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31st July 2006

it’s August already?

*looks back*

I survived my first month of internship. I actually finished yesterday and had my last precious day off (spent once again tackling the loan issue. Still no answer, but I’m not giving up) today. It wasn’t that bad, really, this first month, I certainly expected worse. I was busy, but not horrendously so. My patient load was fairly light (I averaged about 3 patients, the most 6 on my first day, a couple of 0 that was really sweet), I was on a great team, worked with fabulous medical students who were eager, humorous and brilliant, had great attendings, two call nights where I got 6 hours of sleep around calls, and most days didn’t have to arrive at the hospital until around 7:30.

So, only 71 more months I guess. 🙂 But who’s counting.

I start working in the Neuro ICU tomorrow. It’s been over a year since the last time I did critical care and over a year and a half since I did adult neurology. So, I think it’s going to be much more of a learning curve… I guess I’ll be finding out whether or not this neurology thing is really for me.

I’ve spent the last couple of evenings watching the first season of Everwood on DVD. I started watching it because i was a little homesick (after the pilot, it was all filmed in Utah. They used to shoot scenes near where I lived and oh! those mountains!), but I got sucked in. I had forgotten how incredible their first season was… I’m not a big fan of first seasons of most shows (Buffy, Voyager, XF).. where the writers and the actors struggle to figure out how the story is going to unfold, but honestly, I think the first season was the best of the four of Everwood. The acting is honest and raw, every human emotion is so poignant and touching and real. This, this is what is great television, with (mostly) medically accurate portrayals to boot! Do yourself a favor…find it, rent it, buy it, watch it.

And that is the end of my commercialism preaching today.

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27th July 2006

crayons for bartering

I hate money with a loathing passion. Hate, hate, hate.

Especially when troubles with my loans (school this time) ruin my day off–I only have four of them a month, people, so when I have to fix mistakes that I didn’t make, I get a little peeved. Especially when I had spent hours in March/April/May talking to financial counselors to prevent just such a thing from happening.

Grrr.

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25th July 2006

Backhanded compliments…

Snippets of conversation from the past two days.

Patient #1: “I was telling the psych nurse what a wonderful doctor you are and how I easily I can talk you.”

*continues before I can interject a sincere thank you*

“She didn’t know who you were, so I tried you describe you. The little (indicates a height approximately two inches above his bed) blond girl with glasses who’s not very skinny but more plump. Kinda pretty.”

Um. My hair is still red, isn’t it????

Patient #2: *reaching over and patting my belly* “So, are you pregnant?”

(after I politely, without too much blushing, tell him that I’m not)

“oh! I’m sorry. The nurses were just talking and wondering, so I didn’t know….”

Yep, great day for the self esteem. I apparently need to work harder on finding a gym that is a) affordable (sorry, I’m NOT spending $63 dollars a month for the privilege of working out) and b) open past 6 at night.

*sigh* These are definitely the times when I think seriously about a tummy tuck or liposuction…

But to be fair. The Good Things That Happened Today
~ My patient (#1) has said that he’s going to write a letter to the hospital and tell them what a good doctor I am.

~I’ve been able to get blood cultures, AND I’ve been able to teach my little “Baby Docs” (the medical students, as one nurse affectionately terms them. Was humorous when she called them that, not so much when she used the label for me) how to do them and get them on the first stick as well. Am very proud.

~The oh-so-cute pharmacy student whispered sweet nothings in my ear…. about drug names and dosages that made me look like I knew what I was talking about. I swooned. 🙂 I think he calls me Jules, or at least it’s never come out as a complete Julia. Hmm…

~My medical student called me “darling.” He’s got a girlfriend that he’s planning to propose to soon, but the fact that he is comfortable enough with me is great (or maybe it’s not, should I be fostering an environment of respect and authority?). Oh, did I mention he’s cute too?

~ My attending, after I paged him with some results, paging back with the message “Strong work, doctor.” After the atrocious presentations that I’ve given recently (my mind does not work post call), that’s a very nice compliment.

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24th July 2006

we’ve got those happy feet

Days off are the most wonderful things in the entire world.

Especially when they are filled with the company of a dearly loved, old roommate. Allison and I didn’t do anything real exciting, but I showed off my house and we hung my pictures, so it looks a little more like a home and I got to sleep in (until 10:30. It was bliss) and it was just wonderful. She lives close(r), so there are promises of repeated adventures.

I can’t wait for my next day off!

Especially since it promises to be even better, as Chris is finally coming home!! I won’t get to see him, but oh, the mere thought of talking to him, hearing his voice, is sheer bliss. Am very, very excited. 😀 😀 😀

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15th July 2006

Protected: milestones

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11th July 2006

resolution

My patient, the one who threw me out of the room, thanked me profusely today for giving him great care and helping him get better. It might have been because I had just signed his discharge orders and he was getting out of there.

I must admit to having a thrill of satisfaction when I read in the nursing report that he threw out the lab drawers this morning and refused to let them poke him as well. So it may not have been just me (although, to be honest, I definitely contributed).

Down to one patient, who should have been discharged two days ago (he was the other patient was was mad at me yesterday. Today, he was all sunshine and wit… I’m not sure that he remembered who I was). Every day, I get thwarted on my plans to ship him out and back to the other service, where he does need treatment. Tomorrow. Tomorrow, that’s what Annie sang. It’s going to happen tomorrow.

On call again tomorrow as well, all night. The chief resident messed up our schedule (or rather, we didn’t understand his motivations for the schedule and switched things on Saturday, making them even more messed up). I’m not sure that I’m fully ready for the “excitement” that being the cross cover provides again.

P.S. I think Orlando should stick to the tried and true action adventure movies. Drama, he does not do (although I think a crummy script contributed to the dismal Elizabethtown), and I don’t think he’s cute, unless he’s wielding a sword or a bow and arrow. Then I swoon. I haven’t been to the movies in months, and I was such a fangirl! So much fun!

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10th July 2006

salt over the shoulder

I am not a superstitious person.

Or at least I didn’t used to be.

Now, I rap on tables when passing on my patients to the covering night intern that “there’s nothing to do. They’ll be like lambs all night long and not bother you.” I stop mid-sentence when talking about how calm things have been, or how we haven’t gotten any admissions.

Just so I don’t tempt fate. Or the powers that be. I forget in those moments that I believe in a supreme, benevolent God who doesn’t smite out vengeance at a lark.

Right now, I’m regretting writing about how good things have been. Because I did that, today was the worst day I’ve had yet.

I had two patients yell at me, swear at me of how I wasn’t listening to them and keeping them there and making their lives miserable. One was probably justified… my patient with the fever that I stuck a half dozen times trying to get some blood…and whom I walked in and informed that we needed more, and he was going to be my pin cushion again. It didn’t matter to him that I had practiced, that I had talked to the nurses and IV team and had gotten tips of how to do it better and get the vein when I needed to. He told me to leave, and I did. I got the other intern and begged her to do it.

The other was a patient that I had been trying to transfer back to another unit for two days and came in and discovered that all of my plans had come to naught. He was upset, I was upset and spent the rest of the day, trying to figure out what went wrong.

I haven’t cried. I didn’t get hurt or really upset, because I do understand that this is hard for them. But they don’t understand that it’s equally hard for me, to figure out my place, to be told that I, who have only practiced on fellow students, must go in and get blood on my patients…and my fellow students with their nice, plump, healthy veins are a far cry easier than these gentlemen. Thrown into the wolves and I have to fight my way out.

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9th July 2006

Protected: threee, two, one, I fall into the space

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9th July 2006

now I know that I can fly alone….

I survived my first week of internship. And my first night on call all night last night, crossing covering all 4 teams’ patients for the night. It wasn’t too bad, comparing it to the other intern’s experiences. My pager was going off nonstop from about 3 pm on (at the same time I was trying to get blood cultures draw…6 sticks later, I had to admit defeat and get another intern to come and help. So frustrating. I’ve done IVs before, but apparently, drawing blood is a slightly different technique. And can I just say how ridiculous it is, in a hospital, to not be able to have labs drawn on weekends? If you want something, you have to draw it yourself, which is a complete and inefficient waste of time. I did have two patients who spiked a fever overnight and I needed blood cultures on them. Luckily the IV nurse took pity on me (I think I looked pretty frazzled by that point) and offered to draw all of the labs that I needed last night, which saved me a lot of headache and stress. I could have hugged her.

Our team took five admissions yesterday (we were supposedly on divert because the ICU was full. Didn’t stop the ER team from allowing a woman to be transfered from one of the local hospitals for no reason what so ever…. and then admit her. Nice lady, but I was really frustrated that I had to work her up and admit her, when she really didn’t belong in the hospital), two were mine. That was probably the hardest thing, trying to admit and balance the numerous pages from all of the nurses and try to figure out what to do with patients that I know very little about (it’s hard enough figuring out what to do with my patients!), In addition, there was a fluke in the call schedule, which meant that while my resident was supposed to accept sign out and cover one of the medical teams, everybody signed out to me, which meant my load was heavier.

Things calmed down at around 11… the pages stopped, allowing me to write up my two admissions and then get some sleep. I got about four hours of sleep, which since everybody else that I’ve talked to has only gotten about 30 minutes, I was extremely blessed. It wasn’t good sleep, because I kept waking up in a panic that my beeper was going off and I was sleeping through it (I wasn’t). Or it really would go off and I had to figure out how to manage things in my sleep deprived mind. Fun, fun.

I came home and promptly went to sleep. Or tried to, as my pager kept going off. It’s true that it’s very difficult to leave the work behind at the hospital. One patient’s wife had come by, and as she was power of attorney, wondered why she hadn’t been informed of her hsuband’s transfer to our service, so I talked to her for a bit. Then, as I had basically give everybody the go ahead to transfer him back to the other service, I then got a call from that admitting physician, wondering why I was transferring him back when the cardiology consult said that he wasn’t stable in their note (completely opposite of what they told my team in person, btw). I think I got most of that fixed–I’ll find out tomorrow morning of whether or not the transfer actually went through.

So, I survived. I might be on call again on Wednesday (our schedules got messed up, as I said, so I have no idea anymore), which I’m hoping not. I need a couple of days to recover, and as I’m not getting a day off anytime soon (13 days, and counting), well, I’d rather not be on call again until Sunday.

I am loving my internship. Despite the hard work and the constant feeling of inadequacy (does it ever go away?). The vets that I work with are very sweet, especially the little old 80 or 90 year old men. I get very sad when they come in, very sick often, but always very patient with what we can offer them. They vets are some of the most appreciative patients you’ll see, and our VA system offers them so little sometimes. There are great things about the VA… their computer system and their clinics, but when it comes to hospital care… where they are really really cared completely by residents (great for residents to get experience, maybe not so good for the vets) and can only get PICC lines on Tuesday and Thursday (and not after 3 on those days, making them stay in the hospital until the next Tuesday or Thursday), or the million other ways that the system breaks down (and sorry, folks, I don’t think it’s because of evil socialized medicine. The VA could be providing some of the best care, It’s more the inefficiency of the system in place and the laziness/unwilling of those in the system to change), it saddens me.

So that’s my life, busy, tired, but generally happy. What’s going on with you?

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3rd July 2006

doctor in infancy

Today is my day off. Which is nice. I survived the first two days of internship, as did my patients, which is always a good thing. It wasn’t too horrible, except there was so much that I forgot (didn’t do a physical exam on two of my patients. Not good. Didn’t tell the nurse that I was changing medications. Not good.) and I spent most of the time floundering in the decisions that I did make (giving that patient cough syrup, was that okay, or did I just make the other medical condition that we were treating him for worse? (you laugh, because it’s just cough syrup but when you think of all of the drug interaction….)).

So now, I get to enjoy the day being away from the hospital. Except I can’t figure out how to put a notification on my pager that I’m away, so I keep getting paged. I’ve just ignored them. That’s probably bad too.

And my next day off? Will be on July 22nd. That’s right. 19 days without a day off. I’m already getting crabby at the thought.

Don’t get me wrong, I am really enjoying this, I am between the freak out fits, and it was wonderful to be back in the hospital environment. I love talking to the patients and getting to know them. My patients have been wonderful and have very nicely been as well as they can be in a hospital, so I haven’t had to worry too much about them. But I get antsy when I have to be up every morning at 5 and don’t get a chance to just be lazy. *sigh*

I’ll be on call tomorrow, so I won’t be done until 9 pm, so I won’t be really celebrating the 4th, except by taking care of the veterans who sacrificed so much of themselves to protect our country, and when you look at it that way, it seems like the best use of a day.

Still without internet access. Getting beyond perturbed. It’s flipping a switch people, it shouldn’t take 10 days to do. I really, really, really need it working, so I can figure out how to get my new Pocket PC working and download some oh so valuable medical information so I’ll actually know how to manage my patients.

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1st July 2006

moved

Still don’t have internet access at home, hence the long absence.

But I’m moved, my house is great (with a few annoying quirks that I’ll detail in the future), I finished my training yesterday. And today…

I became a Real Doctor. Actually I’m more like Pinoccio when he was still wooden, and not quite the Real Boy. I’m kinda missing the strings.

I will be busy for the next bit, trying to figure things out. Being an intern is very stressful. This morning, I felt like the biggest idiot (and probably was), and it’ll take some time to get over that.

*sigh* It gets downright depressing when I think how busy I’m going to be, compared to the relative ease that I’ve had the last several months. And the worst is there’s no end in site, just one day after another.

Sorry for not replying on the goings on in your life. It’s going to be some time before I can be as actively involved as I was before. *sigh again*

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