to do as much nothing as possible...indigo, md

View From a Loft: Angel Knoll Goat Feeding!

2010-07-06T18:59:00.001-07:00

IMG_0446
Originally uploaded by view from a loft

This is hilarious! I find it interesting enough that we have the shortest railroad here in downtown LA but now we have goats grazing along the hill by it!

WARC 2009 Palm Springs

2009-05-02T22:48:00.000-07:00

So am at a conference for work this weekend---end of my vacation nonetheless....but se la vi. Western Anesthesiology Resident Conference----at Rancho Palms in Palm Springs---great showing of people---like 18 residents, three med students, several faculty including department chair and program director. Presented two posters--one for a fellow classmate---both went okay. Had reception and dinner tonight---was okay---painful with intermittent bits of humor in our 'entertainment' talk by an ER doc talking about venom and snake bites----jazz festival here this weekend also. group of them hanging out by mike's place---i felt sick so came back to the room and am now resting....don't feel very good still. going to bed now---conference misc in am again, to a tram thing and then home tomorrow afternoon sometime....night

May Day 2009 Downtown LA

2009-05-02T15:39:00.001-07:00

IMGP4103
Originally uploaded by view from a loft

So given all the May Day events----most of the downtown streets in the main core were closed. This included the majority of the bus routes and so buses were re-routed yesterday!!! Can I just say clusterf*ck!!!! Took forty minutes to drive a mere six blocks....Painful.

3009.....i mean....2009

2009-01-23T18:41:00.000-08:00

this is how the year has felt so far. a bit confused and slightly off kilter. now as an anesthesiology resident----aka CA-1----aka clinical anesthesia-1----aka typically a second year resident and a first year anesthesia resident----PGY-2, etc as the acronyms could go on and on.

i am training at a county institution in a large urban center----basically this translates into what is better known as the 'knife and gun club' for the ER and trauma services. county has their own terminology for what is known to many in the medical world as a 'trauma'----an 'RB' or 'Red Blanket'. Now i am not well versed in history of county or our armed services medical terms but i do believe this term comes from that in so much as throwing a red blanket on someone who was a trauma victim and required emergent care to survive. so as we go through our days and nights of training that the RB becomes part of our vocabulary.

the interesting thing is the abuse of such a system----see when someone calls an RB to the OR---we treat it as a life-threatening situation that requires immediate surgery----we prepare for starting the surgery in seconds to minutes from the time we hear the call. this is critical for cases where someone is bleeding from a stab wound or GSW----possibly coming up from the ER with their chest already opened and the surgeon performing internal compressions, sometimes the pt still breathing and somewhat stable....for now....but in all of these situations team work is critical and we all have our roles. now back to the abuse story....see when a surgeon puts an urgent case into the scheduling genies as i call them----they turn in a 279----or 479---the paper with the patient info/surgery planned/surgeons/equipment needed----and from the golden paper the nurse manager who is running the or board places them on the board and prioritizes cases based on urgency of case and staff available at any given time. from the anesthesiologist's standpoint we must always have at least one if not two people available for an RB b/c we are a level 1 trauma center and could get hit at anytime....but this sometimes translates into fewer 'urgent' cases going during certain times of the day----and the surgery residents get annoyed with this----'why are you only running two rooms?; why can't we do our surgery first? blah blah blah.....and what often ends up happening is if they get really fed up with waiting they end up calling a case an RB and bring the pt to the OR immediately----basically putting us into a situation where we have to take the case but is kind of b/s b/c they will often take a long time to get the patient to the or---i am talking 30 or more minutes----or even better----oh well we are going to call this one in as an RB in about an hour....just fyi-----that goes completely against what the idea of an RB is in the first place man!!!! yes neurosurgery i am talking to you! just b/c it is now convenient for you to bring the pt to the OR doesn't give you the right to call it an RB!

so we now tend to call such cases pink blankets....or fake RB's-----so when we get an RB call now we ask 'is it a real RB?'......

that is just pathetic.

hiatus

2008-12-07T10:06:00.000-08:00

so after not writing for a long time i am realizing that i should really be writing daily after talking with a good friend.

after going back and looking at the past few months so many things have happened and changed both personally and professionally that i don't even know where to start. but i am going to work on that.

Back to work I go

2008-09-07T19:56:00.000-07:00

At the end of vacation and back to work tomorrow morning. Not super-excited about going back yet am a little excited to keep learning. Sick huh!!! That's what happens when you go to school for your entire life----just keep learning and if you don't for a bit----you want to.

first day on my own tomorrow....

2008-08-10T21:23:00.000-07:00

tomorrow is the first day i will be on my own for cases without another resident. of course will always have my attending there if i need them, for induction and emergence....but that is true for all of residency in anesthesiology. i am excited and nervous and at the same time feel like it is just another day.....very strange!!!

will keep ya posted on how things go.

From a Fellow Anesthesiologist

2008-08-04T21:31:00.003-07:00

No one gets up one day and says, “I want to be an anesthesiologist when I grow up.” I wanted to be a ballerina, or a bookstore-café owner, or an artist of some kind – someone who was required to play close attention to the world, take real notice of it, and take creative and compassionate action. But I am neither a ballerina nor a bookseller. I am an anesthesiologist.

Frequently people ask me a version of “What on earth made you choose that?” I try to explain that I love the way anatomy and physiology come alive moment-to-moment in daily practice. Or I try the concrete approach and admit that I actually enjoy placing intravenous lines and breathing tubes. The response I get is usually a glassy-eyed “Uh-huh” or, occasionally, a nose-wrinkling “Eew.” If the conversation progresses beyond “eew,” the more people talk to me about what they think I do – that is, if they think I actually do anything in the first place – the more bewildered I get over how difficult it is to convey to others an understanding of my work.

One time I visited a patient the day before her planned surgery. After I explained what she could expect, she exchanged a few words with her family in her native language. They clearly assumed I couldn’t understand them. An older woman instructed my patient not to bother asking me too many questions, saying, “She’s just an anesthesiologist; what do they know?”

After years of annoyance at many people’s assumptions that I was not a physician because of my gender or my young appearance, this remark – not the first I’d heard along those lines – made me take stock. I realized that not even other physicians understand what we anesthesiologists do, sitting back there in our little cockpits behind some blue drapes (“the blood/brain barrier”), periodically looking up at large machines but appearing otherwise idle. One doctor asked me once, “You have to take an oral exam? For anesthesia? Is there enough material in anesthesiology for an oral exam?” Considering the profound suffering the ordeal of the orals caused me, and causes many anesthesiologists, I felt like shaking the guy by the hair – except he didn’t have any. If other doctors don’t get it, how could I hope to find anything but murkiness and misunderstanding in the perceptions of non-doctors?

I did a little experiment. I constructed a detailed questionnaire about what kind of physician people would want to come to their rescue if they collapsed in a public place. No one wrote down that they would be glad if an anesthesiologist were around.

I figured out about four broad, wide-spread misconceptions about anesthesiologists:
-we are not doctors
-what we do is easy
-we don’t establish rapport with our patients
-if anything goes wrong, “it’s Anesthesia’s fault.”

Then I realized something else: because people have absolutely no idea what to imagine about our work, they decide to make stuff up. It’s amazing.

People react to the mysterious in one of three ways: with fear, with fabrication, or with efforts to deepen their understanding. The fear I see daily. The fabrication – well, let’s just say if I hear one more person declare that all I do is put people to sleep, then sit next to my anesthesia machine and—what? Daydream? Wait for the patient to wake up? Twiddle my thumbs?—that will be one person too many. But that is what people say.

I have heard more times than I can count, “Well, all you do is knock people out. How hard can that be?” My hairdresser asked me when we first met, “So, once you put the patient to sleep, do you leave the room since your job is done?” Excuse me? My job is done? Then who did he think was keeping the patient alive while the surgeon was mucking around with his vital organs and causing all sorts of dangerous disturbances to his vital signs? Who was going to make judgments about what was specifically appropriate for that patient’s particular brand of heart defect, or lung disease, or neurologic abnormality? And then there’s my personal favorite: “You mean, anesthesia for appendicitis is different from anesthesia for heart surgery?” Hmm. 1-inch abdominal incision versus sawing through a person's chest. Yes, it's different.

My husband once tried to mollify my irritation by pointing out that people just couldn’t be expected to know about anesthesia. “Do you know what a machinist does? Or a gaffer?” To which I replied, “Of course not. I have no idea. But I don’t assume that their jobs are easy, and I don’t presume that their work can be summed up by one simple task.” Even my lawyer husband had to admit I had a point. “Well,” he said, “what DO you do, and what do you want people to know about it?”

I don’t think of myself as a doctor whose function is to induce sleep. My primary function is to resuscitate those who need resuscitating. Yes, about 1% of what we do does involve calculating the appropriate dose of the appropriate drug, drawing it up into a syringe, and injecting it into the veins of people who would like to avoid feeling pain or hearing unfamiliar noises during surgery. But I spend most of my energy making sure that I can bring them back. Designing an anesthetic is a thoughtful act. My resuscitation of my patients often begins the night before I meet them, when I am going over safety plans in my head.

Most of my training, in fact, was focused on becoming an expert at resuscitation in its various forms – reviving patients who were dead or near death; intubating those who could not breathe; rehydrating the dehydrated; unparalyzing those I had paralyzed chemically for surgical purposes; awakening the unconscious with judicious use of anesthetic drugs and gases; creating pain relief and anti-nausea regimens for the afflicted; and making sure failing heads, hearts, or lungs functioned well enough to ensure survival of a given surgical procedure.

Late in my training, I realized our level of expertise when I asked a resident in a different specialty – one whose members also take pride in their resuscitation skills – how many intubations she had done after two years. I was expecting to hear perhaps half of my quota of about 1200. “I’ve logged about 84,” she replied. And this was the physician-type people wanted nearby if they collapsed in a public place and needed a breathing tube to stay alive.

Anesthesia affects consciousness, blood pressure, heart rate, respiration, and a whole host of other body processes. If I am not there to watch over you, that first injection can harm you. And that’s just the first step. I should be breathing for you if you stop (and you will), administering fluids when your surgeon nicks a “bleeder,” and giving you the medications you need to wake up safely and comfortably. This can mean a lot of scurrying around, checking, and readjusting within the confines of my “cockpit.” Is the IV running too fast? Is the machine blowing in enough air with each breath? How’s the urine output? Oh, they’re closing – should I turn the gas down now, or will he take a while? Is that heart rate a little too high for his aortic or mitral valve problem? Did I give the drug to slow it down? Let me dive down under the drape to make sure his eyes are still protected…This is all behind-the-scenes, largely unacknowledged work, but it makes even the tiniest task a meaningful act, and I love that about my job.

And that’s just in the O.R.

I've written elsewhere about my E.R. and I.C.U. intubations, but I haven’t even addressed the expertise anesthesiologists bring to laboring women, not only in placing and ensuring the safety of epidurals for labor and spinals for C-section at any given moment, day or night, but also in caring for mothers when childbirth becomes dangerous. On occasion help is needed for an alarmingly sluggish newborn, and yes, we are useful for that too. The code that made my heart beat the fastest was when “Anesthesia, Stat” was paged overhead to the labor and delivery suite and I realized the person coding wasn’t one of the moms, but rather a minutes-old newborn. The family practice attending physician handed over the laryngoscope he was holding, and I intubated the baby so we could bring her oxygen saturation back up to liveable.

Many people have assumed that their limited understanding of our profession reflects a limited scope of medical practice on our part. Assumptions can be unfortunate, but I prefer to focus on the things that keep me coming back to the O.R. despite people’s colossal lack of awareness about what I try to do for them. I know what you’re thinking: it’s gotta be the paycheck, right? Never mind that childcare costs and six-digit educational loans eat up half of it. Sure, the pay is good, but it’s good because of what we are capable of doing for people, and the amount of sweat and tears it took to acquire and prove those capabilities. This is not a job you can commit to just for the pay and be truly happy. It’s too hard.

Nor can anesthesiologists be motivated simply by glamour and prestige – there’s too much ignorance about anesthesiology to allow for either. For me, real job satisfaction has to rest on tenacity, self-respect, humility, kindness, and happiness with the work itself. The big pay-off, in my mind, lies in my relationships with my patients, whom I may meet only briefly but during intensely significant moments in their lives, when they may need the most comfort. All the scientific gobbledygook that goes into the practice of anesthesiology has a chance to get sifted and transformed into a true human connection, into resuscitation that goes well beyond the needs of the body.

It’s my hope that someday, when a person collapses in the bookstore-café that I don’t own, or in the opera house in which I’m not dancing (or playing the oboe!), and an anesthesiologist responds, it will be common knowledge that the professional responding to the situation is providing expert care in the truest sense of the phrase.

USMLE Step 3

2008-06-05T18:58:00.000-07:00

Took the first half of step 3 today and the other half tomorrow. It is a terribly long day to take one full day of testing....but two.....not only is it long and dreadful but then you have to wait overnight to take the rest of the test. Finally you get the joy of waiting like four to six weeks until you get your test results.

At Prometric it is interesting b/c there are people there taking all types of tests----real estate, etc. I probably cannot even begin to guess all the tests they offer. Yet we seem to be the only ones who take a day-long test....let along a two-day test.

Oh the good times to be had.

on being a doctor

2008-04-05T23:08:00.000-07:00

we spend years of our life investing in education and working towards the next step....volunteer to get ready to apply for med school, mcat, stay active in med school, do well to get into a good residency, work for the fellowship, and on and on....it is always forward thinking. i suppose most professionals think in this manner but it is an interesting phenomenon because it changes how you view life and the world in general.

Random comments from random people....

2008-03-14T19:50:00.000-07:00

"The 80 hour work week is twice that of the normal human being....but then again, if you are a marine don't bitch about getting shot at, and if you are a priest don't complain about not having lady friends---- we all knew what we were getting into when we applied to medical school.....we need to be trained to be competent, that shouldn't happen as an attending, it should happen as an intern "--I love it!

Health Insurance, Universal Healthcare etc.

2008-02-21T18:04:00.000-08:00

Now I know there are no perfect plans out there...different countries have different modes of universal coverage...but I also know...as many others do as well...that our system in the US doesn't work. So what is the answer? More to come.

Happy Valentine's Day!!!

2008-02-13T22:35:00.001-08:00

From me to all my friends and family---
Have a wonderful day and celebrate just being "YOU" on this day with so many other things on the table.

225 down and 141 to go

2008-02-01T20:03:00.000-08:00

Now that I have completed more days than I have left in my internship I must say something. I am feeling like a doctor. But don't know what that means just yet. Just finished my second month of ICU and start back on wards tomorrow with call.

"Internship" by annonymous author

2008-01-20T20:48:00.001-08:00

Welcome to Intern Year...an excerpt from another great blog about medicine and stuff....those of you not in medicine...this is sadly accurate...and those of you in medicine...you know i am right!

Is That Smoke Coming Out of Your Ass or Mine?

You are loved. No doubt about it, the one lesson of your intern orientation is that now, finally, after four years of medical school where you were beneath contempt in the medical hierarchy you are now one of the gang, a valued colleague, someone who will be treated collegially. After all, as the designated speakers will point out with heroic rhetorical flourishes, whereas up until now you didn’t count, now you do and with your great responsibilty as real doctors comes the expectation that you will be treated professionally and courteously.

Then of course you will actually start intern year and they will treat you like a piece of shit, both institutionally and professionally. Need some sleep? “Fuck you.” Want some time off? “Screw you, you big fucking baby.” Don’t know where anything is or how they run the service? “Fuck you, moron. We sent you an email. Didn’t you read it?”

And so it will go. Now, I am not the smartest Asian bear-mammal to ever lumber out of the bamboo grove but I can tell when I am having smoke blown up my furry ass. You can tell me that I’m going to be treated like a valued junior colleague and you can make nice noises but the reality is that for your entire intern year, and possibly your whole residency, the default position of everybody with whom you work will be to treat you like a sweat-shop laborer.

So welcome to the dysfunctional residency training system which was designed, literally, by a cocaine-addicted physician and which has changed very little since its insane beginnings. Sure, some of the hours have been limited but the system still depends on depriving you of sleep and making you work the kind of hours that are considered war crimes in most other countries. Heaven forbid you point this out. Apparently when it comes to an abusive medical training system, everybody is a hoary old conservative protecting their peculiar institution from reform. Swing low, Sweet Chariot. Them residents sure can sing! Why brother, it would be a sin to set ‘em free seeing how happy they are. Lift that bale, tote that barge!

Ol’ Man River he keeps rollin’ along.

This is what they really mean to tell you at your orientation to intern year:

“Welcome to our hospital. We’re so glad you’re here. the first thing I want all of you to do is to reach down and feel your testicles. Ladies, go ahead and palpate your ovaries. Feel those things? Well, we own them. Oh sure, technically they are attached to you but for all practical purposes they are ours and we have them gripped firmly. If you step out of line we will give ‘em a squeeze. Step too far and we’ll tear them out of your body and present them to you a la Bruce Lee before you die.”

“Just wanted to clear that up so you folks don’t get too uppity. Your contract? Hah. We call it a contract but it’s more of a receipt for your indentured servitude. We agree to practically nothing and in exchange you are ours for the duration of your sentence…I mean your training. Don’t like it? I think we can fire you for just about anything and at any time. Not too many other professionals would work under those conditions but as long as there is a steady supply of you stupid motherfuckers ready to mortgage your souls to get into medical school we can pretty much do whatever we want. You can leave of course, but good luck getting another residency position after we shake our heads sadly and opine that you are a trouble-maker. Not to mention that we have the system set up so even if you manage to escape you can only do it one time a year and only if the stars and planets align just right. So shut your stinking gob-holes. You’re in it now.”

“And we don’t give a rat’s ass about your sleep, your rest, your health and your well-being. Oh, we’ll pay the usual lip service to these things and in later orientation lectures we will encourage you to take naps on call and instruct you how to best use caffeine to optimize your wakefulness but the fact is that we are going to beat the crap out of you for at least a year and hopefully for as many years as we possibly can. We just don’t care. Now, because some disloyal pussies couldn’t keep from whining to their mommas and killing themselves on the exhausted drive home from the hospital we are only supposed to work you eighty hours a week. I can not stress enough what a bunch of fucking crybabies that makes you or how sick I am of looking at your fat lazy faces sitting there knowing that you might actually get some time off. It makes me physically ill to think about it so I expect all of you to uphold the highest ethical traditions of the medical profession and lie about your actual hours if it comes to it. I suffered and because I have a personality disorder, you need to suffer too. Besides, everybody knows that we only have to obey rules if we agree with them…and we certainly don’t agree with this one, do we?”

“If you complain too much we will ressurect some dinosaur who trained back in the days when they were still using poultices as a first line therapy to try to shame you into keeping your mouths shut. Obviously everything was better fifty years ago, especially when interns were all geeky white males with no families and no responsibilities outside the hospital. Man! those were the days. We owned those motherfuckers. I mean, we own you but we really owned them. There was so little that could be done for patients in those days that we could waste their time with wild abandon. Those were the golden days of scut work my friends, the likes of which we will not see again.”

“As to your pay, well, the federal government is giving us a shitload of money for your training. Almost twice as much as we are reluctantly going to pay you. We’re going to cry poverty and feed you a line of bullshit as to how expensive it is to train residents, how much you are damaging our efficiency, and how this extra money doesn’t even cover the economic damage you will inflict to our bottom line but this is just fragrant smoke wafting up your ass. Try taking a day off or calling in sick when you have call and see how we are going to panic. As if it isn’t bad enough that many of you little pussies can’t work more than eighty hours a week and we can’t always screw one of your colleagues to cover your call, we may have to actually pay somebody real money to do your job which is really going to eat into our bottom line.”

“And who is really going to suffer? Why, The Patients of course. Your insistence on not working with hospital-grade gastroenteritis or your gay desire to spend a day or two every month with your wife and kids is stealing, yes stealing, precious medical care from the poor underserved wretches frequenting this hospital. Don’t you stupid fuckwits understand that Patient Care comes first? Patient Care is our primary responsibility and with the exception of the nursing staff, the respiratory therapists, the Physician Assistants, the phlebotomists, the lab techs, the janitors, the cafeteria ladies, the attendings, the parking attendents, and those ladies slopping the hash in the cafeteria everybody in the hospital is expected to sacrifice their entire life for Patient Care.”
.
“So we need you to work a lot. Unfortunately we have to give you little wimps four (and I weep to think of it) days off every month but we’re going to send you home a little early post call and call this a day off, even if it is less than 24 hours and you will sleep through most of it. Those pesky rules again I’m afraid but we’ll subvert ‘em somehow because you guys are a fucking goldmine. Have you seen what Hospitalists are charging (not to mention PAs and other midlevels who will do in a pinch)? Let me tell you, they ain’t cheap. Not by a long shot. You poor sons of bitches, however, are ridiculously cheap. Insanely cheap. And the more we work you the cheaper you are because, get this, we don’t have to pay you overtime. Try getting the janitor to work some extra hours. Even my taco stuffer gets time-and-a-half if he goes over forty and all he has is a GED.”

“Who’s yer’ daddy now?”

left foot s/p ....

2008-01-20T16:29:00.001-08:00

IMG_2227.JPG
Originally uploaded by IndigoPhoto2233

this is what my foot looked like two weeks after the injury that occurred 11/06 and can i tell you that i am still having a terrible time with the foot. diagnosed one year later is a non-union fracture of the cuboid at the fourth metatarsal....woohoo....rare fracture cuz i'm a doc....what i'm told anywho!!!!

the 3*hr shift....

2008-01-14T18:35:00.002-08:00

now as many may know and others may not...for about four years now there has been legislation that regulates the work hours for medical residents...now when i say regulates...i really mean provides guidelines that some follow, many do not, despite the appearance that they are followed on paper....including the 80 hour work week restriction with q3 call and blah blah blah. now just by saying you are "limiting" work hours to 80 a week is insane. if you do the math there are 24hours/day, seven days/week...that means there are 168hours in a full week. so technically our limit is just under half the hours in the total week. not so bad right! only half...that leaves the other half for things like...hhmmmm sleep. after the 80 hours you have 88 hours left....now if you consider sleeping daily...which doesn't always occur...and sleeping an average of 7hours/night....which is on the conservative side of sleep requirements for most people...then you are sleeping...hopefully....about 49hours of your time left from the 88hours. so then you have 39hours left. WOW....so much time!!! yeah right! now you have to also consider that the 80 hours doesn't include commute time and is more of a guideline than a hard and fast rule for work hours you end up with not much time for LIFE! now if you actually say you sleep for 8 hours/night then that leaves a whole 32hours for 'other'...maybe 5 of which are spent driving for many and another 6 or 7 doing such things as showering, brushing teeth, etc. so that leaves us with 20hours left. not to mention eating, cleaning, laundry, bills, and the other 'errands' of life...not much time left for things like having fun, exercise, cooking, etc.

now i challenge you to look at where your hours of the day and week go. and just see how much you spend on "life" and let me know if you are really expected to even consider having a "life" during residency!!!

***just a side note about hours...traditionally most people have worked 120hours/work during residency and although they will remain nameless...many surgical programs still work upwards of 100/120hours/week....at effectively minimum wage if you break things down by hour....how is this possible in a world where pilots, air traffic controllers, etc. have strict work hour limitations....??? we have people's lives in our hands as physicians yet this is the dirty little secret of medical training that the public doesn't really know about......just a note after sleeping for five hours after a 3*hour shift....so you know where i am coming from!

ICU Medicine

2008-01-10T21:00:00.000-08:00

Somehow things that are foreign to so many become second nature...how and when does this happen in our training?

post i wrote last year

2007-12-31T18:57:00.001-08:00

As a fourth year student, grassroots participant in campaigning, and patient advocate I can benefit from the study tour experiences in several ways. Namely through the collection of information and experiences and bringing that back to my medical school, fellow students, and community to further the grassroots efforts in making UHC a reality. Further, as I am intimately involved in the future of medical education at my medical school through committee participation for our new sister campus I not only have the inclination to distribute this information I also have a mechanism and means to do so in a constructive and pragmatic manner. I have just recently completed campaigning for a statewide candidate with a strong grassroots campaign. Through the six weeks I spent with the campaign I have learned more about the campaign process in elections, the importance and struggles of grassroots campaigns, and am energized in pursuing further campaign and possibly candidate training in the near future to assist and be involved in future political endeavors. With this recent experience I am more excited now than ever to participate in the grassroots efforts in both learning about universal healthcare systems in other sites and in the fight to make universal healthcare a reality in America. This being said, the study tour can help provide further grassroots exposure and information to strengthen my base of knowledge and first-hand learning about universal healthcare in general and the pros and cons of Canada’s healthcare system. I look forward to participating in the study trip and hope I can join you in furthering the reality of UHC here!

Happy New Year!!!

2007-12-31T18:42:00.000-08:00

Now halfway through internship and on the down slope for the year I will be starting in the ICU again tomorrow morning and am on-call to boot...what a way to start out the new year! It is amazing how much different I am now than I was in July, the last time I was in the ICU. Different professionally and personally. Professionally it is all about perspective. From my current perspective I feel like I still hardly know anything. Yet looking back six months and from that perspective, I am much more confident and competent clinically. So wishing you a happy new year and best wishes with all endeavors in 2008!

Holiday Season

2007-12-15T21:02:00.000-08:00

Internship doesn't really allow for much beyond the basics of living...you know...eating, sleeping, etc. of which sometimes don't even get done or at least not done well. So I don't know what I was thinking starting a blog but seriously....WHAT WAS I THINKING??? Needless to say I am now on vacation from work for the next week or so and I will try to update my thoughts about internship and the practice of medicine.

approaching the end of the second month and counting...

2007-08-28T20:21:00.000-07:00

so my endeavor to try to write everyday had not been a successful one...but nonetheless here i am finishing up my second month of internship and am wondering to myself...how did two months already pass yet also feel like "oh my goodness i feel like have been doing this forever"---quite the dichotomy i must say. i now know why we are told to get our financial aid paperwork in order before starting internship as those things and well life in general are pushed to the wayside during this thing called residency...so for my few and beloved readers...here is a bite of my life right now but hope to continue to keep things updated as much as i can.

been a few days...

2007-08-13T19:45:00.000-07:00

I find more and more that our medical system is inefficient and that systems-based practice is the source of many problems in the system. Allocation of resources is not exactly appropriate either. Been working in ambulatory medicine for a few weeks and covered a wards call shift that was a very busy 30-something hours---and completely without any rest...let alone sleep. Specialty is still a problem for me and is even more of an enigma right now than ever.

between a rock & a hard place....

2007-07-29T15:52:00.000-07:00

so i feel like i am stuck right now...having been sent home and covered since was not feeling well after returning to work after surgery i now feel like i 'shouldn't' feel well and should rest...but in reality i am feeling okay but have a terrible headache today and feel like i should have been at work today...and am wishing i was still on wards this month so could work with team i like!

as for other things...specialty is a tough one given my internal struggle between anesthesiology and obstetrics/gynecology for over a year and actually almost two years now; not to mention that i am already matched into anesthesia and don't know what to do now about...well...pretty much everything. heart says one thing. mind says another. then which do i listen to???

working out the kinks of this blog thing still..

2007-07-26T17:30:00.000-07:00

so the title of the blog is similar to before....little different...still trying to figure out the best title for this page; not that anyone is really reading it anyway, but just in case there is a single soul out there that is....

still recuperating....do as i say not as i do...

2007-07-25T01:40:00.000-07:00

so after careful thought and convincing i was able to talk with my team and get my call shift from tonight covered so i could continue to rest and recover---yeah yeah yeah---i know that three days after surgery is probably not enough rest but you know how us docs are...do as we say not as we do...it is kind of ironic that when you are working in a hospital....a place where one comes to get help for their health and to rest, recover and recuperate...you are even less likely to get to rest and take care of yourself...oxymoron in a way frankly!

needless to say...i am glad i was home today b/c slept all day and am finally starting to feel a little better---even though the middle of the night now. i am having all sorts of fleeting random thoughts fly through my head and feel like i should somehow use those thoughts for something productive...but i am not sure what that would be right now. so....just a quick little note and back to bed i go.

recuperating easier said than done...

2007-07-23T17:01:00.000-07:00

29 yo female s/p lap chole on 20July07 now post-op day 3; pain improving, no drainage from incision wounds, no erythema, or other signs of infection present; tolerating normal PO diet, voiding without difficulty, ambulating without difficulty, pain controlled on percocet;

pt annoyed with random things related to this event--namely miscommunication and timing of things in her program; unable to get point across clearly and complete the month as is already arranged; unclear of outcome from this point forward;

so doctor as patient...surgery in a few days

2007-07-18T22:07:00.000-07:00

had pre-op for surgery yesterday and once again it feels weird...actually just wrong somehow...to be in the office as a patient and not as a doctor; hard to put yourself into that role when you know what is going on on the other end...needless to say...like my surgeon and have help for after, have my days covered for three full days off afterwards and then back to work and on call;

the last call night--two nights ago---i had was very busy: four admissions throughout the night; several pretty sick ones; drama thrown in there on a few; and crosscover busy but not insane; didn't sleep at all though for the whole call---worked from 0615 one morning till 1245 the next day---so 30.5hours---then to the surgeon's office---so went for about 35hours without sleep; thinking of this is actually a bit sickening in many ways but that is the way medicine is; and if you believe it---that is actually improved over how it has been in the past;

so we will see how things go while off the next few days for surgery...and go form there!

Friday the 13th

2007-07-13T21:35:00.000-07:00

yeah so i ended up having some pretty bad pain few nights ago---GI....thought was heartburn...no improvement with Tums, then maybe gas...yeah simethicone and a few painful hours later i went to the ED on the morning i was to be on-call---got there at like 0330---fortunately only waited like half hour----only b/c am a doc in the hospital there i am sure---and was seen---knew was gallbladder by that point...but thought i was headed to the OR---well u/s and labs later...did have stones....but no obstruction and no evidence of cholecystitis at all, just cholelithiasis, so home with pain meds and antiemetics....on the am of call...so back-up had to go in to cover me---shi**y in all kinds of ways...returned today to find four new patients i didn't know, one transfer to SNF, another died---first patient had to pronounce ever---and the other two very sick. also after talking with my chief i learned that they want me to get the surgery done like the 1st or 2nd of august and have that be my vacation week---have my wards month for august swapped for an elective with someone else so can even take the vacation----so that will mean i really don't get vacation b/c will be recovering from surgery, will then do three months of medicine wards in a row..frustrated with life and not sure what to do with any of it anymore. blah blah blah..friday the 13th

starting residency like i started medical school

2007-07-12T08:54:00.000-07:00

Four years ago I started medical school---the first week of school---there I was on Friday of the first week with a fever of 102.5 and feeling awful! after several days of not getting better, fevers, and many other things, we finally determined that I had mononucleosis!!! Needless to say, I was tired, weak, febrile, and generally speaking felt terrible----but somehow managed to pull it together and do okay---passing everything and not having to repeat any of the semester.

Well now, here I am starting residency, now about three weeks into it and having ended up in the ER now twice in the past two weeks---with no ER visits for years prior to now---first was for an asthma attack that came on while working and the second, just yesterday, was for unrelenting pain that started at 0030 yesterday morning waking me out of a dead sleep. The pain was somewhat like general GI pains but this one was sharp, did not stop, went through to my back, and nothing helped to improve the pain. Well after a few hours of this b/s I decided that I had gallbladder pains and needed to go to the ED===and in my head was going to end up going to the OR that morning also---so took off the toe rings and all and headed in. Felt terrible and got to the ED---as a physician at the hospital they tried to get me in as soon as they were able---so only waited like thirty minutes really. Got some zofran b/c was really nauseous, saw the doctor, and went to rads for u/s. talked with my senior for a few also about some issues we need to address and then the doc told me i have gallstones, but no duct obstructions, no white count, no elevated alk phos or LFTs so need to f/u with GI and/or surgery for further care. My senior recommened surgery and doing it asap but since i am in the unit right now and have wards next month that is going to be difficult to get scheduled...so we will see what we have to do to make it work out. Phenergen and percocet knocked me out all day yesterday and today so far---and am falling asleep now as I am typing...return to work tomorrow and will need ot cover a call shift for my fellow intern at some point in the future for wards or icu. Also talked with my chief about some issues we are having in the unit with another senior and we are going to plan to sit down and chat about things sometime tomorrow if possible for everyone involved. Will write more later since cannot keep eyes open right now!

more rants about work....

2007-07-09T22:30:00.000-07:00

so i am annoyed with several things about...well...work. in order to not to offend anyone in a public forum i will be somewhat cryptic...but if you must know---then ask!

someone today made me feel someway today that i did not like and appreciate---or should i say that this person's actions initiated me to get into a particular mood or to 'allow' myself to be annoyed by him or her....and all that psychobabble that i know i believe in yet do not completely buy for all situations...yeah i know doesn't make much sense--but it is not supposed to. needless to say...told was 'the worst' today....of what...figure that one out! and talk about kissing some ass by some people...my god!

so here i am tired and should be going to sleep yet writing this to just blab about it one more time...and hopefully not let it continue to 'bug' me!

post-post-call day is actually one of the worst feelings you can have.

2007-07-08T21:10:00.001-07:00

Students Discuss
Options at Congress
Our AMWA student members report that they came away from the 2007 Congress of Women in Medicine with new insight into balancing life and career. One of the student sessions, "In Search of Options," allowed students to ask questions of physician panelists, representing disciplines in internal medicine, gynecology, psychiatry, and surgery, regarding career and family choices. The discussion culminated with three major points: First, follow your bliss - you must enjoy what you do on a regular basis. Second, use your support system or be the catalyst for forming one. Third, the only person that can stop you from achieving your goals, professional or personal, is yourself.

postcallandfeelingit

2007-07-04T21:17:00.000-07:00

soforthisentryiamnotgoingtotypeanyspaceswhichisactuallyhardformesinceitouchtypeandamsousedtodoingit.firetruckoutafterfireworks.
soiamexhausted,headachethatissurelytensionsinceitisalloverandiskillingmeandthatnothingishelpingitgetanybetter.sotoldmyfirstfamily
memberofapatientlastnightthattheirlovedonewasgoingtodie.cannotbelievehowdifficultitistonotgivefalsehopeespeciallyastheyareinobvious
denialandyouwanttobesupportivebutyouknowthepatientisnotgoingtogetbetter.iguessthatissomethingeverynewdoctorneedstogothroughandexperience
ifeellikeiwantotquiteverytimeiamoncall.mustbethecombinationofbeingtiredandlearningandnotknowingeverythingiamdoingyetandbeingtired
sotobediamgoingonthispostcalldaythatiamnotreallymuchbetterrestedsoletshopethatbysaturdayformynextcallthatisnotthecaseandiammorerested.

random thoughts....

2007-07-02T22:26:00.000-07:00

so it is interesting to me the bizarre dynamic of being a new physician. there are people with all kinds of backgrounds...some nothing but school...others with many other experiences before them...all starting as new docs and taking care of patients. now i wonder about those who never worked before now...i know they exist and i know there are several from my class like that...not sure about the intern class i am with...but i don't think they have the slightest clue what it is like to work hard. really just blabbing at this point and am very tired and on call tomorrow so need to hit the hay...but thought would write something since has been a few days...and yes...can breathe for now! since last entry i was on-call and had five admissions that night to the icu, worked about 30hours that shift and 12 the next day...that is another thing....worked like 42 hours over the weekend...now why do people think we make oh so much money----figure out the hourly and you would learn it is less than minimum wage...hence the salary positions!!!

doctor as a patient

2007-06-27T16:42:00.000-07:00

starting the day out with looking at labs and checking in with nursing from overnight when a code is called---ran to the code, stand at the door and watch, listen and learn...as interns do...after about twenty minutes we left the code---interns---as they were still working on the patient but we were not being of any assistance to anyone...so back to the icu to see our patients. well after getting back started coughing and couldn't stop...couldn't catch my breath, lightheaded, difficulty talking and focusing, and finally when we got to start rounding i continued and finally needed a SVN so RT came to give me one and then still not better really---albeit talking---still coughing---my chief walked me down to the ed to see them and 'do it right' and i know that she was right to do that...as much as it sucks b/c had to leave rounds, not do teach rounds and told to go home after done in the ed. needless to say was seen, got another svn by rt and then the nurse placed an iv, history and got solumedrol iv, contineud to be tachy and tachypnic; got my stuff and came home...lethargic and short of breath with chest and throat tightness and tenderness, respectively. decided to rest when i got home and crashed for over four hours. woke up drenched in sweat, headache, jittery, and still tachy at like 120 or so. need to rest. catch up more later.

survived first night of call as a doctor...intern...resident...person...ICU coverage...

2007-06-26T16:58:00.000-07:00

so besides the fact that i am exhausted because of extremely broken crappy sleep...but sleep nonetheless i should say i suppose...at least four or so hours i guess all together...first night of call as an intern and doctor was okay but soooooo scary too. scared of doing something wrong, scared of waking my resident to ask too many questions, scared of not waking him to ask him too many questions, scared of well just about everything to be honest!

this all being said i must have had a white cloud over my head or something because no new admissions all night despite some cross cover issues from about midnight till like around 4 or so...so during rounds worked on getting some other stuff together, reading chest x-rays to prep for teach rounds readings, reporting overnight events to other interns, and so on and so on. we did work rounds and then teach rounds and that actually worked quite well i have to say. covered mechanical ventilation during teach rounds...after i had the luxury of reading the am cxr for all our patients for the whole team....can you say nerve wracking....?

headed out just as was hitting the 30hour mark...and took a nap for a few hours and here i am...now need to study for quiz for tomorrow teach rounds over mechanical ventilation and some other stuff i don't remember right now. going to pick up one patient tomorrow from family since none on my census right now and she is leaving friday anyway. so just one patient tomorrow, then off thursday, then call again friday!

and so the life of the intern begins....and how i am supposed to get that yearbook done again???

yours,
one new and still very nervous resident doctor

writing orders without a cosigner....yeah...strange!!!

2007-06-23T13:16:00.000-07:00

my first official day as an intern (aka first year resident, aka post-graduate year 1, new doc, physician, etc.) was today! can't say it started out all that great given I overslept and was like 20mins late---but my senior was great about it thank goodness.

all packed with my bag of tricks...reference books, cheat sheets, stethescope, neuro tools, etc....i headed to the hospital. starting as a new intern is scary, exciting, nerve wracking, bizarre, and bizarre!!! after getting an overview of the unit we got our patient assignments and off we went to review everything and write our notes...then rounds....no idea what i am doing...confused about how to write an icu note vs. wards note and somewhat forgetting how to even write the note in the first place...given it has been like 7 months or so since i wrote a 'real' note! but took the feedback, used it and changed things; made phone calls and wrote orders...lots and lots of orders....so after 7 1/2 hours i left for the day...short day actually...but it is saturday...and actually off tomorrow since i will be pre-call!

late entry for orientation

2007-06-23T13:14:00.000-07:00

so didn't have a chance to write yesterday....needless to say it was our second day of orientation---department specific information mostly. policies, procedures, records, people, plans, logistics, etc. that lasted all day. my fellow interns are all very nice---we are a good mix and are all feeling the same way...scared!!!

orientation squeezed into one day...GO

2007-06-21T17:33:00.000-07:00

So after 9 hours of orientation and information overload i am completely overwhelmed! not only with policies & procedures...but notes, things to do, not do, f-ing white coats and pictures, permits, etc. I now remember why i am so annoyed with our society and system...such b/s like having you know---forty coats there---none fit me---can't get one at the store b/c don't have them; blah blah blah---same story different place. Pictures...on our business cards???/ so would have been nice to you know---say---know that ahead of time!~!! yeah and the little asthma patient exercise was oh so much fun---here---write some orders---plans, etc. Can I also say how freaking scary it is to know you are to write such orders from the memory that you feel like is non-existent at the moment!!! So the internship begins...not a good thing when they tell you...yep...get ready for sleep deprivation..oh and if you can't drive home..cab voucher for you! why am i doing this again??? and what am i doing later???

Night before orientation

2007-06-20T23:38:00.000-07:00

So starting residency, or internship should i say, is something filled with many emotions---excitement, fear, overwhelming fear, and more fear!!! Mostly of hurting someone! Many who are not in medicine may not know...but many say you shouldn't go to the hospital in July!!! This is because the 'new batch' of interns typically start nationwide on July 1st and are 'newbies' as our friends on Scrubs call us! So despite being supervised tons----there is the ongoing joke of July being the month to "not get sick"!!! Needless to say...I will begin this new chapter in life--personal and professional---tomorrow morning as I complete two short days of orientation before starting in the intensive care unit early---not so bright as the sun won't be up---but early nonetheless---saturday morning!!! So stay tuned and I will attempt...could prove to be difficult...to keep this updated daily....that is a tall order but we will see...as I enter the new world of being called "Doctor".