Dear Program Director:

Please accept my apologies. Had not realized that page was sent to all of us loser residents and was not meant to be a chastisement, rather a reminder that 6 months to complete a note might be a little lengthy. I concur and will do better. Feel properly remorsed for little tantrum yesterday. No hard feelings.

XOXO,
Your Resident

On call today and for the first time in the entire month, the service is quiet. The NICU patients are stable (sick but stable, that’s a first), I’ve discharged all but one of my patients, I am only a few dictations behind, I managed to see almost all of my clinic patients (and if I had had someone to staff with on time, I could have seen them all) and I haven’t had an acute stroke (yet). Rather amazing that. It’s incredible what a better day today is compared to yesterda,y just because I could finally get some of my work done. And because work has now blocked Gmail, Yahoo Mail, and Facebook, I’m almost bored. But LJ still works (ha!) so that’s something. So I’m perusing my friendslist and looking at the newish Doctor Who promos, and I’ve forgotten how much I love wasting time.

Tonight looks like a night where I might be able to get a few hour of sleep. I love those call nights and I think, after the last few calls I’ve had, I deserve it.

Gotta love the 13 hour days. When we don’t round until almost 6 pm, and I’m still so far behind that I’m just finishing the admission note for the 8 o’clock (am) stroke. When Cointern takes the day off. And senior resident is post call. And there are four strokes within a hour of each other, with just me to see them.

Things did get better, two of the neurology residents stepped in and admitted two of the patients (*loves*) and I did manage to see all of my patients by the time we rounded, so I guess I should be proud of that *snort*. But I never got lunch (and I only had orange juice and Saltine crackers for breakfast) and I missed the “interview” dinner where we take out the potential residents…free food, love it. That’s probably a good thing, because I am so tired and so frustrated and so ready to be done that I might have painted an overly negative view of the program and then nobody would want to come here which would create more work for me.

And now I’m scrounging up a frozen dinner and climbing into bed, because if I don’t get more sleep tonight, I will start crying tomorrow.

My patient told me that [they] were going to die. I had come up to see them as they were having some difficulties and not getting better with the treatments that I had ordered over the phone. Patient looked anxious and uncomfortable, but vitals signs were stable and were certainly nothing to worry about. I ordered some tests and stayed there, while we started some treatments, reassuring that everything was okay and to just calm down. And I watched, horrified, as eyes rolled back into the head and the lungs stopped taking in breaths. Within seconds, the pulse was gone as well.

This is the second time that a patient has died in front of me and it felt like deja vu (really starting to dread the 5-6 o’clock hour). I felt only slightly more competent this time, listening for breath sounds, feeling for a pulse, directing the chest compressions. The medical ICU team was there within minutes and took over directing the code. I won’t go into any more details as to what happened next, because this is flirting close enough to HIPAA noncompliance, but as always, it’s really causing me to doubt me as a physician. I want to do critical care, but I just feel like a fish out of water in these situations. I know that it’s lack of experience, but there’s a big part of me that instantly defers when others arrive on the scene, and that’s wrong. I should be taking charge. I should know enough that I’m making decisions instantaneously–that why we learn the algorithms so it becomes second nature. And of course, there’s that part of me eating me up inside, wondering what I should have done sooner, faster. I chalked up the complaints to anxiety, when there was something seriously wrong. Am I that bad on my assessments? Even looking back, I still think that that I would have acted in same if I did it over again and that’s not good.

I was going to write more about my date tonight, but I got three hours of sleep this afternoon and I am utterly exhausted. The short version: I had a great time, I like the guy (as in, I haven’t found anything yet that is overwhelmingly a turnoff, otherwise, I’m still being cautious), deer hunting is loads of fun, and he gives pretty good hugs. 🙂 Look for more tomorrow.

So I just got asked out on a double date. For this Wednesday, when I’ll be post-call, smelly, and sleepy. I think it’s going to be a winner!

The best part: it’s with the one guy in this town that Chris knew from college and he loathed him. I haven’t found him to be so bad yet, but I don’t know him super well. But still, what are the chances?

I went to a neurology conference this weekend. Can’t remember what one of the talks was about (probably because I dozed through a good portion. Right in front of the neurology chair, not the best idea I’ve ever had), but the rest were good – pertinent and somewhat helpful (although, right now, I’m just feeling so overwhelmed with neuro in general, that I think the only thing that would help me feel better is a remedial course). And of course, I sold a little more of my soul to the drug companies and got free textbooks and pens and little airline pillows, so it was profitable. All of the residents and their spouses and the few kids got together for dinner, which was so much fun and probably the best part of the evening. The residents are really what keep me from deciding to quit neurology, because for the most part, they’re fantastic people and I just love being with them.

And I think that’s all that’s going on in my life. You probably don’t want to hear about me walking into church today, finding out that there was no Sunday School teacher and winging it (and “The Gathering of Israel” is not an easy topic to wing) or the constant struggle with the thistles in my raspberry bushes (I am going to conquer!). Life in general is a heck of a lot better than it was two weeks ago–a good portion of the improvement came after the louse of an attending left the service and I worked with a very friendly and efficient (which is a trait worth gold) attending who by the end of the week was offering me dating advice in the middle of rounds. Between her and one of the patients, I’m pretty sure I had bright cheeks for many mornings. But, oh, I love laughing and teasing so much better than scowls and tears.

From ivydoor

Comment and I’ll pick 7 of your userpics for you to discuss (or something like that)

The Seven in Question

That, I think, was the hardest call I’ve ever had. A list:
~~ 5 floor consults, one who was pretty ill and got transferred to the ICU right after I saw her.
~~2 (and 1/2 – I punted to medicine on the third) ER consults that I discharged home).
~~4 ICU admissions, two of whom arrived at the same time and were both quite ill.
~~10 calls from outside patients– my favorites were the 2 am call because patient had had gas and some slight diarrhea for 24 hours (which was improving!) because “something wasn’t right” and the 4 am call from a patient who had taken a bath and noticed a new, non-ithcing, not inflamed, not warm slight rash and just wanted to know what it was…!!!!).
~~1 floor admission (thankfully NOT to stroke).
~~1 patient who crumped so suddenly that it was all that I could do to keep them alive overnight. That was a four hour ordeal of calling my fellow, three different attendings and trauma surgery and general surgery and just praying that I could figure something to do.

Luckily there wasn’t an acute stroke or I really would have been screwed. But I managed, even with my lazy louse of a senior resident who got something like 6 hours of sleep (and I got 10 minutes with my head on the desk), who just managed to succeed in pissing of those I was doing consults for. I finished my notes at 7:00, ran around and put them in charts, signed out the consults that needed to be seen, prerounded on the ICU patients (which took all of ten minutes, since I had been glued to their side all night long), wrote my notes, rounded with my attending (he’s my favorite, but oh, he gets so painfully distracted when I’m just itching to leave!), called radiology to beg for an MRI, talked to anesthesiology to get the patient intubated so we could get said MRI, wrote transfer orders, and finally walked out the door, where I turned the air conditioner on in my car so I wouldn’t fall asleep driving home. And now I’m home and utterly exhausted and will be sleeping for the next 12 + hours.

Good night!

Please somebody remind me why I’m doing neurology.

I had thought my experiences last December were due to my wonderful resident. Now, I’m realizing that the attending probably contributed to it as well, as he has certainly made these last few days less than tolerable. He yelled at everybody yesterday, which I missed because of clinic (never have I been so grateful for clinic), so we all arrived extra early to have the precious notes finished just the way he liked them, only to find myself the target today. I gave up counting the snide remarks because I was pretty much fighting back tears for most of rounds.

I have a patient to staff who I refused to admit the other night on call, who actually did have a stroke. It’s been eating me for the last two days, when I discovered the confirmatory scan, and tomorrow I get to present why I didn’t feel like I should admit an obviously ill patient (however, in retrospect, I still maintain that I was right in my decision, I just don’t know if I’m going to be able to defend it).

I’m clinging to the nice moments, of meeting up with Sonja and Satya, who reminded me that they loved working with me (and oh, I miss them and the MICU and the laughter and call nights…) and I’m not a horrible doctor (just a rather horrible neurologist). Running into Aaron who greeted me with a large, toothy grin that warmed me to the bottom of my toes and made it seem like November again.

The crush is fading. Maybe sleep deprivation. Maybe because I look/am ridiculous and Stephanie Meyer books aside, nobody finds the klutzy behavior cute (I’ve dropped my knife, my fork, all of my papers, my pager, tripped on my own feet, knocked over a tray trying to squeeze by someone, all in front of him. I’m really not usually this bad). Maybe the fact we’re all so battered that we’ve lost any fun loving spirit and we’re all grouchy and ugly to each other. Right now, I don’t even care.

Facebook makes it way too easy to stalk. It’s no fun when I can find out his alma mater, birthdate, AND see photos of his family in one fell swoop.

*pout*

No girlfriend pictures there, that’s promising. And he fits into my “two years younger” category of every guy who caught my attention of the last 6 years (another lingering effect of the horrible crush/humilitation of the Oliver saga, I wonder? Or am I just refusing to grow up myself?). So many answers, so little effort.

I guess I’d better put my detective skills to work in locating my credit card that has disappeared again (and I’m just about out of gas. I don’t think I could make it to work and back).

I decided to make a list. I don’t know why.

– Crush news (which right now, is ever so much more interesting than patients and their neuroanatomy): He has a freckle on his right ear lobe, and a faint, thin scar down his right middle finger. His hair curls across his forehead (it’s such a good thing that these many many years have trained restraint!) and he’s had his beard for as long as he’s been a resident here (as evidenced by his name badge) which manages to hide a very small dimple and I can’t find adjectives to describe his blue eyes. And he has really bad breath post call. Oh, and he owes me big time for doing his discharge summary for him. Am I wonderful or what?

– I had a wonderful weekend. Saturday night, when I woke up from the post call coma, I went to the symphony with one of the neurosurgery residents. Mahler. My dad used to love Mahler, but until Sat. night, I never understood why. I’m now addicted. Absolutely lovely.

– Sunday I went to watch conference at my bishop’s house, which is always a spiritually uplifting time. Pres. Hinckley is still looking amazing for his 95+ years. One of the guys there hugged me and reminded me that it was exactly one year since we had met. I had forgotten. I thought that was sweet.

– It was the first day off that Chris and I have had off together in 2 months, so I drove up to Madison and spent the afternoon and evening with him, fixing his bike, eating Vietnamese food, and digging through all of his music collection. I came home with 300+ new songs and all of his pictures from Ireland and Scotland. Scotland was incredibly gorgeous from his pics… I guess I’d better add that back to the list of Must-Go places.

– Chris broke up with his girlfriend. And didn’t tell me until I pressed. Okay, I think I overlooked a big dropped hint earlier in the evening, when we were putting together pictures for a framed collage, but still. *sigh* Anyway, we had a great talk sitting on a park bench overlooking the lake. I told him about the many dating woes of the past two months. He thinks I’m missing clues (I think that no reciprocation and avoidance of conversation afterwards speaks volumes). He’s thinking about taking up Match.com dating, which I can’t wait to see how that goes. 🙂

– I’m still really bad at music guessing games. Apparently I need to listen to more Phish and Eagle Eyed Cherry(ies?).

-He beat me on the word games as well. The Word of the Day emails are not helping.

-I’m not on call again until Saturday. !!!

–The Seeker has gotten terrible reviews and didn’t do so well at the box office. Maybe that will stop any sequels.

-Still can’t figure out exactly what you do on Facebook, but at least it lacks the ads and spam of Myspace. Am trying to collect friends like mad over there. Perhaps I will make a trophy wall with all of my friends. I guess I need to add more photos, or so a little bird told me.

-I’m reading New Moon right now, as I finished Twilight a few weeks ago on call (man, I miss the ICU call). Liked Twilight, although spent a majority of the book irritated at the heroine and her love interest. I’m really looking forward to reading this, after mulling over valancy_s‘s recent posts about why we go for vampires.

-Congrats to Michelle and Kelly! Maybe, hopefully, I’ll be able to see this little one before he/she’s 40 (are you going home for Christmas?)

-I love Matchbox Twenty. This new album is just gorgeous as always.

– You all are watching Friday Night Lights, right? You’d better be. Best show on TV right now. I’m watching it online, so what’s your excuse?

-Clinic tomorrow. Only 3 patients. Maybe I’ll actually finish on time (and possibly get my notes done, that would be amazing).

I really love early crushes. The crush way before any emotional attachment or heartache–no thank you, have had enough of that for a lifetime! No, the crush when you barely know the person but he’s cute and funny and smells really nice and you just wanna be next to him and contemplate grabbing his hand during rounds…

Er. Yes. In other words, I’m just smitten with my coworker. No idea if he has a girlfriend. Don’t really care. All I know is he’s not married and he’s cute (still a sucker for blue eyes. And I’m so infatuated with his beard. Very weird) and it’s going to make a rather tough month that much more lovely.

What’s not so lovely is being on call, and getting 2 patients admitted directly that I know nothing about. Bah.

It’s going to be a long month two long months. Rounds today lasted 6 hours. 6 hours to see 8 patients. No discharges. I didn’t get notes in the chart until 5 pm. I didn’t even have my morning orders written until 5 pm. Oh, and did I mention that I know nothing about my patients…why they’re there, what kind of strokes they had, what kind of interventions, and what kind of work-up they had had. No clue. I looked like an incompetent moron (the intern who’s gorgeous, btw, asked me if I was post-call. He was, and didn’t act it at all), which got worse when my attending started pimping me on differential diagnoses of syndromes that I’ve never heard of. I’ve got families demanding updates on when their loved one is going to be discharged (no clue, sorry), juggling showdowns between dueling services (the neurosurg attending’s opinion of me is even lower, but I don’t care as long as he does something surgery-like), and trying to find social workers and case managers to see if I can’t get somebody home tomorrow. It made for a very, very long day.

But my attending does one of the best neuro exams I’ve ever seen and he’s unbelievably brilliant (and is starting to change my opinion that neuro docs don’t know much about general medicine) and wow, I wanna be just like him.

I’m on call tomorrow, where the chances of me even getting 5 minutes of sleep are pretty slim.

Oh, and I really need a better reflex hammer.

*sets alarm for 5 am*
*crawls into bed*

Schedule for tomorrow:

6:30 alarm clock will go off
6:30.05 snoozer will be depressed
repeat every 9 minutes for next hour
7:30 awaken in a panic
7:35 shower in a panic
7:50 dress in a panic
7:59 shove papers aside in a panic looking for scheduling ticket
8:10 leave house ten minutes later than planned on, hope testing location is easy to find
8:30 arrive at testing center after missing a turn, not being able to find building and driving around in a panic
8:35 hand over cell phone, backpack, all papers
8:40 listen to instructions about how to click buttons on a computer and to keep my identification number with me at all times.
9:00 start multiple choice questions. 7 blocks. 50 questions per block. 60 minutes per block. I’ll be done with each section with approximately 10 minutes left. This amount will increase with each section.
11:20 Ten minute bathroom/water break
12:30ish Lunch break
4:30 Finish with test. Have major migraine. Neck stiff. Brain beyond dumb. Can’t tell you how I did. May have passed. May have not. Don’t really care anymore.
5:00 at home. Will splurge and call my friends, who I haven’t spoken to in at least a month. Hope I don’t cry.
And Saturday, I get to wake up and do the whole day over again! Yay!

No magical ball or fortune-telling here. Just exhausting, repetitive experience. It’ll be four blessed years before I have to go through this (officially–I’ll be taking “in-training exams” that are oh-so-similar twice a year for the next four years, but thankfully, those don’t count for anything), and that’s what’s keeping me going.

Wish me luck?

So, my little hometown apparently has two escaped convicts on the lam. Murder convicts at that. Luckily, it appears they have left town and were spotted 40 miles away, so I can stop freaking out about my parents’ safety. It’s a town of about 250 people, where nobody locks their house or car and we live out away from town–not the best combination with unsavory people around. The sheriff’s department is receiving a lot of flack about the escape (and they should receive some criticism about safety concerns as this is not the first escape and to the department of corrections who should have never put such dangerous criminals out in a county jail to begin with), but I’m really getting tired of reading all of the news articles, editorials and comments from people who really have no idea how small towns work and how truly small my little hometown is.

*grumbles*

In other news. I have the day off tomorrow. What I really, really want to do is get in my car and go driving up into one of the nearby lakes, have a picnic lunch and take pictures of the gorgeous fall leaves. Instead, I will be cooped inside studying, because I take Step 3 on Friday and Saturday (2 days of 8 hour testing! YAY!) and since studying during my ICU month wasn’t nearly as productive as I had hoped, I will be doing some major cramming. I’ve found it very difficult to study on my own–for the past how many years, I’ve had a partner, and even if we did most of our studying separately, at least you knew there was equal suffering and if you had a question, then you could bounce it off and come up with the answer. I’m horribly distracted when I’m by myself (I watched the entire first season of Friday Night Lights in the last week. Not good. For my studies, that is. The show is awesome and I’m addicted and I promise, it’s not really about football and I’ll stop now). Also, I haven’t found a good study place–I found a coffee house just around the corner that showed promise–until I saw that it closes at 4 pm!! I miss my Beehive Teahouse or Coco’s Cafe (yeah, I’m a little homesick right now).

All I need to do is pass, because retaking this thing would be nightmarish.

I return to the neurology department on Sunday. Which I’m not exactly looking forward to. I really had a great month this month (even if I didn’t get the number of procedures that I wanted: 3 central lines, 1 that was a failure, 2 arterial lines and I missed both of those. No intubations. Bugger. Oh, and not one real code. Still useless at ACLS.) and any change isn’t going to be as good. I’ve been away from neurology for so long, that I really don’t feel like a part of the department–I’ve been left out of social invitations, I haven’t been able to go to the business meetings, etc. Plus with all of the drama recently over call schedules, well, I don’t want to get sucked back into all of the (pointless) drama.

2008 marks the 100th anniversary of the publication of Anne of Green Gables. 100 years, can you believe it? Wow. Prince Edward Island, in continuing their traditions of pandering to the tourists, is celebrating the occasion with year long festivities. There’s a big part of me, that pesky, sentimental tourist (I do realize that I’m a hypocrite, but not so much that I can embrace the idea of “meeting” Anne and Diana in the streets), that really, really wants to be in PEI for the festivities

Of course, equally verbal in the inner dialogue is the frugal, money-panicked me who is trying to calculate airfare, lodging and transportation costs and wondering how I can possibly save up the money plus get the snow blower that I so need to make this winter more bearable.

Choices, choices.

Anybody inclined to tag along?

***
Today was my day off; 16 days without any time off is a very, very long time to survive. I was getting a wee bit punchy by the end. I only accomplished one thing today… I slept in until 11, which was exactly what I wanted to do. 🙂 I got up in time to prepare my lesson for church (on marriage, which everybody groaned when I mentioned the topic, but I think I pulled it off well–got a few laughs and some good discussion until the end where it veered off into pointless tangents), went to church and then have spent the rest of the afternoon and evening on the couch, doing absolutely nothing. It’s been great. Unfortunately, I’m on call tomorrow, so the reprieve was very short. Hopefully, this call will go a little nicer than the last, and I can actually get a few minutes or even better a couple of hours of sleep. Last one, I came home so exhausted that I went straight to bed and woke up around 3 in the morning. Hence the reason for no posts recently.

I take Step 3 of my boards in 12 days. I’m starting to get nervous now, because I really have had little time to study. And I still can’t tell my dermatologic diseases apart. All of this schooling and training and I still don’t know half of what I really ought to know.

I hate the neurology department. I am so close to just walking up to them and just quitting, because it’s been a long time since I enjoyed myself and I’m sick and tired of the laziness of the senior residents. The only part of neurology that I like is the neurocritical care and I can do just plan critical care from the medicine side and be done almost 3 years earlier.

“If a senior is delegated intern work from another junior resident because of a lack of their in-efficiency or work-ethic then perhaps we should re-evaluate who we are accepting into our program.”

Bastards.

My iTunes is in a sappy mood. Frank Sinatra, Dean Martin, Phantom of the Opera, Vienna Teng, Eva Cassidy, Josh Groban all have rotated on in the last hour. Hmm. I don’t know what it’s trying to tell me.

All I know is that I’ve been reading about some of the discussion in reducing resident work hours from 80 hours to 72, and limiting it to 24 hours straight, rather than 30. Half the posts are about how all it does is train physicians to be sloppy and less dedicated and less educated. And that’s enough to make me cry. There’s a nice post here about Labor Day and resident physicians. England is going to a 48 hour week for its residents. 48 hours. I can’t even imagine.

More blogs:
http://fatdoctor.org/2007/09/03/doctors-labor-day/
http://www.hourswatch.org/
http://pandabearmd.com/blog/2007/08/23/in-which-your-uncle-panda-rips-off-the-lid-rolls-it-in-a-tube-and-places-it-politely-where-the-sun-doesnt-shine/

My program is quite good about getting us out within the 30 hours. I usually am out in 29 hours. And I usually only feel exhausted and overworked when I’m on call and unable to claim more than 15 minutes of sleep with my head on the table. Those are the hard nights and it depends on the rotation of how frequent they are. My last two calls have been unbelievably sweet. No new admissions. I went to bed by 11 pm and didn’t leave my room until after 6 am. Saturday night, I didn’t get a single page all night, until 4:30 am. But I sleep with a light on and I wake up every 20 minutes or so, worried that I am missing something. I still go home in the morning absolutely exhausted.

I worked today. In the hospital by 7:30, didn’t finsih until after 3. And it was a holiday, but I didn’t get paid extra. I don’t get time and half. My paycheck states that I work 46 hours a week, isn’t that nice.

*sigh* Sorry for the negativity. I came home from the hospital after spending over an hour trying to get a foley catheter into a man with prostate cancer, with a bad migraine and my smoke detector beeping every 3 minutes because the battery was dying. So I’ve never gotten rid of the headache. And sometimes, it really depresses me that this is what my life is like and it won’t ever get better.

I’ve got a date tomorrow night. I’m a dating machine, I guess. Either that or a masochist. Different guy, one that I find conversation with to be somewhat stilted and painful, really. But he was the medical student on the neuro wards and my friends were raving about how great he was (which he is a very nice guy) and they all seemed to enjoy talking to him, so I decided to give him another chance.

We’re going to a baseball game. I apparently don’t learn my lesson. Luckily, it’s with about 40 other people, so there will be a chance to engage others, if we decide there’s nothing to talk about and the game goes into extra innings.

And I’ve got clinic tomorrow morning and have to round on my patients before rounds. Oh, and did I mention that it’ll be another 14 days before my next day off (16 days total)?

Okay, iTunes is now playing Enrique Inglesis’ “Hero”. It is definitely time to go to bed.

Title: Tardus Semita
Author: Julia (jcd1013)
Characters: Ten/Rose, Eleven/Rose
Rating: All ages
Warnings: General spoilers for Doomsday and Gridlock. Character death.
Summary: Living the slow path means facing the fact that someday, he’ll lose her.
Author’s Notes: Written for the Anywhere But Cardiff ficathon. My prompt was: Blackpool, England, 21st century, which turned into a rather “blink and you’ll miss it” mention. Sorry about that. Especially big thanks to shirerain for looking over it and reassuring me that it wasn’t terrible and valancy_s for the last minute editing job.

Humans decay. You wither and you die. Imagine watching that happen to someone you…
~ Doctor Who, School Reunion

She’s twenty-five when her family convinces her that she needs a vacation.

Would anybody be willing to read over/rip apart a short story? I finally finished my ficathon piece and as the deadline is today, I guess, not a minute too soon. I’m not entirely happy with it–I thought up the best ending for it last night when I was at a concert, and of course lost it before I could get home to write it down–but I don’t think it’s entirely horrible either. It’s shortish, five pages, so it wouldn’t take long.

Comment with your email address if you have some time today, and I’ll send it on. I prefer using Word with its editing tracking, but otherwise, I’m available on AIM or MSN (let me know your usernames) to discuss some of the changes.

It’s rather comforting to know that I spent enough time doing call last year, that even after not doing it for two months, it all comes back. Of course, still haven’t had to run a code *knocks fervantly on wood…except I need the experience…so maybe I should be wanting it*

Have I mentioned recently how much I love the ICU? Seriously, this is going to be one tough month (I already inherited one of the sickest patients on our service), but oh, it’s going to be good. Procedures (I may get to intubate!), very knowledgable nurses, and an unbelievably fabulous team. Two of my favorite residents from last year are on the team and now we’re collegues, rather than resident/intern, so it’s even more fun. Right now, Sonja and I are watching House. If only things were like a tv show.

Orkin came by and evaluated my house, did I mention that? Two small holes, no evidence of mice inside the house, and certainly no enough for me to justify the expense of having them come every two months. So I cancelled the service. I have to patch the holes myself, and there’s been a mouse spotted, running across my back door, so the sooner that gets done, the sooner I’ll be able to rest in peace. I’m just glad that I was overreacting. 🙂