Paging Dr. Obsession July 11, 2009

Last night I took my first call as an intern!  After a full day in clinic, I headed over to one of our affiliated community hospitals for call.  The chief resident showed me around L&D, the Gyn floor, the ER and most importantly the cafeteria.  He was in the middle of working up a patient for preeclampsia, so I tagged along for that.  Then around 8pm he went home to be with his family.  Yep! That meant I was alone in-house… Of course, there was an attending in house as well, but it was up to me to evaluate the patients, call/pg my chief after I’d done the work-up, and then present to the attending.

The night started slow with a few pages: Ambien here, Zofran there, etc.  I did a post-op check on a patient and was quite surprised how the night was going.  Then a lady came in with possible preterm rupture of membranes (breaking her water too early).  I went and saw her, sent off basic tests (urinalysis, fetal fibronectin, nitrazine) did an exam, and also looked under the microscope for evidence of rupture, and also evidence of infection.  Via phone, my chief agreed with my plan and I presented her to the attending.  After everything came back negative I sent her home!  I was so happy to make it through the first one.

After that, I went to my call rooom, worked on my notes for the next morning, and laid down to sleep.  Just as I was getting into a nice dream, the phone rings!  Yet another rule out labor patient… this one was full term.  I did the appropriate workup with her, called my cheif, presented to the attending, and she was out the door too.  I was really happy to be able to handle the patients on my own (for the most part) without having to physically call my chief back in house.  I think the attending was a little annoyed to go over the strips with me (even tho my chief viewed them at home), but overall it worked out well.  The attending even complimented that I was doing very well, and she wouldn’t have guessed it was my first call!

By now, it’s 3:30am and a C/S is called by the another private attending on call.  Since I was in house, not my chief, she asked me to be her assistant.  It was great.  I helped push the baby out successfully and she pinked up nicely once we got the cord from around her neck!  After that, I got to suture the bladder flap that we created back to the uterine serosa.  I also got to close the fascia.  My experience on my Gyn Sub-I definitely had me ready!!  She complemented that I was doing a great job with my suturing skills.  She was patient with my knot tying, but hey I’d rather it be slow and a square knot than fast and a slip knot.  Since it was the middle of the night by this point, she did the dictation for me and said on my next call she would let me do more!

I can’t wait until tomorrow… yep, I typed correctly.  I’m already on call again tomorrow.  I should probably get to bed so I can function.

Crazy Clinic July 7, 2009

These past few days have been pretty hectic with the clinics!  I spent all day monday in Urgent Care… yes, Medicine Urgent Care.  I’ve got to admit, I really didn’t enjoy it.  It’s the never ending clinic.  At this particular clinic, patients start arriving around 7:30am and they can check in until 4:30pm.  There were literally 7 interns working there with 2-3 attendings depending on the time of day.  The process seems so inefficient.  After seeing a patient, I still had to wait after 1-2 interns to present my patient.  Then there was something wrong with my ability to sign orders, so I was back to med student status having the attendings sign my orders.  After seeing a patient if they needed labs or imaging they go back in the lobby and wait for hours since those services were backed up too.  Too make it even harder for us… the list keeps growing and growing!  Since they can keep coming until 4:30pm, the list has no limit.  We didn’t leave until 7pm!!  Even more frustrating was that several of the patients use urgent care to have very non-urgent complaints attended to.  I don’t know how to solve the health care crisis, but I really do believe there has got to be a better way.

Then today I got to work in the county health clinic.  I love it there!  The patients are an underserved population, so I saw my fair share of teenage pregnancies, late prenatal care, African American and Mexican American patients.  These patients are mostly all good listeners and are just happy that I am taking the time to talk with them about their pregnancies.  What sucks is the sheer number of patients that had to be seen today.  Myself, an attending, and a medical student got through 52 patients today!  I literally was running from one room to the next doing histories, exams, fetal doppler, cultures, wet mounts and everything else.  I definitely picked up speed compared to last week’s clinic, but I know that the attending definitely picked up a little of my slack.  To go from seeing maybe 3 patients in a half day as a med student to 15 as an intern is pretty steep.  I managed to do 8 this AM, and another 9 in the afternoon.  My goal next week is to at least get up to 12 in a half day… I’ll keep you posted!

Overall, I’m still very excited about getting to work with patients as their doctor.  Part of the reason that I’m still slow is because I don’t want to lose my ability to be thorough just because I’m in a rush.  I really hope to strike the balance between efficiency and accuracy.

My 1st “Surgery” June 30, 2009

As you may have gathered from the past few posts, I’m pretty excited to be a doctor!  This year, and the next few years at that, will be full of “firsts” for me.  Today, I had the pleasure of performing a male circumcision (from here out referred to as “circ”).  Interestingly, I had never actually even seen one done!  In med school, when I was on my Peds rotation at a private hospital, the Ob/Gyn team did all of the circs.   Then on my Ob/Gyn rotation at the county hospital, the Peds team did all of them.

In preparation to not royally screw up this baby’s manhood for the rest of his life, I went to the best resource ever: UpToDate!  Sidenote: I’m being slightly sarcastic, considering I know there are better resources.  Anyhow, UpToDate had a great article with pictures and everything.  It paid off because when the attending was asking me about what type of block to do, and what clamp we use, I knew what to do.  Even better, it paid off for the little boy!  I did work on my ducking speed when he started to pee like a squirt gun as I cleaned the area for the procedure.  He shrieked in pain as I injected him for the dorsal penile nerve block.

During the procedure the boy didn’t actually cry too much.  I managed to successfully circumsize the baby, with the guidance of my attending of course, with no complications.  I will say, I felt so bad to be essentially operating on his penis.  As I stated in my tweet, I’m not sure I could be a guy and handle cutting the foreskin off little boys.  To make it even more interesting, turns out that I had to save it because they use it for eyelid replacements!

I was so excited that my first circ went well. Minimal blood loss… baby asleep by the end of the procedure… and then I get paged in the middle of clinic.  Turns out he started bleeding!  Luckily the floor team was to the rescue to apply pressure and achieve hemostasis with this special film. Whew!

Multi-Tasking Galore June 29, 2009

Today was definitely really my first day as a doctor!  I arrived at the hospital at 5:30 am in order to meet the team and get ready for postpartum rounds.  I did a pretty good job: saw all of my patients, used an interpreter phone for the first time, and managed to only be 2 min late to rounds.  Considering the other intern was about 15 min late to rounds, that 2 didn’t feel quite so scary.  I only got interrupted for more details on one of my patient presentations, and the rest went smoothly!  It was so cute, the new cheif clapped for me after my first presentation as a Doctor .

So after rounds, I met one of the patients in labor.  I got started on all of my notes… the goal in the first few days is to have all notes done before rounds.  I finally managed to get all of my notes, daily orders, discharge papers, discharge prescriptions done.  In the interim, I was paged about patient’s diet, taking a shower, starting benadryl, new triage patients and more.  The rest of the day I was in triage seeing patients. I’m so thankful for the midwife because she really held triage together as I was pulled away for postpartum issues, and of course: deliveries!

I had the smoothest deliveries today.  Both of the women weren’t on their first baby, so those tend to go pretty quickly.  What made it exciting is that these were the first 2 deliveries that I ever performed as a doctor!  Amazingly enough, neither of them had lacerations.  Of course, like I said before neither were on their first born, but still, I was impressed.  The great thing about the L&D at my hospital is that we have midwives.  So far they know what they are doing and these moms are having smooth deliveries.

I wish I could say that I would be having more of this, but I will be starting in the clinic tomorrow!  It’ll be some time before I’m actually on the L&D service.  Overall, I had an amazing day.  I pulled a 13-hour shift and really didn’t feel tired until I got in the car and thought about it some.  Can’t wait for what the rest of the week holds.

Ready to Work June 26, 2009

Well, I don’t know whether to breathe a sigh of relief that I’m done with the most painful Orientation process, or to beg for more instead of having to work on Monday!  Literally, it’s been non-stop from 7:30 – 5 everyday (well one day a little earlier, but still had online training, which took me past 5p).  These past 3 days have been information overload.  I learned 3 different computer systems, got new log ins for these systems in addition to 4 work-related websites, did multiple online quizzes regarding GME policies, enrolled in direct deposit, and learned about all of the requirements for the entire year.  By the end of today, my mind was spinning.  I hope I retained even 50% of what was presented to me at Orientation, since most of it will have to be put to direct use on Monday.

I’m officially ready to work since I’m now in posession of a functioning pager, an ID badge, and my own prescription pads!  It’s actually pretty exciting to see the transition from Med Obsession, Medical Student on the Badge to Med Obsession, MD Obstetrics & Gynecology.  On top of that, I have my own prescription pad!  Not that I’m about to be some pill pusher, but seriously I know that I will be excited to not just write a prescription on my own pad, but to be able to sign it myself.

What also makes me feel ready to work is the people.  I really actually like all of my fellow interns thus far.  I know that it’s just the start, but I have a good feeling about them all.  The program director is really just like they were on interview day, same with the chair.  All of the residents have shown such interest in getting to know us further.  I can’t wait to get to know everyone better.  It definitely eases some of my first day jitters…

Speaking of jitters… won’t be starting out on clinic right away!  I’ll be covering on L&D starting at 0530… hopefully I’ll get some reading in to be prepared.  I hadn’t been reading since I was going to be on clinic… shoulda followed the Girl Scout motto: be prepared.  Oh well, I was always better at buckling down to study when I had pressure.  I’ll keep you posted.

Last Day of Freedom June 23, 2009

Today is my last day before I start my internship!! No, I didn’t do anything particularly exciting.  Instead, I went on a shopping trip to Wal.Mart.  I bought a new phone for the apartment.  It’s great… one of those 3-in-1 deals where you get the base phone and 2 additional cordless headsets to put in different rooms.  I also set up wireless internet in the apartment.  Time Warner had this deal for phone, DVR cable, and internet that I had installed yesterday.  They were about to charge me an extra $20 a month for wireless, so I opted out.  Instead, I just bought a wireless G router for 40 bucks and did it myself!  I definitely got a great deal, since after just 2 months the router would’ve paid for itself.  My last purchase of the day was a new printer.  I figured after 4 years, I could splurge for a new photo printer.  This one has all the functions of my last printer, but is damn near half the size!

Well… now I’m just trying to keep busy until tomorrow AM, in order to ease some of the anxiety that I’m feeling.  When I met up with my friend I mentioned in the previous post we reflected alot about med school and in particular 4th year.  In so many ways, 4th year is just a cruel joke.  I mean seriously, I have been SOOO happy, had free time to catch up on my hobbies, reconnect with old friends, travel, sleep in, and even get my hair and eyebrows done on a regular basis.  My family calls me so much more because they know that I am always available to talk.  4th year reminded me that I have a life, a great one at that.  I suppose the thing that scares me even more than being unprepared for my first day alone as an intern, is that my wonderful life will be only a distant memory.  I definitely plan to let that fear remain unrealized!

Friends June 20, 2009

A good friend of mine from college matched at the neighboring University in the same city as me, so we decided to meet up for drinks.  It was great catching up last night… we talked over wine until 5am!  I hadn’t done that in ages.  It’s funny how life goes and will put you in places where you can rekindle friendships and have the right people by your side.  She and I are in the same boat in that we both just got engaged, are just becoming interns, and have fiances that will be long distance for these first few months.  Just talking with her last night eased some of my anxiety about being alone in the city, since my fiance hasn’t found a job here yet.  We will definitely have some of the same hurdles initially, and I’m very glad to have a friend here by my side!

ACLS Certified June 18, 2009

For those of you that read my Twitter, you may have noticed that I passed Advanced Cardiac Life Support!  It was actually not nearly as painful as I’d anticipated for an 8a-5p class.  The day was varied between watching video, doing skills stations individually, and then ultimately running a code as the team leader.  In fact, I felt that my “Intro to Internship” course that I took at school definitely put me in the right mindset to not be nervous as team leader in front of my peers.  For my final test megacode, my person went from symptomatic bradycardia, to ventricular fibrillation, to aystole.  So I had to go down the proper algorithm for each of those scenarios.  It was actually kinda fun.  The day ended with a 25 question test that I got a 96% on… I guess my brain still functions despite all this vacation!  All I have left is BLS renewal next weeek, which is slightly backward, considering the first part of ACLS is BLS.  But whatever.

SITE CHANGES:

Also, I just wanted to point out a slight change to the site.  In the uppermost box on the right hand column, I put the post topic categories into a heirarchy under the subtitles “as a med student” and “as a resident.”  This way, for those new readers that only want to read about my experiences in medical school, they can click directly on that category for all the old posts, without having to sift through my new posts talking about residency.  Let me know if you have any difficulty with the new navigation!

Catch Up June 16, 2009

I only have 8 days left until I’m officially an intern!! I’ve been “borrowing” someone’s wireless signal until my cable/internet guy shows up…

Anyways, these past few weeks since I’ve posted have been jam-packed.  You know how it can be painful to play “catch up” with a friend you haven’t talked to in months… I’m going to spare you all the nitty gritty details.  But just like those catch up calls, I’ll just give you the highlights:

- I graduated medical school: yep, I even giggled the first time someone from the hospital called me “Dr.”  I’ve gotten better at it now.

- I went to my home town for a joint graduation party with my lil bro that graduated highschool.  It was so much fun! My favorite food – Mexican, my favorite drinks – margaritas & appletinis, and of course lots of family and friends.  I raked in lots of cash, which will get me through the next month without a paycheck, and allow me to furnish my empty second bedroom!

- While I was home I did TONS of wedding planning in just 2 days: visited 3 reception sites with my mom and fiance, tried on 28 dresses at 3 different bridal salons with my mom and sister, picked out my bridesmaids and their dresses, and bought my wedding gown.

- I was a bridesmaid in one of my close friends’ wedding.  It was beautiful… she set the bar high for my own wedding!  I definitely have to invest in waterproof mascara for my own wedding – my tears were flowing for hers. The wedding means so much when you really know both the bride and groom, and know all the work that went into the relationship and the wedding.

- I met with Employee Health and will be cleared once I get my PPD read.  I’m surprised that I’m able to type given the soreness in my arm from my Tdap shot!

- I met with my GME officer and will be cleared once I do my ACLS and BLS training over the next few days.  It was great because I received my Resident Training License!  I was also pleased to be reminded that my $600 parking will be paid for, along with 3 new white coats (my sis got me one that’s embroidered, so I’ll be wearing that while my other ones are getting embroidered too!).  I’m also ahead of the game – apparently half of the Ob/Gyn interns will be starting a week late because they didn’t get paperwork in on time… I’m pretty shocked considering most Ob/Gyn’s at academic programs are type-A.

Well that’s the last 11 days in a nutshell!  I have ACLS tomorrow and orientation in just a week from tomorrow… getting nervous, but also excited.

Senior Banquet Update June 4, 2009

As I noted in my post yesterday, I missed the big Senior Class Banquet due to my little brother’s graduation.  However, at the smaller affiliated school banquet today I got filled in on all of the details!

During the senior superlatives, the MC noted that the next particular winner had a blog.  He talked about reading the blog daily to keep up with my life.  I supposed at that point, the people in my class that knew I had a blog knew the award was for me… Most Likely to Become Department Chair!  I thought that was a good fit considering my love for orgnizations, leadership, research, and the fact that I’m going on to residency at an academic institution.  I guess we’ll see 20 years from now if that came true!

In addition to the superlatives, they distributed the yearbooks.  I can’t wait to see the yearbook since I worked on 6 of the pages.  Despite missing the drunken festivities at the senior banquet, I’m sure the yearbook will have captured the essence of many of my memories over the past 4 years.  Tomorrow I’ll be Dr. Med Obsession!  I guess I may have to adjust the header on my blog… no longer my life as a medical student; it’ll be my life as a doctor .