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.

It has been 1 week

So I have been an Intern for a whole week, as stated in the title of today's episode. The cool thing is that when I walk into see patients, I say I am Dr. Lerman, no longer saying Student Doctor Lerman and it is awesome. This whole month I am in the emergency room, which is kind of like an extension of medical school because I cannot chart anything, order anything, and I have to report everything to attending and have to try to follow my patients.

But, I am learning some. And that is the main point of course. I have taken the time that I am not seeing people and using it to read articles and get myself ready to take on the role of a good intern and eventually a good resident and practitioner. Not to mention, I have to get ready to take step 3 of the boards. I plan on taking them in 6 months. So to get ready, I am reading Kaplan's Mastering the Boards and will be signing up for the Q-banks. The more questions I do, the better I will be. I plan on getting a fellowship so I would like to score very well. While I did about 2500 questions to prepare for Step 2, I plan to do at least this many for Step 3. The big difference is that this test is 2 days long. That's right dear readers, you heard me; 2 DAYS!!!! Lord Help Me.

Our last loan check came in, so we no longer have to eat Ramen Noodles and I am going to start getting paid, which is a nice return to the way things ought to be.


   Uptodate: Clinical Reference

Next time, I will talk about my first on call in the ICU!!

Last Day of Vacation

So today is it. The last day of my vacation and the last day that I am among the ranks of the unemployed (hopefully for good). I am putting finishing touches on my vacation, am going to try to get some fishing in later today when the sun goes down a little and get some me time. The last time I had me time was in Las Vegas.


This week is also tough because we are still waiting for our last residency loan check to come in but expenses do not wait for that. The cash reserves are starting to really scratch the bottom of the barrel and I may have to suck it up and take a few late fees just to wait. But at least in 2 weeks I get paid and then a steady stream of income will come our way.

The wife and I were talking yesterday about all of the great FREE things that are going around that, if we can, we should take advantage of. For example, free concerts sponsored by the recreation department, going to parks with a picnic, etc. This is certainly the lowest point in our financial life. It is ironic that I am going to be 37 years old and I still cannot hold my head above water financially. It will be great that I can start feeling that my family can hold its own. Yet, I know in my mind that this will be the case once I am done with training either in 3 or 6 years if I get into my fellowship (which I intend to).

So many things that we would like to do. And yet we still have to wait. But if we waiting this long, what is another few years right? We are young and fairly healthy.

OK. till next time.

Orientation almost over

Hello there dear readers. I hope that everything is going well. I am speaking to you from the other side of orientation. Well, not quite. I have 2 more days to go. Tomorrow I take the ACLS exam and then on tuesday I learn the electronic medical record. Then I have 2 days off and the I officially start with my first day as an intern.

So, according to my schedule I am spending my first month in the Emergency Department. Kind of ironic in that this is what I was originally trying for. However, I get to be on call in the ICU and THAT is what I AM going for. Then I do 1 month in the Intensive Care Unit. I will be happier than a pig in shit.....Then I get a month of elective, which I may either stay in the ICU, or do pulmonary. Although I am leaning towards ICU. My hours are probably 7a-5p unless I am on call, then my hours increase until 10:30pm. But I am psyched.

This whole week in orientation, I was anxious and excited and scared at the same time. I am anxious and excited to start, but I am also scared that I do not know much....this is normal for all new interns. But I started reading. I read the NEJM every day and I am going to be adding 1-2 hours per day of a pertinent subject. I will take 1 or 2 cases and read all about them.

In the meantime, have been reading "The Jungle" by Upton Sinclair. It is about the meatpacking industry at the turn of the century. Since the Kindle is a free app for android, the book is available for free as well. So when there is a break, or lunch, or I am in line I break out the phone and read the book. It is a nice diversion from everything else.

   
Until Next time.