really kicking my butt. Hopefully everything will turn out ok tomorrow; I'd hate to be an incompetent doctor.