A few months ago, when Milwaukee weather had performed its usual trick of warming up to 35 degree thereby melting and then snowing 6-10 inches that evening, I came home from work and … slid into my garage doorway, knocking off my side-view mirror (me and my garage do not get along very well, as the scrape along my front headlines will attest). *sigh*

Anyway, having learned from previous experience (*ahem*) that the mirror can be replaced by taking apart the car door, rather than going to an auto shop, I purchased the part and today, in a misguided effort to flirt (um, I don’t seem to be learning from those past experiences), persuaded my friend to assist me in installing it. I went over to his apartment and we took apart the car door in his parking lot (where I discovered that it’s a freaking small world after all). He had to pick up a friend, I got into my car, attempted to roll the window back up… and it wouldn’t move more than halfway. I fussed with it a bit but couldn’t figure out my screwdriver (it’s one of those that ratchets around and switches directions and I couldn’t figure it out how). By then my friend had long left, so I drove home, found other screwdriver and took apart my door, took off the mirror, found the problem and fixed it and then reassembled the door, after figuring out how the screwdriver works as well. Yay for me!

I had to get it fixed today because tomorrow, I’m driving down to Urbana Illinois to spend a couple of days with Susan and her family. I’m so excited! It’s a long drive, however, and I’m already exhausted today from being post call and not getting a chance to nap (laundry and dishes and chatting on the phone), so I’m headed to bed soon. I live such an exciting life.

I finished another month of rotations this morning. It was a busy call, we capped (admitted the maximum # of patients) by 4:30 yesterday, so the rest of the day was spent tucking everybody in and checking on my interns. I got to “talk” to the Pleth during our monthly book club meeting, which was lovely. And then I got sleep. I like sleep.

Overall, it was good month. I learned to trust my instincts and training. I learned how to be a “hands off” resident, which after my month in February where I fretted over my interns all of the time was something that I needed to perfect. I gave a kickbutt presentation on examining comatose patients and didn’t even let the fact that my pictures didn’t load stop me (I just pointed at the blue screen and said “here you would have seen a picture of me and my giraffe friend, Daisy. We were so close, that here in this next picture, you would have seen me make out with Daisy”, etc. I amuse myself). I had fun complaining about our lack of responsibility (which was frustrating at the same time as being enjoyable) with the other residents, who are some of my favoritest people ever. I liked my interns and medical students and more importantly, I liked working with them because they were competent and diligent and made my life easier. I enjoy every afternoon that I had off, basking in the sun (and snow) and catching up on some little things that I needed to do (haven’t gotten to the taxes yet. Must do taxes on Monday!!).

I’m always a little sad at the end of a month, even during the hardest and most exhausting, because I hate leaving the people behind. And it is harder when I’m changing from the internal medicine department to neurology as I am this month… not just because I’ll be going from being the senior and being semi-in-charge to the “junior” resident (intern-in-everything-but-name) and taking orders and writing daily notes and long H&Ps and all of the scut work, but also because neurology is ten times harder than medicine and I’ve gotten used to sleeping on call, having only one pager that I have to answer, etc. *sigh* It’ll be a long 3-6 months, but it’ll be good for me. I hope.

Oh how I love thee, Tuesday morning clinics.

I had five patients on my schedule this morning. My first patient was one who I haven’t seen in over a year and a half, but patient had been calling my nurse on a daily basis for the past 3 months, so I was very aware how needy this particular patient is. I prevailed and managed to get through most of the list of complaints and exam in 25 minutes. I stepped outside to staff him with my program director, who after hearing patient’s name, told me to find someone else to staff, because patient was complicated and needy. Fine. Waited 15 minutes for another doctor, finally staffed and we went back into patient’s room again, where he briefly examined the patient and I wote out new prescriptions and instructions on how to take the medication so patient won’t come in again saying “I thought I was supposed to take it this way” (at least 10 minutes of the discussion had been focused on that).

Visit started: 8:40 (medical assistant took ten minutes to get meds into computer, which were still wrong).
Visit ended: 9:55
Visit scheduled to end: 9:00

Second patient (scheduled for 9:00) was placed in room, a new patient to the clinic. Patient spoke thickly accented English and I have to ask questions several times to get answers to what I asked. At 10:30, I noticed that my 10:00 patient had arrived and at 10:32, my 11:00 was there as well. (My 10:30 patient, thankfully, never showed up as I have no idea why I’m seeing this patient in the first place). Patient moved very slowly and most movements were limited by pain, so examining him took a long time as well. Because I hate feeling like I’m just the scribe for the attending, I took a few minutes to counsel patient on what I thought was going on and the lifestyle modifications that were necessary to prevent further problems, before heading out to find the attending. I briefly outlined the case in 5 minutes, we discussed other treatment options, and went back into the room where my attending confirmed the complaints and the physical exam and once again, counseled patient on lifestyle modifications and what was the cause for symptoms. We decided to make some changes to patient’s medications and I’m left to do the counseling, the instructing, the reinstructing, the refocusing away from the litany of other concerns that have now cropped up.

Visit started 10:00
Visit ended 11:35

In the meantime, my 10:00 patient (who arrived late) was seen by another resident, so I was only a half hour late. I walked out of the room to find my 11:00 patient AWOL and my program director telling me that he’ll be sitting in “like a bump on a log” for my next clinic day, so he can figure out why I’m so slow.

That’s right boys and girls, I’m now in remedial clinic and being observed like a fourth year medical student.

I’ve got only 8 more months of this. Eight more and then I’ll be off to medicine clinic where it’s even more patients in a shorter amount of time (but only 1 attending to deal with and I think it’ll make a big difference).

To top it off, I just read this story and now I’m so disturbed and squicked out that, ugh, I’m having bad nightmares tonight.

Argh. I’ve got a presentation that I’m supposed to give on Thursday, which I haven’t done much more work on than just opening up PowerPoint and picking the background (blue, always blue with white letters. Easiest to read). So I should be doing that.

There are other things that potentially could be brewing that are freaking me out and I know that, as usual, I’m overreacting, so we’re going to hold on discussing them until things settle one way or another.

We’re supposed to get more snow on Thursday. They say that we’re about 12 inches from the record set something in the 1800s, so I’m all go for it. It might as well be for some good.

And this ends the random news for the day.

So, I was right on my call night predictions. I’ve had such good call nights so far that I knew I was due for a doozy (I swear, I never used to be superstitious before!). We had 3 ICU admissions, my senior medical student’s patient almost coded on her and was transferred to the unit, where I once again was reminded how much I dislike this hospital and their “whatever strikes their fancy” way of managing patients. We attempted to get a consult to prevent this patient from actually dying on us… when my student is explaining what happened to this particular consultant, his response: “I don’t believe you” over and over again. !!!!! She told me of this particular conversation after she hung up with him or I seriously would have had some words with him. My med student is awesome. As a med student, I so would have had my senior call, but she pluckily does so without a complaint. Luckily this patient didn’t die and when the consultant finally dragged his lazy butt to the hospital the next morning, he agreed that the patient was sick and needed urgent intervention. Ya think? Stories like this, has, unfortunately, been a frequent occurrence. *sigh* Patient, by the way, is doing well.

Chris ended up not coming into town, because he wouldn’t be able to see me. Yay! Now, I’m trying to figure out when our schedule actually match up, which is of course impossible. His free weekend don’t line up with mine. I do have a few actual weekends off coming up in April, May and June, so hopefully, we’ll figure out something. I haven’t had more than a 5 minute conversation with him in months, so I don’t know what we’d talk about for an entire weekend now anyway (I kid).

I slept about 4 hours or so on call and then went and taught Sunday School. Now that was an experience! I was slurring and mispronouncing all kinds of words and I think I repeated myself a couple of times. Luckily, I had had enough time to go home and shower and actually dress up for church so I didn’t look as exhausted as I felt. I came home and crashed by 6 and didn’t wake up until almost 8 this morning. And I still feel tired. It’s rather amazing how my body gets “unused” to being on call and up all night when I go a few weeks without doing so. Going back to the horrors of neuro call in April is not going to be fun.

In other news, the hospital that I work for has established a new policy that all clinic notes have to be done with a month or they start docking from paychecks. Now, for residents this doesn’t matter because 1), they hardly pay us anything because they bill it as 40 hours a week rather than than 80 that we really work and 2) it’s not a real paycheck, it’s a stipend as if I was doing a summer internship selling alarm systems.

But it does matter for the attendings, so all of a sudden, they’ve been down our backs on getting the clinic notes completed. Which is all fine and dandy, except because of the way that the clinic schedules are set up, there is no time to get the notes done and as I mentioned, I already work 80 hours a week (well except this month. I think I’m closer to forty hours, which is insane when you think about it. On my slow month, I’m working as much as the average American and I feel bored. THIS IS HOW THEY HAVE BRAINWASHED ME. Anyway, continuing…) and I get testy about devoting more time to paperwork. Since I am on a cozy rotation this month, I figured I’d better get them done so I can get some peace. I completed 13 already today and have another 9 to go. Yay progress! Of course I have 5 patients that I’m to see tomorrow morning, so I’ll be promptly behind again, but let me bask in my accomplishment for a minute here.

No repeat episodes with possessed, crazed doorbells to report, thank goodness. I’m finally sleeping with the lights off again…

You wanna hear about my awful day?

I awoke this morning at 1 am, to the sound of my doorbell ringing. Confused, I grabbed at my phone, my alarm clock, and my pager, trying to get the sound to stop, before I realized that it was coming from my front door AND it was 1 in the morning. I stumbled around, got dressed, turned on all of the lights in my house, grabbed my cell phone (and dialed 911, with my finger on the button to press send) and opened the door.

No one was there. The street was absolutely deserted and quiet.

Of course, I was freaked out. I stood in my kitchen, breathing hard, heart pounding, trying to get myself to calm down. I was almost convinced that I had imagined it (except that I don’t hear my doorbell ring all that often and it’s a pretty annoying sound). I turned off the kitchen light, moved to turn off the lights in the living room, and it happened again, with me standing right next to the front door.

I’m surprised I didn’t scream.

This time however, it rang continuously as if someone had their finger against the bell. I cautiously crept up to my front window, parted the curtain a fraction…. and no one was there again. My doorbell apparently decided to malfunction.

I stripped the batteries, but of course, I was way too agitated and nervous to sleep, but I managed to convince myself to go back to bed. I “slept” with the lights on in the rest of the house and even this morning getting ready for work, I was spooked, scaring myself with the shadows and reflections. I know most of it is silly paranoia–my house is old enough that everything creaks when you walk, so it’s not like someone could sneak up on me and my neighborhood is generally safe, but then again, I do live in the city with the fastest growing crime problem in the nation.

Then Chris called at 6 this morning to tell me that he was coming to “Milwacky” today to see the Body World exhibit. Of course, I’m on call. I was so frustrated (and sleep deprived) that I almost started crying in petulance. Because this is probably the easiest rotation I’ve had yet, with afternoons and weekends off except when I’m on call; I’m almost going mad in boredom. This sucks. He says that he’ll try to come by the hospital and say hi, but that likely won’t happen, because knowing my luck, I’ll get hit with a code and ICU admissions and not be able to break away.

I’m really tired right now. I wonder why. Maybe there’s a chance I’ll get a nap today.

I had my friend Erika over for dinner and to watch “Bride and Prejudice” (which was her first Bollywood experience) as she’s had some rough times recently and I’ve been so bad at socializing for the last few months. I made my world famous grilled salmon with northern african marinade (yes, yes, I’ll post the recipe later) and, because I have been craving it so much, frog-eyed salad. It was yummy. Unfortunately, it made enough to feed a parlor of funeral guests, and I have so much left over, I don’t know how I’m going to get through it. Plus, she brought a mint chocolate cakeherself (I was very, very good and only had a sliver), so that also needs to leave my house immediately. There is a guy at work that I’ve been attempting to flirt with. Maybe some home cooking will do the trick….

Speaking of flirting, CuteIntern paged me today, a “call me when you get the chance” type of page. Of course, I called him back immediately, heart pounding. Could it be….

“Hey, kiddo, what’s up?” he greeted me, “I’ve got one of your patients here in the E.R.”

*sigh* I think that “kiddo” just killed any lingering wisp of hope for romance between he and I.

Chris called me last night on his way back from Guatemala. I had no idea that he was down there; I though that he was slaving away and too busy to talk, like I was. Words do not exist to express my jealousy. It was really awesome to hear him talk about the places that I had been. He stayed in Antigua, climbed the volcano ( which was erupting!), visited Lake Atílan and went to the markets (where he had a much more enjoyable time than I did, because he’s used to the in-your-face bartering-and-begging system than I was).

It was, btw, 4 years exactly when I was Guatemala myself, struggling to learn Spanish, enjoying the 70 degree weather heat, hiking the ruins of Tikal, riding a donkey in the mountains near Antigua, wandering through the cathedrals during Lent and seeing the processionals. I dug up and posted a few of my Guatemala pictures here. Unfortunately, I have lost a bunch of the emails that I had written at the time to document my travels and didn’t realize it until now. I had written them on my old school account and I thought I had forwarded most of the messages to my other accounts, but apparently not (and that account is now way beyond defunct). I’m hoping (*hint, hint*) that my family decided to be sentimental and preserved some of those emails, but as we communicated mostly by instant messenger that trip, I’m not sure that they exist any more. I know I emailed Chris on a regular basis, but for the last 2 weeks of my trip, he was in British Columbia and didn’t write me. And his school email account is gone now too…

This was the only place that I had been that Chris hadn’t, so once again, I’ve fallen way behind in the world travels race. Drat.

****

In other news of my life, (aka work), the new hospital has certainly proven to be interesting. It ‘s a private hospital a couple of miles down the road for me, and I feel like I’ve entered a different world, because things are so different from the academic world that I came from. Here, decisions are made purely by the whim of the attending physician (which never seems to be the same person for more than 2 days in a row) and trying to get the attendings to practice evidence based medicine, well, it’s a battle that I don’t think I’m going to conquer in the 4 weeks that I’m here. For example, yesterday the admitting physician seemed to have this bias against giving IV fluids. Our team admitted 6 patients over the age of 80 and ALL of them were dehydrated and showing signs of going into renal failure, but I had to fight with this particular attending to give them any fluids at all. I also had to fight for 2 patients coming in with fevers and elevated white counts to get the appropriate antibiotics–I’ve discovered a little bit of a stubborn streak that I never knew that I possessed.

The positive side of this has been that I finally can see that I have learned something in residency; that I am comfortable in making independent decisions. There’s still a ton that I need to learn – it’s not like I feel any where comfortable enough to go out on my own yet, and I’m more than grateful that I’ll have another 3 years of training before I get to that point, but I have developed the critical skills in that I can look at a patient, their labs and their x-rays and determine if I need to give them fluids. Or (roughly) which antibiotics I need to start them on and so forth. There are certainly areas where I need more guidance and direction, but I don’t think that the philosophy here at this hospital (where the interns meet with the attending and he tells them the plan and they scribe it down) is the best way to learn that.

But I certainly am enjoying finishing work and leaving the hospital by 1 or 2 pm on my non-call days. Friends, did you know that there is such thing as a round yellow ball that sits in the sky and gives light and warmth to the world??? Who knew??

I love having a little more free time. I’ve been done at work most days by 2 pm. That’s like, 4 hours of daylight that I get to experience, people! The sun! Comes out during the day! Amazing. I’ve been to the gym this week, took care of some clinic stuff (*ignores the something like 25 clinic visits that still need completion*), and managed to waste a whole bunch more of it.

Wanna see what else I’ve done? jcd1013. Go on, click. I’ll wait for you to ooh and aww.
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I know, I know, it’s super, super girly (I promise that it’s more green than pink). But I love it. I had to learn all of the code (it’s been way too long since I did anything resembling webdesign, and I never really learned it properly then either), and I made more mistakes and flubs than you can imagine. At one time, the journal repeated itself 3 times; that was a fun one to figure out. But, if you’ll notice, I now have a drop down link list, a random Anne quote generator (keep refreshing the page, it’s fun), a entry separator, a quick reply text box, a pretty header, 2 sidebars, etc, etc.

The Anne series (books and movies) have always been my series. Since a young girl, I’ve aspired to be Anne, and there’s something about the stories that is a haven of comfort, even now. So, Anne it’ll be.

I’ve still got some tweaks that I want to do, namely rearranging my links and custom filters and uploading more user pics (I’ve had some of them for almost 5 years now. It’s really hard to part!). And I foresee that it’ll take some time getting used to the links that are now on the side of the journal.

I’d love to hear your thoughts on it! Even if it is that I have to get rid of the pink.