Wow!
Being a resident, part of my training is performing procedures on little children. During these procedures we always practice on a stable child (one not about to possibly die) and we always have an expert on hand to guide us. Today I tried my hand at intubation of a little 30 week kid with gastroschesis (the baby's bowels are born outside it's belly).
Intubation first involves sedation of the child. After the child is sedated you then take a small blade with a light on the end and stick it down the child's throat. After that you use force to open the sedated child's airway up. At this point the baby's vocal cords, ect. should be in view. You then slide a small tube down the blade, through the cords, and into the trachea, which will be used to pass air down into the child's lungs....sounds simple right?
Why wouldn't it be simple? I've done this with many plastic dolls that are supposedly very "life-like" and they were all easy. Well, let me tell ya, its a bit different when it's a fragile looking little 32 week child with it's bowels hanging out in an "icing-sack". Another thing is that the word "sedated" is a term used very loosely with this child...it's been on pain medications for several days, so a tolerance to the medication has developed. So although he seemed sedate when I started to pry his throat open forcefully, he came right out of it....my attending told me this is perfectly normal (as the child is writhing, gagging, and fighting and I have a 3 inch piece of metal prying open his mouth) - "We used to do it without sedation...that was hard." (As if he is actually sedated right now.) I fight this little kid's head and arms which are ridiculously strong for such a little thing...but I guess having a 3 inch blade of metal forcibly jammed down your throat would give anybody a little bit of mad strength. Anyways long story short, I work on him for awhile never once gazing upon the vocal cords I'd heard so much about...I think it was after about 5-6 tries, each turn giving him a little break, then the respiratory therapist had a go...(while I wouldn't wish bad on anybody, it made me feel better that she couldn't get it either). But then my attending decides to give it a shot and WaaaLaaa! He shows me the vocal cords and in seconds has the tube slid down through them....How did he do that?!?!?! One SINGLE try!
As with anything in medicine, if you say to yourself "I can do that." or "That's easy enough." Get ready for a lesson...needless to say I obviously need more of them.
Wednesday, June 30, 2010
Tuesday, June 29, 2010
The Art of Medicine
Today was kinda the same ol' shtick. But you know how some days just aren't quite on key, today was one of those days. For example, we're standing next to a baby's room talking about what's going on with him. We're discussing that we've had to increase oxygen during feeds, the baby is growing more edematous (fancy word for swollen with water), and the lasix (a drug that makes you pee off that water) isn't doing the trick at the moment. My plan today was to get an X-ray of her chest today and consider changing or increasing his diuretics (lasix). I said my plan, which immediately was shot down (nicely of course) by the attending. Basically he said, "Lets give the lasix a bit longer to work and see how she is doing then. The X-ray won't change our plan of management."
Damn! Why didn't I think of that!
When to act, when not to act. That's one of those things that fall under "THE ART" of medicine. Going through medical school you gain the medical "language" and their way of thinking, enough so that you can see a problem when it's coming on most times. You even know enough to intervene in the "right" fashion to correct that particular problem and if you don't know, looking it up is quick and easy (usually). However, it's the experience and skill in the art of medicine that tells you when to act on what you are seeing and even if what you are seeing is "important" in the first place.
The art of medicine is where those phrases come from like "the enemy of good is better", "sometimes doing nothing is the best treatment of all", and (my favorite) "treat the patient, not the numbers". Most times I falter because I want to fix every little thing I see, "Oh! The baby's sodium is down a couple of points maybe we should supplement." My best advice, to myself, is to chill out (I constantly forget to). I find I do best when I'm loose and in the moment. It reminds me of hitting a golf ball, if you're squeezing the hell out of the club and you try to hit it with all your might, you'll shank it, which, if you are like me, you do more often than what you are trying to accomplish, which is a long drive straight down the fairway. However, there are those rare times in golf and in medicine (for me) when I hold the club just on the firm side of "loose" and instead of focusing just on the ball, you see the big picture and boy is it pretty when you see that ball fly right where you want it.
When I'm uptight and treating numbers and small signs of problems, that's when I get to putting a band aid on every little scrape I see. You become that annoying person who is always raising his/her hand in class asking pointless, insignificant questions - it's a complete waist of energy and time. (Most times patients will get better on their own if you let them - another "Art" quote) Sadly, today I was more of that person than I would like.
I know I've said this but sometimes the amount of things I need to know, the height my skill level has to reach (and where I'm currently at), it's daunting. Today I was a little depressed. If one day a person is reading this, thinking of joining the doctor ranks, I would think long and hard about it. Up to this point it has daily tested my pride, my knowledge, mental endurance, and optimism...it's something that when I'm doing well I love and when I'm doing sub par it gets me supremely discouraged. But tomorrows another day, I'll sleep, I'll wake up, and I'll try again till I get it.
Damn! Why didn't I think of that!
When to act, when not to act. That's one of those things that fall under "THE ART" of medicine. Going through medical school you gain the medical "language" and their way of thinking, enough so that you can see a problem when it's coming on most times. You even know enough to intervene in the "right" fashion to correct that particular problem and if you don't know, looking it up is quick and easy (usually). However, it's the experience and skill in the art of medicine that tells you when to act on what you are seeing and even if what you are seeing is "important" in the first place.
The art of medicine is where those phrases come from like "the enemy of good is better", "sometimes doing nothing is the best treatment of all", and (my favorite) "treat the patient, not the numbers". Most times I falter because I want to fix every little thing I see, "Oh! The baby's sodium is down a couple of points maybe we should supplement." My best advice, to myself, is to chill out (I constantly forget to). I find I do best when I'm loose and in the moment. It reminds me of hitting a golf ball, if you're squeezing the hell out of the club and you try to hit it with all your might, you'll shank it, which, if you are like me, you do more often than what you are trying to accomplish, which is a long drive straight down the fairway. However, there are those rare times in golf and in medicine (for me) when I hold the club just on the firm side of "loose" and instead of focusing just on the ball, you see the big picture and boy is it pretty when you see that ball fly right where you want it.
When I'm uptight and treating numbers and small signs of problems, that's when I get to putting a band aid on every little scrape I see. You become that annoying person who is always raising his/her hand in class asking pointless, insignificant questions - it's a complete waist of energy and time. (Most times patients will get better on their own if you let them - another "Art" quote) Sadly, today I was more of that person than I would like.
I know I've said this but sometimes the amount of things I need to know, the height my skill level has to reach (and where I'm currently at), it's daunting. Today I was a little depressed. If one day a person is reading this, thinking of joining the doctor ranks, I would think long and hard about it. Up to this point it has daily tested my pride, my knowledge, mental endurance, and optimism...it's something that when I'm doing well I love and when I'm doing sub par it gets me supremely discouraged. But tomorrows another day, I'll sleep, I'll wake up, and I'll try again till I get it.
Monday, June 28, 2010
KUMC - Music Videos
I'm really proud of this video, even though I didn't make it - a couple of my good friends did. I figured since my last post was kinda dull I'd punch it up a bit with this, enjoy :)
Ramblings
So a little update on the baby from the previous blog. She is doing well, but as it turns out I wasn't completely paranoid. She did develop some respiratory problems over the weekend and into today, however, that's not to say I was right about the treatment, I guess I knew enough to see something going wrong possibly, but not enough to know how to treat it (my attending today recommended a diuretic to get the fluid off the baby's lungs and she is doing better).
Today I put in umbilical artery and vein lines. It's amazing how much faster you learn as an intern compared to being a student. When you are a student, everything is hands off. When you are a resident, you would actually have to say "I can't do this." in order to get out of doing it. In the week or so I've been doing this I've already learned so much, I can see how intense this is going to be and how well it will prepare me for when I hop off the branch and fly on my own.
Overall today was pretty low key, I'm finally getting the hang of alot of what the NICU is. My patients didn't have any big interesting issues today, some I'm preparing to discharge (the parents are so happy when we tell them - some have been their for several months. Can you imagine?)
A little on my current schedule. - might be boring so skip it you want.
So right now I'm working on the NICU which is from 6am till I get my work done (max of 5pm). I have call every 4 days which is from 6am until 12am the next day, during that day I have to go to deliveries and receive any high risk babies that come my way (no matter the hour). The days off I get are variable, depending on where my call day falls, basically if I'm not on call on the weekends then I get those days off (ie thursday-call days I get both saturday and sunday off; saturday-call days I get half a day off...in two weeks...ouch, which I will probably use to sleep).
It's actually not so bad, however I'm just starting it so maybe I should say that at the end of the rotation - I think hay harvest on the farm sucks worse - these city kids got it easy ;P. Tomorrow I'm on call and I feel like I just got done with my last one. Also one day out of the week I go to my clinic in the afternoon to see my patients, so tomorrow will be the first day I grace outpatient pediatrics as a doctor (sounds fun, we'll see). I also got some handy-dandy business cards from the school that I hand out to new patients, which is cool...I can't believe after 12 years high school, 4 years pre-med, and 4 years medical school I finally have a job (that I get paid minimum wage for - but at least I'm getting paid) I just calculated it out, I get paid 11.78$ an hour, however, I have to pay ~2000$, a month in medical school loan bills - thank you health care reform! (you used to be able to defer them until you started getting paid well)
I know I should pay more attention to reform, but my stance (right now) is that I'm busy and health care is going to do it's thing regardless of what some peon resident does or doesn't do. I wish I had something more interesting to blog, but I can't think, I'm so groggy right now, so until then.
Newbie-Doc
Today I put in umbilical artery and vein lines. It's amazing how much faster you learn as an intern compared to being a student. When you are a student, everything is hands off. When you are a resident, you would actually have to say "I can't do this." in order to get out of doing it. In the week or so I've been doing this I've already learned so much, I can see how intense this is going to be and how well it will prepare me for when I hop off the branch and fly on my own.
Overall today was pretty low key, I'm finally getting the hang of alot of what the NICU is. My patients didn't have any big interesting issues today, some I'm preparing to discharge (the parents are so happy when we tell them - some have been their for several months. Can you imagine?)
A little on my current schedule. - might be boring so skip it you want.
So right now I'm working on the NICU which is from 6am till I get my work done (max of 5pm). I have call every 4 days which is from 6am until 12am the next day, during that day I have to go to deliveries and receive any high risk babies that come my way (no matter the hour). The days off I get are variable, depending on where my call day falls, basically if I'm not on call on the weekends then I get those days off (ie thursday-call days I get both saturday and sunday off; saturday-call days I get half a day off...in two weeks...ouch, which I will probably use to sleep).
It's actually not so bad, however I'm just starting it so maybe I should say that at the end of the rotation - I think hay harvest on the farm sucks worse - these city kids got it easy ;P. Tomorrow I'm on call and I feel like I just got done with my last one. Also one day out of the week I go to my clinic in the afternoon to see my patients, so tomorrow will be the first day I grace outpatient pediatrics as a doctor (sounds fun, we'll see). I also got some handy-dandy business cards from the school that I hand out to new patients, which is cool...I can't believe after 12 years high school, 4 years pre-med, and 4 years medical school I finally have a job (that I get paid minimum wage for - but at least I'm getting paid) I just calculated it out, I get paid 11.78$ an hour, however, I have to pay ~2000$, a month in medical school loan bills - thank you health care reform! (you used to be able to defer them until you started getting paid well)
I know I should pay more attention to reform, but my stance (right now) is that I'm busy and health care is going to do it's thing regardless of what some peon resident does or doesn't do. I wish I had something more interesting to blog, but I can't think, I'm so groggy right now, so until then.
Newbie-Doc
Saturday, June 26, 2010
A Small Price
".......room 453 decreased fetal heart tones."
It's three am and in being woken up I barely catch those last few words on my in-house pager. I'm wondering if I imagined it, but as the fog clears in my head I realize that they were calling for me...I know you are supposed to be scared, I should have been but I was too groggy to be scared (this was my first night on call by myself, so I should be). I hustle down several hallways to where I think the room is at. There's a woman screaming and people telling her to push. A nurse asks for my name and title, still groggy I say my last name and then say the letters "M.D." behind them...that woke me up. I'm standing at the head of the warmer, this baby's coming to ME, and I better be ready. I check my equipment as best as I can, ask for patient history, and in the meantime I hear a scream...but from a much smaller person (that's a really good sign for me who is now frightened to hell and back). They bring the babe over and all that fear is for nothing. A perfect baby. We wipe him down, give him bulb suctioning, he pees on the RT beside me (close call ;P) pretty much normal and routine. While all this is happening the attending (my boss) rolls in, I report apgar's (a overall sign/rating of how well the baby is doing acutely) to the nurses and my attending says "thanks, I'll grab the paperwork..you can go back to sleep if you want"...WOW. I say "WOW" not because it was exciting (it was definitely that) but because of how big of an ego boost that was to walk in, control the scene (by myself) without my authority ever being questioned, and then my attending speaking to me as an equal...what a rush.
Flash forward to 30 minutes later. My pager goes off again. This time I'm awake. The nurse has lab values and an X-ray of a baby that I am covering for the night (usually you have your own patients, on call you cover everyone's). I check the labs over, look at the X-ray. This little boy was born a "bit" too early and developed a nasty pneumonia, which has been resolving. Looking over the labs I see some trends in values that I don't like, the heart rate is trending just a bit higher than normal for the kid (maybe I'm overreacting), I check respiratory rate which is decreasing along with the O2 sats. Checking the X-ray it looks much improved compared to two days ago. I look back at all the values/vitals and they are "acceptable", buuuutttt I better go down and see the baby. When I get there I see the tiniest human you've ever seen, hooked up to this extremely large mask and machine that's helping him breath. I wash up and listen to him with the stethescope over his chest..."what the hell was that?!?!"...sounded like a little bird tweeting in his lungs. I check his vitals, still right where they were, not helping decide at all on this one. I go out and talk to the nurse, nurses are awesome. I tell her that I am hearing a musical kind of stridorous* sound in the babies breathing, I ask her if she thinks we aught to give the racemic epi prn that one of my co-workers has ordered (I would check that decision with my attending before I did it - I'm pretty high on myself at this point but not that high thank God). The nurse is completely nice, but I think she knows I'm really jumping to conclusions (even if I havn't figured that out yet), so kindly she says "I didn't hear any stridor when I was in there." The respiratory therapist happens to walk by and the nurse and I talk with her, she also doesn't think epi is necessary (I thought the nurse was pretty sure the way she said it...it sucks being wrong, by this point I figure I probably am overreacting), she says the machine sometimes causes the weirdest sounds if there is water in the tube. She goes in and shakes the water out of the tube connected to the babies mask. I listen again and it's miraculously gone. (how stupid am I?) Granted I still don't like the trends I'm seeing in labs and vitals (which are still acceptable), also the nurse notes that she thinks the baby is having more retractions (when you're using more of your muscles to breath harder - a sign that it's more difficult to breath). By this point, I've had a quick reality check.
It's three am and in being woken up I barely catch those last few words on my in-house pager. I'm wondering if I imagined it, but as the fog clears in my head I realize that they were calling for me...I know you are supposed to be scared, I should have been but I was too groggy to be scared (this was my first night on call by myself, so I should be). I hustle down several hallways to where I think the room is at. There's a woman screaming and people telling her to push. A nurse asks for my name and title, still groggy I say my last name and then say the letters "M.D." behind them...that woke me up. I'm standing at the head of the warmer, this baby's coming to ME, and I better be ready. I check my equipment as best as I can, ask for patient history, and in the meantime I hear a scream...but from a much smaller person (that's a really good sign for me who is now frightened to hell and back). They bring the babe over and all that fear is for nothing. A perfect baby. We wipe him down, give him bulb suctioning, he pees on the RT beside me (close call ;P) pretty much normal and routine. While all this is happening the attending (my boss) rolls in, I report apgar's (a overall sign/rating of how well the baby is doing acutely) to the nurses and my attending says "thanks, I'll grab the paperwork..you can go back to sleep if you want"...WOW. I say "WOW" not because it was exciting (it was definitely that) but because of how big of an ego boost that was to walk in, control the scene (by myself) without my authority ever being questioned, and then my attending speaking to me as an equal...what a rush.
Flash forward to 30 minutes later. My pager goes off again. This time I'm awake. The nurse has lab values and an X-ray of a baby that I am covering for the night (usually you have your own patients, on call you cover everyone's). I check the labs over, look at the X-ray. This little boy was born a "bit" too early and developed a nasty pneumonia, which has been resolving. Looking over the labs I see some trends in values that I don't like, the heart rate is trending just a bit higher than normal for the kid (maybe I'm overreacting), I check respiratory rate which is decreasing along with the O2 sats. Checking the X-ray it looks much improved compared to two days ago. I look back at all the values/vitals and they are "acceptable", buuuutttt I better go down and see the baby. When I get there I see the tiniest human you've ever seen, hooked up to this extremely large mask and machine that's helping him breath. I wash up and listen to him with the stethescope over his chest..."what the hell was that?!?!"...sounded like a little bird tweeting in his lungs. I check his vitals, still right where they were, not helping decide at all on this one. I go out and talk to the nurse, nurses are awesome. I tell her that I am hearing a musical kind of stridorous* sound in the babies breathing, I ask her if she thinks we aught to give the racemic epi prn that one of my co-workers has ordered (I would check that decision with my attending before I did it - I'm pretty high on myself at this point but not that high thank God). The nurse is completely nice, but I think she knows I'm really jumping to conclusions (even if I havn't figured that out yet), so kindly she says "I didn't hear any stridor when I was in there." The respiratory therapist happens to walk by and the nurse and I talk with her, she also doesn't think epi is necessary (I thought the nurse was pretty sure the way she said it...it sucks being wrong, by this point I figure I probably am overreacting), she says the machine sometimes causes the weirdest sounds if there is water in the tube. She goes in and shakes the water out of the tube connected to the babies mask. I listen again and it's miraculously gone. (how stupid am I?) Granted I still don't like the trends I'm seeing in labs and vitals (which are still acceptable), also the nurse notes that she thinks the baby is having more retractions (when you're using more of your muscles to breath harder - a sign that it's more difficult to breath). By this point, I've had a quick reality check.
You are inexperienced. You don't know the difference between OK and dangerous. You are not staring as the lead character in your own movie. Talk to the expert before you hurt someone being an idiot!
I'm back down to earth. I swallow my pride and tell the nurse and respiratory therapist "thanks alot for showing me what that was, I had no idea about that. I really appreciate it." (you fight the urge to act like you should have known that...which I know isn't true...it's my THIRD day as an intern! I should be confident when I'm experienced, not confident because I'm arrogant. Dumb!) Now that I am also in understanding that I am the most inexperienced person on the wards, I let them know that just to be safe I'm going to let my attending know about the vitals/labs/retractions. I cringe as I walk back to the residents room to wake up the attending watching this little one. I tell him all that has transpired (I make it quick...conveniently leaving out the whole musical stridor thing), he sleepily looks over the labs/vitals and decides they are "fine". I thank him and come back to the resident's room to write this blog about how arrogant I was just a second ago and how pathetically easy it was to get my head swollen. It's hard to write about.
Regardless if the vitals/labs get better or worse for that baby (which I have confidence in my attending that they won't) I got a very small taste of what has turned alot of good and great doctors into egotistical snobs...some mean/rude to people under them because they simply can. I wish I could say I realized it from the start and checked myself immediately, then I wouldn't have to embarrass myself on this blog. It was so easy to fall into that "star" role in that first delivery. I realized when you tell the people around you (who don't know you) that you are a doctor, they assume experience and authority. The questions they ask you are phrased so much differently than when you are a student, they force answers, statements, ect. that reinforce that role, and if you are as inexperienced as I am, that can be very dangerous thing if it's not caught. It's embarrassing to write about, but it's a good lesson and hopefully one I don' t need retaught again, because I got this lesson for a very cheap price, just a little pride.
Thursday, June 24, 2010
The Screaming Little Girl
Well today I admitted my first patient onto the unit. I think if I was writing about something else less serious I'd be wishing I had something more interesting to write about, something more eventful, but since I'm writing about little babies, I'm more than satisfied that this little girl had an uneventful birth, although it looks like she has genetic disorder, that's gonna make her bones pretty fragile. She's gotta a long road ahead of her and a lot of pain. It's crazy that I see the number of bone fractures she had and think the birth went well, but there are so many worse ways to start out, some don't really even get much of chance. Honestly it's hard to say who has it worse or whether they even notice that they have a decrease in quality of life, that stuff is better relegated to the ethics books and politicians, what I can say is that others way of life makes me cringe more than others. I remember in medical school a little cute 3 year old girl screaming, it was the first night I worked a pediatrics call. I came down into the ED and saw her covered in small 1cm size boils covering the left side of her face and head, her chest, back, and most of both arms. She was having a reaction to Herpes Simplex Virus, a virus that in you and me would cause "cold sores" or "fever blisters" on the lips. She had a rare T-cell deficiency, a cell type that among other things kills cells that have virus in them. So she can't make these, so the virus runs rampant. To make things worse HSV is something that never leaves your body, which is why you and I will get cold sores over and over again. We get sick and our immune system isn't strong enough to keep it dormant in the body, so out pops another cold sore. Except with this little girl, this was her cold sore, and to some degree or another, this would happen again and again. Not to mention the other pains that a T-cell deficiency would cause her. Depending on how bad this genetic disorder is with the little baby I just admitted it could be that painful for her as well. But it doesn't matter, that first experience with that little girl screaming terrified me. But it's also why I'm a pediatrician, but that's a whole other can of worms and I'm tired.
Newbie-Doc
Newbie-Doc
Wednesday, June 23, 2010
"I'm No Super Man"
SO today was my first day on the job as a new doctor. I'm going to start with getting up in the am - I think it is the scrubs song "I'm no superman" that made me think of this comparison, but when I threw all my clothes on and SLOWLY put on my white coat, I suddenly felt very weird. I felt like a poser, imagine if you'd been to superman school and learned how he does all his miraculous acts and how those things happen, but most of them you've only seen done once or twice, maybe some of it you don't even know about, but today is your first day as ol' supes, and while you know you are SUPPOSED to be able to do what he does, you won't be stopping trains with your bare hands anytime soon (if you can help it). You put on the suit and cape and realize your kinda scrawny to be wearing it. You know that when you go outside someone will laugh at how ridiculous you look trying to pretend to be that hero when you know you totally are not. Mostly your scared because you think someone might expect you to jump over a building or do something else incredible. This doesn't even cover your fears of what the other superhero's will say when you show up at their headquarters, even if the real world gets fooled into thinking you are that superhero, they, your co-workers, most definitely know you are not that guy, are they going to laugh when you come in dressed like this? Maybe I should just wear scrubs, but you know you're supposed to wear it so you take a deep breath and put that long white coat on that so many of the people that you've looked up to and learned from for so many years wear - it's scary.
Then you get there and there is SO much to do and learn. You thought you were smashed with stuff to know when you were a medical student, now you not only have to know all those things, but you are expected to take responsibility for your patient, so you do, knowing that today you most certainly will experience crushing defeat. Luckily, this residency I'm at had the old interns (the ones I'm replacing) stand behind me all day and show me how to operate the computer and sometimes even show me stuff I don't know (OK that's actually probably the theme of today - What I don't know, that second one happened ALOT). Anyways they were great I felt overwhelmed and a bit out of place like I'm walking around in over sized clown shoes, but for the most part it's what I've come to expect from new rotations: discomfort, sense of being overwhelmed, and feeling like you're an idiot...then you learn and get better and soon you'll be able to fake it convincingly...I haven't got to the whole "being" the doctor part yet, but I imagine that comes after the faking it convincingly.
Patient wise I really didn't have any crazy ones today (which was a blessing). Really just gather the facts and make a plan, present it to the attending, write a note and some orders, and you're out. I did get to go to a delivery. It was another new intern's baby but I tagged along just to watch (every little bit helps). The baby was born with some risk factors that made it likely to be in trouble, so we were called in to assist with delivery. Overall, the baby ended up being pretty easy going, he did have a head defect known as craniosynostosis (sutures of the head are closed - usually they are open at birth allowing for brain growth), which isn't horrible if its caught early which it was, he will simply need some corrective surgery soon. The little guy was really cute and gave us a good old cry straight out of the womb (good sign). My biggest scare/surprise of the day came when the baby was born and it was our turn to take care of it.
As a medical student, training isn't real hands on. You get to see people do stuff, but mostly the actual doctors are doing it. It's really aggravating sometimes as a student to think you're going to get to perform something cool only to have it stolen out from under you by a doctor who wants to do it. So mostly you're standing in the corner of the back of the room watching things go down, it's annoying but you get used to it and you try to do things when you can. That's why it was such a shock to me when Karly (our senior resident) had Jen (the new intern in for the baby) stand up front and center with the baby and warmer as it was received. Karly pointed out all Jen's tools and made her do everything....WOW! While Jen didn't have much to do with this well-behaved little boy, it was still an awesome shock for the realization to hit me that we're the doctors now...(so far I'm not feeling it yet).
Scrubs - The Complete First Season
Then you get there and there is SO much to do and learn. You thought you were smashed with stuff to know when you were a medical student, now you not only have to know all those things, but you are expected to take responsibility for your patient, so you do, knowing that today you most certainly will experience crushing defeat. Luckily, this residency I'm at had the old interns (the ones I'm replacing) stand behind me all day and show me how to operate the computer and sometimes even show me stuff I don't know (OK that's actually probably the theme of today - What I don't know, that second one happened ALOT). Anyways they were great I felt overwhelmed and a bit out of place like I'm walking around in over sized clown shoes, but for the most part it's what I've come to expect from new rotations: discomfort, sense of being overwhelmed, and feeling like you're an idiot...then you learn and get better and soon you'll be able to fake it convincingly...I haven't got to the whole "being" the doctor part yet, but I imagine that comes after the faking it convincingly.
Patient wise I really didn't have any crazy ones today (which was a blessing). Really just gather the facts and make a plan, present it to the attending, write a note and some orders, and you're out. I did get to go to a delivery. It was another new intern's baby but I tagged along just to watch (every little bit helps). The baby was born with some risk factors that made it likely to be in trouble, so we were called in to assist with delivery. Overall, the baby ended up being pretty easy going, he did have a head defect known as craniosynostosis (sutures of the head are closed - usually they are open at birth allowing for brain growth), which isn't horrible if its caught early which it was, he will simply need some corrective surgery soon. The little guy was really cute and gave us a good old cry straight out of the womb (good sign). My biggest scare/surprise of the day came when the baby was born and it was our turn to take care of it.
As a medical student, training isn't real hands on. You get to see people do stuff, but mostly the actual doctors are doing it. It's really aggravating sometimes as a student to think you're going to get to perform something cool only to have it stolen out from under you by a doctor who wants to do it. So mostly you're standing in the corner of the back of the room watching things go down, it's annoying but you get used to it and you try to do things when you can. That's why it was such a shock to me when Karly (our senior resident) had Jen (the new intern in for the baby) stand up front and center with the baby and warmer as it was received. Karly pointed out all Jen's tools and made her do everything....WOW! While Jen didn't have much to do with this well-behaved little boy, it was still an awesome shock for the realization to hit me that we're the doctors now...(so far I'm not feeling it yet).
Scrubs - The Complete First Season
Tuesday, June 22, 2010
I Am J.D.
Scrubs is the most realistic doctor show I know of. My wife makes me watch Grey's Anatomy which (I'm Sorry) is basically people sleeping with other people, it's addictive and totally unrealistic trash...I can't believe they shot McDreamy in the heart!!! :P Seriously check out scrubs for a reality check.
Scrubs - The Complete First Season
"Tomorrow We Dine In Hell"
Last day of orientation was today and they dropped a crap ton on top of me for work to do. Along with it I also got several hallmarks of a doctor - DEA number (number that lets me prescribe drugs), my long white coat (students have to wear short ones that look pretty dumb), and drum roll....my medical license ohhhh ahhhhh! (it's like a drivers license, but it's easier to kill people with it). That was gallows humor, sorry if it seems callus, I really am pretty freaked out about the whole doctor thing, because tomorrow I'm on the NICU as an actual doctor. Crazy! Tomorrow at 6am I'm gonna be taking care of little babies and people are going to expect me to know what I'm doing...probably not the "know what I'm doing" thing, but I gotta wear the pants...I'm not going to sleep tonight. (actually I got 2 tylenol pm's says I will).
If there had to be a theme of today it was STRESS: HOW RESIDENCY WILL DESTROY YOUR LIFE AND CHANGE WHO YOU ARE AS A PERSON. We had several lectures just on this. You know that's what they said about medical school and they were right it grew me up alot and I'm sure residency/internship will be worse like they are saying, but from here I just can't comprehend it so I'm not going to worry about it if I can help it. If I have people reading this, you'll get to see it's effect on me probably more than I will - I often don't realize how stressed I am until whatever is stressing me is over. Send me a comment if you think you see some cries for help or suicidal comments in my writing ;P
Sorry I don't have more to write about. I'm sure I'll have something for you tomorrow (it's going to be a wild ride). Also I am writing about some of my med school experiences - there is this one that I've been saying I'd put to paper for a long time as it is hilarious, I know I've got the worst, most embarrassing 1st day experience in all of the medical school students in 2010 if not all time, but your gonna have to wait on that one because I want it a little more well written than these blurbs I put out. Alright I'm out. Peace.
Newbie-Doc
If there had to be a theme of today it was STRESS: HOW RESIDENCY WILL DESTROY YOUR LIFE AND CHANGE WHO YOU ARE AS A PERSON. We had several lectures just on this. You know that's what they said about medical school and they were right it grew me up alot and I'm sure residency/internship will be worse like they are saying, but from here I just can't comprehend it so I'm not going to worry about it if I can help it. If I have people reading this, you'll get to see it's effect on me probably more than I will - I often don't realize how stressed I am until whatever is stressing me is over. Send me a comment if you think you see some cries for help or suicidal comments in my writing ;P
Sorry I don't have more to write about. I'm sure I'll have something for you tomorrow (it's going to be a wild ride). Also I am writing about some of my med school experiences - there is this one that I've been saying I'd put to paper for a long time as it is hilarious, I know I've got the worst, most embarrassing 1st day experience in all of the medical school students in 2010 if not all time, but your gonna have to wait on that one because I want it a little more well written than these blurbs I put out. Alright I'm out. Peace.
Newbie-Doc
Monday, June 21, 2010
Baby Steps
Today was another orientation day. Started at 7am and went until 8 minutes ago...it's funny how a day of sitting through hours and hours of boring bureaucratic stuff can drain your energy - seriously a whole day of "don't do this...don't do that...don't get us sued...don't lose your license". It was brutal.
I was walking in to it this am and saw a guy walking down the path ahead of me. He was well dressed in business slacks, nice shoes, matching collared shirt, and a tie. I was walking in with my T-shirt, shorts, and flip flops on. I thought to myself, "There goes a doctor. Gotta be." I walked around to the front of the hospital, somewhere in there I lost him. I sat down in the orientation and next to me was, yep you guessed it, that guy. Turns out he's an OB intern starting new like me. It came to me suddenly that I'm done being the student and I'm going to have to start presenting myself as a doctor in order to be taken seriously as one...I will NOT wear a tie though (did you know they spread disease - if you see a doctor wearing a tie - give him hell - there are studies that prove he is putting you at risk). It's not that I want to "fit" in, it's that you won't be as effective to your co-workers and your patients if you don't look the part.
I think it's a combination of me looking younger than I really am and being a doctor (a role specifically associated with the words "old", "wise", and maybe "nerd") that lends to me really being able to see how dress effects patient and co-worker relations. For most of medical school I had my hair grown out and didn't wear my glasses because I really didn't need them (legally my eyesight is barely impaired). It wasn't until I realized my patients would follow my directions better and ask less questions indirectly aimed at "are you really a doctor" that I really began wearing my glasses everyday...it just made life easier. I really felt pressured to "Be" the doctor when I cut my hair and wore the glasses - you might think I'm neurotic, but I went back to the long hair really as quick as it would grow out...there were too many nurses asking me what to do and patients wondering what I thought. If you're wondering what I look like right now (GASP!) I'm sporting my nerd glasses and short hair...baby steps people...baby steps.
I was walking in to it this am and saw a guy walking down the path ahead of me. He was well dressed in business slacks, nice shoes, matching collared shirt, and a tie. I was walking in with my T-shirt, shorts, and flip flops on. I thought to myself, "There goes a doctor. Gotta be." I walked around to the front of the hospital, somewhere in there I lost him. I sat down in the orientation and next to me was, yep you guessed it, that guy. Turns out he's an OB intern starting new like me. It came to me suddenly that I'm done being the student and I'm going to have to start presenting myself as a doctor in order to be taken seriously as one...I will NOT wear a tie though (did you know they spread disease - if you see a doctor wearing a tie - give him hell - there are studies that prove he is putting you at risk). It's not that I want to "fit" in, it's that you won't be as effective to your co-workers and your patients if you don't look the part.
I think it's a combination of me looking younger than I really am and being a doctor (a role specifically associated with the words "old", "wise", and maybe "nerd") that lends to me really being able to see how dress effects patient and co-worker relations. For most of medical school I had my hair grown out and didn't wear my glasses because I really didn't need them (legally my eyesight is barely impaired). It wasn't until I realized my patients would follow my directions better and ask less questions indirectly aimed at "are you really a doctor" that I really began wearing my glasses everyday...it just made life easier. I really felt pressured to "Be" the doctor when I cut my hair and wore the glasses - you might think I'm neurotic, but I went back to the long hair really as quick as it would grow out...there were too many nurses asking me what to do and patients wondering what I thought. If you're wondering what I look like right now (GASP!) I'm sporting my nerd glasses and short hair...baby steps people...baby steps.
Sunday, June 20, 2010
Of Roads Less Traveled
So this last Friday we had to shadow the interns on the NICU (Neonatal Intensive Care Unit) to observe how they do their job...because come Wednesday it will be OUR job. Over all, the NICU, which I havn't worked on before, is pretty similar to the other rotations I've been on.
(I'll describe it because I don't think this is something the people understand very well, mostly because of it's poor portrayal in the media)
In the morning you gather facts (labs, overnight events, vitals, neonatal physical exam, ect.), you use those facts to uncover the patient patho-physiology (what's going on in their body), and if needed you apply your medical knowledge, as best you can, to intervene on the behalf of your patient...but being totally inexperienced, as I am, you aren't allowed to act until you run this whole discovery/thought process thing by your attending (ie. THE HEAD DOCTOR...capitalized for effect). That's where "Rounds" come in. Rounds is when every intern & resident gets together to run these things by the attending all at the same time. To compound things further, rounds is also the time when the attending gets to quiz (some would say torture) the group with medical questions in order to find gaps in knowledge and make them better doctors. For first/second year medical students, mentioning rounds will invoke a serious amount of fear and dread...if they say it doesn't scare them they are flat-out lying. But by the time you get to the intern level, most of the "sting" of constantly saying those hated words "I don't know" is taken out of you and you begin to view the process as a way to make yourself better rather than a way to make you look stupid. It took me along time to see rounds that way and my pride/ego still struggles with it often enough. However, rounding with this new doctor was a little different. He didn't question us incessantly, at least not today, but he did give a quick lecture which I was surprised by more and more as I thought on it.
During rounds we came to one of the neonates, around 36-37 weeks of age, that was in the NICU to get a little bigger and also to get off of the nice little drug dependency it had developed in it's momma's belly. We had it on several drugs to counter the withdrawal and it was doing nicely, however it would be in the hospital for several more weeks. As we were new to each baby the interns who were presenting (going through the process previously described) would say a quick blurb about the patient's history so us, the new interns, would understand what the babies were "in" for and what had been done to them thus far. When this poor neonate with the withdrawals was presented the attending stopped the intern mid-history to deliver this odd very elaborate story, which I will summarize as this blog is already very large. (NOTE: I don't think he was reprimanding the intern giving the history as the intern was being very professional about it)
Imagine there is a birthday party going on and you are all invited. There are pieces of cake on the plate and next to them small personal cartons of white milk to drink. However, the night before, you (he points to an intern) sneak in and with a syringe replace all the milk in each box with a different drink, apple juice, orange juice, coffee, strawberry milk, pop, ect. The day of the party the hospital gathers and as is normal for a celebration the crowd toasts with the milk. With the toast, one and all slurps simultaneously from their milk cartons without looking. Suddenly cries of surprise and disgust go out among the crowd as everyone discovers the contents of their cartons not to be white milk. "OH MY GOD!!!"; "DISGUSTING!!!"; "EWWW, IT'S BLACK!!!"
Where does this disgust and resentment come from? It's not because it is poisonous or that it tastes bad. It's because it isn't what you think it should be. A doctors job isn't to pass judgment, a doctors job is to pass on healing and compassion to his or her patients.
I thought this was a really fresh and positive outlook that he'd presented us with, compared to the often cynical views I'd seen and sometimes even expressed myself in my previous place of work. It's funny how you'd often hear people say "I won't say that." or "I probably shouldn't be saying this."...but then they'd say it anyway. It's odd how often the "non-judgmental" thing gets stressed in the academic part of medical school and yet I was 4 years through school and into my 1st year of work when I finally received my first lecture/lesson on the subject in the clinical setting. Like most things in life this idea of a non-judgmental doctor often falls far short of our imagined ideal.
As a beginner in medicine, I often find myself lacking in most things whether academia or practical skill, it's daunting to see how far you have to go to become the thing you wish. The only way I've found around freaking out about how far you have to go is to look at the ground and place one foot in front of the other towards your destination and tell yourself that you'll get there someday. I suppose this "non-judgmental doctor" is just one more freakishly far away place I have to go and as long as I'm moving one foot in front of the other toward it as a goal, someday even if I don't ever get there, I will be far closer to it than if I had never moved at all.
Newbie-Doc
(I'll describe it because I don't think this is something the people understand very well, mostly because of it's poor portrayal in the media)
In the morning you gather facts (labs, overnight events, vitals, neonatal physical exam, ect.), you use those facts to uncover the patient patho-physiology (what's going on in their body), and if needed you apply your medical knowledge, as best you can, to intervene on the behalf of your patient...but being totally inexperienced, as I am, you aren't allowed to act until you run this whole discovery/thought process thing by your attending (ie. THE HEAD DOCTOR...capitalized for effect). That's where "Rounds" come in. Rounds is when every intern & resident gets together to run these things by the attending all at the same time. To compound things further, rounds is also the time when the attending gets to quiz (some would say torture) the group with medical questions in order to find gaps in knowledge and make them better doctors. For first/second year medical students, mentioning rounds will invoke a serious amount of fear and dread...if they say it doesn't scare them they are flat-out lying. But by the time you get to the intern level, most of the "sting" of constantly saying those hated words "I don't know" is taken out of you and you begin to view the process as a way to make yourself better rather than a way to make you look stupid. It took me along time to see rounds that way and my pride/ego still struggles with it often enough. However, rounding with this new doctor was a little different. He didn't question us incessantly, at least not today, but he did give a quick lecture which I was surprised by more and more as I thought on it.
During rounds we came to one of the neonates, around 36-37 weeks of age, that was in the NICU to get a little bigger and also to get off of the nice little drug dependency it had developed in it's momma's belly. We had it on several drugs to counter the withdrawal and it was doing nicely, however it would be in the hospital for several more weeks. As we were new to each baby the interns who were presenting (going through the process previously described) would say a quick blurb about the patient's history so us, the new interns, would understand what the babies were "in" for and what had been done to them thus far. When this poor neonate with the withdrawals was presented the attending stopped the intern mid-history to deliver this odd very elaborate story, which I will summarize as this blog is already very large. (NOTE: I don't think he was reprimanding the intern giving the history as the intern was being very professional about it)
Imagine there is a birthday party going on and you are all invited. There are pieces of cake on the plate and next to them small personal cartons of white milk to drink. However, the night before, you (he points to an intern) sneak in and with a syringe replace all the milk in each box with a different drink, apple juice, orange juice, coffee, strawberry milk, pop, ect. The day of the party the hospital gathers and as is normal for a celebration the crowd toasts with the milk. With the toast, one and all slurps simultaneously from their milk cartons without looking. Suddenly cries of surprise and disgust go out among the crowd as everyone discovers the contents of their cartons not to be white milk. "OH MY GOD!!!"; "DISGUSTING!!!"; "EWWW, IT'S BLACK!!!"
Where does this disgust and resentment come from? It's not because it is poisonous or that it tastes bad. It's because it isn't what you think it should be. A doctors job isn't to pass judgment, a doctors job is to pass on healing and compassion to his or her patients.
I thought this was a really fresh and positive outlook that he'd presented us with, compared to the often cynical views I'd seen and sometimes even expressed myself in my previous place of work. It's funny how you'd often hear people say "I won't say that." or "I probably shouldn't be saying this."...but then they'd say it anyway. It's odd how often the "non-judgmental" thing gets stressed in the academic part of medical school and yet I was 4 years through school and into my 1st year of work when I finally received my first lecture/lesson on the subject in the clinical setting. Like most things in life this idea of a non-judgmental doctor often falls far short of our imagined ideal.
As a beginner in medicine, I often find myself lacking in most things whether academia or practical skill, it's daunting to see how far you have to go to become the thing you wish. The only way I've found around freaking out about how far you have to go is to look at the ground and place one foot in front of the other towards your destination and tell yourself that you'll get there someday. I suppose this "non-judgmental doctor" is just one more freakishly far away place I have to go and as long as I'm moving one foot in front of the other toward it as a goal, someday even if I don't ever get there, I will be far closer to it than if I had never moved at all.
Newbie-Doc
Thursday, June 17, 2010
Video: Spanish Love Song
A Dying Doll
All of the interns got together for neonatal resuscitation training today. It was pretty interesting and low stress, as there is too much to learn in one sitting. We just did alot of scenarios with dummies (plenty of repetition). The very beginning is a 2-3 hour video going over all of the material in one broad swoop by doing reenactments of recussitations again using dummies. Everybody has seen a billion of these between all the other similar courses we take, so when we see some soap opera show actors trying to make a very obvious plastic doll-resuccitation look real, all the while shouting all kinds of made for tv movie cliche's, we have to snicker a little...or alot :P.
But then it came to the 7th and last lesson, which was a neonate born too young which was going to die (like had 99.9% chance of it). Even though it was a plastic doll and the acting was again abysmal, the class was totally silent. We've seen all these things throughout medical school, some of which are really sad, and we're used to dealing with most of them, but I don't think many or any of us had experienced the end of life care of a neonate. As the doctor discussed the choices the parents had, when they pulled out a very small, very fake plastic doll, when the doctor came to tell the parents they had stopped providing respirations for the small "dying" doll, and the mother gave out this long hammy whail, throughout the whole thing the room was in complete silence.
Whether or not my fellow classmates were stunned for the same reason, I can't say. For me, I was spooked by the idea of that doll being my son, or for that matter, any of the other dolls in any of the other scenarios I had laughed at...whatever the reason for everyone else, that 30 minute section got passed every single one of our desensitizations and guards leaving us completely silent at this seemingly dying doll.
But then it came to the 7th and last lesson, which was a neonate born too young which was going to die (like had 99.9% chance of it). Even though it was a plastic doll and the acting was again abysmal, the class was totally silent. We've seen all these things throughout medical school, some of which are really sad, and we're used to dealing with most of them, but I don't think many or any of us had experienced the end of life care of a neonate. As the doctor discussed the choices the parents had, when they pulled out a very small, very fake plastic doll, when the doctor came to tell the parents they had stopped providing respirations for the small "dying" doll, and the mother gave out this long hammy whail, throughout the whole thing the room was in complete silence.
Whether or not my fellow classmates were stunned for the same reason, I can't say. For me, I was spooked by the idea of that doll being my son, or for that matter, any of the other dolls in any of the other scenarios I had laughed at...whatever the reason for everyone else, that 30 minute section got passed every single one of our desensitizations and guards leaving us completely silent at this seemingly dying doll.
Wednesday, June 16, 2010
The Truth
This is hard to write about. It's one of those times I'm going to have to fight the urge to say I did excellent today, that I came prepared, and I was the best doc in the room.
The truth is I didn't do excellent today, I wasn't prepared, and I for sure wasn't the best doc in the room. Today was PALS testing (Pediatric Advanced Life Support) where they teach/test us to save children who are "crashing". Yesterday was perfect when I was practicing it in the first class but today it's testing and I find it's one of those days where all the coffee in the world won't put you back together again. They have these "decision-trees" for how patients present to you ect. Yesterday I flew through them and today I'm crawling. Not to mention the knowledge portion which I'm usually good (no matter what) - I open the test book and I can't keep a read sentence in my head, which makes deciding clinical treatment kinda hard. All in all, just in case you were holding your breath...I passed, but barely. I'd be more worried about my professional future except that I used to do these when I was a fourth year in medical school (before I had 4 weeks of sitting on my butt not thinking about medicine) give me some rest, which at this point sadly is much needed, and some studying/practicing and I'll be back to snuff - its just a constant assault on your pride when everyone else seems to be a walking, talking baby-doc...and you find yourself crawling. :S
Newbie-Doc
The truth is I didn't do excellent today, I wasn't prepared, and I for sure wasn't the best doc in the room. Today was PALS testing (Pediatric Advanced Life Support) where they teach/test us to save children who are "crashing". Yesterday was perfect when I was practicing it in the first class but today it's testing and I find it's one of those days where all the coffee in the world won't put you back together again. They have these "decision-trees" for how patients present to you ect. Yesterday I flew through them and today I'm crawling. Not to mention the knowledge portion which I'm usually good (no matter what) - I open the test book and I can't keep a read sentence in my head, which makes deciding clinical treatment kinda hard. All in all, just in case you were holding your breath...I passed, but barely. I'd be more worried about my professional future except that I used to do these when I was a fourth year in medical school (before I had 4 weeks of sitting on my butt not thinking about medicine) give me some rest, which at this point sadly is much needed, and some studying/practicing and I'll be back to snuff - its just a constant assault on your pride when everyone else seems to be a walking, talking baby-doc...and you find yourself crawling. :S
Newbie-Doc
Helloooooo!
WHY: I'm starting this thing for a billion reasons, namely catharsis, fun, and the ability to look back on my daily experiences in my little hospital years from now.
WHERE: I'm keeping the specifics out of it to be safe from HIPAA (did I spell that right - doesn't matter)
HOW: I'll write SOMETHING daily about my experiences in becoming a doctor at my new residency/internship. NOTE: The names, events, ect will be altered slightly to achieve anonymity of my coworkers, patients, and myself, however, I hope to keep my experience intact and realistic.
WHO: I'm a new pediatrics intern at a very large free standing children's hospital (IE. a hospital only for kids). My wife is a brand spanking new physician as well, doing her internship at a hospital about 10 miles away from me in family practice. We are pretty alone out here in a city bigger than we've ever lived in, farther away from family than we've ever been.
It's scary and exciting (at least for us) and there will be many more posts before this blog closes so if you're interested, stay tuned.
Newbie-Doc
PS - Sorry for the poor spelling/grammar I could do better, but it would hamper how fast I get these out. Wish I was an English major as well, but if you put yourself through reading this for now at least you'll have to do with my spell check :)
WHERE: I'm keeping the specifics out of it to be safe from HIPAA (did I spell that right - doesn't matter)
HOW: I'll write SOMETHING daily about my experiences in becoming a doctor at my new residency/internship. NOTE: The names, events, ect will be altered slightly to achieve anonymity of my coworkers, patients, and myself, however, I hope to keep my experience intact and realistic.
WHO: I'm a new pediatrics intern at a very large free standing children's hospital (IE. a hospital only for kids). My wife is a brand spanking new physician as well, doing her internship at a hospital about 10 miles away from me in family practice. We are pretty alone out here in a city bigger than we've ever lived in, farther away from family than we've ever been.
It's scary and exciting (at least for us) and there will be many more posts before this blog closes so if you're interested, stay tuned.
Newbie-Doc
PS - Sorry for the poor spelling/grammar I could do better, but it would hamper how fast I get these out. Wish I was an English major as well, but if you put yourself through reading this for now at least you'll have to do with my spell check :)
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