This thing I refer to as My Life

4 more days of Medical ICU

For my little sister's birthday I had call during which I admitted two O.D. One supposed for Ambian and the other for Meth. The Meth person most likely won't make it. I admitted a guy who had been pushed down some stairs earlier this year and broke his neck and was receiving VERY poor care at his nursing home. Took care (at least tried) of a young man who is trying to die from pneumonia, an older woman who got a very bad infection from the line used for her chemotherapy and an older man who has a 1 inch deep ulcer in his stomach that keeps bleeding.

For some reason, I was not able to conjure up a nice "light" e-mail to send to my little sister in the light of all of the positivity surrounding me during my 32 hour shift. But a few hours of sleep seemed to help.

Taking a day off.

Well, actually, I have today off and Monday off. I ended up with an "extra" day off that I needed to spend early because I don't get a day off for my last call simply because of when it lands. But, I'll be post call before a weekend and they tend to end a little earlier in the day. At least in theory. My days have been much like this:

-Up at 4:45a-ish. The alarm is set to 5a, but I have not slept to the alarm as of yet

-Do my morning "stuff" and out the door by 5:50a

-Decide if I will be warm enough with the top down and the heater on or not. There was more top-down this last week than before.

-At work by 6:45a-ish -> go to my locker which has "cool" locker shelves that I built after my 1st day -> put on my long coat and get my metal clip board

(Aside: I have this metal (probably aluminum) hospital clipboard of the type that was used around the time of the Korean War was taking place. It has a clamshell-like design and I know I've had it since elementary school because it has a "Good Job" sticker on it, still! At first, people look at me kind of strangely because I have this old thing, but then they see me writing on it and the response is always the same, "Oh! That's kind'a nice!" Maybe one of my parents could shed some light on the origin of this thing?)

-Walk across the hospital and up to the 4th floor where the MICU is, with lots of "Good Mornings!" along the way.

-If I get there earlier enough I look up some patient lab values before going to rounds

-7a we start Sign-In rounds where the nightshift team updates us (and our Attending) on all of the patients on the floor. The attending actually arrives early and sees all of the patients first to minimize the number of surprises.

-That takes about 30 to 45 min. If the attending is in a hurry, he'll let us know and our running joke is that translates into "No Elliott-questions until mid-morning rounds."

-We write all of the orders that were discussed during the rounds which takes another 30min

-We go grab a quick breakfast (about 15min), which, for me is: two scoops of egg beaters, cover them in salsa and a toasted garlic bagel half of which I eat with a normal amount of cream cheese and a diet soda.

-Back to the MICU to follow up on labs, orders and "stuff."

-If we get all of the paperwork done, then we update "the list." It's a list of all of the patients and a summary of what is going on with them

-Academic rounds start around 10:15a where we go through all of the patients again and discuss any new changes or make new orders for the day and this is where we usually ask educational questions. Even I try to limit my questions to these rounds since the post-call senior has already gone home. Once we have gone over all of the patients, we go view all of the chest X-rays from that morning. These rounds take longer and last until 11:30, but it is still much more palatable than the rounds I had during my M3 medicine months. Probably because I have a better understanding of what is going on and it is much less stressful.

-Write some more notes and decide if I want to go to the internal medicine afternoon conference. I have not been going too much because all of the other interns have to go so I stay back and help out. But, now that I have finally had my orientation, I know that I'm supposed to attend about 70% of them. Oops! Too late for that! Best I could hope for is about 50%. ;-) Good thing it is not a requirement! For lunch I usually have a turkey sandwich, Sun Chips and a banana and soda. (You'll see why this is important later.)

-Finally, there are afternoon rounds (which are quick) around 3:30p.

-In between all of that time, we are evaluating potential new patients out on the regular medical floors and the ER. I'm speaking with and updating families and occasionally placing central lines. I'm starting to get to the point where I am making clinical decisions without asking my senior first, but I am usually updating him on the decision with a few minutes. :-) Since I have tried to get to know all of the staff, their friendship comes at the price of them asking me to write orders and do procedures which means I rare leave before 6p. But, on the days that I do get to leave earlier, I always hit bad traffic so I'm not in that big of a hurry. The plus side is when I need some help, there are plenty of people willing and they usually steer the procedures my way because they know I enjoy them. I also get a lot of praise for how well I handle family and how patient I am. So, maybe all of that time I spent honing those skills during M3 will pay off. At least for this month. :-)

-I get home around 7p, spend a little time with ML and eat dinner and I'm usually heading for bed, completely exhausted, around 8:30p.

-On the plus side of all of this eating (oh! I usually eat some fruit or a little something on the way in to work…forgot to mention that), is that, although I do not get to exercise at home, I'm walking around so much that I'm still losing weight! How exciting is that?

First Days (and Nights)

My first day turned out to be call night! Actually, ML told me that was going to happen and I found out about it from a fellow intern on Sunday.

We (the night senior and I) got totally slammed (Monday night) and we were up all night admitting and managing patients. (Fortunately, I really like both of my seniors!) It was tough and we had some critical PTs, but everyone pulled through...amazingly! The most notable was the pt that was brought in obtunded with: a glucose of 3; hgb of 2.6; wbc of 0.4; plt of 10 (each of those numbers are an order of magnitude lower than they should be) with a 20" liver span (3x larger than it should be). Oh, and I had to share new about their ill loved-ones to THREE families all by myself...on my first night. I also had my first code as an ACLS trained physician. It does make quite a bit of difference having better knowledge about what is going on. An!!! I placed my first central line! That's where you run a catheter into the superior vena cava (just above the right atrium) so you can deliver fluids very rapidly and determine the central venus pressure. That turned about to be very important because we had one patient that we could not tell if they were in congestive heart failure and needed pressors OR were hypovolemic and needed fluid resuscitation. When we found out the PT's CVP was 3 (it is normally 8 or 10) we new that fluids were the right answer. Oh, and then we found a bilateral pneumonia which probably caused all of the Pt's problems to start.

Out of the frying pan and into the fire!! But, I made it and took today off. The call is only q5, which is better than q4.

In a matter of just 7.5 hr from now, the sh!t is going to h!t the fan!

I had my Advanced Cardiovascular Life Support training over the weekend and I did well! Which was nice and a little surprising...(I had my written and practical exams earlier this morning.) One of the nurses I was working with during the practical works in the ICU and was nice enough to show me (and one of my fellow interns that starts tomorrow) around the unit.

If all goes well, my alarm will go off at 5am -> do my morning "stuff" and hit the door no later than 5:45a -> drive to StJH&MC and arrive no later than 6:45a. That will give me 15min to toss my stuff in my locker and walk across the hospital to the MICU (Medical Intensive Care Unit) where I will have my first day as a licensed physician AND, I will take call me first day. Just like in Medical school. Don't know why that sh!t always happens to me. I will leave the hospital by noon the following day, drive home (after a nap if I need it), and sleep until the following morning. I will live THAT day every four days for the next two months.

The other days, I will have the same morning, but I will get to leave around 6p. Just in time for traffic. Yippy.

We'll see how much time there is for posting. There will probably be more time at the beginning than later in the month since they usually take it easy on you at first until you learn the system.

Don't get so sick that you have to go to the hospital for the next several weeks. This is taking place all over the country!