Practicing My ER Skills

Back in September, our residency program had a practical skills lab where we got to perform venous cutdowns, diagnostic peritoneal lavage, chest tube insertion, cricothyrotomy, and emergency thoracotomy. It was SO MUCH FUN!!!!

Below are a few pictures of me practicing my mad skills!

Venous cutdown (You could do this when you can't get "normal" IV access - it involves making a small incision near the ankle and finding the vein there to insert the catheter.)

Here I am watching my partner perform cardiac defibrillation - shocking the heart. We do this when the heart starts acting up - by shocking the heart we are hoping to stun it back into a regular rhythm.

Now I get MY turn to shock the heart.

Here I am performing the thoracotomy. A thoracotomy is making a big incision on the side of the chest, spreading the ribs apart, and getting to the heart by pushing the lungs out of the way. We might do this in the ER when someone gets shot or stabbed - with the injury penetrating the heart. Because the heart continues to pump blood in this instance, you MUST control and close that injury, otherwise the patient will die.

Clinical Skills Lab was SO MUCH FUN and I can't wait til next time!

FAST Exam

This is what an intern looks like while learning how to perform a FAST exam on a live patient. It was AWESOME!

Has It Really Been This Long?

I promise - I have a very good excuse for why I have taken THIS LONG to post.

I've been on Block Nights for the whole month of October. I've been counting down the days since the first night shift I worked. Did you read the blog I posted a while back about being House Officer? Well, during the Block Night rotation, it means that I am H.O. EVERY NIGHT OF THE WHOLE DANG WEEK......

It means that I am in charge of everything that goes down in the hospital. Someone has a fever? Page me. Someone throwing up? Page me. Some old, frail person fall? Page me. Someone's heart stopped beating? Call CODE BLUE first. Don't worry about paging me...I'll be there. Someone needs to be admitted from the ER? Page me. Talk about responsibility! I'm left to deal with patients I have never seen, patients whose medical history I don't know..... And I'm relied upon by all the attending physicians in the hospital to keep their patients alive while they themselves can't be in the hospital. It is stressful!!!

Last week, on what could have been - actually it was, the worst shift of the entire month - I was called by a nurse to check on a patient who wasn't breathing very well.

RN: Doctor, can you come look at this patient? When he has his oxygen mask on, his O2 sat (Oxygen saturation of the blood) is 98%. But he keeps pulling off his mask and it drops to the 70's.

ME: Sure, I'll come take a look at him.

***What I see when I walk into the room: The patient appears to be sleeping...with his oxygen mask down on his chin. There is a tech sitting at the bedside - I assume he's there to prevent the patient from pulling off his mask. (Apparently not paying attention to the fact that the mask was around the guy's chin!)

ME: Well, let's start with putting the mask where it should be. And let's get an accurate pulse ox (the device that measures oxygen saturation).

TECH: Yes, the respiratory team had a tough time getting a good read on him earlier.

ME: (Thinking in my head): Oh boy.
****Tap patient on the shoulder*****
ME: Sir?
****No response****
****Shake patient's shoulder****
ME: SIR?
****No response****
****Sternal rub****
ME: SIR!!!!!
****No response****
ME: Okay. Please go call a RAPID RESPONSE.

TECH: On my way.

Please note that the RN who originally called me about this patient was no where to be found.

Long story short, I ended up having to intubate the guy (stick tube down throat so he could breath) and transferred him to the ICU. This was all while I was receiving pages from the ER for more admits......yikes!

And here was the page I received last night:

NURSE: Um, doctor? This patient you admitted with COPD exacerbation sounds really tight...but you didn't order any breathing treatments.
ME: Yes I did. Did you look at the orders?
NURSE: No, but the respiratory team told me.
ME: I wouldn't have admitted someone with COPD exacerbation without ordering breathing treatments. I swear I ordered them for this patient. Do you have the chart?
NURSE: Yes.
ME: Can you turn to the orders, please?
NURSE: Yes. Oh, here it is. Yes you did order it. Sorry.
ME: Thought so.

Hanging in There

I'm sort of getting the hang of things....

I have decided that being the House Officer is a really awful job. My first 24 hr shift was last Sunday...and it was CRAZY busy. We were actually slow all day long until about 7pm...when things starting picking up. I ended up not having ANY sleep. In fact, I couldn't sit down for more than 2 minutes at a time. Tons of people got admitted...and I was in charge of all of them. I had people seizing on the floor at the same time other crazy things were going on. It was overwhelming and awfully tiring.......

I learned quite a bit though...and I figure that is the whole point!

Outside of house officer shifts, it has been a little busier on my Orthopedic service. In fact, they let me scrub in on a Total Hip Replacement and Total Knee Replacement last week. That's right.....little ol' Emergency Medicine intern got to scrub some big ortho cases! I learned that the scrub nurses don't get to see outside interns too often....only the general surgery, OB, and orthopedic people....so they liked having me around. Especially having a female around. It was pretty fun to get back into the OR....I really do like blood. Is that sick?? =)

The rest of the month should go pretty well. I have learned what is expected of me during this month and I feel like I'm doing a good job right now. The best thing is that all of my house officer shifts are done for the month....WOO HOO!

First HO Shift

I had my first job as a HO today. Never thought of myself as a HO.

Actually, HO stands for House Officer...meaning I was in charge of everything going on in the hospital from 7am until 7pm today. Not everything I guess...but I was in charge of admitting all patients, giving verbal orders to the nurses (and remembering to go to the floor to sign those orders), changing bad orders, writing prescriptions for the doctors who had forgotten, etc. Basically if the nurse needed something done, I was the go-to person.

My day started off with a patient who needed "pre-medication" orders before getting an MRI. I asked the nurse politely, "Well, what do they normally write in this instance?". To which she responded, "Normally we'd just give a little Valium....but this patient has a heroin problem and we probably need to give them more. Plus they have chronic pain and are requesting morphine."

Great. Real great. Just what I needed for my first call.

I did exactly what the nurse told me to do. Then I ran down to the ER (my favorite spot) and was able to run my order by the doctor there. He laughed that I was having to deal with this....but said it would probably turn out okay and I probably wouldn't over-sedate the patient to the point that someone would be calling a Code Blue. I felt a little better after that.

Actually, it was kinda fun being large and in-charge. I got to write my DEA number 3 times today! Yippee!

Treading Water

Well, I'm treading water.

I didn't get "pushed in" and I didn't "drown"...yet....but I jumped in on my own will and have been treading water for the past two days.

Actually, my first two days have been quite uneventful...quite boring in fact. I haven't gotten to scrub for surgeries (since I am an emergency medicine resident, it means that I don't get to scrub in....only the ortho residents do). It also means that I am at the paging will of the people above me. And since the ortho service is pretty slow, I haven't been getting paged. I've been down on two consults in the ER....and they have turned out to be my favorite parts of the past two days. The rest of the time I have walked around the hospital with the other two interns on the service trying to figure out what we are supposed to be doing. Now that I'm getting paid, it feels like I should be working...not walking.

The people on the service have been really nice. I like the senior resident with us - he is really laid back - and even apologized for not having anything for us to do yesterday (even though I had to stay still 6:45pm!). Today was not quite as bad...they finally told me to leave around 3:30. I've got to round this weekend though.....and it is the 4th of July. BUMMER!

Hope everyone has a good 4th!!! I hope rounds don't last too long!!!

It's Up To ME

It's time for me to spread my wings.

Tomorrow is July 1. The day all the interns (first year residents) begin working in the hospital. And....I'm scared out of my mind!

From now on, I can't use the "I'm a medical student" excuse.

In the middle of the night, when I'm the house officer (in charge of everything in the hospital while the other residents and doctors are sleeping) and someone pages overhead saying there is a Code Blue (no breathing, no pulse), it is ME who has to respond. It is ME in charge of reviving the patient. It is ME prescribing the life-saving drugs. It is ME who decides if the patient needs intubation. It is ME who has to read the EKG and decide if we have to shock. It's up to ME!

I begin on an Orthopedic rotation in the morning. I've heard the schedule is do-able (at least as an emergency medicine resident...not so sure for the orthopedic residents!) but it is still a scary thought that I am now, finally, allowed to write prescriptions. I've also heard that as an EM resident, I probably won't see the bright lights of the OR (operating room) - but it means that I am in-charge of the patients in rooms while the surgeons are surgicizing.

"Doctor? This patient is spiking a fever. Can I give them some Tylenol?"

"Uhhhhhh..........I'm just a medical student.........I mean........I'm just an INTERN!"

Wish me luck! And DON'T GET SICK!!!

Finally....a SALARY!!!

Today marked my very first day as a doctor.....as an emergency medicine intern to be exact.....and also the very first day of getting paid. WOO HOO!!!

We began orientation this morning at 10am (not too shabby...still got to sleep in a bit!) and got a full tour of the hospital and facilities. We had multiple lectures regarding insurance, human resources, and the computer system - and we were done by 5pm. Nice! (Although I doubt this will be my typical day!!!)

It was nice to see my classmates (9 of us graduated from med school together) and it was great to meet the other new interns, especially the other ones who will be working in the ER with me. They were all so kind...and all our personalities are similar...so it will be a lot of fun!

I found out my first rotation - beginning July 1 - will be Orthopedics. I like the operating room, so I'm really looking forward to this!!!

Tomorrow is another day of orientation....7:30am until 6pm (that's probably more like it...).
I'll keep ya'll posted!

Graduation Party!

Right after my graduation last week, my parents held a small graduation party for me with family and close friends. It was so much fun...and I was glad to have Jeri, Scott, Cindy, Randy, Marie, Denny, Brandon, Mom, Dad, Kasey, Sam, Taylor, Grandma, and Jon there to celebrate with me!!!

How do you like my new, bright and shining diploma? This is going to go SO GREAT in our new office in Columbus! Thanks Mom and Dad!!!

When Randy showed up, it made Brandon's day...they are both big Cub fans! Brandon had to go upstairs and change his shirt!

We had an awesome spread of food. Cheeseburgers, hash brown casserole, chips and dips, fruit, and veggies. Everything was SO GOOD!

The cookie cake was a hit....not too much was left over! BUMMER!

And the surprise for the day was this bouquet which showed up right before the party started. It was from Brandon's parents, grandparents, and brother/sister-in-law. THANK YOU! It was so nice and thoughtful...and they are still in bloom on our kitchen table!

Thanks everyone who came to the party. It was nice to celebrate with you guys!!! Thanks for supporting me all the way through medical school!

Trust Me...Now I'm ACTUALLY A DOCTOR!!!

Well, I've done it! I have just graduated from medical school and am now, officially, a doctor!!! Holy cow! How scary....yet, how sweet!

As you can see, the title of my blog has now changed to "Life in an Emergency Room" as I am no longer a medical student. Don't let this fool you....it's still me and the blog will continue! Maybe not quite as frequently in the future....but I will definitely keep this up! Thank you to all my faithful readers for encouraging me, supporting me, and having confidence in me!

Graduation weekend was SO MUCH FUN! Our school did a great job of welcoming friends and family - and made the weekend one I will NEVER forget! I hope you all like pictures...because you're about to see all the fun events that went on...

Here I am out in front of my school. Each year, they put up a HUGE congratulations sign for the graduates. It never had much meaning to me until now. I felt butterflies in my tummy every time I saw it.... (**Note the awesome placement of my hands which make it look like I'm holding the sign....that took some extreme photography skills by Brandon!)

On Thursday night, we had a "Class of 2009 night at the ballpark" and watched the Iowa Cubs get smoked by the other team. I don't remember watching any of the game, but had a GREAT time catching up with classmates that I hadn't seen for 2 years while out on rotations. Thanks to my sister, Taylor, for enjoying the game with Brandon and I!

This was the idiot mascot pizza thing that decided the best place for him to stand for about 20 minutes of the game was right in front of us. This picture doesn't really do justice to where he was really standing....I swear, I couldn't see anything from the 1st base line to the pitcher for a whole 2 innings! Get out of the way!!!

On Friday at lunchtime, my school hosted a big graduation picnic. It was so good and so much fun! Thanks to Brandon, Sam, and all my family for celebrating with me!!!

When we got home from the picnic, I had a surprise hand-painted sign (from my mom) posted on the garage door! It is still weird to see "Dr." in front of my name....but, DANG, it looks good! =) Notice Brandon....who is showing what my school loans are going to do to our pockets!

On Friday night, Brandon and I attended the Graduation Banquet which was held at the Embassy Suites downtown. It was a very fancy and nice dinner...and since we were so dressed up, we couldn't help but take a "high school prom" picture.

My Grandaddy came to town for the weekend...and he happens to be the minister for our wedding in 2 weeks!!!

Here I am with one of my very best friends, Julie. She and I grew up together and ended up going to the same medical school! She will be starting her residency in Pediatrics while I am going to pursue Emergency Medicine. She's going to make such a great physician and I am so proud of her!

Graduation was this morning at a complex downtown. They did such a nice job decorating...and the arena was HUGE. I couldn't believe that many people would be attending the ceremony...but it was PACKED! This is a great view of the stage courtesy of my photographer and fiance, Brandon!

When my class came walking down the aisle, we were preceded by our college flag. I am SO PROUD to be a member of the Class of 2009 College of Osteopathic Medicine!

And here I am....walking down the aisle to get my diploma!!!

The ceremony was really great. The commencement speaker did an EXCELLENT job. The name thing took quite a while....but when I walked across the stage and got hooded.....man, what a feeling!!!

Here I am, afterwards, with my fiance Brandon. He is SO SUPPORTIVE of me and the career I have chosen to embark upon. I am SO GRATEFUL to have met him and I can't wait for our wedding in 2 weeks! Thanks, B.....you've been there for me this whole weekend....and I can't thank you enough!

Thank you also to my Grandaddy for being here this weekend. You are the BEST GRANDFATHER a girl could ask for...and so much more!

To my Grandma, THANK YOU for being here today! It really meant a lot to me!

THANK YOU THANK YOU THANK YOU to my Uncle Jon for being here today. Graduations can be a really boring experience...and you drove all the way up to be here for me!!! Thank you SO MUCH!

And finally, to my family.....

You guys are the best. I couldn't ask for any better parents or sisters. You guys have supported me all the way through and encouraged me to be the best doctor I could be. I really appreciate everything you do for me...and I love you guys so much! I will REALLY MISS YOU GUYS when we head off to residency.

Overall, the weekend was SO MUCH FUN.

I'M A DOCTOR!!! I'M A DOCTOR!!! HOLY COW....I'M A DOCTOR!!!

PS....Don't go to the hospital in July....that's when the interns start! =)