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.

8 Things to Know About Resident Physicians

My old roommate wrote this and posted it on her facebook, and it's too good not to share... So here you go, enjoy:

Yesterday, my friend sent me this blasphemously hilarious article called, “5 Things to know before dating a scientist.” http://www.thejayfk.com/?p=1709  Not to be outdone, I decided to write this 8-item blog because studying for Step 3 is boring and let’s face it, dating a resident physician is terrible.

1. Page us if you really want our attention.
It is frankly rude for us as residents (aka underlings) to pull out our cell phones 90% of the time we are at the hospital.  We are either presenting a patient on rounds, sitting in a lecture, or pretending to listen to a patient.  Please understand that we are in a service industry and a learning environment that takes no text breaks, snack breaks, pee breaks, or lunch breaks.  Very often, textswill not be checked or replied to in a timely fashion.   So if you must communicate a dire need / clarify a dinner plan to us… please page us.
It is much easier to read a page at the hospital because it appears to be work-related!  Many of us have mastered the “I am communicating important patient information to another colleague” look while we are paging other resident physicians emoticons and pages about where to get free food.  Most likely, our response time will be much better on the pager because while we are not a slave to you or our phones, the pager is our ball-and-chain.  However, if you get an automatic response, such as “Yes/OK, Thank you, or In 15 minutes,” then just know we are supremely busy and we apologize for the curtness.  So don’t take it personally.

The caveat is that some resident physicians do not like using their pagers for non-hospital communication.  So just ask yours if you should page / text / call them.

2. We love sleep.

We adore it, worship it, love it, and crave it.  All the time.  Since our second year of medical school, we have had a yearning for it.  It is precious to us.  When you’ve been up 34 hours straight and have half-slept on a hospital cot clutching a pager, you will understand our love for our beds.  I’ve heard of residents sleeping on the kitchen mat before their kitchen sinks while doing their dishes, residents sleeping through their friends’ weddings, and residents falling asleep talking to their significant others—you.   Sorry.

If we have the chance to be uninteractive for more than 10 minutes, then we will invariably close our eyes and drift into REM sleep.  What we want is uninterrupted, un-anxious, fulfilling, undeprived sleep.  Most of the sleep we accumulated in medical school was drunken hangover sleep and dreaming of test material, and most of the sleep we experience now is with a dysfunctional circadian rhythm.

So please do not wake us up early on days we can sleep in.   Most of us only get sick during residency because we do not sleep enough.   An early 6:00 am morning walk on the beach to see the sunrise is akin to a non-urgent page at 4:30am— tolerable, but annoying.

3. We love to ask questions.  Please ask us questions too!

Most of us resident physicians have been learners for 20+ years, heck, some of us even have PhDs and Masters degrees.  We have evolved to learn, memorize, analyze, and think critically extremely quickly.   If it is rude to you that we whip out our cell phones to wikipedia every building or foreign food or new drug being advertised, consider us sorry—but not really.  Our jobs require us to keep on learning, so it is only natural we apply the inquisitive approach to whatever seems interesting to us. 

Our brains were beaten to a pulp to learn each minute, relevant and irrelevant detail so that we could somehow catalogue those tidbits into a useful, accessible database.    As a consequence, if you say something remotely fascinating, please don’t be offended by our follow-up interrogating.  It is our way of interactive learning.  Blame Socrates.

So, broaden our horizons by teaching us something.   And ask us if you don’t understand an acronym or the jargon we’ve just spewed out.  We generally like teaching you too.
 

4. Don’t ever lie to us. 

Been anxious? Not sticking to your diet plan?  Didn’t really like the dress?  In pain?  Don’t really know the directions?  We can usually tell.   It’s a good thing though, because we would do anything to help ya.  But if you have an ulterior motive—don’t think I’m a naive nerd who made it this far by studying.

Our job as physicians is to find the truth in the patient’s history, symptoms, lab results, and imaging.  We love to believe you, but if what you says seems fishy, we will inadvertently turn to objective data to corroborate your story.

We see enough pathologic liars at work.  Believe me, you don’t want to be lumped in with the pain-med seeker who has 10/10 headaches and can still sleep soundly in the ED, yell at the triage nurses, and eat a full meal while sitting under bright fluorescent lights.
 

5. We are not medication or medical imaging vending machines.

Please tell us if you aren’t feeling well.  Feel free to refer your family/friends to us for an informal conversation re: their low back pain or new rash.  Let us know if you have been in an ER waiting room for hours.  We want to help you, but generally, we cannot give you stuff other than medical advice that is better than WebMD.  If we can help you, we will offer to.

In addition, it is unethical for us to prescribe your mother’s Xanax and impossible for us to give you a free MRI.  In addition, we as physicians are taught to never treat who we're dating and to never date who we're treating.  It is an ethical issue.
 

6. Color us cynical, but we still have feelings.

The things we hear, the diseases we see, the people we touch, the emotional burden we bear, the hours we work, and the medical responsibility we have—those are things you will never experience.  So please don’t say you understand how difficult my job is or how my patient feels.

The painful, ugly, humiliating, and private things that make you gasp on TV, we’ve probably seen ten of them in living color and had to touch them.

Most of us have healthily coped with the stresses and situations by becoming a bit cynical and numb.  If we cried for every cancer patient, if we felt sorry for every drug abuser and homeless man, if we were mad for every hour we worked “overtime,” we would be so emotionally spent that we could not function as a person.

But still, every resident still has feelings that the day to day coping mechanisms cannot compensate for.  For me, when I hit rock rock bottom, I just need to spend lots ofalone time with my dog on my bed. Find out your MD/ DO's means of escape from the hospital and make sure you R-E-S-P-E-C-T it.
Thank you.
 

7. Non- hospital food and coffee is ALWAYS superior to hospital food and coffee.
We would love some—homecooked, deli, leftovers from a restaurant.  Anything.  Anytime. Anywhere.  You can totally make our day with a Chipotle burrito or a morning donut/ coffee.  When we sip that Starbucks coffee cup at work, it is a pleasant reminder to us that we are still somewhat normal human beings in touch with the outside world.  Life becomes very lame when all of your fluid intake/output is at the hospital.  Remember, jellos and saltine crackers are not dinner.

8. VERY IMPORTANT: Don't ever complain about your work hours and your salary.  We have it worse.
But if we complain to much, please kindly remind us that it was way worse 30 years ago. 

(Thanks Eileen! This is awesome!)

The One Where I Confess I'm a Horrible Person...

*** sorry, it's long and I don't have time to proof read, please forgive the errors and just be surprised I managed to get something out into the blogosphere***

Despite weekly reminders popping up on my phone, and inconsistent (but nonetheless, copious) comments from my parents about my negligence in regard to this blog, I confess, I have been abhorrently horrible about updating my blog. Although I can rationalize my absence in the blogosphere as residency being too taxing and my false claim that my time too precious, we all know that I could have found a few moments to update you on the life of this general surgery resident. So, to the few and proud still lurking around, I beg for your utmost and (hopefully), expeditious forgiveness.

I believe the last time I was here was the end of August, at the end of my most favoritest rotation to date: pediatric surgery (yes, the verbose proclamation of love for pediatric surgery happens on an almost weekly basis, but I'll spare you, for now). That being said, I do believe I owe you all some recaps (for those of you not friends on Facebook or following me on twitter):

September: September found me on the endoscopy/ nutrition service. It was a lovely, and very low key, month. I didn't have to arrive to the hospital until about 6 or 7 on any given day and was usually done by around 3pm (this is unheard of for most surgery residents). I spent 2 mornings a week doing upper endoscopy (EGDs, or putting a camera down the throat and into the stomach and first part of the small intestines). 2 other days I would head over to the VA hospital and do colonoscopies in the afternoon (camera up the butt to look at the colon). The rest of my time was spent rounding on the nutrition support service and learning the intricacies of different tube feed formulas and how to give nutrition through IVs. On Saturdays you could find me covering the burn ICU, and having a plethora of free time to read. It was a thoroughly enjoyable month.


October: My October started with a week of vacation, which started off with the wedding of one of my best friends from college, who married his middle school crush. I then headed to my parent's house in Michigan and enjoyed the beautiful fall that happens in Michigan. I went to the apple orchard with my mom and had gloriously delicious apple cider and enjoyed the changing of the leaves (if you've not experience a northern fall, you are missing out... and, although I've very biased, I believe Michigan has one of, if not the best autumns). I returned to work the following week, were I started working on the general surgery service at a private hospital east of the city. My days started between 3:30 or 4, and the days were long... but I loved my time at the hospital (with the exception of the horrible EMR they have). I learned a lot, got to observe some really amazing and advanced surgeries, and even got to operate (almost daily). During this rotation the PGY-1 residents spend a lot of time with the program director doing breast surgery. Although the procedures may seem small to many, it was the first time I really got to do surgery on my own (the program director was there the whole time, but she just redirected and taught). Also, it's an amazing feeling to be able to tell a women you got rid of all the cancer we could find. I also, despite of the long hours, was able to get a lot of studying done during the month and spent a lot of time with my residency best friend studying at coffee shops and having weekly dinners.


November: Can I just say that I still REALLY like trauma and the intensive care unit?! I loved the complexity of patients that I took care of during November and really enjoyed the chance to be involved in the trauma resuscitations. I didn't get a lot of chances to operate, but I did get a few, and it was wonderful. But in spite of not operating, I had a wonderful time taking care of the ICU patients, having to think through all the problems, and really digging deep into the literature about different conditions and treatments. The month was also fabulous because one of my favorite coresidents was there with me; we had a system worked out so that I would bring her coffee in the mornings and she'd bring me tea at night when we were both covering the unit. We had so much fun complaining to each other about what was going on (venting is really good, especially when you have a friend right there with you... and we knew that a lot of it meant nothing). One of my other favorite coresidents was the floor doc during the same shifts I was in the unit, so we had time to hang out in between the crazy busy moments. Overall, it was a wonderful month!


December: I'm not going to lie, this past month was a rough one for me. I was on vascular surgery, which at it's roots is the exact opposite of pediatric surgery. The patients are generally old and have about a bazillion different medical problems. Also, I hate feet. Needless to say, I did not have a very good month at work and many times found myself questioning not only why I went into surgery, but also why I even became a doctor. At more than one time I postulated that it wasn't too late to drop out, until I remembered the massive amounts of debt I have from medical school. The month was hard because more than half of it was spent on night shift, covering about 5 services and never really feeling part of any team. Despite being the vascular intern, I only ever saw one of the attendings and spent most of the month by myself in the hospital at night (which aint fun). The week that I was on days wasn't horrible, however, and I found that I didn't mind the rotation nearly as much as I hated it while on night float.  The one great thing about the month was I managed to finagle about 11 days off between a week of vacation and a holiday schedule that got me 4 days off at Christmas (best idea ever!)

During my week off my mom came to visit me. We went to all the sites, saw part of a show (before we left, because, while the acting was great, the script itself was horribly unbearable), went to the zoo, went shopping, decorated my Christmas tree and made holiday cookies. It was wonderful, and exhausting. After my mom left I spent about 2 days on the couch recuperating from all the excitement.

At Christmas I actually managed to get home to Michigan. I got to see my entire family (almost, I didn't see 4/21 cousins) and spent quality time with my best friend and her family (whom I hadn't seen in almost 6 months). It was a wonderfully excellent Christmas.

Things to come: January: This month I'm on the transplant service, while I hear it's a busy service, I'm excited. I think transplant is fascinating and I'm looking forward to caring for pseudo-ICU type patients. The truly stressful aspect of this month is that this is ABSITE month. For you Grey's Anatomy fans out there, this is that big test that they have to take each year; or rather, the ABSITE is the year in-training exam all surgery residents must take. It's 250 questions and is a big predictor on what your options are for fellowship (kind of like the SAT for college, or MCAT for medical school, or USMLE for residency). Needless to say, most of my free time this month will be taken up by studying for the exam, which occurs on the last Saturday of the month.


Reflections: Despite of the intermittent horribleness that can be any residency (specialty or institution), I am glad that I chose to do surgery. The highs are great, even though the lows can be rather low and dark. Most of the time has been a great experience. I still love operating. I still love the diseases and complexity that occurs with surgery patients.

I'm glad I'm where I'm at for residency. No matter where you end up for residency, you'll be able to find issues or attending that you maybe aren't a huge fan of... but for the most part, I love my program. I think the attendings are rotations are great and I've learned a lot over the past 6 months.

I love my new city, even though I've not had a lot of time to explore it. I love my friend here, they're all awesome people.

That being said, residency is hard. Residency is exhausting. Residency sometimes wants to make you buried your head in your pillow and not wake up. I think this has been made harder by the fact that I'm at least 12 hours away from my family and all my friends, and the fact that communicating can be difficult with the limited hours of free time to get ahold of people. Someone told me to pick a residency close to home, I'm not sure I would do that even now, but I can understand why people told me that often.

Anyways, I'm half way done with my intern year, and that to me is a huge accomplishment. As far as I can tell I'm not floundering too badly and I'm having fun more days than not.


Resolutions (because, you know, it's a new year... Happy 2012!):
1. Be better about blogging (I promise I will try)
2. Be better about communicating with the most important people in my life
3. Be better about studying everyday, no matter how tired I am or how soon I have to be back to work
4. Make 1 new recipe every week
5. Work out (I don't know where I'm going to find the time... so I'm not going to designate a number of times per week... we'll just leave it as, work out at least weekly)
6. Read (or listen) to my Bible more consistently
7. Work on my bad character traits (impatience, getting frustrated easily, etc.).
8. Pay off my credit card debt
9. Buy a house??
10. See Newsies on Broadway with the best friend


On that note, I'm post night shift and still have beacoup d'etudiant.
Paix et benediction a vous tous pour la nouvelle annee (Peace and blessings for the new year to you all)

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!)