One rule at this hospital is that night float interns work Mondays through Saturdays but get Sunday evening off. On Sundays, whoever is the overnight intern has to do double duty as overnight intern (admissions) and night float (cross cover). It's been called "Black Sunday" and was supposedly the worst night of any intern's life. Guess who had Sunday overnight call yesterday? Me.
I started getting sign-outs from the other teams (I covered a total of eight teams, the 4 Yellow and 4 Green teams) shortly after noon. For the most part things were calm until around 5 pm. Then the calls started from nurses needing orders for their patients. I let my MS3 go home at 7 pm so that she could have dinner with her husband (on top of that she had nothing to do). Shortly after that I got my first admission: a patient of Dr. RRR's with metastatic colon cancer who had exquisite abdominal pain. All I did was brush her abdomen with my stethoscope and she pushed my hands away. She wasn't really able to give me a good history because of her pain so I had to ask the ER attending what was going on.
While I was down in the ER presenting to the triage resident, I suddenly got bombarded with pages and ignored them to finish my presentation. The bottom line: this patient was not well enough to go to the floors; MICU or surgery would be a better bet. Then I got a call on my cell phone from a very impatient nurse on the 17th floor (when I didn't answer her pages, she called the operator and asked for my cell phone) practically demanding that I put in some orders for her PRONTO. Even though my note wasn't completely written (didn't elaborate on the assessment and plan), I went to the 17th floor to see what was up.
"Four things," said the nurse. "___needs a Foley renewal. ____ needs to have tube feeds held after midnight. ____is vomiting. And I need to know whether or not to give this patient (certain cardiac drug)." When I asked the nurse what indications were for giving the drug, she rolled her eyes and said she didn't know. Um, what? I looked through the sign-out list and the patient's chart and learned she was being given the drug for A-fib, and the resident had a note saying "QT < 450." Did that mean I should give the drug as long as the QT was less than 450? The QT was 380, so I told the nurse to give the drug. It wasn't until the morning, when I spoke to Alan, that I realized that the drug was known to cause QT prolongation and that it was safe to give as long as it was less than 450. Whew. Looks like I made the right choice this time around. Even still, I felt really stupid when it was all said and done.
The calls kept coming throughout the night; at best, I lay down for 10 minutes. Several of the heme-onc patients had problems, especially one from the other team who was tachypneic and agitated after getting a breathing treatment. The cafeteria was closed on Sunday nights (much to my dismay) so I ordered takeout Chinese and ate it when I had a spare minute. I also didn't eat anything after midnight until around 6:30 am when I quickly ran down to the cafeteria for breakfast. I was surprised to see medical students at 5:30 a.m.; they were on their surgery rotation and seeing patients right before their surgeries. Finally 7:00 a.m. came and I had to sign out to a new group of residents, including my own. Residents switch services one week after the interns do to give the interns a week to adjust to a new team (and pass on words of wisdom). My new resident was kind enough to let me go home at 11:30 am, but man...I hope I don't have another Black Sunday for a LONG time.
Monday, July 27, 2009
Friday, July 24, 2009
Yellow 3: Getting started
There are 16 medicine teams at HUH, four in each "color" of red, blue, green, or yellow. Red is a strictly cardio service. Blue is strictly general medicine. Green is half general med, half nephro. Yellow is half general med, half heme-onc. I was assigned to Yellow 3, one of the two heme-onc services, and I wouldn't have had it any other way.
There are three attendings that cover Yellow 3, along with one heme-onc fellow, one resident, one intern (me), one sub-I, and one MSIII. We have one attending MW, the other TTh, and the other Friday, and then they take turns covering the weekend. The MW attending just finished fellowship so he's really fun and cool, as is the Friday attending, who completed his fellowship at HUH and still wears the white coat he wore as a fellow instead of an attending's coat. The TTh attending has been on the service the longest, as she used to run Yellow 3 alone. From the first day, my resident warned me that she was everything I should strive not to be (an opinion shared by most of the medicine residents and attendings). I soon found out why. She answers personal phone calls in the middle of talking to patients ("Oh, you saw___? What was he wearing today?"), she admits patients directly to the hospital without telling triage (which confuses the heck out of them and messes up the census), and she doesn't communicate that well with her partners about treating certain patients. Not the best example of professionalism.
The rest of my team is pretty cool. The fellow's really nice and approachable, my MSIII is one of the sweetest people ever (and very helpful, too), and my sub-I puts me to shame because he's so smart and hardworking, doing all the consults and discharge forms. My current resident is a PGY-3, and he took it upon himself to tell me what was expected of me as an intern and train me to become an active member of the team. "You're running the floor," he said. "The med students and I are here to help you, but this is your service." Lots of responsibility, wow. I actually get a new resident next week (they switch a week after interns do), and this one will be a PGY-2. He was an intern just one month ago, so I imagine working with him will be different from working with the PGY-3. I just hope we won't BOTH be clueless.
Now that I'm out of the ER, I also have clinic every week. My clinic is located across the street from the hospital. So far I have 2 patients per afternoon, though I expect that number to increase with time. For now, no complaints =P
There are three attendings that cover Yellow 3, along with one heme-onc fellow, one resident, one intern (me), one sub-I, and one MSIII. We have one attending MW, the other TTh, and the other Friday, and then they take turns covering the weekend. The MW attending just finished fellowship so he's really fun and cool, as is the Friday attending, who completed his fellowship at HUH and still wears the white coat he wore as a fellow instead of an attending's coat. The TTh attending has been on the service the longest, as she used to run Yellow 3 alone. From the first day, my resident warned me that she was everything I should strive not to be (an opinion shared by most of the medicine residents and attendings). I soon found out why. She answers personal phone calls in the middle of talking to patients ("Oh, you saw___? What was he wearing today?"), she admits patients directly to the hospital without telling triage (which confuses the heck out of them and messes up the census), and she doesn't communicate that well with her partners about treating certain patients. Not the best example of professionalism.
The rest of my team is pretty cool. The fellow's really nice and approachable, my MSIII is one of the sweetest people ever (and very helpful, too), and my sub-I puts me to shame because he's so smart and hardworking, doing all the consults and discharge forms. My current resident is a PGY-3, and he took it upon himself to tell me what was expected of me as an intern and train me to become an active member of the team. "You're running the floor," he said. "The med students and I are here to help you, but this is your service." Lots of responsibility, wow. I actually get a new resident next week (they switch a week after interns do), and this one will be a PGY-2. He was an intern just one month ago, so I imagine working with him will be different from working with the PGY-3. I just hope we won't BOTH be clueless.
Now that I'm out of the ER, I also have clinic every week. My clinic is located across the street from the hospital. So far I have 2 patients per afternoon, though I expect that number to increase with time. For now, no complaints =P
Monday, July 20, 2009
EM: Finale
Wow...these last few days in the ED were definitely memorable, as were the patients. One of them, a guy in his late 30s with a history of DVTs, had a note placed in his chart requesting confidentiality from his own family members, which didn't make much sense to me. When I spoke to him alone, he was really friendly, but when I tried to ask him more questions while his wife and son were in the room, he looked horrified and asked me to come back later. "Everything is confidential, right?" he asked. I didn't understand what he meant until visiting hours were over, and he confessed that his wife was not aware that he was HIV positive (which was written in his chart). Apparently he tested positive soon after they were married (about 5 years ago), and the most likely carrier was a woman he had a relationship with before he met his wife. At any rate, that's why he requests patient confidentiality on all his files, and why he didn't want to talk to me when his wife was in the room: he'd thought I'd ask about his CD4 count and other things. He stated he takes all his HIV meds faithfully and has a undetectable titer. His wife keeps a copy of his medications with him, and I saw that beside the usual HIV drugs it said, "Antiviral medication." I wonder if his wife questions just what kind of virus he has. Maybe she thinks he has hepatitis or something. My attending later commented that his wife can have him arrested and prosecuted for lying about his HIV status, but hopefully it won't come to that anytime soon.
For my last ever ER shift, I had to work from 11 pm to 7 am, and then run up to the 12th floor lounge at 7 am to pick up my patient list and immediately start working on the floors. Thank goodness Dr. PB was willing to let me go at 6:30 am so that I could start on time, and that I was allowed to leave the hospital at noon as though I was post-call. I saw only three patients, and they were all trainwrecks. Two of them had ESRD and their electrolyte levels were outrageous (potassium of 6.8!) The third was a cachetic man dying of terminal lung cancer who was in hospice care, but his wife brought him to the ED after he stopped eating and became less responsive. She was supposed to call hospice before bringing him to the hospital, because hospice patients are discharged from hospice once they're admitted to the hospital. I had to get on the phone with hospice to try to figure out what we could do for this patient, and that took up a huge chunk of my time. Even worse, all three patients had crappy veins, and we couldn't get blood from them without the help of ultrasound-guided line insertions, which could only be done by the third year resident (I knew nothing about using an ultrasound machine). Needless to say I felt useless in the ED and was all too happy to sign out to the ER intern and haul my butt up to the 12th floor, where I once again exchanged scrubs for business casual.
I immediately went to the heme-onc floor (15th floor) to get started on seeing patients. There were currently 5 in the service, not a bad number at all, and I was able to see them all and get notes written on them (with some help from my med students) before the attending arrived. Steve went to morning report but gave me his cell phone number in case I needed help. So far so good. There were three attendings who rotated through our service, two males and one female. The female doctor was in charge of the service; the other two are fresh out of fellowship and therefore more "cool." One of the male attendings came to round with us today and introduced himself to us as "Mickey." Mickey loves to teach, and we spent a good 20 minutes talking about breast cancer and its prognosis based on ER/PR/Her2-neu status. Pretty interesting stuff.
As promised, I got to leave at noon and slept for a good chunk of the afternoon. Hopefully I'll be able to fall asleep tonight.
For my last ever ER shift, I had to work from 11 pm to 7 am, and then run up to the 12th floor lounge at 7 am to pick up my patient list and immediately start working on the floors. Thank goodness Dr. PB was willing to let me go at 6:30 am so that I could start on time, and that I was allowed to leave the hospital at noon as though I was post-call. I saw only three patients, and they were all trainwrecks. Two of them had ESRD and their electrolyte levels were outrageous (potassium of 6.8!) The third was a cachetic man dying of terminal lung cancer who was in hospice care, but his wife brought him to the ED after he stopped eating and became less responsive. She was supposed to call hospice before bringing him to the hospital, because hospice patients are discharged from hospice once they're admitted to the hospital. I had to get on the phone with hospice to try to figure out what we could do for this patient, and that took up a huge chunk of my time. Even worse, all three patients had crappy veins, and we couldn't get blood from them without the help of ultrasound-guided line insertions, which could only be done by the third year resident (I knew nothing about using an ultrasound machine). Needless to say I felt useless in the ED and was all too happy to sign out to the ER intern and haul my butt up to the 12th floor, where I once again exchanged scrubs for business casual.
I immediately went to the heme-onc floor (15th floor) to get started on seeing patients. There were currently 5 in the service, not a bad number at all, and I was able to see them all and get notes written on them (with some help from my med students) before the attending arrived. Steve went to morning report but gave me his cell phone number in case I needed help. So far so good. There were three attendings who rotated through our service, two males and one female. The female doctor was in charge of the service; the other two are fresh out of fellowship and therefore more "cool." One of the male attendings came to round with us today and introduced himself to us as "Mickey." Mickey loves to teach, and we spent a good 20 minutes talking about breast cancer and its prognosis based on ER/PR/Her2-neu status. Pretty interesting stuff.
As promised, I got to leave at noon and slept for a good chunk of the afternoon. Hopefully I'll be able to fall asleep tonight.
Friday, July 17, 2009
Shadow for a day
On the day before residency started, new interns on wards had a "Shadow Day" in which they shadowed their future teams to get an idea of what went on and what was expected of them in their service. Since my first rotation was ER, I had "Shadow Day" off, but felt like I had missed out in not getting oriented with where things were in the hospital (i.e. the call room). I'm supposed to start heme-onc next week, and since I wasn't scheduled to work again until Saturday night, I sent my classmate Maria (who's currently the intern on my future team) an email asking if I could shadow her team for one day. She talked it over with her resident and said it was all right, so this morning I exchanged my scrubs for a sleeveless sweater and slacks to go to work.
I met Maria in the 12th floor lounge where she was getting her sign-out from the extremely stressed night-float intern. Apparently several of the heme-onc patients had trouble during the night (one became tachypneic at 44 breaths per minute, another threw up 700 ccs of coffee grounds), and no one knew the tachypneic patient's DNR status. Even worse, the night float intern didn't write a note for our patients, so the resident was extremely pissed. "I'll have to have a talk with that kid," he said.
The two residents covering heme-onc were both DOs, and next week, another DO and I will be joining the team. "There's going to be four DOs here!" Steve (my future resident) said excitedly. His enthusiasm made me look forward to joining the floors even more, and the more time I spent with the medicine teams, the more I realized I missed internal medicine. Sure, EM has a cushier schedule, but I never wanted to specialize in EM, and I'll be glad when my last two shifts are over. It's about time I returned to the internal medicine side of things. Still, I know I can't avoid the ED after this; there'll be admits to do when I'm on call, and as a third year I'll be expected to do 1-2 months of being the MAR (medicine admitting resident). Maybe it's a good thing the EM doctors will know me then.
Maria was great about showing me around the floor and pointing out where everything was. I also got to meet Mylene, the heme-onc fellow, and the two medical students, Amelia (MS3) and Karthik (MS4). Apparently the heme-onc attendings are pretty cool, with two recent grads of the fellowship program recently joining the staff, so they invite residents to call them by their first name. I think there will be a lot expected of me since from what I can tell, Maria was a pretty stellar intern. I'll have to do my best to keep up and not let my future team down. =)
I met Maria in the 12th floor lounge where she was getting her sign-out from the extremely stressed night-float intern. Apparently several of the heme-onc patients had trouble during the night (one became tachypneic at 44 breaths per minute, another threw up 700 ccs of coffee grounds), and no one knew the tachypneic patient's DNR status. Even worse, the night float intern didn't write a note for our patients, so the resident was extremely pissed. "I'll have to have a talk with that kid," he said.
The two residents covering heme-onc were both DOs, and next week, another DO and I will be joining the team. "There's going to be four DOs here!" Steve (my future resident) said excitedly. His enthusiasm made me look forward to joining the floors even more, and the more time I spent with the medicine teams, the more I realized I missed internal medicine. Sure, EM has a cushier schedule, but I never wanted to specialize in EM, and I'll be glad when my last two shifts are over. It's about time I returned to the internal medicine side of things. Still, I know I can't avoid the ED after this; there'll be admits to do when I'm on call, and as a third year I'll be expected to do 1-2 months of being the MAR (medicine admitting resident). Maybe it's a good thing the EM doctors will know me then.
Maria was great about showing me around the floor and pointing out where everything was. I also got to meet Mylene, the heme-onc fellow, and the two medical students, Amelia (MS3) and Karthik (MS4). Apparently the heme-onc attendings are pretty cool, with two recent grads of the fellowship program recently joining the staff, so they invite residents to call them by their first name. I think there will be a lot expected of me since from what I can tell, Maria was a pretty stellar intern. I'll have to do my best to keep up and not let my future team down. =)
Friday, July 10, 2009
EM: The difference between you and me
The medical students have started their rotations, so the ER seems twice as crowded nowadays. We've had soon-to-be second years shadowing us for 1-2 days, and we have fourth years doing their ER sub-I's. Apparently at DUCOM, ER is not a required rotation; only 4th years interested in ER can do their sub-I's here. One good thing about having the 4th years around is that they can help see patients, so I see fewer patients a day. The bad part: having to wait in a longer line to present my patients. The 4th years usually present to the 3rd year resident, who then presents those cases to the attending. Sometimes the 3rd year residents present more than one patient at a time, and that makes an even longer wait.
For all the straightforward and uncomplicated patients I see in the ER, there's always a few who insist on being a pain in everyone's butts. Sometimes it's so hard to be sympathetic for them. One homeless guy didn't want to leave the ER and purposely lay in the middle of the street after he was discharged hoping a car would hit him so he'd be rushed back inside. After someone dragged him off the street and put him under suicide watch, he was overheard bragging about how he "played the doctors." Then there was one patient who complained about everything from the bed to the nurses, and when I walked past her room she called out to me and asked me to put artificial tears in her eyes. "I got Sjogren's, ever hear of that?" she said. Yes, I have. Normally I don't mind doing small things for patients that nurses normally do (bringing them food from the nurse's station, giving them urinals and bedpans when need be) but this woman was really demanding. She said her ankle hurt and asked if I could go to the CVS across the street to pick up a special kind of Bengay cream. I told her I was on duty and couldn't go, and she said, "That's the only thing that works for my ankle, and if you can't go, put me in a wheelchair and I'll go get it myself! At the very least I need an ice pack!" The arrival of her nurse saved me from having to respond to that and I was more than happy to leave. The irony of it all is that she herself is a nurse, yet she was being mean to the nurses caring for her. *sigh* Patients come to the ER and feel entitled; don't they realize they're not the only patients and we're short staffed?
Despite working side by side with the EM attendings and residents, there is still a huge gap between me and them. I wear my white coat all the time while the EM residents wear scrubs; a handful of attendings wear their white coats. I continue to want to treat the whole patient, while the ER docs are only concerned with what they need to do to keep the patient alive/stable until they can be discharged or admitted. Even more, the EM attendings definitely favor their own. There was a patient who needed to be intubated and the attending called out that he wanted "an intern." I just happened to be in the area but he didn't even look at me; it was clear he was looking for one of the EM interns. I returned to the station and a minute later Holly (EM intern) came running down the hall saying she wanted the intubation. Later I told a prelim going into anesthesiology about it, and he laughed and asked if Holly needed any assistance (he's done lots of intubations before). I said it was probably better to stay out of the room, and later the attending proudly announced that Holly just did her first intubation with flying colors. Hopefully I'll get my chance at a real intubation in ICU.
For all the straightforward and uncomplicated patients I see in the ER, there's always a few who insist on being a pain in everyone's butts. Sometimes it's so hard to be sympathetic for them. One homeless guy didn't want to leave the ER and purposely lay in the middle of the street after he was discharged hoping a car would hit him so he'd be rushed back inside. After someone dragged him off the street and put him under suicide watch, he was overheard bragging about how he "played the doctors." Then there was one patient who complained about everything from the bed to the nurses, and when I walked past her room she called out to me and asked me to put artificial tears in her eyes. "I got Sjogren's, ever hear of that?" she said. Yes, I have. Normally I don't mind doing small things for patients that nurses normally do (bringing them food from the nurse's station, giving them urinals and bedpans when need be) but this woman was really demanding. She said her ankle hurt and asked if I could go to the CVS across the street to pick up a special kind of Bengay cream. I told her I was on duty and couldn't go, and she said, "That's the only thing that works for my ankle, and if you can't go, put me in a wheelchair and I'll go get it myself! At the very least I need an ice pack!" The arrival of her nurse saved me from having to respond to that and I was more than happy to leave. The irony of it all is that she herself is a nurse, yet she was being mean to the nurses caring for her. *sigh* Patients come to the ER and feel entitled; don't they realize they're not the only patients and we're short staffed?
Despite working side by side with the EM attendings and residents, there is still a huge gap between me and them. I wear my white coat all the time while the EM residents wear scrubs; a handful of attendings wear their white coats. I continue to want to treat the whole patient, while the ER docs are only concerned with what they need to do to keep the patient alive/stable until they can be discharged or admitted. Even more, the EM attendings definitely favor their own. There was a patient who needed to be intubated and the attending called out that he wanted "an intern." I just happened to be in the area but he didn't even look at me; it was clear he was looking for one of the EM interns. I returned to the station and a minute later Holly (EM intern) came running down the hall saying she wanted the intubation. Later I told a prelim going into anesthesiology about it, and he laughed and asked if Holly needed any assistance (he's done lots of intubations before). I said it was probably better to stay out of the room, and later the attending proudly announced that Holly just did her first intubation with flying colors. Hopefully I'll get my chance at a real intubation in ICU.
Saturday, July 4, 2009
EM: Halfway through
Happy July 4th! I was fortunate to have the day off today (though I do have to come in for work tomorrow) and went downtown to watch the Independence Day parade. Philly sure knows how to celebrate the birth of a nation; there were a lot of people in colonial attire in the parade, a few bands that I've never heard of before, and lots of talented kids showcasing their band, dance, and color guard skills. Not to mention the fireworks display: I knew better than to venture downtown b/c Sheryl Crow was performing, but I watched the program live from home and the fireworks were amazing. If I'm on call next year, maybe I can catch the fireworks from the hospital; the top floor should have a great view.
Working in the ER has been a pretty interesting experience. I'm starting to get the hang of knowing what labs and tests to order on patients before I even present my patients to the attendings. I have no idea what the attendings think of me but hopefully I'm not a total failure in their eyes. One attending said, "You did go to medical school, right?" when I forgot to do a complete neuro exam on a patient suffering from sudden bonset weakness and dizziness. "Did you forget how to do a physical exam?" *sigh* Neuro was never my strongest subject. I've seen lots of interesting cases, but will just mention a few below.
One time a middle-aged man was brought into the ER in a post-ictal state, just lying there resting, so we figured he was all right and left him alone when the woman next door to him went into V-tach and needed cardiovesion. Suddenly someone said, "Go check on the guy in ___," which was my patient. A nurse and I went in there, and we saw him lying awkwardly in bed with his head stuck between two of the sidebars along the bed. "Dammit, he's seizing!" the nurse yelled. He wasn't actively shaking, but he had persistent bruxism (he was chewing on his tongue at one point) and we had to give 4 mg of Ativan to get him to relax again. After that, when he regained some of his senses, he kept trying to climb out of bed and ended up flashing most of the ER b/c he was completely naked once the blanket was off. At one point we heard a huge THUNK! and ran into the room and saw him sitting on the floor in a puddle of his own urine. Apparently he had to pee, got out of bed to go to the toilet, leaked some urine, and slipped in it. My attending and a nurse helped him stand, and since we were near the toilet anyway, they just let him finish his business. After that, I ordered wrist restraints for him, but it still didn't stop him from kicking off his blanket and flashing the rest of the ER. *sigh*
During my first overnight shift, I had a mentally challenged patient in his 60s come in with cocaine-induced chest pain, and everytime I talked to him he got himself worked up into a frenzy, saying he'd "never had pain like this before" even though he was a regular in the ER for drug-induced chest pain. He was also very easily angered, and if anyone tried to calm him down, he started ranting about how we were talking down to him and treating him like a "dumb black man." Once he even got out of bed and got in my face because the nurse and I were discussing what to do with him while we were in the room (and not including him in the conversation), but fortunately I was able to calm him down almost every time he got mad. Even still, we pricked him 4 times and were unable to draw his blood, and he was hungry but couldn't eat until we drew his blood. Telling him he couldn't eat was the last straw. "That's not my fault!" he said about us not being able to draw his blood (his veins were shot and were wasn't a good vein left to draw blood from). "You're the ones who mess up! I came here to feel better and you only made me feel worse! (sadly, we were only torturing him by keeping him in the ER unable to eat) This is my hospital, I've been coming here all my life, and I've never been treated like this! I'm going to file a complaint, and I'm never coming back here again!" When I tried to keep him in his room (my resident had told me not to let him leave while she attended a trauma), he got even angrier and said, "What's your name? I'm gonna report you!" Well I wasn't about to tell him my name. I saw no benefit in keeping him in the hospital any longer, so I let him walk out of the ER and told my resident later. "That's okay, but next time, call security and have someone watch him," she said. I asked why other people can leave AMA and he can't. "Because he's not mentally capable of making his own decisions" was the reply. I think he'd beg to differ. *sigh* It's patients like these, the ones we can't help, that make me glad I'm not going into EM. I left the hospital that morning feeling drained and worthless, and I hope I don't have many days like that.
Working in the ER has been a pretty interesting experience. I'm starting to get the hang of knowing what labs and tests to order on patients before I even present my patients to the attendings. I have no idea what the attendings think of me but hopefully I'm not a total failure in their eyes. One attending said, "You did go to medical school, right?" when I forgot to do a complete neuro exam on a patient suffering from sudden bonset weakness and dizziness. "Did you forget how to do a physical exam?" *sigh* Neuro was never my strongest subject. I've seen lots of interesting cases, but will just mention a few below.
One time a middle-aged man was brought into the ER in a post-ictal state, just lying there resting, so we figured he was all right and left him alone when the woman next door to him went into V-tach and needed cardiovesion. Suddenly someone said, "Go check on the guy in ___," which was my patient. A nurse and I went in there, and we saw him lying awkwardly in bed with his head stuck between two of the sidebars along the bed. "Dammit, he's seizing!" the nurse yelled. He wasn't actively shaking, but he had persistent bruxism (he was chewing on his tongue at one point) and we had to give 4 mg of Ativan to get him to relax again. After that, when he regained some of his senses, he kept trying to climb out of bed and ended up flashing most of the ER b/c he was completely naked once the blanket was off. At one point we heard a huge THUNK! and ran into the room and saw him sitting on the floor in a puddle of his own urine. Apparently he had to pee, got out of bed to go to the toilet, leaked some urine, and slipped in it. My attending and a nurse helped him stand, and since we were near the toilet anyway, they just let him finish his business. After that, I ordered wrist restraints for him, but it still didn't stop him from kicking off his blanket and flashing the rest of the ER. *sigh*
During my first overnight shift, I had a mentally challenged patient in his 60s come in with cocaine-induced chest pain, and everytime I talked to him he got himself worked up into a frenzy, saying he'd "never had pain like this before" even though he was a regular in the ER for drug-induced chest pain. He was also very easily angered, and if anyone tried to calm him down, he started ranting about how we were talking down to him and treating him like a "dumb black man." Once he even got out of bed and got in my face because the nurse and I were discussing what to do with him while we were in the room (and not including him in the conversation), but fortunately I was able to calm him down almost every time he got mad. Even still, we pricked him 4 times and were unable to draw his blood, and he was hungry but couldn't eat until we drew his blood. Telling him he couldn't eat was the last straw. "That's not my fault!" he said about us not being able to draw his blood (his veins were shot and were wasn't a good vein left to draw blood from). "You're the ones who mess up! I came here to feel better and you only made me feel worse! (sadly, we were only torturing him by keeping him in the ER unable to eat) This is my hospital, I've been coming here all my life, and I've never been treated like this! I'm going to file a complaint, and I'm never coming back here again!" When I tried to keep him in his room (my resident had told me not to let him leave while she attended a trauma), he got even angrier and said, "What's your name? I'm gonna report you!" Well I wasn't about to tell him my name. I saw no benefit in keeping him in the hospital any longer, so I let him walk out of the ER and told my resident later. "That's okay, but next time, call security and have someone watch him," she said. I asked why other people can leave AMA and he can't. "Because he's not mentally capable of making his own decisions" was the reply. I think he'd beg to differ. *sigh* It's patients like these, the ones we can't help, that make me glad I'm not going into EM. I left the hospital that morning feeling drained and worthless, and I hope I don't have many days like that.
Sunday, June 28, 2009
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 =)
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 =)
Saturday, June 20, 2009
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.
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.
Friday, June 19, 2009
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.
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.
Sunday, June 14, 2009
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.
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.
Subscribe to:
Posts (Atom)