Friday, September 28, 2012

Still here!

Hey there, it's been a while!

In an announcement that will come as a shock to no one, I have had little to no free time since starting residency.

Shocker, I know!

I've been through so much in the three months since residency started that this post can't even start to describe it. Here's a brief summary, but I couldn't possibly express how residency has affected me as a person in three very quick months.

My first month was on the infectious disease service. It is one of the busiest in the hospital, with lots of complex infections. And any patient with HIV, no matter how well controlled and with any medical complaint, gets admitted to the service. I had no ID (infectious disease) background, but I learned a ton. I worked insane hours, mostly due to my intern inefficiency. It took me a few hours to admit each patient--mostly because my history & physical for each patient is a novel--and that will get better, I know. But the first time we had to track our weekly hours for duty hour compliance, I worked 98 hours. Yes, that is over 80 hours a week--but those hours are averaged over 4 weeks. And I'm not faulting the program at all. They are great about having things in place to get us out on time, and with only one exception, every senior resident I have had has been outstanding with helping me get done.  It's just that when you have patients crashing and two admissions that come in right at the buzzer, it's difficult as a new intern to get out in time.  That has gotten better, which I am thankful for!

My first month, I saw so much interesting stuff. I saw patients with HIV who have no detectable viral load and a CD4 count that is better than mine. I also saw HIV patients that were not well controlled or newly diagnosed (but had likely had the disease for years). I saw toxoplasma in someone's brain, tuberculosis, cryptosporidia infection, and other complications. Some patients got better and went home. Others unfortunately didn't. It was a very humbling and informative rotation. It was also an emotional rollercoaster. I had good days and bad days--though I think I was only close to tears once, and I kept it together. Sleep deprivation definitely diminishes my ability to keep my emotions in check!

My second month was general medicine at the VA. Again, I learned a ton, and I was insanely busy. I had some bread and butter patients, and I had some rare cases too. I actually saw a lot of infectious disease here--pertussis, west nile, pseudomonas bacteremia, and others. When they say general medicine, they mean it; we had everything. It was another month of very long hours too. I did finally lose it the last call night I had. I had a patient with a very bad infection who was unstable, several other very sick patients, and I got two admissions at the last minute that I really did not think needed to be admitted. I knew I would be there late, likely till 1 AM or later. I was furiously working to transfer my very ill patient and admit my other two patients. This is when I had the only resident I have worked with that wasn't very helpful. His comment was that I needed to be faster, because now he was going to get yelled at for me breaking duty hours.  I was tired and drained emotionally; I was already upset that I didn't get to see my sister leave to go back to California that day, after staying with us all summer.  I held it together long enough to have a nice cry in the bathroom for a few minutes, pulled it together, finished my work (late, but I did the best I could), and I left.

Last month was outpatient primary care. It was exactly what I needed after two extremely busy months on the wards. Mostly 8-5, no weekends, no call...awesome! It had its own challenges--you went to a different clinic every half day, so it was difficult to change gears, figure out what each attending wanted, learn how they like notes written, etc. I did get a chance to catch up on life--and see my kids, who were shocked to see me every day!

This week, I started time in the MICU (medical intensive care unit). As I posted on facebook, changing rotations every 4 weeks means that you have a day every month--the first day on that service--where you feel the most stupid that you've ever felt. That day was Monday in the MICU. I did no ICU during medical school. I could've done it as an elective, but I did more teaching electives so that I could have an extended maternity leave. My first day, there are patients bleeding, stopping breathing, and otherwise crashing everywhere. It seemed like everyone else was totally calm and knew just what to do. I had to actively breathe so as not to freak out. On the wards, when a patient is unstable, you send them to the MICU. I always assumed the people in the MICU knew more than I did. Now I am the MICU! In all fairness though, I probably have less patient influence in the MICU than anywhere else--which is best for everyone. There is always at least one critical care attending, and we have 24 hour MICU fellows. Plus, there are four senior residents and four interns covering 20 beds. And the ICU nurses are absolutely amazing. They do more than any other nursing staff I've worked with--and I think my hospital's floor nurses are outstanding. These ICU nurses know everything, and they are completely in tune with what the patient needs. Having them around helped me get my heart rate under 150 bpm!

The ICU is such an interesting place--there are patients in for a short time, just requiring a tuneup before they go back to the floor. And then there are patients who are SICK. Many patients are unfortunately in the end stages of their diseases and will pass away in the MICU. This is tough for me, especially because many of these patients are young. I have one patient now that had been barely hanging on--I don't know how much I can describe on here, but every morning I came in and half expected her not to be there. I am off today, and I prayed that she'd get a miracle. And today I found out she did--if all goes well, she'll have a new chance at life after today. I had no part in her getting better, but I'm so glad that now she has a chance!

I'm still completely intimidated by the level of illness in the MICU, but it's gotten better in a few days. My senior residents tell me that I'll be comfortable here by the end of my 4 weeks. I don't know that I'd go that far, but we'll see.

I actually haven't done any procedures yet in the MICU--I've been told I'll have patients needing central lines, hemodialysis catheters, arterial lines, and other things that I will learn how to put it. I'm a little intimidated by that, but I look forward to learning. I did do my first lumbar puncture within days of being on the infectious disease service--and I had a champagne tap too (no red blood cells in the cerebrospinal fluid from a traumatic tap). That's given me a little confidence that I can overcome my nerves and do what needs to be done in a pinch. I don't want to do critical care long term; I'm not enough of an adrenaline junkie! I am learning a ton though.

Life has been insanely busy these last three months. There has been some life reflection in the fleeting quiet moments I have that made me think about what I want out of life long term. It has me rethinking medical specialties, but I am still very undecided. More on that another day.

For now, I'm home today (because I work both days this weekend). Time to finish the bills, get my car fixed, and generally tackle the massive to-do list that backs up after months of working 80 hour weeks.

Again, no promises on frequency of posting. I'll do what I can, but my guess is it will be a busy month!  In general though, I am doing well, my kids are hanging in there (thanks mostly to Tim doing the kid care, with help from Amy for a few months and our families in emergencies). I've had low moments to be sure, but overall I am learning a ton. I've got a great group of supportive people in my program--which is absolutely mandatory. So far, so good.