Welcome to 2012!!!

Hello there dear readers, I am still here. I hope everyone has had a joyous holiday season and they are recovering from the festivities of new years day.

I have not blogged recently because my schedule has been very busy lately and I have been very, very tired. I was on the general medical floors the past month and therefor was on call every 4th day and trying to recover in between. But this month, I will be on Gyn so I have a little more time.

Well, things are going really well. I submitted a grant for a research project that I am going to do and I am working on a Quality Improvement project as well. Both of these are required for the program but it is still a good thing for the resume. So the plan is kind of changing with recent financial burdens.

One thing that you need to remember, if you are about to start this journey or are thinking about this journey is that once you are done with medical school, things do not necessarily get easier. they get more complicated. You need to contact your lenders to see if you can have a deferrment of a forebearance. The number of loans you have are now very limited and while you do not have to have your school certify your loan, you really need to think about a residency loan early on. What do I mean? Well, since you only have about 6 months after your graduate to apply for these loans, you may not know that you need it until the 6 months are either almost up or are already over. Then, you are in a bit of a lurch. You need to start cutting things. But how do you know where your money is going? I mean there is not enough time to keep a diary or even write things down?

Good point, however there are software out there like MS Money and IBank for Mac that are very helpful. We were able to find the areas where we could and probably should cut. Now it is just a matter to wait and see to determine if these cuts are helping. It is also a good idea to tap into family. These are people that you can create an IOU and discuss terms such as no interest and even a payback policy where you start a plan after you are done with residency and/or fellowship and start making a normal salary.

We have also decided to go see a financial planner and look at what we can do to not only save more but to get through this rough patch.

Well done for now. One of my resolutions is to blog more often, so come back and see if I keep that resolution.

Almost 1/2 way done

Hello there dear readers. I know, I know. It has been far too long since my last posting. I bet you thought that I forgot about this little blog of mine. Well, I did not. I have just been so tired that I have not had the chance to sit down to write. Of course, right now I am taking a break from writing my grant in order to write my blog. But alas, so it goes.

Since my last update, I have been done with my first time on the medical floors and now I am almost done with Cardiology. Both have been great to do. In addition, I have had clinic time each month. In fact, today I was told the best thing ever. I had a patient come in and say that she wanted me to be her Primary Care Physician!!! How about that. Although I am getting used to it, I still find it hard to believe that this is real. But now there are new challenges.

The biggest one is that of finances. Now that loans are starting to come off of their grace period, I have to get on the ball and call them back to get them onto deferment. No, I did not wait until the last minute but these things are very confusing. I mean I apply for it and first they tell me that I am in deferment until 2014 and then they tell me that I am not. Well that is not a nice thing to do to a guy who is very tired and works about 80 hours a week. Next there is trying to refinance a mortgage in this economy, good luck. And finally there is trying to get back on our feet financially. Well, I decided that we are obviously going to need help and so there is an appointment to be made with a financial planner.

The other challenge is trying to spend enough time with everyone. Yes, I did lapse a little in my Daddy/Daughter time and I am trying to get that back on the role. However, I also need time for the wife and myself. At least the time for myself should not be at the library writing a grant. But rather maybe reading a non medical magazine or going out with a friend (which I am planning). I did find out that our babysitter can come back from college with enough notice. Phew, now the wife and I can plan some outings. As long as I am not on call or post call. That is something I would advise those parents who want to go to medical school. Not only should you find a babysitter, but have several back up ones as well. They do come in handy. Sure you can find one or two or three amongst your classmates, but also have a local teen or two who are available as well.

Not much else to report. Other than the upcoming local NonTraditional Conference in March. I am going to try to get back into Paintball, I had so much fun with it and I have a cousin who is really into it. Always nice to have a hobby other than driver of kiddoes to birthday parties. Till next time.

NonTraditional Conference has been announced

This is a quick one dear readers. The Annual Old Pre Meds Conference has been set for Orlando Florida in June. But, there is more good news..........

The Old Pre Meds NorthEast Regional Conference is set for March 18, 2012 at UMDNJ-School of Osteopathic Medicine in Stratford, NJ.

The school is in Southern NJ just outside of Philadelphia. So far there are 3 confirmed speakers and once I get everything fully confirmed I will post.

TTFN

on the floors

I know it has been some time since I last posted, but then again I have been very busy at work. well maybe not at work because I love what I am doing and therefor do not feel as if I am working.

Last month I was in the SICU, Surgical Intensive Care Unit, medically managing some of the post operative patients. The good thing about that rotation was that I was the only intern and resident so it was just the Intensivist and I which was great for 1:1 teaching time. But at the same time, if something was not done, the onus was 100% on me with no backup from a senior resident. And boy did I learn a lot.

There was one patient were I really learned how to manage shock and maintain blood pressure. I was in constant communication with the attending and it took about 5 hours to get the patient stable. By the end of the night, I really knew what to look for and how to manage things. Although I can use more practice my confidence went up. In addition, I really learned how to prioritize things in the ICU patient. And since my census was not very high I had to do several presentations to the other interns in the ICU so I learned a lot about topics including compartment syndrome, acute coronary events, delirium, etc.

Now I am on the general medical floors and I am doing well. These patients are much more stable and I am happy to be able to generate some form of relationship with them while they are in the hospital. And with my experience in the ICU, I do have confidence because before calling the resident, I think about the problem and come up with potential solutions. However, this is having a hard time at home because of my schedule.

I am on call every 4th night so I am at work from 7am until 9:30 pm and do not get home until about 10/10;30 so I can go a day or so without seeing the girls. This is why I do my best to spend quality time with them. Not always successful because I am so tired. I am learning to be much more patient with my girls, which is hard when you are sleep deprived. The other day I became angry and I took a drive to calm down, of course I went to get my clogs for work which are more comfortable for my feet but I was able to cool it and chit chat with my 10 year old the next day and smooth things over. Now I am going to close my eyes and count to 10 when I am starting to get frustrated because I forget that they are kids and are going to do kids things. Forgive me, I am human and therefor flawed.

With the wife, the issue is spending couple time. And the solution apparently has to be to schedule our time. While it may seem unromantic to say, "9pm thursdays is our night" it almost guarantees that it will happen because we wont schedule things at that time. However, while the schedule may not be romantic the time itself can be romantic. From putting a fire place on the computer from youtube, to going to the backyard and having some wine. It is a chance to be creative. Hopefully this will resolve one issue.

The other issue of course is finances, but that is for another discussion.

in the ICU!!!!!!!!!! Love it.

So I am in what we call a "Golden Weekend". The first weekend in almost 2 months that I don't have to work either day. I was actually able to not only sleep in today, but I can look forward to doing it tomorrow.

Last month I was in the ICU and loved every minute of it. I was able to put in central lines, write orders, evaluate patients, but I also had the unfortunate responsibility to pronounce 3 patients, with family in the room.

I have been learning a TON in my program so far. I was also involved in several family meetings regarding the potential outcomes of the patients and having to tell the families that there is almost no chance of any meaningful recovery and that we would recommend comfort care and letting the patient die comfortably with no more invasive tests or procedures. While some families have agreed, others hold out hope beyond hope that things will change. I learned that with families who want everything done, the only way for them to come to the decision that they should let their loved one die peacefully is with time. But we never give them any false hopes.

Right now I am in the Surgical ICU, which in my program is my surgery rotation. Makes more sense than my doing surgical consults or being in the OR since I do not want to do that. Rather I take care of the patients Post operatively with the intensivist. So not only am I still doing ICU but I get 1:1 time with the attending and therefor get teaching.

This was great because it solidified my decision to go into critical care medicine. One day I am up to my neck in new admissions, 2 code blues, 3 lines, the next day I discharge 4 patients and pronounce 2. The next day, the unit is sparse and the hospital is quiet. Only to be broken by a rapid response.

But the hours are a killer. I have put in, on average, 75 hours a week. The one week I was actually over the limit with 85 hours. But I am so happy that it does not bother me. It really is true, I am not working. I am enjoying my new career.

But it really is weird, when someone calls me who does not know and I hear, "Dr., would you like some saline for this patient?". and all I can think is, holy crap, they are talking to me.

wwwwwwoooooowwwwww

I know that it has been quite some time since I posted but a lot has been going on. First of all, I am done with the ER, and thank god for that as I can now really work and not just feel like a student. I have been in the ICU for 2 weeks now and I am not only loving every minute of it but I am exhausted.

I have to be in the hospital by 6am which means I have to get up at 4:30 and leave by 5. Then we sign out to the overnight crew at around 6pm and it takes about 30 minutes to go through each patient and give the night team an idea of who the patient is, if the patient is new to the unit, what happened during the day, and what needs to be followed up or what needs to be done. Sometimes it even takes an hour if we get paged. I  have a 6 day work week. Last week I worked 89 hours and this week I will be pushing 75.

We get an incredible number of sick people. From heart attacks to strokes, to terminal conditions. I have had to speak to patients about their illnesses, talking to families about their loved ones and communicating with other doctors. Everything I have been experiencing has substantiated my decision to go into medical school late in life. And because I am older and have been in the workforce, I know the politics of work and I have the emotional intelligence to react or not react to things that are said.

In about a month, I start clinic hours and I get my own census of patients that I will be following for the next 3 years. This is just getting better and better.

Till next time.

 

Month almost over

So my first month as an intern is almost over and I finally have access to patient charts in the ER. But I cannot write anything or order anything. Fine. But I did get to spend some time in the ICU, which is where I will be tomorrow night, next saturday night and then for the entire month of August.

While I was there, it was great. But nothing was really going on at night so it was still no different from being a medical student. Until the nurse paged me. She told me that the patient's blood pressure was still high even after getting medication and wanted to know what I wanted to give him. Well, my heart DROPPED!!!!! Now I really have to make a decision. If I do not give the right medication then the patient can be in bigger problems. But if I give too much they could be in problems also. The nurse hinted that it may be a good idea to give the patient hydralazine. So I looked up the labs and called my resident, which he told me the same thing. And I wrote the order.

The nurses know that we are all brand new doctors and so they are there to have our backs. As long as you are not nasty or rude to them. Which I am not (something that gives non trads an advantage over our traditional counterparts due to our emotional intelligence). Since then, I have decided that I am going to be reviewing the treatment of each emergency for each organ system. So far, so good. The only issue is that I have not been able to put the information to good use, yet.

Since starting, I have seen common medical problems enter the ER. Things that I eventually will take care of either on the floors or in the ICU. I have been able to perform several pelvic exams (with a chaperone of course), put in a couple of nasalgastric tubes, and IVs. But I am looking forward to putting in central lines, intubation, and other stuff life that.

I am looking forward to my time in the ICU. I plan on reviewing my notes on the information I have been reading about. And wondering how I am going to feel when I put in 72 hours a week.