Welcome to the Research Years

Second year is officially over... Since you all last heard from me (too long ago) I have completed my second go around at pediatric surgery, trauma, and finished off the year with general surgery. The end of the year was busy, but very good.

Someone told me earlier in the year that by the end of second year you really start hitting your groove, and I couldn't agree more. That was until one night on trauma call. While standing in the trauma resuscitation bay, waiting for an incoming trauma, my abdomen started feeling funny. The trauma patient arrived and we got through the initial evaluation and starting getting x-rays when I started feeling even worse. Like, had to leave the trauma and coupled over a railing in pain. And then I got really nauseated and ended up vomiting. I laid down in the second shock trauma room until I was steady on my feet and then headed back into the trauma ER to finish call and my mock orals (i.e. mock exams for the oral board examination).

I was fine until the next day it started all over while I was in clinic. I ended up as a patient in my on ER. A couple hours later I walked out with the diagnosis of biliary colic. The problem was then trying to schedule my own laparoscopic cholecystectomy, and as any surgery resident can attest, our schedule is hard to add any days off into. I had a week of vacation, but no OR availability with the surgeon doing the case... So like a good patient, I put it off, until the 1st of the academic year (or rather the 2nd).

For vacation, mom and I headed even further south, down to the gulf coast and had a fabulous 3 days of sun and beach and pools. And then we headed back for the rest of the week. The week ended with surgery prom, and all the amazing chiefs from last year graduating.

Then on July 2nd I had my own lap chole. The last thing I remember was saying something about feeling the versed kicking in, and then the next thing I knew I was waking up in the PACU sans gallbladder. My gallbladder was apparently acutely and chronically pissed off, resulting in some difficult dissection. My surgery last about 2 1/2 hours, when a normal lap chole is 1 to 1 1/2 hours. But, thankfully, my surgeon did not convert to an open procedure, which would have bought me a week long hospital stay. I went home that day and slept on and off for the next day or two. But by the end of the week I was up walking around, albeit, a little slower than usual.

Then on Monday of this week started the second chapter of my surgery residency. A surgery residency is usually 5 years, with the first 2 years as a junior level resident and that second 3 years as a senior level resident. But seeing as I want to do pediatric surgery, I am taking an addition 2 years to do clinical research and to get a master's of epidemiology (which starts next month); so I have a 2-2-3 pattern instead of the traditional 2-3.

Can I just say, I now understand how people have time to read or work out in the mornings? I had no idea what it was like to work an 8-5 job. Now, don't get be wrong, it's not like I haven't had jobs before. My parent's were firm believers of having an after school job in high school, and I continued to have a part time job throughout college. And after that I worked as a biology teacher in Thailand (see: thailandkate.blogspot.com), but that was different than a standard 8-5 desk job.

It has been wonderful to be able to wake up in the mornings, actually have time to drink my coffee and read my Bible, and be able to take my pupster out for some play time. And today, for the first time since surgery, I went to work out after work... And I still got home by 6:15pm! Miraculous things, people, miraculous things.

All that being said, I am still taking pediatric surgery call (had one on Tuesday, in fact). And starting in mid-August I'll be adding on the master's program and it's associated homework. But it's been wonderful.

The research itself is coming along. I have about 3-4 projects starting up, all clinical research. One proposal is almost ready (fingers crossed) for an IRB submission. Two of them are well into the literature review (one of which I've started the proposal on). It's been a productive week; I'm really excited for the coming years.

So that's where I am right now... Excited and ready for the new adventure of research.

Thought Dump

Frequently I find myself reading other peoples blogs, and wishing that my life were so interesting that I could blog multiple times a week, making cute quips while posting lovely photos of my amazingly adorable family and life... But let's be honest, that's just not me, or surgery residency.

Don't get me wrong, my life is pretty interesting... mostly because I get to interact with all sorts of different people at work, both the staff and the patients. And there are tons of funny and unbelievable ( amazing, and sad) situations that I experience every time I'm on call... but there's this thing called HIPAA and personal privacy of those I get to serve which does a great job of protecting them from me blabbing their stories all over the internet. And then there's the situations that just make me boil, which I could easily just spew into the interwebs, but that would make me look like a horrible person (and potentially get me in trouble)... so I keep those to myself too, until girls night with my lovel residency friends, where we sit and vent out our frustrations.

Seeing as most of my life is spent at the hospital, the few minutes I'm not there are spent either studying, watching TV to relax, or cuddling with my lovely puppy (who is currently giving me sad puppy eyes and repositioning herself to be as close as possible.... she's basically a cat).

Needless to say, I'm always left wondering what to share with you all... and I feel like a horribly boring person because of it. I honestly wish I could be more interesting for you all.

That leaves me leaving you with my train of thought random thoughts on this past week.

• Only 7 more trauma calls until the end of the rotation (at least until I come back to the trauma center for one last 7 week rotation this year)
• A patient broke my heart when she told us she wasn't eating well at home... Thinking it was because she didn't have an appetite or was sick, we asked further and found out it was because she didn't have money to buy food. She'd been eating ice for meals.
• My heart is breaking for one of my close friends... she has a really hard decision to make, and is in a crappier situation in which to make it in. 
• My dog makes me so happy... with her puppy-like playing with toys, to refusing to realize she can't go under the bed because she keeps getting stuck
• I really need to work on my patience and easily frustratable personality -- it kills me when people are rude and self-entitled, especially when it's used as a front for their laziness; or when someone "corrects" me when I was right and they were wrong... it takes a lot in me not to show them how wrong they were... and it's even more annoying when it's from someone I really dislike (long story)
• I wish I could change some of my personality traits, but it's so hard... I just wish I was a better person
• ABSITE is over, and although I need to study, I can't bring myself to do it.
• Mindy Kaling's book is funny and I wish I could just sit down and read it... but studying and or falling asleep is not helping
• I wish that I could make my medical students better, but trying to teach and show them how to do well with a new batch every two weeks is really draining, especially when I'm also trying to take care of patients... I just don't know why there's so much disconnect and disengagement from them

Anyways, lots of random thoughts... but all that have been driving me crazy and/or consuming me over the past few days and weeks.

What's keep you all lit up or up at night?

The In-Service

Courtesy of FunPrep.com

If any of you have ever watch any medical TV show in the last decade, whether it's Grey's Anatomy, Scrubs, or Emily Owens MD, etc... then you have probably at seen the residents taking an exam. In surgery, this exam is called the ABSITE, or American Board of Surgery In Training Examination. This exam takes place every year, at the end of January. And it is taken by every surgery resident in the country (or every resident in an accredited program). There are two levels. The Junior Level (for first and second year residents) and the Senior Level (for third through fifth year residents).

This exam, while designed to give diagnostic feedback on the where the resident is weak in knowledge, can cause all sorts of anxiety. The test lasts about 4 hours and covers any and everything that a surgery resident is supposed to know. However, the the anxiety comes with how one performs -- each level of resident is grading against all the other residents in the country at their level (i.e. a second year at Hopkins, UCSF, and U of Miami, are graded against each other). This results in a percentile score and a raw score (not affect by how everyone else does). The one that matters the most... the percentile score, especially if you want to go into a competitive fellowship (i.e. pediatric surgery).

So, this month all my free time is being dedicated to studying... and trying to retain everything that I've forgotten over the past year (and from medical school). Countless hours of reading review books and guides, cramming in questions between seeing patients in the CCA and post-call, while trying not to fall asleep. Caffeinated days off spent at the coffee shop, and anxiety filled nights while trying to remember what was learned. Praying for the days to go by slowly, while anxiously awaiting the day after the test, when there will be a huge burden lifting off the shoulders.

If you happen to run into a exhausted looking surgery resident, which injected eyes and empty cups of coffee in front of them, don't judge them on their haggard appearance, just remember we're striving to be the best doctors we came be, at least in the academic sense.

And now it's time for me to get back to hitting the books...

A Personal Update

Image courtesy of http://www.vascularsurg.wustl.edu/

About a year and a half ago, as I was justing starting my residency, I got a call from my dad. He said that he was on his way to the emergency room because his big toe was cold and blue and his leg hurt. Being in the medical field, I started freaking out, cause I had an idea of what was going on... and I didn't like what has happening at all to my dad -- He had clotted off the artery above his knee and wasn't getting blood flow to his foot. Luckily, the physician taking care of him got him on blood thinners and to an intervention rather quickly. He walked away from the event with all his parts plus a shiny stent in his leg.  However, since that time, he's been hospitalized multiple times and had to have the stent revised more than once.

I was able to get home during the initial event. And although I was grateful that my dad did well and his foot was saved, I really didn't like the care he was getting, or the vascular surgeon taking care of him. I urged my parents to get a second opinion, and after he had been hospitalize two additional times (once cause the stent clotted off, and another time for a hematoma after he was overly anticoagulated), and had another procedure to salvage the stent, they took my advise and transferred his care to the University of Michigan, where he has been taking care of in an exceptional manner.

However, earlier this week I got a call from my dad -- his foot was cold and his leg was tingling and in pain. He emergently went to the ER in our home town and was transferred down to U of M. He had clotted off his stent, again. The surgeons took him to the vascular suite and started him on a clot busting medication, and were able to get blood flow back to his foot over the next couple of hours.

During the conversations I had with my dad, I started prepping him for the fact that he'd likely need a bypass surgery, to bypass the diseased arteries in his leg. On his arrival, the chief resident taking care of him called and voiced the same opinion, and the following day, the attending vascular surgeon said the same thing.

Thankfully, due to the therapy he received, this does not need to be done emergently, but is being planned for the next couple of weeks, on an elective basis. And I will hopefully be able to get home for the couple days surrounding the surgery -- which is a big surgery.

I have to thank the surgeons at University of Michigan, though, for their great care of my father, and for the conversations they were willing to have with me -- and for talking to me as a medical professional who understands what is going on, rather than talking down at me (like dad's previous surgeon, who treated me like someone who didn't understand anything medical, in spite of him knowing I was a surgery resident).

In the meantime, please send up some prayers for my father -- that he does well over the next couple weeks, that he gets through surgery without difficulty, and has a quick recovery -- and for the surgeons taking care of him.

"A cheerful heart is god medicine, but a broken spirit saps a person's strength." - Proverbs 17:22

Shock Trauma, ETA 2 minutes

The Ambulance Bay. Photocredit: M. Ramirez

Welcome to January... And yes, I do realize it's half way through the month already.

This month I found myself back at the trauma center. My program is well known for its trauma -- it's one of the busiest Level 1 Trauma centers in the nation. Which means that it's always a full house, of patients and residents. As the second year I'm basically in charge of running the trauma assessment area. The CCA (or critical care assessment) is where I live every 3rd day for 24 hours -- this area is basically an ER room just for trauma; it's actually completely separated from the level 1 (or medicine) ER, which is located done the hall from us (and about 500 feet away from the ER ambulance bay, whereas they can just roll into "my" ER).

My job is to see, evaluate, and "dispo" all the patients that arrive by ambulance or through triage. And then help run the shock traumas that arrive, with the rest of team. Basically, the second year resident functions as an ER doc for traumatic chief complaints (i.e. "I fell off a ladder and now my ankle hurts" to the "Some dude just shot me in the leg, doc"). What's really good about this rotation is the amount of autonomy... I have a chief resident who is a phone call away should I need help or advice, and I run every patient by the attending (in person or on the phone) before sending them home or admitting them, but for the most part, it's a time for the second year resident to get a lot of experience triaging patients and honing their skills at assessment and treatment.

I was last in the CCA in July -- in fact, I was the resident who got lucky enough to be on call July 1st and 4th... For those of you familiar with the new ACGME duty hour rules, it means that July 1st, as a newly minted second year resident, it was the first day any of the kids in my class could take the 24 hour call. I was there for 7 weeks, and in those 7 weeks I saw and learned a lot.

July is busy, especially in the trauma center. There's a few reasons, but the main reason is that it's warm. And like I said when I lived in Detroit, "It's a lot easier to shot someone in the summer and get away on your bike, then in December, when there's snow on the ground." Down in the south, it may not snow, but people just don't go outside when it's cold. In July, during a 24 hour period, I would see and assess, work up, and dispo about 50 to 60 people. In January, it's about 30-40 people.

That being said, there's a certain air of electricity at any time of the year in the trauma center. You don't stop. Even if there's nothing to do, you find something that needs to be done (even if it means squeezing in a few extra minutes of studying).

Trauma is exciting -- you never know what's going to come through the door. There could be 1 person in the CCA one minute, and 2 minutes later there's 4 s/p MVAs (just had a car accident), a GSW to the LLE (gun shot wound to the leg), a person that has a pneumothorax in need of a chest tube (air outside their lung but inside the chest, causing collapse of the lung) and a shock trauma that's unstable arriving to the shock trauma room.  You are always on alert... it's what makes shows like, Trauma: Life in the ER, popular. Trauma is "sexy" to the general public. But not necessarily when you're the one living it -- then it's just exhausting.

That being said, it's not too bad... and can be a lot of fun.

It's a New Dawn, It's a New Day

Wow... I suck at blogging (even in spite of weekly reminders on my phone).  9 months?! To all those who are still subscribed, please forgive me.  But it's a new year, so I feel I should make a little bit of an effort. And hopefully, I'll get better over the year -- I can make excuses (life is just so busy), but that's not what you need, or what this is about... Let's start again. New year, new start, right? So, all that being said....


Hi, my name is Kate and I am a second year surgery resident at an academic program in the south (too easy to figure out which one if you look at any other social media, but I'll leave that to you). Let me start by saying, I love my job, even on the days that I hate it or just want to stay in bed. I have been blessed with amazing friends and have the best puppy in the whole world (her name is Adson -- and yes, she's named after a surgical instrument, a small pick-up, in fact, because she is my little pick-me-up).

Since it's the beginning of the year, I thought I would share with you all my new years resolutions (which, suprisingly, given the nature of this post, does not include being better about blogging). Anyways, here's my 13 resolutions and goals for 2013:

1. Finish my 1 year Bible (I started it a year ago November... yeah, life is distractingly busy at times) - aka start doing daily devotionals
2. Memorize a new Bible verse every week (this one, and the one above are going to be aided by youversion and shereadstruth) 
3. Be consistent in efforts to exercise (currently on day 5 of Jillian Michaels' 30 day shred, which I will only do if I do it before work... which means I'm jumping around my apartment at 3:30 am right now)
4. Make a new recipe every week (did this in medical school, really liked it, wish I hadn't stopped)
5. Pay off credit card debt (there's not a lot, but I want to get rid of it -- and along with that, build up my savings)
6. Buy a house (yep, gonna be here for another 5 1/2 years, seems like the thing to do)
7. Lose 30 lbs (silly but something I want to do)
8. Clean apartment weekly (I found a 15 minute daily cleaning schedule)
9. Study at least 30 minutes a day (actually doing pretty well on this one so far)
10. 13 miles by the end of '13 (yep, run a half... Maybe the St. Jude Half? Starting goal run is the Pancreas Run at the end of March, with some of my residency friends)
11. Swear less (It's there every year... trying to catch myself, but I'm really bad at it)
12. Publish (or at least finish) one research project (this should be aided by the fact that I'm starting a 2 year clinical research stint starting in July)
13. Cultivate friendships.

Since making that list, a few more things have been added as goals for the year:

• Eat healthy
• Read medical journals more consistently
• Stop texting while driving (I know... I'm horrible)

What are your goals and resolutions for the year of 13?

1 year later

One year ago today I was sitting anxiously in a room with all my medical school colleagues, awaiting to receive the envelope that held my future. In the past year so much has happened; I moved south, after living in Michigan for most my life (exceptions being college in Indiana and the year I spent teaching biology in Thailand), started residency, made some amazing new friends, and got a puppy!

Yesterday many of my friends embarked on the same epic journey... so congratulations to all my friends who matched yesterday into the programs of their choice (for more information on the match, check it out on my medical school blog)!

While sitting in my car post call, I waited anxiously half a country away to hear where my friends would be going. But it wasn't just exciting to hear that my friend were going to their top choice, it was exciting to see who the new interns in my program would be come July 1. Yes, new interns are on their way!!!! It's hard to imagine that my intern year is 3 months from being done, but it's true. And now there's a light at the end of the tunnel, the replacements have been identified, and will be coming in to take over.

However, with that means I'm stepping up to my PGY-2 (post graduate year -2), and that comes with a whole lot of changes. Firstly, the infinitely wise ACGME hour restrictions (hence my sarcasm, please see below), will allow me, for the first time since I was a medical student, to take in-house 24 hour call. It also means that I'll be running the CCA ("critical care assessment"), which is the trauma ER at our program.

My biggest fear (and one that I'm pretty sure is going to come true) is me being the desk doc in the CCA on July 1... when the amount of traumas are at the highest. Its a daunting task for any second year resident to be in the CCA during the beginning of the year. But now throw into the mix that it'll be the first time I'm taking real call. Needless to say, kind of freaking out about the whole thing.

Anyways... Residency has been going well since I last updated you all.

In January I was on Transplant Surgery. I really like the rotation and had a wonderful time! I got to operate a fair bit, and even got to do a vascular anastomosis (i.e. sew an artery to a vein for dialysis access). The transplant staff was awesome and I learned a lot! Honestly, I'm kind of excited to rotate through the service again as a third year (in, you know, 3-4 years).

In February I spent some time of the cardiovascular surgery service. The month wasn't too bad, and I had enough time to get a puppy!

Currently I'm back in the Surgical Intensive Care Unit, which I really like, again. The more I thought about it, the happier I am that I came to a program that is so intensive care heavy, I think it makes me think a lot more about why I do what I do... It's been an excellent month so far.

And may I now introduce you to Adson:

At PetSmart the day she came home

She loves hiding in bushes and tall grasses

Playing with toys at the apartment

At "The Barking Lot" downtown

Nothing like the pathetic "It's raining mommy" looks

Love her SO much!

Hour Restrictions Rant: I really don't understand how the ACGME thinks it's completely fine for PGY-2s to take 24h call, but not the interns. And I don't say that because I think the 16h rule is valid, but because I think it's incredibly stupid. Walking into my PGY-2 year, I'm incredibly behind where my second year colleagues were when they started their year. Not only that, but now, in addition to taking 24h call for the first time, the expectations of where I should be are incredibly higher. Oh, and because of the hour restrictions I've seen a whole lot less operative time that the interns in years past.
And then there's the whole "you can't take more than 6 night floats in a row"... How having us switch from days to nights constantly, instead of allowing us to take all our nights in a row is supposed to be better and make us less tired makes absolutely ZERO sense to me.
I just want to yell at the ACGME, "what the hell? have you all completely lost your minds?"
and, soap box done... for now.