Wednesday, December 20, 2006

Six months down

Yesterday when I walked out of the hospital I offically concluded my first six months of my intern year.
More importantly, I concluded this year's stint with internal medicine. Next week when I go back to work, I will be starting pediatrics, where I will be for the last six months of my intern year.
Doing combined internal medicine and pediatrics means I am going to be living a kind of double life during my training, alternating back and forth between the world of adult medicine and kiddo medicine. This year was split six months of each, and the next three years will have me switching every four months.

Do I have reflections on the first six months?
Here is a tally:

Number of times I got pulled over in the VA Hospital parking lot: 1
Number of times I was accused of "evading police" by not pulling over quickly enough in the VA parking lot: 1
Number of patients I see regularly in my clinic who weigh over 350 pounds: 5
Number of them interested in losing weight: 0
Number of patients I have seen who weight over 650 pounds: 1
Number of people I have pronounced dead: 4
Number of "code blues" I have gone running down stairs and hallways to get to: 7
Number of "code blues" that were called when someone accidentally hit the "code blue alarm": 6
Number of times I have cried in relation to work: 9
Number of times I have laughed in relation to work: too many to count
Number of times I have thought, "I can't believe I get to do this:" roughly 182
Number of times I have been asked by a 3-year old "Are your a doctor or a veterinarian?": 1

Oh, and here is a story about the highlight of my Christmas celebration with Tommy's family.
Our 6 year old niece was telling me about losing her teeth and how she gets a dollar from the too th fairy when she loses a tooth. His 10 year old nephew then asked me how much money I got from the tooth fairy when I was a kid. I told him "A dollar." He looked at me, and with no malicious or smart ass intent, said, "Wow. That was a lot of money back then wasn't it."

Saturday, July 15, 2006

Call version 2.0

So, the first piece I tried to write never really got off the ground and never really got finished. I have really wanted to make myself do a better job of recording my experiences and feelings as I go through this year, but haven't had the discipline to actually do it.
Here I am on my second overnight call. The fact that it has been two weeks since my first overnight call is something amazing. Most interns like me would be having overnight calls every 4th or 5th night for 11 months of this 12 month year.
My program, though, is doing something different this year for the first time ever...no weekday call for interns.
Instead, they have a "night float" system, in which there is one team that covers the patients from 7am until 7 pm and another team that covers the patients from 7pm until 7am every night of the week. Saturday and Sunday nights the "day team" people rotate the overnight coverage in the traditional call system of what has recently been reduced to a 30 hour shift.
This means that I and my fellow interns are a month the luckiest in the country because rather than spending 9 or 10 nights a month in the hospital, we are there for just 2 or 3.
This has its good and bad points. The good is, clearly, the ability to sleep in your own bed, and the actual part about sleeping is a real highlight. It means we are supposed to be less fatigued in our daily activities and this is intended to make everyone safer.
The downside is that there are things you learn how to do on call that you just don't learn how to do anywhere else or at any other time. When you are on call, you are first in line to get to do procedures, and the senior resident backs you up and steps in if you can't do it. You are the person responsible for making decisions ranging from the mundane ("this patient hasn't pooped in three days, can you order him a laxative?" ...something that is clearly urgent at 3am) to the interesting ("this patient's blood pressure is 78/40, what do you want us to do.") There is an element of facing a challenge and solving the problem that belongs to your hours on call that helps shape doctors from know nothings like me into confident men and women who can solve problems even when they are a little drowsy...think of how well it prepares them to think when they are rested.
Anyway, that is my digression about the call system in my program, and all in all I have to say that I would take what we have now over the days of endless shifts and every other night call and walking through the hospital in five feet of snow up hill both ways that our attendings apparently had to endure, because they remind us of it often and readily.
The short of it that I can't really believe all that I've learned in this past two weeks. The MICU I'm working in has been rather slow for business, but I've been getting to see enough to learn, and having just a handful of patients means I have the time and energy to spend learning, rather than just trying to keep my head on straight.
I'm feeling more confident, but waiting for that moment when I flub up horribly, so that keeps me from getting to excited just yet.
I'm not as afraid of nurses anymore.
I'm still worried about getting called to put in an IV because I frankly wouldn't know here to begin.
I'm nervous about being called with a question that I can't answer...although that is just about every question right now.
And I am truly terrified of someone having a CODE BLUE, and me being a central player in that whole crazy mess.
Overall, though, I just can't complain about how things are going so far. I think I prepared myself for the worst and so far my experience has been, dare I say it...enjoyable?
I know I haven't seen the worst of it yet, though, and that things can and often do, go downhill fast. Like the knowledge that my first big screw up could be just the next pager beep away, it keeps me from getting too comfortable.
In general, I think I am a happier person now that I am back to work, back to a schedule, back to doing something that I really enjoy. Not that staying at home with little to do for the past several weeks wasn't enoyable, but I was beginning to get bored with myself and I have to say it was affecting my mood and my outlook... and Tommy will nod his head in agreement here when I say I have been much more pleasant to be around since this all began.

Tuesday, July 04, 2006

Doctor? Who? Me?

Well, because it would be sad to let it go to waste, here is something I started writing two weeks ago on my first overnight call (July 2nd, my second day of residency)...it never got finished.


July 1 is a day that should be on everyone's calendar. It should be declared, "Don't Show Up at the Hospital Because If You Do You Might be Taken Care of By Someone Who has Been a Doctor For Exactly One Day," Day.

Walking into the MICU on Saturday Morning was an odd thing. I had no idea where to go, and frankly no idea what to do once I got there. I entered the unit and spotted a nurse, and said, "Hi, I'm Emily and today is my very first day as an intern and I don't know where I'm supposed to go."
She could have been really mean or really rude. Actually, though, she was very nice. All of the nurses were nice that morning. I admit I'd been expecting the worst. I was expecting to be welcomed less than warmly by the people who will have to deal with me and the rest of my intern class as we learn the ropes and figure out to do this doctor thing. They are the ones who have to scramble to draw blood when we forget to order a lab test, or have to call us when we forget to write a standing order for a pain medication. They have to do what we ask when they have been doing their job just fine for many many years and we have been on the job for just the blink of an eye. In some ways, I don't blame them for having a bad attitude toward us, but I never knew what a huge difference it would make to get to work with nurses who are actually kind and warm and who, at midnight when they are ordering Chinese food, are actually nice enough to ask you if you'd like to order something, too.
Anyway, that is how I feel about the nurses here at the VA MICU.
So day 1 arrived and I felt both excited and incompetent. The exciting part was that I was finally starting to work, and I know that this next year is going to be the time when I learn more than I've ever learned before. Incompetent because, well, I am going to spend this year learning more than I've ever learned before, but I'm going to be responsible for all of those things I have yet to learn.
As the first day on any new job goes, there was a lot of having to ask where things are, how to et places, the protocol for addressing certain issues. And the most important part of any first day---finding the nearest restroom.
Overall the day went well. The strangest part of the day was when the attending introduced me to one of my patient's families as," Dr. Riegel," and informed them that I'd be "primarily responsible for Mr.R's care." I hate to admit it, but tears came to my eyes when he said that.

Wednesday, June 28, 2006

We really want to be your doctors.
















Alas, they have not yet given us the "Everything You Need to KNow to Be a Doctor" microchip implant. Hmm.
L to R:
Dr. Dave Kolhoff, urologist
Dr. Jen "Adventuresome" Goldman, pediatrician
Me, internal medicine and pediatrics
Dr. Eliza Bennett, ob-gyn
Dr. Abby Snavely, psychiatristPosted by Picasa

On The Brink

I have the four extra years of education.
I have the diploma.
I have a new stethoscope.
I have the knee-length white coats.

In two days I am going to walk into a patient's room and introduce myself as "Emily Riegel, your doctor."

Like I mentioned for the photo above, there was no microchip slipped into our rbains at any point during the graduation week events, nor since then at the endlessly boring days of orientation I've been attending. In fact, I am really starting to think there will be no microchip.

What I am looking at instead is a huge shelf of books, filled with details of anatomy, biochemistry, physiology, all the secrets of the inner workings of the human organism. I think at some point, much of that information was supposed to become lodged in my brain, at a place readily accessible for future use.

The problem is, I'm not so sure where exactly it is in my brain, nor if it was ever actually firmly lodged there in the first place.

Come Saturday, though, I'm being entrusted with people's well being...or as well as their being is while they are in the medical ICU at the Kansas City VA.

Of course I've been given the "help is never more than a phone call away," and "you won't be allowed to do anything unless you are comfortable doing it," and even better, "you're just the intern, no one expects much of you the first few months."

Despite all the reassurances and good advice we've all been given, there are worries in my mind that just can't be addressed until I am in the situations that I actually worry about. Whether it's how I'm going to stay awake to drive home after being up all night at the hospital, or what I'm going to tell the nurse to do when she tells me that my patient has a fever, or how I'll react when I have a patient die for the first time...you just have to get through those things yourself in order to know how you'll handle them. Even then, you know the next time will be different, or better, or worse.

This is going to be a whole new adventure.

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