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8th April 2009

budding neurologist

Today, I woke up and thought to myself that for the first time in almost three years, I like neurology again. I’ve taken care of some really interesting patients with diverse diseases; I’ve come up with diagnostics and differentials that my attending agreed with; and I had a chance to read so I was starting to feel like I understood the difference between polyradiculopathy and polyradiculoneuropathy (don’t ask). It didn’t hurt that we had maybe 1 consult a day, so I could really sit and think about my patients care.

Of course, right after I thought that, my pager went off nonstop all morning with new consults and complicated questions (as well as stupid questions), making me feel like a freshly chopped chicken and the love faded. It’s still there, dimly trying to stay alive. Who knows, if I manage to survive tomorrow and clinic, it might take up permanent lodging; that would be nice.

Other thing going on in my life:

  • I have just about caught up with all of the little requirements that residency piles on me. I completed the last of my dictations (it was nine months old, but, as I discovered when I dictated it, I had never even taken care of the patient and it really wasn’t my responsibility. So I suppose that evens out). I finished all of my evaluations. I’ve stayed caught up on my clinic notes (that will probably change tomorrow). So I’ve finally been able to concentrate on something else: my house. It’s been a disaster since January when I got sick for a month and was working close to the 80 hours/week limit. But this week, I went through all of the papers that I’ve collected and recycled three entire boxes of junk mail and have collected another 3 boxes of patient information that I need to bring back to the hospital for shredding. No wonder I felt like I was drowning. I’m focusing on the progress and ignoring for now the pile of dishes, the laundry that needs to be washed and all of the sweeping. All in due time.
  • My beloved mommy finished my Regency dress this weekend and mailed it on Monday. I hope to get it tomorrow. There will be pictures. πŸ™‚
  • I had a fabulous weekend, visiting Chris and his friends. We went to the symphony (incredible pianist!) and out to eat and then made crepes the next morning as we watched Sicko. Three years ago, as a fresh idealistic medical student, the documentary might have inflamed me to action. Now, after experiencing the multiple complexities of the medical system, I am become more cynical about the likelihood of success with medical reform. Doesn’t mean that I don’t support efforts to do so, but I see much more of the pros and cons of all of the proposals. Surprisingly, Chris was as conservative about the movie’s premises as I; residency has changed him as well.
  • In any case, there is some pictorial documentation of the weekend at my Picasa site. It already hurts thinking how much I’m going to miss this.
  • I’m getting an elliptical machine and a bench press from my friend who is also moving away (*sniff*). I’m so excited to have my own little gym. Now, the bitter cold of Milwaukee won’t be an excuse to keep me from exercising AND I won’t have to endure endless ball games. As soon as my house is in order (I’m hoping this weekend) I’ll get to retrieve it.
  • It’s actually been really hard recently, thinking about all of the friends that are leaving this year. My medicine resident buddies are graduating and going on to fellowships and careers, leaving me behind for another two years.
  • I am trying to get the courage to buy tickets to visit Sam and her little one in New York over Memorial weekend. In New York. I start hyperventilating at the thought (serious phobia issues here!) but I think my love for baby Meghan’s poofy hair might win out over my fears. I may not see anything more than central park and in the inside of her apartment, and I may just be one quivering jellyfish the entire trip, but it’d be worth it. Right?

And that’s all folks. Tune in next time for another addition of Glimpses of Julia’s Oh So Boring Life.

posted in All About Me, Chris, Friends, Healthy Living, Resident Life, Social Life, Those Rare Days Off | 1 Comment

24th July 2008

For those of you without the $90 to spend on DVDs…

iTunes has just released Season 1-3 on the downloadable DVDs, for a mere $25.87 ($1.99 each episode). The Christmas episodes aren’t there and obviously, there’s no “behind the scenes” commentary or David Tennant diaries, but still, it’s an option.

I was also going to say that X-Files season 1-3 is also available. But those are much more expensive and Season 1 is missing one of the best episodes (Beyond the Sea), so personally I’d wait (well, personally, I already own the DVDs, so the point is moot. Moot. I love that word).

My X-Files party went splendidly, by the way. There was a newbie in the crowd, so we watched The Pilot (always a favorite), Squeeze and Post-Modern Prometheus, which was voted the favorite. I gave a quite the girlie scream and betrayed my cool demeanor during Squeeze, even though I’ve seen it a dozen times and knew what was going to happen…. I’m never going to survive tomorrow/Saturday when I finally get to see the movie.

I got recertified in ACLS (advanced cardiac life support) yesterday. Man, it’s so much easier after two years of experience. I haven’t run a code in months, but just knowing exactly what the drugs do and the thought process and the pathophysiology helps so much. At the end of med school, I was so clueless and ignorant. I’m still behind the time (ask my attending when I was unable to tell him what the common side effects of niacin are), but at least, I’m better than I was two years ago.

And other than that, not much going on. My life revolves around the various clinics and I’m getting a little wearied at the constant change. Every place has different expectations, different places to hang your bag, different places to find forms, etc, and it’s tiring learning it all over again, both morning and afternoon. Plus, clinic patients always drain me. I don’t get the chance to review their labs and their images, or whatever. They’re there for those 20 minutes and they want answers, regardless of whether I have them, so I’m always thinking on the fly and I hate that. Still enjoying the free evenings. Tonight I picked raspberries, tripped on one of the bushes and lost the entire bowl. Luckily, I have a very abundant crop this year and was able to pick more to use with the Yogurt Cream that I made for my XF party (sooo good. Sooo creamy. So many calories (we’re ignoring the advice about using whipping cream and going with milk next time. It may taste better, but I’m the only one around to eat the leftovers and golly, the guilt!).

I really need to do laundry.

Oh, yeah, and Happy Pioneer Day! I rather miss the middle of July state holiday. Any special celebrations? BBQs? I wish I was there, but in the mangled words of Brigham Young, “This is the right place for me.” Hee.

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19th July 2008

gosh, don’t you wanna fight evil?

I’ve hated clinics since I was a med student–I learned very early on that the place where I thrive, where I fit, is the hospital, and the 20 minute focused visits where I’m supposed to address the reason that the patient is there as well as any other issues that invariably crop up (social issues, always social issues) make me crazy.

Granted, my visits with a patient in the hospital usually are as short, if not shorter (ie, morning rounds: “Hi Mr So and so, how did you sleep? Breathing better? Any overnight issues? Okay, well, let me just listen to your heart/squeeze my fingers/press on your belly. I still haven’t seen your latest labs/images, but I’ll be reviewing them this morning and the whole team will be by to see you later this morning. Oh, probably around 10 or so. Hmm, I’m not sure when you’re going home, it depends on if the labs/images are improving. Work hard with physical therapy today. Any questions? Okay, I’ll see you later. Have a good morning!”), but the overall effect of seeing them day after day, discussing the case for hours with the team, looking at labs and images and making changes then to the plan, etc… It all makes it seem like there is a much more comprehensive rapport that develops over the 3-4 (or 10) days that they’re there in the hospital.

So, anyway. I’m doing outpatient clinics for the next two months (well, we’re down to 5 weeks now). And I had been dreading it. Okay, besides the weekends off, the 8 to 5 hours, the no call, dreading it. Strangely, I’ve really enjoyed the month so far. I’ve worked in the Allergy clinic, in the Cardiac Arrhythmia clinic, learned how to do PFTs, worked in the VA emergency room, in urgent care. And it’s actually been fun. It’s definitely better when you have a little more control on what goes on with the patient.

Oh, and the half days off… Brilliant.

****
Because of the half days and free weekends, I’ve almost got a social life back. I went to the movies on Friday night (Hellboy, was rather unimpressed, which surprised me, because I had heard such good things about it. Sean Means, my personal movie reviewer *cough* gave it 4 stars! We have never parted company in opinions before. What is the world coming to?), on Saturday, I volunteered at a nursing home playing Bingo with the inhabitants; I was the announcer of the numbers and gave out prizes such as a stuffed purple poodle, that I craved myself.

A friend came by later that night and we made microwave cakes and complained about the shortage of dateable guys in our ward. There’s a large group of us who are older and getting slightly bitter (more than slightly in my case), that these guys, who are our age, are only dating the 18-19 year olds, if they’re even doing that. We’re thinking about starting a support group, because like it or not, the chances of us dating and getting married get smaller every year, and it’s a hard realization. I think it’s just hitting me now, the fact that I’ll be 30 in just a few short, short months. Bah.

****
CuteIntern is still freaking adorable (although no longer an intern *sniff*). While commiserating with him about the should-have-expected-it ending of Dr. Horrible, he told me to check out a new show. A new show on ABC Family. A new, extremely campy, yet somewhat witty show on ABC Family, entitled “The MIddleman” which should should be checked out by everybody. I had to search everywhere for a streaming video (they lie about the season being available at ABC Family) so if anybody is interested, I can send you the link. It’s extremely campy, I don’t think I can emphasize that enough and it’s exactly why I think some of you will enjoy it. Seriously, take the pseudoscience alieny feeling of Doctor Who, add a good dose of insanity ala Red Dwarf, splash it with the chattiness of Gilmore Girls, and then spoof it all on turbo, and you’ve got the show.

****
I’m having an X-Files party tomorrow to get ready for the new movie. I’m so excited, yo! We’re going to be watching a couple of our favorite old episodes and then the old movie. Hmm, which ones would you pick?

I’ve been very, very good about avoid spoilers and reviews, so I haven’t heard if the new movie is good or not. I don’t care. It’s been 10 years since I watched the first one and became an instant X-Files fan. Ten years since I lived and breathed X-Files, watching the new eppys with Sus on Sunday and all the reruns on FX whenever I could catch them, collected action figures (shut up), cut my hair like Dana Scully. I’ve lost my XF callouses though… I used to be hardened enough that I could watch even the most disturbing episode (Home, anybody?), and not flinch (too much). Now, I’m a wuss; I’m going to be whimpering and cowering in the theaters. I. Can’t. Wait.

Please, make it good, Chris Carter. I’ve cursed your name and doubted you since the series ended. You had over 5 years to get it right.

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7th June 2008

affirmation

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…

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5th June 2008

kiss of perfection

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. πŸ™‚ )

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19th May 2008

hip! hip!

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).

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15th April 2008

more than the blues

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.

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12th April 2008

I swear I did not fudge the results


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. πŸ™‚

(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

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10th April 2008

sundry

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!

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1st April 2008

transitions

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. πŸ™‚

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25th March 2008

my day

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.

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17th March 2008

this and that

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…

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10th March 2008

Tonight….

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.

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9th March 2008

travel bug

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 AtΓ­lan 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??

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27th February 2008

*loved*

You know you have really really good friends when they call you up to say that they want to see you on your day off…and they are coming over with cleaning supplies and expect to be put to work.

My kitchen, bathroom and living room looks fabulous. Still have laundry to do, but will have fresh scrubs to wear tomorrow.

*loves*

So glad that this month is over. It has been difficult and frustrating in many ways that I could have never predicted. I liked my interns individually but we never became a team, and I really struggled with how to improve things. I was in change of 15-20 patients every day, we rarely seemed to make any progress in discharges, and I think I set the record for the number of patients transferred to the unit (12). I was rarely done and home before 7 pm…when my interns usually left by 5, I was still there making sure everything had gotten done.

Tomorrow will be met with a new set of challenges: new interns and students, new hopsital, new system, new rules, (and I get to start by being on call! Yay!) but I’m glad to get a fresh start on things. Plus, all of the other residents keep teasing me with promises of work days ending by 3 pm, and that sounds unbelievably alluring.

Night all.

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8th February 2008

stuck in a rut

I spent my day off today sleeping in and lounging around the house. I only left to get pancakes, because after this past week, I deserved pancakes. I transferred yet another patient to the ICU (who by the time I finally managed to talk to the fellow (who has to see and agree to admit patients before they get transferred), didn’t look quite near to death as he did mere minutes before, so the fellow thought I was quite off my rocker. Especially since I had a tearful breakdown in the middle of the hallway, because I couldn’t find anybody to help me out. I’ve never ever done that before at work, and I’m still horrified by my behavior.). My team was on “daytime admissions” so we were admitting patients who I had to see and discuss with my interns, while this other patient was slowly funneling down the tube. I was at the hospital until 10:30 last night running around seeing everyone.

It had, as forecasted, dropped 12 inches of snow (luckily, not 18: I don’t know what I would have done), and I managed to drive home, only to get stuck in middle of the very much not plowed side street that I live on. I trudged back to my house, got out my shovel, and tried to dig myself out with no luck. Finally, somebody with a truck (I LOVE TRUCKS), came back and pushed me out to where I could slide my car in front of my car. Of course, I get out today to get my pancakes to realize that the plows had finally come through and had plowed me in again, so I was stuck again and had to be pushed out again. Argh. Getting tired of this snow thing. If I have time before heading to work, I’ll try to take pictures.

The only saving grace in this, is that yesterday morning as I was fractically trying to snowblow before heading off to work so that I’d only have 8 inches to plow through, is that my neighbor offered to do my place. So I at least came home to mostly cleared sidewalks. I’ll have to see what I can offer in terms of homemade goodies to entice him to do it again. πŸ™‚

They’re going through with the plow again right now, hopefully it’ll be more driveable in the morning.

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5th February 2008

weight of the world

Since I started as the senior resident on the wards (ie inpatient medicine) team a week ago, I’ve:

– done 2 lumbar punctures (spinal taps – one of them was on a guy who had a seizure as I was inserting the needle. I did manage to get it, but it was no champagne tap)
– supervised 1 paracentesis (abdominal fluid tap)
– Managed 2 encephalopathic (confused and almost coma-like states) patients who became so because my interns continued home medications that the patients really weren’t on (and should have been on in this hospitalization because of their various illnesses affecting how their bodies metabolize drugs) which I didn’t catch until after we had problems waking the patients up (both are living, one has completely recovered, the other is slowly, slowly, slowly waking up). I’ve agonized for hours over their cases.
– Attempted to work up a patient with the strangest brain lesions I’ve ever seen on MRI, and finally, finally managed to get neurosurgery to get a biopsy, only to have the radiologist call me and state that they thought all of the lesions were “congenital” and didn’t need the biopsy after all. Um, too late, bozo, you could have informed me of your “expert” opinion two weeks ago. Grrr.
– transferred five patients to the ICU, because they all seem to crump the moment I lay eyes on them. (Two of these, I transferred this afternoon. Yeah, there went my plans to leave early as I am very very very close to violating work hour restrictions)
– I’m too tired to remember the rest. All I know is that I’m usually not leaving until after 6 at night even when we’re not admitting patients.

Did I mention that I’m responsible for a team of 18 patients? And that we’ll be admitting 6 more tomorrow?

To add to it all, my attending is very disappointed in my intern’s performance and it’s becoming my responsibility to take her aside. I’m not good at these things, especially when I don’t think she’s quite as behind as my attending does, but I really don’t seem to have any other choice. I’m also having problems with my other intern, as he doesn’t listen to me, barely updates me in what’s going on in his patients and to top it off is very serious and stuffy and I just don’t get along with stuffy. It’s stressing me out, I’m having problems sleeping (I end up dreaming about all of the tasks and problems that are going on)

I had started an entry last Tuesday when I was post-call but satisfied at the smooth transition into being a senior resident. Life was good (even though I was exhausted and irritated at having to admit all of the roll-over patients). I had great interns (including one with the most bewitching eyes and sardonic smile) and a great attending and I was so overjoyed at being back in the medicine department and NOT having to write daily progress notes (the bane of my existence). It was lovely. Even though it freaked me out every day of how much responsibility I have and how much I still have to learn to really effectively direct my interns and students in the care of their patients, I could see how much I’ve learned in this past year (I can be taught!). And my patients, even though they were rocks and refusing to leave the hospital, didn’t sap me of my compassion either. It’s all changed this week. I’m exhausted and weary and I’m tired of feeling the weight of responsibility and (my) ignorance.

In other news, I’m slowly making my way through Season 3 of LOST. I think DVDs are definitely the way to watch this show, the instantaneous answers providing the forest big picture so everything makes sense. Still love Charlie. FInally starting to feel the Sawyer/Kate love. Can’t figure out Locke’s motivation. Didn’t even recognize Boone (Boone! I miss you!).

I didn’t vote today. That’s because Wisconsin’s primary is in two weeks and since I always register as an independent, I will actually get to vote in a primary for the first time because it’s open here. Yay! I could even waste my vote and select between the candidates for the green party if I so chose. So what if everything’s going to be decided by then, I’ll still have my say!

It’s supposed to snow 12-18 inches in the next 15 hours or so. It’s going to be great fun sliding to work, I’m going to have to wake up early to snowblow just so I won’t be completely snowed in. The best part is that it’s been warmish the last 2 days, up to the mid thirties and melted all of the snow, which has now frozen on my sidewalks. If I manage not to kill myself by falling in front of my snowblower tomorrow AND make it to work on time, it will be a miracle.

And on that note, to bed I go.

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16th January 2008

Reason me this

Multiple choice question for you.

Select the most correct answer:

The reason that Julia is not switching her call night from Saturday to Sunday night, thereby allowing co-resident to be on call on Saturday instead of Sunday so he can watch the Packers game), is:

A: She wants to watch the Packers game herself! Go Green Bay!
B: She wants to church on Sunday, post-call and exhausted, but still able to spiritually recharge herself.
C: She has Monday off of work already, and being on call means that she’d be sleeping through her day of vacation.
D: She’s just a mean grouch who never does anything nice for anyone.
E: CuteIntern happens to be on call on Saturday as well, and she can’t resist the chance to flirt and look ridiculous.

Ahem. Never let it be denied that I am anything but shallow.

I finished with work a little early today and celebrated by chopping my hair. I hadn’t cut my hair at all since August. August. So it was looking nappy. It’s now too short (just below my chin) and my “hairstylist” must have spent a total of 15 minutes cutting it so it’s slightly chunky, but at least my still-growing-them-out-a-year-later bags got blended in and even though it’s not perfect, I look ever so better than I did an hour ago. We’ll see how it looks once it loses the “new hair” look.

I need to go to the gym. But I have a headache and I’m beyond exhausted (not exactly sure why) and I’m covering the cardiology service for 4 days while my friend Prem goes on “vacation” to Tucson, Arizona (he says it’s for a meeting. Whatever. I don’t believe him). We’re rounding with the attending at 7:30. In the morning. Meaning that I need to be there by at least 6:30 so I can have some idea about what’s wrong with my new patients. So I think I might go to bed. Like right now.

Oh, I did finally make Chicken TIkka Masala last night. Which was really good and yummy, only it tasted nothing like the restaurant dish. I’ll be sharing the recipe in the next couple of days, but as I did a google search on a better, more authentic recipe, I discovered taht it really isn’t authentic Indian in the first place! It was apparently invented in the 1970s by some Indian restaurant owners in Scotland who had all of these British customers complaining because their Tandoori chicken didn’t have any gravy on it. Who knew?

Night all!

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17th December 2007

countdown

Last neuro call for 3 months!!!

Vacation in 2 days!!!

I can do this!

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10th December 2007

bored, bored, bored

It’s nice to know some things never change.

I started a new rotation today (*sniff, sniff* Bye, bye NICU). Neuroradiology, or the reading of CT scan and MRI scans of the brain and spine. I slept in until 7:30 this morning, arrived at 8:30 this morning, an hour and a half later than what I’ve been used to, and was still a half hour early. And I was fighting falling asleep all morning and all afternoon. Just like old times. You put me in a darkened room, and it’s like a Pavlov dog experiment; I instantly want to sleep, no matter how much sleep I’ve had the night before. Exacerbate that by the fact that I’m not doing ANYTHING except looking over the shoulders of the radiologists as they look at every image and it’s pretty tortuous. I mean, I realize that space is limited, but this would be such a better experience if they’d at least allow me to look over the scans beforehand and point out whatever abnormalities I’ve noticed. Since I overread (look over every scan without relying on what the radiologist says is wrong) every single scan that I get on my patients, I’m not completely clueless. I may not know exactly where the cingulate gyrus or the corona radialis are, but I’m getting there. This is just painful.

I’m almost looking forward to clinic tomorrow (almost, people, the world hasn’t completely ended), just so I can get some action. I had been rather upset that because of the call schedule (only 2 more calls! Whee!) and when I start vacation, I’m only there for about 6 days, but man, that’s not such a bad thing anymore.

I’ve been distracting myself with lists of things I need to buy. Today it was groceries (I apparently didn’t have vanilla. How did I not have vanilla?). Tomorrow, it’ll be Christmas presents. So family members, if you rather not have something inspired by MRIs, you’d better speak now (although, fam, I SO WANT THIS).

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      When I was cleaning up the cross-post yesterday, because the wordpress plug-in I use always leaves all of these spaces between each paragraph, I accidentally clicked on one of the tag links on the side bar. Liz. My old college friend and roommate. Two posts down, I noticed that I had said something about how […]