Expecting Again

Heading into my last week of general medicine in-patient work as an intern, with one more block of labor and delivery in-patient medicine in June.  In-patient rotations are the most taxing simply because they require one to work 6 days a week.  I find that generally I end up working 10-12 hours/day during the more chill, out-patient rotations, and 12-13 hours/day during the strenuous in-patient rotations, but the big difference in having a life is that the out patient (aka clinic) rotations are 5 days instead of 6 days per week, which just makes for a happier person.  The in-patient rotations however have their perks.  I feel more of a sense of control, every morning has a loosely structured schedule, and I get to accomplish my work however I want, I get sign-out (the low-down on what happened for my patients overnight and who got admitted to the team) from the night team, chart review, see my patients, start my notes, while chowing down on some breakfast; all this gets done in the first 3 hours of the day.  Then rounding (usually a sitting session – thank GOODNESS! Which is where we discuss the patients, their new labs or radiology reports, and their plan of care with the other team intern, the senior resident, and the attending… and sometimes our awesome clinical pharmacologist and a medical student or two), which takes a pretty variable amount of time depending on how much teaching or tangential talking we do … and the rest of the day disappears in a flurry of random tasks, some big some small, like running up to check an EKG or having a family meeting with the patient and their loved ones, or admitting a new patient from the emergency room, all which I must prioritize to ensure good patient care … and to ensure I don’t stay there till well after my 12 hour allotted shift time, which thankfully really doesn’t happen too often, usually only about once per week by about 1 hour.  The day is so busy and usually I do get some time to read or discuss learning points on my own or with my team, and those learning points are always so interesting because they are immediately relevant to what I’m doing and the decisions I have to make (or think I have to make but in reality, the real doctor, the attending, ultimately makes them, but hey I do have some say).

This is in contrast to clinic where I feel I have no control, I have to wait usually at least 20 minutes to see my first patient because it always takes that long for the medical assistant (MA) to screen them, and usually, since I am an intern, I have not even worked with the MA but once or twice so we are not used to each other and things do not flow very efficiently.  Then the day goes by quickly, yes, however I continue to feel I have no control over the day’s events, as each patient is a complete mystery, someone new I’ve never seen before, and who may or may not have a host of medical questions for me to address at our 40 minute appointment, which may seem like adequate time, but when you start by taking the first 20 minutes away, then add on trying to have a 5-10 min conversation with your attending in between interviewing, examining and wrapping up with the patient, which may at times require several iterations depending on the attending and how many things they want you to go back into the room to recheck, you are running behind by 30 minutes at a minimum at the end of the day and still have at least an hour’s worth of medical record documentation to do.  It’s far more draining than the in-patient work.  Perhaps spending more time in the clinic over the next few months will allow me to become more efficient and master the art of clinic flow.  Additionally, when second year officially starts, I’ll no longer have to take the extra step of precepting (or presenting my patient and the plan to an attending) except for patients in which I have questions or uncertainties.

Anyway, that about sums up the intern year schedule dynamics.  Somehow keeping sane most of the time, Andy-man and Mr. Darcy are ever a source of joy… and then there’s the excitement of expecting…

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Yes we’re having another baby!  I just passed the big week number 24, also known as “vitality week” since it supposedly marks a statically significant difference in vitality between those who are born prior to verses after this date of gestation.  So I suppose I can worry a little less now.  I don’t know how to not worry, there is always something new on which to ruminate.  Did my water just break, or did i just pee myself?  Am I going into labor or is this just what running is going to feel like from now until I give birth? Knowledge on the subject of medicine and health only makes a person paranoid.

But anyway, there is a lot of excitement in the coming July, going to be finished with intern year, and Andy is going to be a big brother!  Also, another 3 minutes and it’s Easter, He is RISEN, he is RISEN INDEED, HALLELUJAH !

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Nights Are Awesome!

I’m surprised to find myself saying this but I’m actually in love with the night-shift inpatient rotation so far! Granted, it’s been very very slow on the ward (things you’re not allowed to say out loud but I don’t believe in that vudo shenanigans) and after that first night, which was much more busy and crazy, things have been pretty much going at just the right pace for me to keep up and have a little extra time to do some reading on the side. Tonight’s topic was gastric outlet obstruction since I got to experience that diagnosis for the first time tonight! Which was pretty neat, …though of course not for the patient… praying for them!
Getting to and from work on nights takes about half as much time, that alone is a huge relief. I hate traffic with a vengeance! 


And I get to stop and notice the beauty around me a little more as I’m not so consumed with the sweltering heat and insanely crushingly long lines of cars and stop and go traffic! Also the weather has been fantastic in the morning drive homes – been rolling down the windows, taking in the fresh air. 
Course I do miss my Andy man… he gave me the oh so sweet present of his attention and joy when I awoke and emerged from my hybernation yesterday afternoon, greeting me with a huge smile and jumping down from his chair to hug me and the preceded  to sit on my lap and smile up at me. The little sucker! 


I miss him and the hubby loads and the in-laws- whom I am barely getting to see while they visit… yes these are the down sides. 

But I am mostly struck by how pleasant it’s been… I suppose I waisted so much dread over it, only to find it’s not so bad when the nights not busy! You get to run around the hospital, not confined to one little space or area, pretty much do completely random and new and interesting things all night! I so feared not knowing things and being ridiculed for it, I was totally wrong to fear that because the peeps I’m working with are so awesome about giving you pointers and help figuring out how to manage the ward! So I feel very blessed… and hope that this post may put to rest fears in new intern to be’s in the future or interns about to start on nights!

Starting Residency – on Nights

I’m only two shifts in, so I can not speak in great depth about the adventures of being a new intern on nights.  But wanted to post a short update anywhoooo…

 

Getting on the correct sleep schedule wasn’t too too bad, I slept in later than usual on my first day (went from getting up around 5:30/6 to getting up at about 8am) and then I took a quick nap in the afternoon while Andy was out for his nap.  But I must say, I was quite fuzzy and drunk feeling by the end of that first shift.  By the time I hit the hay – it was 8am and I had stayed up about 24 hours total, because I got off work a little later than I was supposed to – worked for 14 hours and it was only supposed to be a 13 hour shift (many programs, even to this day, have something more like 18 or 24 hour-long shifts for the resident, and yeah I’ve been told countless times that it was even worse, “back in the day” before duty hour restrictions! Oy, I can only imagine!).  I mean I do remember everything that happened, I wasn’t that out of it, and I remember feeling pretty coherent, however, it was a very slow and cumbersome version of myself I was having to work with.  In addition, I was trying a lot of new stuff and running into countless strange road blocks/new challenges along the way and my brain was ever so reluctant to confront them!

 

I extremely was blessed to work with a very kind, thorough, methodical, and organized senior resident, who not only offered support in every challenge I faced but showed me both by example and by walking me through the various new tasks residents must accomplish – such as how to properly admit patients, how to address nursing concerns on patients experiencing short runs of V-tach, or fevers, or fussy sick babies, as well as other night-shift-type duties.  This helped immensely!

 

Among my new tasks, one of the first was answering calls from the nursing staff.  Unsure of myself initially, I answered with a, “Hello, this is Captain Bier?”  And gradually throughout the night I started to remember to answer with a slightly more confident version of that phrase, making sure to call myself Doctor instead of Captain, as no one really goes by rank when doing any kind of patient care!  I got calls about critical lab values, about patients needing sleep aids, or antipyretics… I learned to make a couple decisions on my own, and a bunch with the second opinion of my senior resident, and even one where I did a quick exam of the patient and called the attending to get his input on a decision.  It felt really good knowing I wasn’t on my own to deal with things with which I wasn’t comfortable flying solo.  I was just a little concerned, because I didn’t feel like I knew when it was ok for me to decide something on my own – as a result, I would always go back to my senior and tell him what had happened whenever I had made a decision, kind of my way of asking/testing him out to see if what I did was appropriate.  He never gave me the impression I was doing too much on my own, so I supposed that’s a good thing.  Hopefully I will get better at this…

 

As I said, I only worked two shifts – and then I got two days off!  Was a glorious little “weekend,” especially as it was the 4th of July in D.C.!  Got to spend some marvelous quality time with the fam, which was great… sad that tomorrow it all must come to an end and despite the fact I now have my in-laws in town visiting, I’m sure I’ll hardly see them, as I have to work!

I can say that going from medical student to intern has been pretty exciting!  Walking in on day one was yes of course very intimidating, but it was crazy the difference between how I felt walking in that first day and walking in the second!  So much more confidence and excitement for the shift to come!  Don’t get me wrong, I was still in a state of being constantly slightly terrified haha, but it’s just so cool to finally be able to say that I’m a doctor and I can finally sign stuff and get things moving.  Yes, there are people above me, who are still signing on that bottom line of a lot of what I do, but it’s definitely different, and more engaging than it used to be as a student.  Also, I feel like I can be myself more because I’m not in a perpetual state of interviewing for a job anymore, feeling like I need to always be searching for what they want me to say or do.  Instead I’m thinking more independently and making more sincere friendships with those around me.  So that’s exciting!

Well I’ve accomplished my goal to stay up until 1am, now it’s time to climb in bed, and tomorrow twill be: nights – day number three!