6-11ish

So another few weeks have passed. I finished up my second week of peds ophthalmology unscathed. There were students and residents who were actually doing that for their career so I just sat back and took in what I could. lol I'd probably saturated what I was going to get out of it anyway by that point.

So I started my first in house rotation this month (september). Medicine. The bane of my very existance. I should start with, I got out of doing regular medicine as a student because I hated it so very much. There are too many things to think about and there are too many things wrong with all of these people. Its so sad to see 40 year olds coming in on more medications than most 80 year olds. Most geriatric patients are on at least 4 medications. I can't remember to take a multivitamin every day. I don't know how they do it. The simple answer is a lot of them don't. So they end up back in the hospital all whacked out again, and as an internal medicine person, its our job to patch them up and get them back out there.

I'll admit it. I cried every night the first week. I hated it. I don't have any other residents on my service, I had to ask the medical student to show me where the patients/lists/etc even were, and I just felt like I couldn't remember where to be. They have a million lectures throughout the day. I dont' know how they expect us to do anything when we have to go sit thru another freaking lecture every 2 hours or so. But, as with anything, if you keep at it, you'll come up with a way to make it work for you.

I never get there before 6 am. I refuse. I promised myself when I decided not to go into ortho that I would never electively go in for a rotation before 6 am unless it was required, and I luckily have the nicest attendings, and theyd on't mind that I don't get all the patients seen by 8 am, just that i get some of them done.

The medical student is helpful too because he can usually knock out a couple of the more difficult patients (difficult cuz the want to talk for hours) and that saves me time.

i've had some pretty complex patients come into the hospital since I started last week.

My first super complex patient was a 70ish year old man who came in generally not feeling well. He was extremely short of breath, and was unable to stand up without passing out. As I looked at him, I noticed he was extremely pale and working pretty hard to breathe. He had open heart surgery about a month prior and had a complication of an upper GI bleed, which he had to receive blood for already. I examined him and he had a positive guiaic (blood in the stool) but no occult blood seen, and he had a new murmur. this murmur was pretty pronounced as well. At this point, I was very nervous. I hadn't had this acuity on the floor before and he wasn't on a floor that could handle it if he crashed. I told the nurse to start some fluids and work on transferring him to the Unit. I called the physician in charge, and he almost poopooed it, saying to order a bunch of tests and wait for him to get there. The only relief was that when he arrived he said "okay we're going to the unit!" I was right! haha Being able to distinguish sick and not sick is a big skill. He ended up having lost about 20% of his blood into his abdomen, and received blood and an emergency endoscopy that night. about 7 days later, he's a completely different man. Very healthy sitting up in bed, getting ready to be discharged. I can't help thinking how badly that could have gone if I just waited for the doc to come later.

i have also survived a 24 hour call. I feel like I'm an invisible sort of idiot now. i had a very helpful senior on with me, which was great because I would have been so far in over my head otherwise.

We experienced just about anything on call. We had a code blue (when someone stops breathing and their heart stops beating), we had a rapid response (what they call before the code blue if someone's circling the drain) I had to see patients in the psych ward, i had 6 admissions, I had to be in the room as we told someone their dad was going to die very very soon, and I had to do a death pronoucement.

The only story I really want to share about this is what can happen when communication is less than optimal.

So I get a page and I call it back (protocol people!) and I say "this is dr barlow i was paged" the nurse proceeds "Yes, Dr barlow, we have a Mrs. X here, she was transferred from the ICU to our floor and she was doing okay for a while but she's stopped breathing." At this point I freaked out. My heart stopped. I repeated to her "She stopped breathing?" "yes" "did you call a code?" at this point my senior looks at me and whispers, I think she means she died! the nurse laughs and says "oh, this was expected, she's DNR... we just need you to come do the pronouncement" Couldn't you have opened with that line?! Anyway, poor communication!

so now i'm halfway through the month (roughly) its the hump week, as there are about 5 weeks total in this rotation. My mom comes this weekend. That won't stress me out at all! (ha!)

but, I'm getting better, and i've only been rude/mean to other residents once, and I have stopped crying about work. Here it goes to keeping up that trend!