Pediatric Surgery Recap

It's hard to believe that my second month of residency is almost over!

This month was spent doing pediatric surgery, which is what I ultimately hope to do with my life. Needless to say, I've really enjoyed this month: from the patients to the procedures. Despite enjoying the rotation, it's been another crazy busy month.

The rotation usually has 3 fellows, 1 PGY-2, 2 PGY-1s, and an NP. At one point this month it was just the 3 fellows and me, as the PGY-2 was on vacation and the NP was speaking at a conference. I'm thankful for the extra help from the fellows, but it was a little overwhelming to be taking care of 20+ floor patients (fellows cover the NICU/ PICU). It's been so busy, that even though I'm leaving when I need to for duty hours, I've found myself having to finish up 2-3 hours of notes and dictations from home on multiple nights over the month (which, I've been told, isn't a violation, so I'm okay).

That being said, I have had the opportunity to operate this month. I've helped on a few really cool cases and I've gotten to be "surgeon junior" on a few lumps and bumps, for which I'm very grateful.

One of the fellows this month asked me why I wanted to do pediatric surgery, after my explanation, she said she loved it for the same reasons. So I thought I'd share here: Pediatric Surgeons are some of the last general surgeons (I'll throw trauma in there as well). Nowadays, most of surgery is really segmented, but outside of pediatric neurosurgery, orthopedics, cardiothoracic, and urology (all of which are separate specialities, minus CTS), the pediatric surgeon does everything else.

And while I know most pediatric surgeons see hernias and appendectomies all day, it's the congenital "stuff" that I love: gastroschisis, omphaloceles, duodenal atresias, tracheoesophageal fistulas, sacrococcygeal teratomas, Hirschsprung's disease, imperofrate anus, pyloric stenosis. I find the disease mechanisms so fascinating. Yes, I feel horrible for the kids that have these conditions, but I love that we can step in and change their lives.

So that is what I've been filling my last four weeks up with. I'm actually kind of sad the month is ending.

Other things happening in my life:
Hmm, let's see... My dad went back to the hospital with a complication during the first week of the month, and was in the hospital for about 2 weeks. But he's doing well now, and is home recuperating.

I've gotten yelled at in the middle of M&M for not studying at all, since I didn't know one thing. While I know I should have been better prepared, I think it's more than a little reactionary to assume I've not done anything in the past 2 months, when you don't actually know.

For the record: I've read 300+ pages of sabiston, read about my patient's conditions, and read for conference every week (usually prepping all the cases, not just the 3-4 interesting cases I'm expected to read). I'm not trying to toot my own horn here, but it's really frustrating to be told you aren't doing your job at all when 1) they only see you for 1 hour a week, 2) don't see your work ethic on the job, and 3) have no idea what your actually doing to prepare.

On to happier things: I received a pair of loupes from an awesome twitter friend. I finally became a Tennessee resident. I got my nails done (twice if you count later today). And have had dinner with a good friend twice, including time to vent our mutual frustrations about residency (you got to do it every once and awhile, no matter how much you enjoy your job).

On that note, it's time for me to hit up Sabiston again.

I wish you all a wonderful weekend and my prayers and luck to all you on the east coast; May Irene treat you more kindly than expected.

Also, next month's rotation is: Endoscopy/ Nutrition

P.S. Sorry for the lack of picture, I wrote this on pages on the iPad and then cut and pasted into blogger on the iPad (blogger, we need an app!)

The First Time is the Hardest

Image from http://www.elderlyjournal.com/

Once again the past two weeks have been a blur of activity, but what is coming into severe focus is that my first month of residency is 1 shift from being over. This month has been a huge learning curve, as I sure the rest of the year will be... but nonetheless, it has a great experience.

Besides being crazy busy, it has been a week of four firsts.

A Patient Lost
I've lost my first patient as a physician. The patient had been really sick for awhile; The family had changed the code status to DNR recently. However, when it actually happened, it happened quickly. Thankfully my attending was already in house and made the call to the family. Either way, it was so strange to watch the vitals fall, knowing we couldn't do anything at that point, knowing that within seconds, this patient, who I've gotten to know over weeks, was about to die.

When the family came in it was hard:. It was hard to see the family I've gotten to know hurting and it was hard to have a patient I've gotten to know pass. I can't say that I didn't have to step away for a moment to collect myself. To be honest, while I do hope that it gets a little easier to lose patients, I hope that I don't lose the emotions attached with it, whether I've know then for a day or a month.

A Patient Stabilized
The second first, I performed a bronchoscopy. Over the past month I gotten a little more comfortable with managing ventilated patients (almost everyone in the unit is on a ventilator), however, there are still times when I make that call to the attending. This was one of those times: The O2 saturation, ABG, and CXR were fine, but peak airway pressures were rising and we were unable to adequately suction the patient. The attending agreed that a bronchoscopy was probably needed and told me to get everything ready and started and that he would be there in 10 minutes. So I walked into the room and started the bronchoscopy, suctioning and removing all the junk in the trachea down to carina. The attending checked out the bronchi and we were done, everything went back to normal. And just like that I realized I somehow managed to do a bronchoscopy; I guess it really can be see one, do one, teach one (although, I think I want to do a few more before trying to teach someone).


A Patient on the Table
The third first: I finally made it to the OR! It took about three weeks, and I had to stay after sign out  and up to my 16 hour limit, but I got to scrub. The case was interesting and went well, and although I was scrubbed I wasn't able to do much (since there was an attending and 2 fellows in the room). But nonetheless, it was a little rewarding to hear the attending add my name as one of the surgeons* to the operative report.

*A note on that, my med student said to me (on one of the rougher days), that no matter what happens, I'm an motherf@#& surgeon. I laughed, and by no means claim that title at this point... I mean, I know I'm a surgery resident, but it's been all of a month. Nonetheless, I came to the realization, that it's probably what my patient's are seeing me as. Weird. I hope that at some point I feel a little more comfortable with that title, but even then, I don't think I'm be claiming to be a surgeon for a very very long time.


A Patient Saved
The fourth first: I experienced my first code as a physician (another title I'm still trying to grow into). Now, I've be "part of codes" as a medical student, but most of them consistent of me standing at the back and just watching it all go down; I think I only was actively involved in 1 during medical school, during which I was doing chest compressions.

This was a completely different situation. First, it was my patient, not one that happened to be on the same floor, or one that my team was cross-covering, it was a patient for which I had already been responsible for taking care. Secondly, I was the one standing there as she as she started to de-compensate, the one who called for stat anesthesia intubation, the one who hit the code blue button, and the one who started chest compressions. Thirdly, I was the only physician in the room... I had the CRNAs there for intubation, I had a lot of nurses with a ton of experience, but it was just me, making the call about what to give the patient. Thankfully, the charge nurse called the attending, who helped to calm the situation and guide the code over the telephone. And thankfully, the patient was resuscitated.

Nonetheless, I was shaken for the rest of the morning.

My attending pulled me aside later and said talked me through everything that happened, confirming the choices I had made and using it as a teaching point for later. It took me awhile to be okay, but I definitely walked away having learned, not only about how to run a code, but having learned how to gain confidence in that situation. Hopefully next time I'll feel a little better about it, and have someone else next to me.

After I left today, I had the chance to talk to a different charge nurse, who really made me feel better about it all. She mentioned, that although I've made some choices in care that they usually don't choose (some of which worked), that my confidence and demeanor was excellent and that she thought I'd do well.

However, if M&M this week were any indication of the year ahead, it's going to be a rough few years.

The Other Side of Residency: Real Life
I've been really blessed to have gotten to know one of my fellow interns over the past few weeks. And at least once per week for the last 4 weeks, we've managed to get dinner post-shift and decompress about everything that's been happening. It's been a great resource to have.

Last night, during one of the downtimes, I also got the chance to catch up with one of my best friend's from medical school. I had been meaning to text her earlier that day, when I received her text. I had a few moments, so I gave her a call. I can honestly say, that the friend's you make in medical school are the people who understand you... they've been with you through the thick of it and you've both made it through the war (that is medical school) *


*I'm pretty sure that friends from residency will be a similar type of experience.

Tonight I had the great pleasure of having dinner with the one and only @Potato_Chip. It was so great to have a few moments to catch up on what's going on with her life over a great meal and ice cream.

Despite all the great, anyone following me on twitter knows life has also thrown a ton of wrenches into my plans recently. My dad was in the hospital about a week and a half ago, but is now doing well and at home. The passenger-side mirror on my car decided to meet a concrete barrier. And then my entire car decided to take a vacation from working (thankfully, I live right near the trolley line, which, although a little unpredictable, has at least gotten me to and from work).

On that note, I should probably crack open the Sabiston or start reading the chapter from ACS for basic science lecture this week.

Hope that life is treating everyone else well.

God bless and godspeed.

2 Down, 260 Weeks to Go!

Image found on Photobucket

We're saving lives at the Elvis Presley Memorial Trauma Center!

I have somehow survived the first 2 weeks of residency, which I can only credit to amazing nurses, understanding attendings, and the big man upstairs... Oh, and some credit to Wayne, for really preparing me to jump in feet first and expect to start running.

To be honest, the first two weeks were somewhat of a blur, considering I worked 140 hours in the first week and a half. But, even though I was exhausted walking out of the hospital on Wednesday, I'm enjoyed every minute of it... even the bad ones.

In the first week I've changed LOTS and LOTS of lines (femoral central lines and arterial lines), and learn not only how to change a swan-ganz catheter, but how to float one and perform a wedge (which I've had to do too many times to count at this point). I've also seen, admitted and discharged patients with the attending relying on me for my judgement (there's no senior residents on my service, but there is a fellow who takes home call).

More than anything, I'm beginning to feel a little more comfortable in my new role (while still knowing that I have a long way to go).

That being said, I pretty much get home and crash, real hard.

For example, during my first week the fire alarm went off in my building, waking me up. However, my thought process was far from rational at this point. On waking up to a noise, I immediately thought it was my alarm, which I tried turning off. Seeing as hitting the screen on my phone was not accomplishing the task at hand I immediately came to the brilliant conclusion that the loud beeping was coming from my broken DSL modem (I know, brilliant)... Nevertheless, I walked over and unplugged it from the wall. When the high-pitched, deafening sound still ceased to desist, I finally thought, "Oh, fire alarm. Did I leave my oven on?" At which point I checked my oven. Finally I realized it was the building's fire alarm and seriously contemplated going back to bed. Thankfully my better judgement told me to thrown on some shoes and go outside. 45 minutes later, the alarm still going, we were cleared to go back inside... Please see, "alarm still going", the FD could not figure out how to turn it off. However, I walked back inside, threw 3 pillows over my head and managed to fall back asleep within a few moments.

Anyways, right now I'm actually back in Michigan. My family had a slight emergency. My attending upon hearing about it called my program director and they both said I needed to come home. Thankfully, I only missed Wednesday conferences and 1 shift. Everything seems to be fine, but prayers are still much appreciated.

I'm flying back to the mid-south at the butt-crack-of-dawn tomorrow (have to leave my house at about 4am, not that that's completely unusual, but it is for my mom, who has to drive me to Detroit for my flight).

I hope that the summer is treating you all wonderfully, and for all those other interns out there, God bless and Godspeed.

A Mad Case of Imposter Syndrome

Thank you NotDeadDinosaur of dinosaurmusings.wordpress.com for posting this wonderfully well point and poignant article.

I can promise everyone that all my co-interns have had the exact same conversation over the past few weeks.

Certified Gold

Image from http://www.mariettaaccidentattorneyblog.com

I finally have the interwebs (super fast interwebs at that, thanks @ATT U-verse)!!! And that means time for a little update.

Thanks to my amazingly wonderful med school I do not have to re-certify in ACLS until May 2012, however, my BLS (aka CPR) certification ends at the end of July... so it was time to re-certify. Now, Wayne State was old school in that for both of these you had to sit through 1-2 days of lectures/ codes or "MEGA-CODES" and then prove to an instructor that you knew what you were doing.

Well, it seems the AHA has since upgraded and digitized... So instead of sitting through lectures, I sat through a bunch of web-modules. And then, instead of just showing people that I knew what to do on a plastic dummy, I had to prove myself on a ultra-sleek super sensitive manikin. And I'm not joking about the super sensitive ("Give smaller breaths", "Give more volume", "Place fingers in the center of the chest."); It seemed impossible to actually do it right and I one point I felt really silly that I was getting mad at a plastic baby manikin. But eventually, with the help of an instructor, we mananged to trick the sadistic little doll into accepting my more than adequate attempts to revive it from it's dull plastic life (no bitterness at all, promise). So, I am now BLS re-certified for 2 more years.

A few days later, me and the other 7 categorical incoming surgery interns headed down to get ATLS certified. This basically means that they trained us in the proper management of trauma patients in order to stabilize them and ship them to whoever it is that is actually going to take care of them (it's geared towards rural docs; in actuality, it means they would be shipping patients to us, and the trauma patients we would be getting would be getting stabilized and/ or sent to the OR).

It was a 2 day course, and the first time we all met each other. It was a lot of lecture, but we had lots of fun learning how to do procedures (i.e. saphenous vein cut-down, chest-tubes, cricothyroidotomy, diagnostic peritoneal lavage, etc). By the end of the second day we were all certified and supposedly ready for the trauma bay (God help us all if we have to run a trauma by ourselves though... but that shouldn't happen anytime soon).

Since then, the days have been filled with functions:

• Friday was the party at the Chairman's house -- basically a time for us all to meet the attendings and some residents, and for them to meet us; had a wonderful time.
• Saturday was a small grill-out with some of my co-incoming residents 
• Sunday one of the outgoing interns had her class and all the incoming interns come over for a get-together to meet, get advice, etc... another great time was had getting to know more people (I feel bad that I don't remember a lot of names, but the past week I've met so many people it seems like a blur).

Today was the first official day of orientation, the additional prelims (urology, ENT, etc) were added to the 8 categorical surgery residents at the departmental orientation. The program director talked through the different rotations/ hospitals to give us an idea of what to expect and what was expected of us. My favorite part was just adding up all the ancillary (i.e. not direct patient care) requirements... mostly just the stuff for studying/ preparing for the ABSITE/ mock oral boards.

At one point I got totally overwhelmed about the reading; Outside of the 12-16 hour shifts we are supposed to read... Totally get that, was already preparing to read, didn't expect anything less. But then she started talking about all the stuff we had to read. In any given week there we are supposed to read:

• A surgical textbook
• The Fundamentals of Surgery curriculum
• The SCORE curriculum (both junior and senior tracks)
• About the "interesting case" and cases presented at M&M
• For every case we scrub

While I knew and expected all this, putting it all together within a few minutes made my brain want to explode a bit. I know it's possible, but it's going to be tough... But hey, no one said surgery (or any residency) would be easy.

On that note, maybe I should start reading... Hmm.

Moved and Scheduled!

I've now been here for a week, and time has flown. Let's just say I'm glad I got here when I did; I have been so busy running around trying to accomplish things:

• Unpacking all my stuff - all done!
• Buying things I didn't have - furniture, toaster oven, knives, etc.
• Filling out and turning in hospital forms - done, with the exception of one place losing my stuff
• Doing online training modules for multiple hospitals - there went 10 hours
• Setting up interwebs - won't really have it for another week, but I managed to avoid Comcast, so I consider this a win
• Fundamentals of Surgery modules - through the American College of Surgeons, part of the academic side of my training is online modules with patient simulation
• Tried changing my residence... but apparently a signed lease isn't enough to prove residence here (more than slightly annoyed)

Still left to do in the next couple weeks (more full weeks ahead):

• Furniture is getting delivered today - hallelujah, no more sleeping on an air mattress
• BLS recertification - mostly done online already, but I have to go in and prove to a real person I know what I'm doing
• Appointment at one of the hospitals on Tuesday to finish the stuff I was supposed to do yesterday (but couldn't cause they lost my paperwork)
• Advanced Trauma Life Support (Wednesday and Thursday)
• Internet set up - a week from Monday
• Orientation - a week from Monday and Tuesday
• Parties - yes, that's right, lots of parties. A few of us interns got together at my place on Thursday (it was supposed to be a BBQ, but a torrential downpour precluding that actually happening). Next Friday there's a party at the Chairman's place and a week from Sunday, on of the second years is throwing a party for the incoming interns.... Oh and I already missed 1 party, cause I was moving in.

Needless to say, moving is no joke and super exhausting. I feel like I've been moving non-stop for the last week... but I've enjoyed it (except for yesterday, which was beyond frustrating).

Oh, and I finally got my schedule for the year and I'm excited:

• July - Plastics/ Burns (intern only rotation, luckily there's two of us)
• August - Pediatric Surgery (yay! so excited!)
• September - Endoscopy (intern only rotation)
• October - General Surgery (private hospital)
• November - B Team ICU (only person in the ICU the whole time, I think)
• December - Vascular Surgery
• January - Transplant Surgery
• February - Cardiovascular Surgery
• March - B Team ICU (again, only person in the ICU the whole time)
• April - A Team floor (so, general surgery)
• May - VA ICU
• June - VA floor

It's ICU heavy; apparently that's what they do for the residents coming from outside programs. But I'm happy with it. I like ICU and it will really help me get ready for the coming years.

Well, I think that's about it for now.

Hope the weekend is treating you all well, I'm about to go enjoy the 90 degree weather on my patio.

Welcome to the new blog!

Image from http://www.georgiahealth.edu/

I have officially graduated from medical school and moved to a new state, which means it's time for a new blog!

If you're interested in a little more information about me and what I'm doing, check it out below the jump.

Residency is going to be crazy but I'll do my best to share what I can along the way. Please bear with me if there's huge lapses in posting... they'll be coming (probably at the prodding of my mother).

So, WELCOME to the new blog.

I hope that everyone can find the humor and plethora of emotions that residency is sure to bring out.

Thanks again for those who have followed me through the past few years and for making the move over here.