So I went to a noon conference yesterday at the adjacent Children’s Hospital. As we were walking back, my fellow was telling me some juicy gossip about some of the pediatric attendings (who I don’t know) and we walked by a couple of residents, who she knew and we greeted them.

As we continued on, it dawned on me why the one who had refused to make eye contact looked so familiar.

Kyle Jensen is apparently a fellow at the Children’s Hospital. Has been for an entire year. Of all the people to be out here in the midwest at MY hospital. I was irate the rest of the way back to my hospital. Instead of it being a joyous reunion with a fellow Utahn, an LDS Utahn at that, it was the same old snub.

I browsed through my entries to see if I had wrote about him in the past; there’s one passing mention of him on my fond look back of third year in the pediatric rotation section. Once upon a time, when he was a med student and I was a pre-med, I had a wee crush on him (which was all Suz’s fault because she had liked him a bit before she started dating her husband and gushed about how wonderful he is) and thought he was amazing because he was a med student. The crush very quickly faded because he never acknowledged my presence. Never. Not even when we were in med school together and we were friends with the same people. Opinion quickly changed to “He’s a JERK!” I was pretty gloomy when I discovered that we were going to be on the same team together, but over the course of the month we at least came to a reasonable state of friendliness, to the point that I thought I’d at least get a hi.

Bah.

The sun peaks through the heavy clouds, shining through the large bay window of the neurology physicians work room. The room, as always, is bursting with people. Dr. Peltier is rounding with her team; they have just admitted a new patient who has been a diagnostic mystery–an illness that not only is causing neurologic deficits, but GI complaints as well. The team is discussing what tests should be ordered: labs for vitamin deficiencies for sure, but should they repeat the MRI and spinal tap or get an EMG? Would a biopsy serve any purpose?

Around the computers, the neuro ICU team clusters. A patient had been transferred from an outside hospital because of a head bleed. The patient is surprisingly stable with no deficits (alert, oriented, pleasantly conversant and able to move all extremities), a different picture than the transferring team had painted. The images show the real truth: a tiny little speck of intracranial blood from where the patient had hit their head–something that would resolve on its own, requiring no intervention and needed nothing more than closer observation for a few hours. The team is disappointed, not only because of the lost opportunities for procedures and action (for real head bleeds are usually the sickest patients we admit), but because now they had to write orders to transfer the patient out of the ICU–when they had just written the orders to admit.

I sit on the window seat, conversing with Dr. Lynch, the neuro ICU attending who had quickly lost interest in the CT images. He’s my favorite attending and I’ve got a bit of a hero-worship crush on him. He’s three-fourths of the reason that I’m considering a career in critical care–I admire his calm demeanor in stressful situations, the relaxed yet structured rounds, the evidence based approach the patient care, and his endless supply of random bits of knowledge. Today, the conversation diverges from discussion of a patient who had had another stroke to the origin and extraction of heparin and its antagonist protamine. It’s a fascinating history lesson on 2 drugs that I’ve used commonly and had no idea how exactly they worked. I wonder if I’ll ever have half the knowledge that he does. He teases me to remember this conversation so that in years to come, I’ll be able to pimp my residents about it.

The conversations circle around me and I look around at all my colleagues, my friends, my teachers and a feeling of peace settles over me. I gripe so much about the endless paperwork and documentation, the senseless protocols and mandates, the increasingly demanding and ungrateful patients, the ridiculous phone calls in the middle of the night, the sometimes long and exhausting hours, and so forth, that it’s nice to have these moments of confirmation. There have been times, many, many times over the past two years that I have regretted my decision to go into medicine, times when I wish that I had a time machine and could go back and warn 20-year-old me to think more seriously about pursuing a career in creative writing or genetic engineering or becoming a bum. But now, looking around the room, I realize again that this, this is the place for me, the profession for me, the life for me and I wouldn’t change a moment of it.

***

It was the medicine department graduation last night. I almost didn’t go–because of my failed camping trip last weekend, I was determined to take off last night. The thunderstorms put an end to that plan, so I dusted off my google maps and went to the ceremony instead. It was a good decision.

Several of my friends graduated last night, friends who were my senior residents when I started as an intern and who guided me in patient care. Jenn graduated, done with her 5 years of residency. I met her when I interviewed for the program two and a half years ago and she’s the reason that I chose to do the crazy combination of two residencies in one, because she was doing it and was thriving. She rallied for me, told the program to pick me, and for that I’ll be forever grateful.

The program was great and I had a blast. I stayed out late and chatted and caught up with all of my friends (and some of the conversations weren’t even about medicine as well!). Now I’ve got to decide whether or not to go to the Neurology graduation this Friday. Normally, I’d just go, but my church is having a barbeque and a dance that night and there’s a good chance a certain fellow will be there…

Chocolate cupcakes with a Hershey’s kiss in the middle AND a slice of a fresh, perfectly ripened strawberry on top makes the perfect breakfast. Yummmm.

I love the epilepsy service. We have 3 patients. I was here at 8:30 this morning. We were done with rounds by 9:30. I watched a wada procedure this morning, which was totally cool. It was as if I was watching somebody develop a stroke right in front of my eyes–and then to be able to conpletely reverse it in a matter of minutes. I’ll be admitting a patient around 1, and then I’m done for the afternoon. Sweet.

I woke up to lightening and thunder this morning and torrential rain. Gotta love the Wisconsin summers. I hope that it clears enough tonight. I’m supposed to go play miniature golf and my skills are pitiful enough in dry weather–I can’t imagine how my swing will be affected by slick grounds and rain streaming down my face.

Okay, I’m off to discharge one of my 3 patients. *sigh* I’m so overworked!

(I only posted 3 journal entries the entire month of May. That’s shameful, folks. Hence the random, does-this-have-any-kind-of-point post here. 🙂 )

Hypothetical question (really, truly):

If you were trying to impress a young lad with your homemade cooking, what would you use as a side dish to complement my signature salmon recipe? (I was going to make it into a real poll, but I got lazy.)

1. Roasted Garlic Mashed Potatoes. What better way to get a man’s affection than through the staple of life? Plus, the author promises that I can expect to be worshipped and kissed for at least 38 hours.

2. Crushed Hot Potatoes. It’s got the potato factor in its favor, but it’s simple, so it doesn’t make me look too desperate.

3. Lemon Flavored Saffron Rice. I brought the saffron in Africa and carried it all the way back with me and haven’t used it yet. I love lemony saffron rice and it would really complement the fish. Plus, Cleopatra reportedly had great success with her use of saffron um, probably not the kind of success that I’m really seeking at this time :D.

4. Other! I am obviously an inexperienced Kitchen Goddess and need to be taught immediately that the perfect side dish would be:______________

Your input would be invaluable. And needed before Wednesday so that I can go shopping. Hypothetically, of course.

(As an aside: I LOVE the Pioneer Woman blog. I discovered it a couple of days ago and have spent most of the day browsing through her site. The pictures are goregous and it makes me long for the small town life that I’ve left behind; I miss those times of absolute solitude. Another part of me is overwhelmingly grateful that Kris Hullinger and I never hit it off, because whoa, I am glad that ranching is not my life.)

***
This is my last month as a second year resident, can you believe that? It just incredible how time can fly and still seem so slow. I’m not halfway done with my residency yet… that endpoint still seems a long way away. I certainly down feel ready to be released on the unsuspecting world, but I find myself chomping to get done with this all.

I’m rotating on the epilepsy monitoring unit, which is a different experience. Basically we admit people and provoke them into having seizures and I’m learning how to read EEGs, which is really like learning how to read petroglyphs done in a 3-year-old’s squiggly scrawl. I have no idea what I’m doing. The worst is that it really comes down to physics and electricity and currents and vectors, and man, that was my weakest point in all of physics. I could never understand it. I read and read this afternoon and I’m still confuzzled. But I’m excited about a new challenge, and the hours will be a little easier than a regular wards month (still have to do call, bleh)

***
I got my DEA license! And promptly had to renew a prescription for a patient, so I’m already being tracked. We won’t talk about how much money this little “privilege” cost me, but all I can say is that the little bonus that they give me at the end of the year to cover licensing and exams(while supposedly leaving enough to fund a gym membership as well), didn’t even cover half of what I’ve paid this past year for the honor of becoming a Real Doctor (like Pinocchio, but still with strings). But it’s all done now.

***
I’ve had “There are no cats in America/and the streets are filled with cheese” running through my head all day today. I have no idea where that came from, as I probably haven’t seen the movie (An American Tail, for those who are less Disney informed (and yes, yes, I know it’s not a Disney movie, work with me here)) since I was 10. Weird, especially since I did give in and buy myself a copy of Mulan since I’ve had an inexplicable urge to watch that movie for the last month, so I should be having “I’ll make a man out of you” there in my noggin instead. I did resist on buying the copy of Escape to Witch Mountain which is another one of my childhood favorites; luckily the store didn’t have The Three Lives of Thomasina or Toby Tyler –those I could not have said no to.

***
I think I’m going for the hammock in the back yard, it would fit the space better. One of these days, I’ll redo the front and make a real porch where I can install the swing. I’ve just gotta make sure that the side of my garage could handle the weight if I hook it there. I wasn’t able to find a fire pit yet either, so my backyard beautification project is on-going.

***
And I think that’s it. It’s all I can think to talk about, unless you want to hear that I have dishes to wash and clothes to fold and my hair to cut and CuteIntern friended me on Facebook (mostly shaved now. Definitely cuter) and I’ve got a date on Thursday that might almost be called a second date and there’s still about 5 clinic notes that I haven’t finished. Yeah, you definitely don’t want to hear about those tedious details about my life. 😀

Camping: difficult to do when you leave the tent behind.

*sigh*

I guess it’s better this way; now I can research better (ie more remote) camping spots and actually get a lantern so that I can see and those sorts of things. But I’m so bummed.

So, I am trying to decide how to best spruce up my backyard.

I have this little patio area (pictured here from when the previous owners had it all cute) that is just begging to have some lounging furniture. But alas, I am torn. Do I go for a hammock that can sway gently in the breeze, or do I go for a porch swing? I’ve always wanted a swing. Some of my favorite memories are relaxing on my grandmother’s front porch swing, watching the swallows swoop in and out with food for their babies. But then those memories are tangled with the memories of drifting in the hammock that Liz brought back from Uruguay (until the stupid neighbors stole the ropes we used to tie it to the tree) on warm summer afternoons. So obviously I can’t make this decision based solely on nostalgia. 🙂

My friends last night were also talking about this ceramic fire pit that they had purchased and I almost instantly had visions of a little firepit in my backyard as well. That one is an easy decision; I’m getting one this afternoon. 🙂

I really want to go camping this afternoon. It’s warm enough and should still be in the 50s overnight. Maybe I’ll give some of my girl friends a call up and see if they want to come.

Name: D******, JULIA
Credential Type: Medicine and Surgery
Credential Number: *********
License Type: regular
Status: credential license is current (active)
Eligible To Practice: YES

Interpretion: I am officially licensed to practice medicine in the
state! More importantly, I will be employed come July! WHEE!

Next step is getting DEA credentials but I think I’ll give me a day to
savor this relief before I start going through that nightmare (it
never really ends, ever).

So I’ve been sitting here on my sister’s couch, catching up on the internet, trying to figure out her TV so I can watch LOST (still catching up on season 3. Two disks to go!), and wondering why my flist wasn’t alive in DW gushing about the latest episode. No reaction posts, nothing. It’s only dawned on me now, that it’s Friday, not Saturday. 🙁

My flight yesterday was delayed by 3 hours because of a blizzard in Denver. A blizzard on the first of May. I shouldn’t be so surprised, my mother couldn’t make it to my college graduation because of a blizzard on May 5th (and my roommate’s mom and sisters were actually in a wreck because of that same snowstorm in Colorado when they were driving out). But still. SO I didn’t arrive to Phoenix until almost 1 in the morning, which is 3 in the morning my time, and I’ve been utterly exhausted all day long. I’ve taken one nap, am contemplating a second, but I’m still in my PJs. and I probably shower before they get home from work. Usually a wise idea.

I’m also getting a cold sore. Usually a harbinger of other symptoms. Maybe that’s why I feel so drained.

I’m in Phoenix for the weekend, to see my sister and her husband and my mom’s family. As usual, it’s been the comedy of errors trying to figure things out. But I hope to spend good quality time with my grandma and I should catch up with a friend from high school as well.

It’s 90 degrees today here. And it was snowing in Denver. Weird. I was going to swim this afternoon, but May is National Skin Cancer Awareness Month, and I know better than going out at noon to go swimming with my fair skin. Even with SPF50. So instead, I’m lathering up, and going to go take pictures of baby ducks. Ta!

Didn’t I promise you polar bears? Baby polar bears at that? I have no idea why I’m such a sucker for these little bears, but they make me gooey inside and I just want to hold her paw. juno_magic have you had a chance to meet her yet?

more pictures of Flocke

The Department of Regulation and Licensing has finally, finally processed my application for licensure. I’m missing two papers (one that I discovered when I was searching for tax documents. Oops) and I need to take an open book test, and that’s it. Yay! Such a relief! I should will be employed come July!

I’m starting to wonder if I’m clinically depressed. Funny, me as a doctor, not knowing whether I should diagnose myself.

I went to a dinner tonight for women in med school and sat on a panel, listening to the other residents give advice such as: “it’s easy to exercise in residency, you just have to make it a priority,” “dating and socializing in residency is essential, you just have to make it a priority,” and “you can easily be married, have kids, spend quality time with family, you just have to make it a priority.” I think I was the only one who was rolling eyes, I do not think that word means what you think it means.

Then it was advice on interviewing and selecting programs. Most of the panel suggested that trying to interview for two different specialties was “not wise” and it made you appear indecisive. I chimed in about how I had applied for three different specialties (medicine, neurology and med/neuro) and how it didn’t hurt me. Then there was the advice of what to ask the programs. One woman stated that she asked the residents if they were happy “and if there was a pause, she thought again about the program.” At this point, another resident looked over at me and started snickering because I had been ranting about my awful day of painfully long rounding wards, my whole slew of whiny, crazy patients, the difficulties of being a scut intern again and how much I hated dictating, etc. etc. So I piped up again, and stated that all residents have bad days and if they state with a Pollyanna smile of how overjoyed they were, they were lying (okay, I didn’t say it that strongly).

I’m having a rough time right now. I’m a little bit sleep deprived because I’m not sleeping well. I’m frustrated at work, because the majority of our patient lists have nothing wrong with them, besides what’s going on in their heads and are thwarting my every effort to get them home or to rehab or to wherever. My attending collects patients, so we can dawdle at every bedside. I’ve been arguing blatantly with my attending so we can make some progress. We round FOREVER. I’m going to be with this same attending for the next 10 days (kill me, please). The ER staff is driving me nuts with their inability to perform even a simple neuro exam. I’m tired of admitting patients every single day. There has been some nice moments, like today when I spent over a half an hour, explaining a procedure to a patient and her husband, really getting the chance to explain the risks and benefits and answer all of their questions. I like that. I just wish that I could convince somebody to rediagnose her and figure out what’s really going on, because I hate that I’m not doing anything to make her get better.

I’m lonely. I do have my friends from church, but I only get to see the once a week… if I’m lucky enough to make it to church. I haven’t talked to my best friend from med school–the guy I saw every day for nearly two years, the guy I talked to every week for our last two years of med school and my intern year–for more than 10 minutes for 4 months. I haven’t seen him in 4 months. I have no idea what’s going on with him. And let’s not even mention the last time I talked to Liz or Sam. The visit to see Susan and her beautiful family seems so long ago now. I think that this disconnect is what’s bothering me the most; I need to pick up the phone and just call… but I haven’t been able to. In this funk, all of my insecurities have been wrecking havoc to my brain…. they haven’t call me, obviously, they don’t care as much as you thought they did.

I was going to mope more, but I need sleep. The next post is going to be happy. I swear. Even if I have to go digging for pictures of baby polar bears again, it’ll be happy.

I’m disabling comments. I don’t want anybody to feel obliged to try to cheer me up; this is what they call catharsis. I think.

In a Past Life…

You Were: A Redhead Warrior. Where You Lived: Central Africa. How You Died: Consumption.

I like this meme. It only asks one question. I can do those. 🙂

(The song was a random iTunes choice as well)

I went out to dinner with my friend Erika, who is having a much worse time (and for more legitimate issues) than I, which helped getting me out of my funk. We had Indian food, which I swear, makes everything better. I, of course, had the chicken tikka masala, which is the perfect comfort food, creamy and savory. Afterwards, we came back and watched Enchanted which was almost enough to get me out of my cynical mood. I am supremely jealous of Amy Adams’ long, gorgeous, vibrant red hair. *frowns at hair that’s becoming more strawberry blond every day* I loved all of her dresses, except for her ball gown, which was a lovely shade of purple, but the bodice was all kinds of ugh.

I then finished my day by watching Doctor Who that featured another gorgeous red head (I didn’t like Donna’s hair the past episode, the bangs and style made her face seem square; today’s was perfect), and she was wearing a toga in that same shade of purple! I loved this episode. cut for mild spoilers

In the midst of the gigantic pity party and sobfest that I held yesterday (being post-call really sucks when you’re trying to control your emotions), I opened my front door to find a big box with a quilt inside, sewn and quilted by my mom, my aunts and my grandma.

I love you too. Thank you. *hugs*

Dear life

Message received loud and clear. I get it. I do. I’m a slow learner, but believe me,you have reinforce the message sufficiently. Boys don’t see me as the dateable type, the marriageable type. I do know my billion of physical flaws, social ineptitudes, genetic imperfections, spiritual weaknesses that keep boys away. I keep thinking that someone going to prove that wrong, but over 15 years of waiting and watching and hoping, well it’s pretty foolish to keep holding on to that pipe dream.

But next time, I respectfully ask that you not prove me with opportunities to foster hope. It’s cruel and unneeded. I thought for a moment… Some things were different, you know. And as you have so helpfully demonstrated, I’ve not the time to nurse a broken heart and broken dreams. Plus tears post-call tend to be more headache inducing than cathartic. So let’s just call it a truce.

Thanks

Oh haha.

Another night on call. It’s been a blue-soul kind of day. I’ve pretty much been cranky since I walked in this morning. We changed attendings today, to one that I’ve worked with in the past. Nice guy, but he’s getting older (at least 5 years past the age of retirement, if not 10) and is becoming forgetful and very, very slow to round. I’ve got one patient that I’m convinced that has been misdiagnosed, and I’d love to have an attending that I could brainstorm with, so that we could provide the right diagnosis, but that’s not going to happen with this attending. Instead we’ll wait for the acute illness to pass and send [the patient] home without no additional answers. It’s just frustrating. Neurology, I’ve discovered is 50% crazy people with all types of somatization and conversion disorders, and of the 50% who have real disease, the majority of those, we still can’t do much more than just throw up our hands and say “dunno what you’ve got, but sucks for you.” Even those we think we give diagnoses to explain things, someone follows in the footsteps and doubt even those.

I almost got to give IV tPA for the first time my last call night for an apparent acute stroke. So close. I was so excited, because I was going to do it. I called the attending, he approved it and told me to do it. Unfortunately (or luckily for the patient’s sake), the patient woke up from the self-induced chemical high just prior to me pushing the medication into the waiting veins. Ah, well, I really wasn’t wanting to deal with all of the complications that would have arisen if I had done so.

I got my schedule for neurology next year (the medicine portion is still pending). Two months of NICU (woohoo!), a couple of consult months and a couple of electives. No general ward months. SWEET! At least I’ll have another year to perfect some of my differential diagnoses before I have to be in charge of interns and junior residents. Next year, I’ll have to solidify my plans for my Real Career and actually decide what I want to do with my life and then start making steps to get there by doing research or whatever.

I think I’m running into problems with my licensure application. I submitted it weeks ago, and in typical Wisconsin fashion, I haven’t heard one word from them. There’s a website where you can check the status of your application…. it hasn’t even been listed there. And of course, attempting to email gets silence and calling gets on a merry go round of automated messages and nobody real to talk to. I know that they received it; they deposited the application fee almost immediately, so at least I don’t have to worry about it getting lost in the mail, but it’s starting to get ridiculous. I’m giving them until Monday, before I start calling every day and harassing them. Since I submitted things in pieces, I want to know what they have and what I might need to go back and recollect (my med school verification for example). I have to have the entire process completed by June. I honestly thought that 4 months would be more than enough time, but I’m starting to get nervous now. I think I’ll be saving my tax refund just in case the unthinkable happens and the paperwork doesn’t get processed by June and I’m suspended for a month. I don’t like thinking that, and I’ll be fighting with claws to prevent it, but I’d rather not find myself with no savings and no employment.

My semiannual review is tomorrow, I swear I just went through that. I haven’t seen any of the reviews I’ve gotten from the interns and medical students from when I was the senior resident back in February/March. I’m a little bit nervous about that.

My med students should be done seeing our ER consult, so I’d better get back to work. Ta for now!

Hi family members!

Welcome to my blog! I think some of you have been reading this for a while now (and not commenting), but if not, glad to have you around. I’ve kept an online journal for the past 4 years, so if you are interested, there’s plenty of old archives to waste your time reading.

I am curious, of who exactly is reading my journal. So, family, friends, countrymen singe men, wanna just click on that little link that says “free your tongue” and tell me who you are. Consider this your guestbook. 🙂

This month is going to be painfully ssllllllloooooooowwwwww. Attending today rounded for 6 hours on our 6 patients (I never thought I’d say this, but wow, I’m glad I had clinic this morning). He’s on for 1 more day, then I get the “round for 10 hours” attending for 2 weeks and finish the month with the “round for 12 hours” attending. Why did I ever complain about the private hospital??

So much for the trying desperately to have a social life. Blah.

On call tonight. Haven’t gotten my three pagers yet, but they are coming.

By the way, going back to being the junior resident, where I have to write notes and orders and actually have to ask all of the review of system questions–painful. Being a senior resident definitely has its perks!

Coming attractions: a blow by blow account of my weekend away (it was fabulous), a icon meme and who knows what else. Let’s hope it’s a slow night. 🙂

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.