In relentless pursuit of my next nap...

Farewell, MICU...

2009-05-31T19:37:00.003-04:00

Tonight is my last night in the MICU. At 7am tomorrow, I will turn over the service to the June interns. It's kind of bittersweet; on the one hand, it's nice to have another month down but I really enjoyed this month. I felt like these were 31 days in which I really grew as a doctor. I took care of some pretty sick patients and made a lot of independent decisions. I finally somewhat understand the mechanical ventilator and can understand how to use it to change a patient's biochemistry. I did a decent number of procedures, and I ran my first code. I relayed terrible news to some families, and shared in others' relief when their loved one took a turn for the better. Good learning experiences all around.

Tomorrow I head to the operating room for a month of Anesthesia (a.k.a. sticking tubes down patient's throats before surgery and then bailing out of there as quickly as possible so I don't have to stay through the whole case).

On Call, Real Time

2009-05-16T01:15:00.002-04:00

It's 1:15am and I'm sitting in my call room in the ICU, looking out the window at the thunderstorm that is unfolding tonight. It has been a pretty slow night so far; I haven't had to admit any patients to the ICU, and most of the existing patients that I'm covering have been quiet, except for one who makes me a little nervous but for now seems to be stable. Nights like these are a mixed blessing. On the one hand, of course it's nice to not be running around like crazy feeling like things are out-of-control busy, admitting people who are incredibly sick and cross-covering ones who are potentially even sicker. It's nice to be able to catch a few ZZ's instead of staying up for 36 straight hours (though I maintain that sleeping while on call isn't really sleeping, at least for me, since I'm constantly anticipating that next page from the nurses or the next Code Blue paged overhead). It's nice to have a manageable workload. It's nice to be able to look out the window on a stormy spring night and watch lightning and listen to thunderclaps. But the further I get along in the process, the more I find that I want to be challenged. I understand fully that calm skies do not make an experienced pilot, and I really want to be put in situations that force me to think, force me to make decisions independently, act quickly, rack my brain for what to do when the pressure is on and there's a patient in front of me that isn't doing well. In this respect, call nights like this are of no use to me.

Otherwise, this has been a decent month so far, once I got comfortable. Overall I'm feeling happier than in recent prior months and seem to be back on track with other life pursuits outside of the still busy work stuff. It's finally warming up, the days are getting much longer, and everything is green again. For better or for worse, only 45 more days as an intern!

Not so spring-y

2009-04-27T20:28:00.005-04:00

As spring unfolds, one thing I have been really struggling with is shaking off all the cobwebs I collected over the winter and finding the energy to do anything but sleep when I'm not working. I have an ever-elongating to-do list and when I get home at the end of a 12-hour day or post-call, the thought of pulling out the list and starting to tackle some of the items on it is too overwhelming. I haven't allotted any time in the last two months for personal organization, and now the chaos that has resulted (or that I perceive has resulted) is starting to stress me out. I'm coming up on a pretty tough rotation (MICU) and I really should have been reviewing my critical care stuff, ACLS algorithms, etc. and I haven't done any of that, and now I'm three days away from starting it, and I have another call night in there so the likelihood that it's actually going to get done I think is pretty low. I'm also finding it difficult to find time and motivation to exercise. This is extremely uncharacteristic of me; I've always enjoyed exercise and have sought out opportunities to challenge my personal level of fitness my entire life and now I can't seem to find the time/motivation/energy. What's going on????

Hoping maybe a different rotation will break this cycle. We'll see, May 1 rapidly approaches...

I'm BAAAACK!

2009-04-20T20:48:00.003-04:00

After a shocking long absence from the blogosphere, I have emerged from hibernation, recommitted to bringing you, dear friends and family afar, all the latest and greatest residency happenings. To summarize the 3-1/2 months that have passed since I last wrote:

January: deep freeze in Michigan, shifts in the university and county EDs. Good times, although considerable separation anxiety from significant other, as he is on a completely opposite schedule. Month caps off with awesome ski trip. I am the happiest girl ever.

February: inpatient pediatrics (insert whatever noise a sail makes when having the wind taken out of it). Lots of frustrating systems issues make for a somewhat miserable month.

March: Neurology consults. Utterly painful M-F but weekends off and they were wonderful! Month ends with last vacation until December: amazing roadtrip to the Southeast! So many good times and good photos!

I am now on OB-GYN at our community site. My experience on OB-GYN as a medical student was terrible, so I definitely approached this month with simultaneous trepidation (here we go with the Crotch Watch again) and hope (it has got to better than my medical student rotation, nothing could possibly be worse). Overall, I think it has been pretty positive. I think I've learned a lot and am confident that I could deliver a baby on the driveway of the ED if I ever had to. The downside is that the community hospital labor and delivery unit is usually not particularly busy for me as the ED rotator, since I don't scrub in on any of the C-sections, or deliver any multi-gravid patients (i.e. twins), or deliver any preterm babies. So I spend a lot of time just sitting around waiting for things to happen. This is not how I roll. I like to be busy, and I'm less tired after a 12-hour day of running around like crazy than I am after a 12-hour day of periods of moderate activity interspersed with hour upon hour of sedentary nothingness. I've done my requisite 10 deliveries, so now it's just time to ride out the rest of the month and see how things go and see what I can learn.

I have to do a presentation tomorrow after rounds (note: this is a very "medical student"-type task that has been assigned to me by the chief resident) so I need to get working on that. I'm on call tomorrow; hopefully more blogging if it's a quiet night!

Some thoughts on immunization

2008-12-19T10:27:00.006-05:00

I'm in the pediatric ED this month at Deep Pockets, and I saw my first completely non-immunized child last night. This was not a child who swam ashore yesterday from a Third World country with no semblance of a public health initiative; this was an American-born child of two seemingly well-educated parents of middle class economic stature. Of course, the child presents to our emergency department with a Fever of Unknown Origin (FUO), meaning a persistent fever for a week or more with no identifiable source. They were actually sent to us from the child's pediatrician who drew some blood for the the baby and was concerned because she had an elevated white blood cell count (the blood cell line that fights infection). We did a bunch of labwork in the ED and then ended up admitted the child and shrugging our shoulders saying, "I have no idea what is wrong with this child."

I don't think this child had any of the diseases we immunize against. The fact that she came to our ED and we couldn't figure out what's wrong with her and so she got admitted to the hospital I'm not sure really has any relationship to her non-immunized status. I guess it just got me thinking about the principle behind immunization and why some parents have chosen not to get their kids' shots. Of course there is the whole "the MMR vaccine causes autism" scare, and the idea that vaccines contain preservatives that might be harmful, etc. I can empathize somewhat with the idea of purism; that the human body was designed to fight infections and that in an otherwise healthy child there's no reason to think that they wouldn't be able to mount an immune response against whatever bugs were to come along. And I can reasonably understand that it seems somewhat silly to vaccinate kids against diseases they have essentially zero chance of ever getting because they have been eradicated in the Western World for 40+ years (i.e. polio). However, even a cursory review of the history of modern medicine will demonstrate that there was significant morbidity and mortality as a result of those bugs, and that vaccines were developed to reduce and eventually eliminate that particular scourge on human existence. I haven't had the opportunity in my career to see very many people with paralytic polio but people who have been in practice for awhile will tell stories about how many elderly patients they treated who had been paralyzed as young children after contracting polio. It's real, it's happened, it still happens in isolated parts of rural Africa where public health workers haven't been able to access tribal populations and administer vaccinations. There have been known outbreaks of mumps when immunity has waned due to parents declining vaccination for their children, or when boosters have not been given. Thousands of people died in 1918 due to pandemic influenza. I guess there's a part of me that views abstaining or deferring of childhood vaccinations as sort of a slap in the face to people who years ago suffered through those illness with sometimes devastating consequences, and for the public health pioneers that worked so hard to eradicate those diseases in this country and to establish some element of herd immunity so that infant mortality and child quality of life could be improved. It also raises a civil liberties question: does one parent have the right to refuse to immunize their child, thereby putting other children at risk for communicable illnesses? Public health is a team effort and we need to maintain high immunization rates to maintain herd immunity and to keep bugs from making a comeback; who has the right to say they want to be a part of community but NOT be a team player when it comes to immunizing? On the other hand, vaccines are manufactured by drug companies who profit from mandatory immunization practices; why should a parent have to subject their child to a (albeit miniscule) risk associated with a given vaccine that benefits Big Pharma? Drug companies are getting rich off of vaccines, but who pays for that, both in dollars and in suffering? Just some interesting thoughts on the subject.

Otherwise, last night's shift was very satisfying. I got to sew up a laceration, and repair an avulsed fingernail. I saw a child with mastoiditis, an pretty rare infection of the bones around the ear associated with ear infections. I also saw an 8-year-old boy with stridor, which is pretty unusual as well. The peds ED has been really good so far; I see a lot of patients every shift and usually it's a pretty quick fix with a rapid disposition, unlike on the adult side where we order tons of test and patients sit in the department for hours.

Post-Trauma-tic

2008-12-08T20:55:00.001-05:00

May the fact that I have not written in this venue in 40 days give credence to the fact that this most recent rotation was an absolute flog; a veritable black hole into which I plunged for the entire month of November. I went 21 straight days without a day off at one point. My first week I worked 93 hours. Before trauma, I had never been responsible for more than five patients at once; I routinely covered 30+ patients at night on the trauma service. I probably received about a hundred calls a day on my pager from nurses, other doctors, speech pathologists, and other allied health professionals.

The night before my first day, I didn’t sleep at all I was so nervous. I can’t remember the last time I was so anxious about anything! It was Halloween night and I stayed in; I handed out candy to some trick of treaters and tried to relax. I employed some chocolate candy and a Sam Adams Oktoberfest Ale to help with this process, I don’t think either helped at all. I got in bed around 10pm and my alarm was set for 4am. I tossed and turned; my heart was intermittently racing, I was sweating; that night will go down in my personal history as one of the worst. When my alarm finally went off, I felt nauseous. I got up and showered and put on some scrubs; I was already wide awake but I made coffee anyway so I wouldn’t get a horrendous caffeine withdrawal headache mid-day. I remember walking into the ICU at 5am and trying to piece together what was going on with the patients; the 31 hours that followed until I left the hospital at 2pm on Sunday are more or less a blur. I do recall not eating until about 8pm that evening, and not peeing until sometime after midnight. But I made it through and survived to go home and sleep for 9 hours, get up and do it again. And such was the routine for the month.

There were some satisfying and some pretty disappointing elements of the month. I don’t feel like I did very much actual taking care of patients; most of my daily tasks involved busy work like maintaining the order sets in the computer, responding to pages from nurses, writing progress notes in the charts, typing up discharge summaries or orders, accompanying patients down to x-ray or to the CT scanner. I hardly did any procedures; most of the patients came to us with all the lines and tubes they needed already in place. On rounds, the chief residents usually told us what they wanted done that day, and our job was to do as we were told. I didn’t go down to the trauma bay at all so I don’t think my ability to manage trauma in the ED is any better. I was also dismayed at how little attention I was able to pay to my out-of-work life. I paid two bills late, I missed a dear friend’s birthday, I let emails pile up in my inbox to the tune of about 65 messages, I didn’t clean my house, rake leaves, or mow the lawn once the entire month, and the only laundry I did was loads of scrubs. I do think that being responsible for so many patients at once helped my brain be more adept at multi-tasking. Perhaps when I go back to the ED I’ll be comfortable juggling more patients. A number of patients on the service had been hospitalized for a long time, and were still on our service when I left. I got to know each of their histories extremely well and got to interact with their family members on a regular basis, which is always a rewarding aspect of work.

But it’s done. And I am glad. I made a long list of things I need to do in order to put my life back together now that I’m off trauma; looking forward to tackling all the things on that list!

Barreling towards a tough one...

2008-10-21T01:16:00.004-04:00

I have been on orthopaedics for the month of October. Nothing exciting has happened; I do mostly nothing but follow around orthopaedic surgeons in their clinic. It feels very medical student-esque.

However, next month, I start on the Trauma service. This will be my first month at Regional Referral Center, the huge academic medical center that is the third training location for our program. I have no idea how to work the computers, where anything is, what my responsibilities are, how the service works, etc. To make matters worse, I start on a Saturday, which means the medical students and physicians assistants won't be around to help. AND I am solo covering the entire service for the first day. AND it's the end of Daylight Savings Time so while everyone else gets an extra hour of sleep, I get an extra hour of work because I'm on call that night. I'm positively dreading it. So staring down the barrel at that has taken a little bit of fun out of this relatively easy month, but I'm trying to enjoy the easy schedule and lack of weekend work anyhow.

Maverick vs. Traditionalist vs. Reactionary?

2008-09-16T11:40:00.002-04:00

I haven't written for a long time...guilty as charged.

I'm back in the ER this month at our community hospital site. I'm enjoying it a lot; although one thing that I've struggled with a little bit is to learn from the senior residents and attendings while also defining my own professional style. In emergency medicine, you have to make calls on patient treatment and disposition without having all the information. This inextricable part of our jobs naturally sorts its practitioners into a few categories (at least in my mind): traditionalists, reactionaries, and mavericks. Traditionalists are as they sound, generally tending to favor a conservative (but not too conservative) approach. Mavericks seem to throw caution to the wind a little bit and are a bit more stingy with their use of diagnostic tests and will pick apart the history and physical for diagnostic clues in lieu of ordering more tests or admitting the patient or whatever. Reactionaries are extremely cautious, at times overly so, ruling out everything under the sun in the ER and then admitting the patient for observation anyway. Most of the attendings I've worked with this month fall under the realm of traditionalist. A few seem to be more maverick-like. Our program director is a reactionary-type guy.

Where do I fit in? I'm an intern; I know just enough to be dangerous. It is essential that I defer to the plans outlined by my seniors. However, when I see patients and present them, I am always asked, "What would you like to do for this patient?" Therein lies the internal debate. Many times, I don't know what I'd like to do. I haven't been doing this long enough to have enough of a sense about patients to always know what they need. So I have to think about what pitch I'm going to deliver, knowing full well that I'm just going to end up doing what the attending thinks, anyway, but how do I want to appear? I don't want to be give too liberal a treatment plan and look like I'm rash, careless, and don't think enough; I don't want to throw the diagnostic kitchen sink at every patient and appear paranoid or clueless and thus flailing. So until I have a better sense of what I'm doing and can actually define my own diagnostic personality, do I want to appear maverick, traditionalist, or reactionary?

I woke up in a panic this morning because I thought/dreamed/hallucinated that I had forgotten to sign out one of my patients last night. The neuroses of residency...

Slacker

2008-08-28T22:28:00.002-04:00

Bleh! One of my co-interns has been wearing on me all month, and today my frustration with him piqued. This kid dodges work like crazy; he's carried the fewest of any ICU patients of any of the group, makes excuses for why he can't pick up patients, asks to leave early whenever possible, and leaves to run errands like go to the bank or post office. Today, at 10:00am, when the day is young and there's lots of work to do and when he knows that the onslaught of admissions never comes until the afternoon, he asks our senior resident if he can leave early because tomorrow is his day off. Our senior says, "we'll see." Around noon, we get word that there's an admission coming to the ICU and he says, "oh yeah, I'll take that one. I'd rather take an early patient because I'd like to leave early." To this, me and the other intern roll our eyes and agree. Then about 10 minutes later when the patient actually gets up to the floor, he says, "Oh yeah, um, I have to go to a meeting at noon and then I have my clinic this afternoon so I don't think I can take this one." What the hell, dude? Why would you offer to take a patient when you know that you have to leave? And then on top of that, when you know you're going to be unavailable for most of the day and the other residents have to cover you, how is it that you have the audacity to ask to leave early?

And then after all that, the slacker got to leave early :-(

Leave him alone

2008-08-25T21:49:00.002-04:00

Something disturbing has been happening on the unit this month. Some of the nurses and even one of the clerks have started making disparaging comments about one of my co-interns. I've overheard a number of snide remarks such as, "If I ever have a heart attack, I just hope it's not when ------ is working." They have commented on this intern's lack of confidence. This has really bothered me for a number of reasons. A) It's August, for God's sake. We've all been doctors for about 50 days; some of the staff have worked in the ICU setting for 20+ YEARS. This particular intern worked on a consult service last month so this has really been their first inpatient experience and so of course the confidence isn't there yet. B) This intern is not that bad! Their presentations on rounds are a little long and a little too detailed, but they show up for work every day with a great attitude, they work hard, and yes, they ask a lot of questions, but it's just because they want to get it right the first time. They have had a number of patients who have been extremely sick and this intern has risen to the challenge of caring for them, which I might add, is NOT true of the fourth intern on our service this month, who seems to ironically disappear whenever a sick ICU admit comes in C) It breeds an unhealthy work environment. This is supposed to be a teaching environment where everyone learns, every day, from every patient. I don't think it's fair that someone who perhaps has a little bit more learning to do than others is ridiculed and whispered about in passing, behind his back D)What are they saying about me?

The first of many...

2008-08-20T21:42:00.002-04:00

...occasions when I deliver bad news occurred the other day. Last week, I started taking care of Mr. R, a gentleman with terrible asthma and a pathologically enlarged heart who we think had a terrible asthma attack that resulted in his heart stopping. The paramedics restarted his heart in the field, and he went to the cardiac cath lab emergently once he got to the hospital. Since he had been in cardiac arrest, we initiated the therapeutic hypothermia protocol (where we basically freeze someone who has suffered a cardiac arrest for about 24 hours, then re-warm them slowly--this has been shown to improve long term neurologic function in patients whose brains have been deprived of oxygen for long periods of time, such as this). At the end of 3 days, when he was re-warmed, we had the neurologist come see him and basically declared that Mr. R was severely brain damaged and would not recover. He was 52 years old. It was time to have a tough talk. The nurse gathered his wife, brother, two sons and daughter into a tiny conference room and then came and told me and the attending physician that they were ready to have a meeting with us. My attending and walk over to the room, and he says to me, "OK, I'll let you do the talking." Ummm, you're having me do this?!?! My pulse quickened and I felt nauseated. We opened to the door the tiny room where they were huddled together, arms around each other, Kleenex in hand. All eyes were on us as we sat down. Where do I begin? I started with a recitation of the facts: that we think Mr. R had suffered a primary respiratory arrest that led to a cardiac arrest, and that we had hoped to preserve brain function by cooling him and then re-warming him--I felt the tension in the room escalating--That in spite of these measures, he had no reflexes, no spontaneous movements, no organized brain wave activity--they are hanging on my every word--and that at this point, we felt there was no chance he was going to ever wake up from the coma he was in. Then I stopped talking.

I was surprised that the first thing that one of them said was, "What do we do now?" I guess to me, the answer to that question was obvious. Mr. R is dead; there are machines and medications maintaining his vital functions, but Mr. R the Husband and Father and Brother was gone on Sunday. I didn't at first know what to say without sounding callous. So I said, "well, I think the important thing to do is to think about what Mr. R would want for himself, and for your family. Would he want to be kept alive by machines, with no ability to talk to you, to be a part of your lives?" Then came the sobs. At that point, his brother asked if withdrawing life-sustaining therapy was an option. I said yes. They said, "We'll think about it." I apologized for their terrible loss and indicated that I was available at any time to talk with them some more, and then I left. As I walked back to the nurses' station, Mr. R's wife erupted in a series of the loudest exclamations of human sorrow I have ever heard.

For the rest of the night, I felt on edge. I felt vulnerable, reminded so vividly that the people we care about can be taken from us in an instant. What would I do if such a tragedy found its way into my own life? How is it that in my 27th year, I have thus far escaped such devastation? How can I keep the seemingly random misfortunes that befall so many of my patients at bay in my own life?

The Glory of "The Off Day"

2008-08-13T21:09:00.003-04:00

One of the toughest things about residency is the lack of time away from the hospital. We often work upwards of 90 hours per week, and you generally only get about 4 days off per month, and TOMORROW is one of those days. It is so nice to be able to stay up late for once and watch the Olympics in HD on my awesome new TV :-) No pressure to be in bed before 11 so I can get a full 6 hours of sleep, no rushing to get my nightly reading done plus whatever household chores I've deemed absolutely necessary that day. For the next 36 hours I am a different person; no longer Clueless Intern, but back to Reasonably Normal 26-Year-Old. I have big plans for the day...checking out one of the local mountain biking hot spots with one of the third year residents. I'm a bit out of shape and I think she's a super-athlete, so I hope I can keep up. Regardless, it will be great to get outside!

The Ten Things You Learn Your First 60 Days of Residency

2008-08-10T20:20:00.002-04:00

10. Worrying about gaining the freshman fifteen as a college student was ridiculous. You're downright terrified of gaining the intern fifty.

9. If you're sitting around not doing anything for more than 90 seconds, panic: you're forgetting to do something.

8. Eating carbohydrates for lunch is a recipe for disaster; you will be in a food coma for the next three hours.

7. You can (and will) fall asleep on the toilet, sitting at the computer, and reading articles. You will not, however, fall asleep while walking around. Do it often.

6. The electronic medical record more than likely does nothing but slow you down

5. You realize how little you actually know

4. You recall hating being scutted out as a medical student, but now really wish that you had a medical student to help you with all this scut!

3. Make lists for everything you have to do. This includes eating and calling your mom.

2. Load the boat.

1. They can hurt you, but they can't stop the clock (thanks, House of God)

1 month down, 47 to go...

2008-08-05T21:38:00.002-04:00

Well, I survived my first month of residency. It was nice to be in my home department for my first month, they took care of me. Now I have moved on to work in the cardiac ICU (CICU) at our program's other site, Deep Pockets Community Hospital (DPCH) for the month of August. The first few days were really tough; I had no idea how to work the computer system, I was following patients that were signed out to me by the previous interns that were really complex and it was hard to remember all the details about them. Thankfully, there were four interns, which made the workload a lot more manageable than if there were only three of us (as there were for the poor residents that started there in July).

The way this service is set up is very weird. Up until June 30th, this had been an ICU that was staffed with residents who shared the responsibility of being on call, so when you worked in the CICU you were on call every fourth or fifth night. As of July 1, they changed it so that now the CICU team also covers the general cardiology patients. There are two attending physicians: one cardiologist that staffs the CICU during the day and a general medicine hospitalist that manages the general cardiology patients from 7a-7p. From 7p-7a, there is a third attending that comes in and takes care of BOTH the CICU and the general cardiology patients overnight. No resident coverage overnight. I hate being on call as much as anyone, but I kinda think they should have kept it how it was. It's really weird to have to sign out your patients to an ATTENDING at night, and we don't get the experience of taking care of patients over a longer period of time. Plus, when one resident was on call, the other residents were able to get out a little earlier because the on-call person would take care of evening admissions. Now, all of us have to stay from 6am until at least 7pm, oftentimes later if there are late admits. It just doesn't seem to be the most effective means of labor distribution, and it's tough to follow all the ICU patients and all of the general cards patients and still get things done reasonably early in the day.

However, we get free food at the hospital...when we have time to eat it :-)

"Has anyone seen my patient, that bleeding guy?"

2008-07-08T20:28:00.003-04:00

I have survived my first few shifts in the ER! We rotate in a couple different emergency rooms as residents, and this month I am at Inner City Trauma Center (names of the facilities will be changed for confidentiality purposes). What a crazy place! On the evening of my first shift, three traumas and a cardiac arrest came in within two and a half minutes of each other! I sauntered into the trauma bay at one point to see if I could help, and no sooner do I don my gloves that the doors to the bay burst open, and the paramedics are rolling in a 6-foot-6, 300-pound patient with a head injury who is extremely combative--so much so that there is a security guard literally sitting on the patient's chest while he is rushed in to the ER! I walk up behind one of the attendings who is doing a quick ultrasound of one of the patients' bellies, just trying to see what she's looking at. She grabs me, pulls me up to the patient's bedside, and says, "he's yours" and then she proceeds to race into the next room to help my other co-intern with the patient who arrived in full arrest. I definitely had a moment of sheer panic, but eventually I made it up to the head of the bed, started asking the patient questions, and I managed to complete a physical exam and assessment of him before sending him off the the CT scanner and turning him over the trauma service. It wasn't perfect, but I rolled with the punches and I think I will be able to do a better job next time.

By the second shift, I was able to locate, see, write orders for, admit, and discharge my patients essentially by myself. This made me feel good, less awkward and useless. The nurses and ER techs so far have been very nice and helpful; no one has treated me like the moron newbie so I am very grateful to them for that. The senior residents have also been extremely helpful; I usually run my patients by them first before talking with the attending, and they usually have good thoughts on what I need to rule out and what therapies I should initiate. My patients have also been great; this hospital serves an extremely needy population and many of them don't have good primary care or good follow-up so it has been rewarding to be able to interact with them and help them get what they need, and so far, the few patients I have seen have been very appreciative.

And of course, it wouldn't be the ER without a few laughs. My senior resident on Monday night managed to lose one of his patients who got beat down by some neighborhood thugs; he was bleeding pretty bad but still wanted to go out and have a cigarette while he was waiting to get sewn up, and so it took a few moments of my senior wandering around asking if anyone had seen "that bleeding guy" before we tracked him down.

So, in short, so far, so good. I'm excited to learn and really happy to be back in the ER for the first time since September. We'll see what tomorrow brings...

Here we go...

2008-07-02T19:23:00.002-04:00

Well, I have been checked in, fitted with scrubs and a white coat, ID badged, trained in 8 different computer systems in three different hospitals, and instructed on the basics of pediatric, adult, and trauma resuscitations, and now it's almost time for my very first shift in the ER as a physician. I'm nervous about it because I haven't done any emergency medicine since September and I feel rusty in my general medical knowledge. I don't know what to do with myself tonight...should I read and review stuff? But what? Anything could walk in the door! It's Fourth of July time, do I know what to do if (if! WHEN!) someone walks in the door with half their face blown off from fireworks? I'm sure it will be fine, but I'm scared!

The fun begins 6/18/08!

2008-06-06T10:37:00.000-04:00

I have decided to start a blog for my residency. I have decided to do so in part because I have been inspired to start writing again, perhaps after a year of sharing a roof with my unbelievably poetic younger brother, who seems to write constantly and with reckless abandon. Writing was something I enjoyed so much growing up, and I would like to resurrect it in my daily life. Also, because this stage of my training will be taking place away from family and most friends, a blog might help me share with those who matter most to me the experiences of the next four years, the things that will ultimate shape me into the physician I will become professionally and the person I grow into personally. I have thought many times about how I wish I had kept a written record of my life in college and in medical school. I will commit to doing so in residency, in part because I fear that exhaustion may cloud my memories and I will look back on my four years in residency and recall only long periods of time spent in the hospital and nothing more, no details, no specifics. So into this new and uncharted territory of blogging I plunge headlong...