I think this is the first time since third year that I’ve had an attending dislike me. I’ve had ones who were difficult to read and who I disagreed with, but we had a pretty cordial relationship in the end. But I can’t seem to impress this one at all. I’m still struggling on how to be a resident–how to give my medical students autonomy and yet make sure that nothing major is missed; and things have been overlooked, pretty substantial things that luckily did not harm any patients. All of this has not been impressing me to my attending.

Can’t believe I’m actually looking forward to my rotation in the ICU to end.

Venting is a very good thing. Can’t say that it made the troubles go away, but I do feel like I may have a little bit of a game plan (yes, I’m being vague, perhaps more details in the future).

Have to give a presentation on a paper tomorrow. Haven’t found the paper yet. Plus I have clinic. Gosh, I love Tuesdays.

Still loving the ICU (for real, no sarcasm here), but it’s freaking me out. Starting to sink in that I’m the one “in charge.” Even though I have a fellow as backup, he’s not always there, and if something goes wrong, I’m expected to step up and direct and manage until he gets there. Plus I have 2 fourth year students that I’m responsible for… and they’re making decisions that I have to constantly evaluate to make sure they are appropriate. Plus, I have to know about every patient on the team, which even though it’s a small team right now (3 patients. 1 consult. 2 of the patients are palliative. All that equals no fun, no procedures for Julia), these patients have been here a long time and that’s a lot of reviewing that I have to do. I’ve already “messed” up once, where my student wrote an order that I should have questioned more closely and didn’t, leading to extra invansive procedures on an already sick guy.

And now, I really have to go track down an article to talk about.

And the most important news of my life?

One more day of work and then a week of vacation. 8 days completely off. I cannot wait to turn my pager off and chuck it far far away.

🙂 Life will be sweet, my friends.

Stupid YouTube.

I’ve never gotten tv this year (no bunny ears, no cable, no nothing), so i’m always a bit behind on what everybody else is watching. But after Becka starting posting clips, well then, that made me want to go out and watch all of the clips of SYTYCD as I could. I had forgotten how much I love this show.

And YouTube took them all down today. 🙁 So I haven’t even gotten properly caught up. I’m sure they’ll crop up again soon.

But I did get to see some of last year’s stuff and I had forgotten how much I loved Benji. It’s funny, Becka always goes for the lyrical, interpretation dances, and I’m always impressed with the formal. And I had forgotten how much I LOVE the West Coast Swing. It’s been so long since I danced; I’d look like a clumsy buffoon if I tried now. I miss it. There are so many of my college, early adult years that are tied in memories of dancing.

Work is incredibly dull right now. Incredibly. I’m completely bored. I have 1 patient that I’m covering. One. We get about 1 consult a day, usually someone with pneumonia and the primary team refuses to take our advice so it makes me feel extremely frustrated; I hate wasting my time, and if you had already decided on a treatment plan, then why did you ask for a second opinion??? Grrr. Also, I’m at the VA which blocks most of the sites that I want to visit (like LJ), so it leaves me with a lot of time to do nothing. I’m studying right now, for Step 3 which I’ll be taking sometime in the next six weeks, but that gets very dull as well (I don’t wantto learn any more about pediatric rashes! I’m done with that forever!). So right now, I know basically everything that’s going on in the world, as I have literally read just about every single article in the BBC.

Ewan and Charley, btw, were in Eldoret today. *sniff* I miss the place, well, not so much the stench and the mice, but everything else. The pineapple. I definitely miss the pineapple. They’re leaving Kenya, going into Uganda and I’ll probably lose track of their trip, but it was so awesome to hear and see pictures of the areas that I was at just a year and a half ago.

I did not end up getting a permanent account. I was really having a hard time justifying the expense of it and kept putting it off. I did convince myself yesterday that maybe it wasn’t that much money, but I was on call and that didn’t leave any opportunities to slip away.

I think I probably would have regretted it. I had been counting on the end of the year bonus from work so that I could indulge a bit and discovered that Uncle Sam had taken 40% of it, leaving me with less than what it’s going to cost to take get my medicine license, so I can’t even afford that, which is much more important in the long run. I’m so tired of money issues, so wearied. I was really hoping that with the very small cost of living raise that some of the money pressures that I’ve been drowning in for the last six months would ease, but taxes and insurance are going to suck that all away as well.

*sigh*

On a good note, I’ve completed my last call ever as an intern! Whee! Of course, things really aren’t going to be that much different next year. When I’m in the neurology department, I’ll be a “junior resident” which is really the exact same thing as an intern (still the low man on the totem pole) and when I’m on my medicine rotations, I’ll still have to take call as a senior resident (just not as frequent and I won’t have to write daily notes! Yay!).

And I just realized how confusing my life must be to those of you who actually read this thing. And that I’ve never explained what I’m doing. I have a tendency to assume that people can read my mind, and are really living my life with me (I should have probably outgrown that belief when I was, I don’t know 15 months old. I’m a little behind) So allow for a brief detour.

explainin’ stuff here

Sorry I’ve been MIA for the past few days (and I was doing so good with the “post every day” thing too). One of my patients died on me, unexpectedly, and it’s been chewing me up inside, wondering what I missed, what I didn’t do that lead to the situation. I was responsible for her overnight… why didn’t I realize earlier that something was wrong.

Also, all of those fears about becoming a senior resident are overwhelming me. I’m not prepared, as this weekend taught me. I was the first one to the code, and all I could do was stare at her. All of the ACLS training (from a year ago), vanished and I could barely even remember to check to see if she was breathing or if there was a heart beat. Luckily, there were others who responded quickly and were adept at setting up the machine and directing others–exactly what I should have been doing. We got a heart rate back, but she was without oxygen too long and the family decided to withdraw care today.

A year later and I’m still not ready for this.

I am 9 days from completing my internship, the first year of my residency. After this, it will be me in charge of the interns, directing the team, and helping the fresh-faced, confused recently-made-doctors in taking care of our patients, making sure that nothing is overlooked, that we consider everything that could be potentially causing our patients symptoms and that it gets worked up properly. A whole new level of responsibility. Instead of 5-10 patients, I’ll be responsible for knowing about 15-20. It’s the next step to becoming a Real Boy independent physician. I know that I have areas of weakness (still hate EKGs, still hate drugs), but overall, I think I’m doing pretty good. I’ve even gotten praise from my attendings and residents in reviews, stating that I’m performing above the level that I should be. Maybe I let some of that go to my head…

I missed the diagnosis of an aortic dissection yesterday. Completely and totally missed it. Granted, my patient didn’t come in complaining of the classic symptoms and we thought we had the reason for the other chief complaints–once we got the blood pressure controlled, the headache disappeared and the abdominal pain was gone as well. I was ready to discharge, had all of the paper work ready and was rather upset at my attending for wanting to get an echo, and then a CT scan on a patient who already had a reason for a murmur and was doing fine. Eating, breathing, walking, with no complaints. But there’s a reason for the hierarchy, and I got the scan without too much arguing (just a lot of internal grumbling).

Even then, I missed it. I looked at the scan yesterday morning, saw a little fluid at the lung bases and that was it. I completely missed the large bulge in the aorta, as the blood leaked out. I didn’t get it, until the radiologist called and informed me what the pictures really showed.

Aortic dissections are deadly. They can rupture, causing instantaneous, massive blood loss. In medical school, it is one of the “red sign” diseases that are always top on the differential, as they are the worst case scenario.

And I missed it.

Last week, when I looked at the nice neat row of blue boxes on my mini calendar, I thought to myself, “Self,” (and then I giggled because I rarely speak to myself as a proper noun), “you know what would be a great goal? To fill that little calendar box with blue boxes. To write a little something every day.” And I was cheered and excited by the plan, and made little ideas of what I would write.

And then of course, I’m on call. And at the hospital until 10 at night. And somehow living a life. And lo, 5 days passed, and there went that idea. It was fun while it lasted. 🙂 At least I didn’t post that lame idea here. I figured that if all of you read that I was going to say something every day for 30 days, you’d run away screaming and I’d be promptly DEFRIENDED. I just couldn’t bear that.

Does everybody note the little happy, lilting tone to my voice? Notice that the gloom and doom has left the building? Yep, it’s true. Things have definitely gotten better. I’m down to 3 patients (who I can’t seem to discharge); one of my difficult patients I discharged a few days ago, the other has yelled at me every single morning (and every other person who walked into the room… I stopped taking it personally). I’ve been finalizing plans to send her home for about 5 days now, today I walked in and she actually apologized and smiled, so I think I won her over as well! My favorite patient was here for clinic today, which was nice (someone that I’ve actually been able to help a little). So all in all… things are better. 🙂

details about my little life

It’s been such a rare thing for me to be in a good mood the past 14 days (day off tomorrow! 1 week without call (already 5 days into it, boo)! Discharging patients! I’m positively euphoric!), that I hope you’ll forgive the multiple posts. Soon I’ll slink back into the dredge of daily life, but for now, I don’t want to be thinking about how this is one of the worst months I’ve had as a medical student and a fledgling doctor.

In the meantime, one of my entries last week got me thinking. And in turn, I’m submitting it to you:

What are some of your favorite hugs from tv/movies/art/media/etc. They can be romantic/playful/friendly/comforting (do I need to go on?). I’m thinking about changing around my icons to a bunch of hugs for every mood and I’d like a good collection. Pictures would be helpful (nothing pornographic or graphic please!), but not necessary. Obscure is welcomed!

(And now to bed go I. Have a busy day. Kristin is coming over to help me make bookshelves and Kara might come over as well. The neuro gang is meeting up for Jazz in the Park downtown and Chris might drive out if he decides that an 1 1/2 hours each way isn’t too bad (I think he’ll back out). So I must get my beauty rest!

*blows kisses*

I almost started crying at work today. Tears of frustration mostly, at my patients who aren’t getting any easier to deal with, at being tired (stayed up too late), and to top of matters, being told right as I was leaving an hour early that I had to stay because the rest of my team had taken off, the overnight intern was in clinic, and therefore, I was the only one in the hospital and had to stay until the intern got back. It was just too much. Luckily, one of my colleagues was willing to cover and I headed home. I’m so weary of this month. Weary and ready to be done. And I’m only a third of the way through the month.

But I’m not on call again until Saturday, I should be discharging most of my patients by then, which I am really looking forward to. I took a nap this afternoon (yes, I do find it pathetic that I get off early and I spend it sleeping). And best of all, I got that hug that I so desperately needed, from the one that I really wanted it from, and dinner and a movie, and I now have a friend from home in the same state as me, so things are definitely getting better. 🙂

We went and saw Ocean’s Thirteen, which was a gazillion times better than Twelve. Many even better, since I don’t recall anything that happened in Twelve. A really, good, engaging time, much like the first one, and definitely the light hearted fun that I was needing. So, highly recommended if you liked the first one.

And I think that’s it. I’m trying to have my friends over for dinner on Wednesday, we’ll see if it happens. But I’ll need to spend tomorrow night cleaning my living room (I did manage to get my kitchen, bathroom and bedroom cleaned before Chris’s surprise visit, so at least that’s done) and putting together the bookshelf and drawers that I bought months ago. It’ll be the first time that I’ve entertained at my place. I’m rather excited. I hope it goes well.

The opportunity to sleep trumps all when you’re on call (except the pager, but that’s unavoidable).

But uh, that has never been tempted against watching Dr. Who. Even if it is just a rerun of “World War Three.” (I had forgotten how much I love Harriet Jones! And Ninth Doctor!! He’s sooo fantastic!)

I guess the most important question is how is it possible that I actually have time to debate between watching tv and getting sleep??? I am not complaining one little iota.

I think sleep is going to win this battle today. 🙁

It just dawned on me tonight, what I really need to make this week better. Not just a day off (although, I’m enjoying every single minute of my day tomorrow, and not thinking about work one iota). Not just an entire new set of patients (my attending, resident and co-intern hate my patients as well; I at least feel better that I’m not the only one), so that I can feel like I’m helping someone, not fighting the demands of entitled, drug-seeking, whining, not-sick patients. Or better yet no patients, since I’m carrying the entire team (yesterday – 12 patients on team, 10 were mine. Today 9 on team, 8 mine and I had the only admission. *sigh*). Not only more sleep. Not sleeping in (this 5:30 thing is going to kill me).

What I really, really, really need is a hug. A good long embrace, where I can weep a little and rest and recharge in the warm, protective arms of another. And as much as I appreciate the virtual squeezes from all of you, it’s just not the same.

It’s got to get better. This month has got to get better.

Nothing like a call night with absolutely no sleep.

And get this. I just discovered that I went to four years of medical school so I could become a professional, legal drug dealer. Isn’t that fun.

5 more hours. Just five more hours and then blissful sleep.

I have not go to bed in 15 minutes. 5 am wakeups, here I come. Have you missed me?

Two months really go by fast, don’t they? For that matter, a year really goes by fast, as I enter my last month of internship tomorrow. 11 months down. 49 months to go. Really. I think that’s attackable.

But I’m not looking forward to giving up my weekends again. It really was nice feeling human again. But I do feel like my compassion and humanity batteries have been charged up, so I’m surprisingly optimistic about how this month is going to go.

I can finally see again. My eyes don’t tear up the instant I set foot outside (seriously, you guys missed the spectacle that was me driving to work with sunglasses perched on top of my glasses. I’ve never gotten mocked so incessantly for the glasses as I was this week, although it usually turned to sympathy when they heard about my battle with the mascara and how I lost. Just for your entertainment sake click for pic!

This has been a rather sucky Memorial Day.

I invited friends over for dinner/hang out early this week. Two people responded. One was on call, the other was post call and would come over if she woke up on time. She hasn’t called, so I’m assuming she overslept (I do the same post call, so I can’t blame her).

There was a big party and BBQ on the lake today with my ward and when my plans fell through, I decided that this would be fun to go to. Until I took one step outdoors and realized that my eyes are not healed enough to face the sun. They feel slightly better, the eye drops are helping. But I won’t be able to wear contacts tomorrow and will have to go to work with my freakish glasses. 🙁 Seriously, people, they’re ugly.

I didn’t get called in this weekend, so I guess it’s something, but I’m still bitter that because of this pseudo call, I didn’t get to go and see Susan or Allison or just get out of town. I barely left the house. Blah. My last weekend free until July and I wasted it. No, it really was nice vegging around the house. I arranged all of the pictures on my computer (and ate up every bit of free space I have), so that they’re ready for uploading. And I watched “Shall We Dance?” which was just the right amount of sappy angst to do me good (and hey, I recognized some of the Chicago stuff!), so it wasn’t all bad.

I’m sorry for the negative posts recently. I’m not sure exactly why I feel like I’m on the edge of depression… It’s something I can get out of easily and I know that I’m not clinically depressed, just something that I tend to slide into. I’ve had a lot of pressures and stresses that I didn’t think I’d have to deal with. Money problems. Lots and lots of money problems. Exposition on the issues, cut to be nice

GUESS WHAT??

I am done with call, done with working weekends until June!!! That’s right, baby! Two whole months of no every-fourth-night (or third, really) call, normal sleep (if I’d ever go to bed), no discharge summaries (behind by 10 now. Did about 6 of them today), no “only four days off a month.” SWEET.

My last call was on the 31st, and it was brutal. 5 patients, essential after midnight. Because it’s the end of the month, I should have been done and gone by 7, but I was three patients behind by 4 in the morning, and falling asleep in my chair. I was there until 10, and by the time I crawled home, absolutely collasped into bed. I didn’t wake up until 9 that night. I know that there are amazing people, who come home post call, take an hour nap and spend the rest of the frollicking. I really wanna know their secret.

I almost posted that night that I was quitting residency and going to go work as a pharmaceutical consultant, as an April’s Fool joke…. but at the time, it was too close to the truth. There are times when I hate what I do. Hate the long hours, the lack of sleep, the inability to have a normal life. And then when I get pages that state roughly that I’m a horrible person for leaving rounds early (!!! I shouldn’t have been at rounds at all! I was nice to stay and actually present a patient, because I knew him best!) and *cry* not updating the patient list, this desire to run away is amplified (I wish I could caulk those to April Fool’s jokes, sadly, I think that these particular persons do not possess that kind of humor. My comrades from last month, oh yes (I’d have done the same to them, the little rascals), but not these ones.

Enough with that. I’m happy now. Today, I spent working on discharge summaries and reading articles in between critiquing the new Dr. Who season, as we have no patients on the hematology/oncology service right now. Not that I mind being bored for once! Oh, and I also bought rose bushes and blueberry, raspberry (I don’t think all of my raspberry bushes made it through the winter. 🙁 ), bosenberry, and grapes bushes, and strawberry and asparagus bulbs, so I’m so excited to be planting a garden! Ah, my friends, spring is here!

Besides YouTube, how is everybody (ie… the four of you on my flist) watching Dr. Who? Waiting until it shows in your neck of the woods? I did try to do torrents, but my connection is way too slow. It was going to take something like 6 hours to download one hour, I decided it wasn’t worth it. You Tube’s fast and it was there, right after it aired, so that’s a plus. I can deal with the fuzzy screen.

In any case, yay! New season!!

Thoughts about Season 3, dar be spoilers

Did I tell you all about the latest development in my life? No, well guess what? I had a very sweet man propose marriage to me.

He’s 91. Do you think the age difference might be too troublesome?

This is why I love being at the VA. There’s the perks of he slower pace of life, and men constantly telling you that you’re pretty. Flattery, my friends, is a heady thing. (Don’t worry, it was very quickly tempered by being called nurse after introducing myself as Dr. D****** every single morning. Bah).

My patients, for the most part, are sweet and genuinely thankful for the care that they receive. It’s like watching Miss Manners in action, why she preaches on minding your manners and saying please and thank you. Because they are more appreciative, I have more satisfaction about my job, and while I might not provide any different care in the way that I work them up or think about their issues or provide medicines, because I’m happier, they perceive that they are getting better care, so they in turn are happier, which makes me happier…

And it’s nice sleeping a little on call. Last night, I was in bed a little after midnight. My pager went off once at 6 am and I woke up at 7. That’s 7 hours of sleep. Granted, I was waking myself up every hour to make sure that I hadn’t overslept a page, but it was still rest and sleep, more than I get at the Big Hospital down the road.

And can I just say how much I love my cointerns?? I work with some fantastic, humorous, smart, fabulous people and I can’t imagine how more difficult this would be without them in my life. Someday, I’ll share the stories, someday. See, sleep makes me a big softie. 🙂

*****
I really can’t figure out the fascination with MySpace. Ads sprinkle every page, which have clashing, difficult to read color schemes. Loud, annoying music blares whenever you, poor sap, make the mistake of clicking on someone’s profile. And I have yet to figure out the allure of adding “comments” to each other profile, which basically turn into instant messaging tag teams, and if you happen to be a stalker a curious bystander, you have to click on all of those profiles to get the whole story.

But I have run into some old friends of mine. A classmate from high school who’s now a nurse, a fellow Access girl who just completed medical school, Sam and her husband and her sister and her mom (*g* Sam, we should just give it up and become blood sisters. We practically are.), a college roommate of my sister’s, etc. And today, one of my medical school classmates… who actually moved out here with his wife to do residency. Besides the month that I worked with Ann in the ER, I’ve barely seen her or Aaron. We live approximately 10 miles apart and it takes a webpage to reconnect us. Yep, that’s the technological world we live in.

OTOH, it is because of technology and the wonderful invention of cell phones that I had a fantastic call last night from Kenya. 🙂 That’s one way to brighten up a call night.

I spent my day off… updating my journal design.

Well not entirely. I did apply for my temporary license where I had to vow with my soul and with blood (okay, with just a notary public) that I was telling the truth and the whole truth that I spent 5 weeks after graduation last year lazing around and moving, instead of doing medical stuff (because heaven forbid I should ever take some personal time and not let TPTB know).

I’ve been wanting to revamp the journal for a long, long time. My beloved Anne layout had been used for over a year, and I just kept looking at it, longing for something better. It’s nowhere near what I want (I gotta figure out how to customize Flexible Squares), but it’s a new pretty background that makes me happy. I had really thought about doing a non-fandom layout, but I couldn’t resist. It was so bright and cheery.

Tell me how it looks for y’all. Not too fuzzy? Doesn’t take too long to load? No white areas? Color okay?

In other news, my patient survived and is doing better. So I’m sleeping better and not being haunted by dreams.

I’ve lately discovered that iTunes is now carrying Pod casts of several of my favorite NPR radio shows, namely “Wait Wait, Don’t Tell Me” and “News from Lake Wobegon” (wish it was the entire show of A Prairie Home Companion) and StarDate that have been satisfying my inner nerd. Today, I discovered that they are also carrying another Garrison Keillor program, “The Writer’s Almanac.” I remember listening to this every morning as my parents got ready for school. Plus, I discovered that they have the transcripts online, so I’m very excited at the prospect of introducing some poetry into my daily life again. I’ve missed that.

And lastly, for at least my amusement: Conversation at work yesterday….

MED STUDENT: Yeah, so {patient} thought that Julia and I were twin sisters. I guess we could be fraternal twins.

ME: That would have been one long gestation period!

MS: I’m 24, how old are you?

ME: *pause* *pause some more* Um. I don’t know. Either 27 or 28. I think I’m 27. Wait. No, I’m 27. I think. I had my birthday in November and I’m pretty sure I turned 27. Or maybe it was 28.

MS: You don’t know how old you are??

Yes, it’s true folks, until yesterday, I didn’t know how old I am. Let it be known, that I am officially (according to the computer because I had to look it up on google before I would believe it) 28 years old. In just over a year and a half, I will be 30. Hmmm. I wonder when I’ll ever start acting my age.