PGY2

I am officially a PGY2 (post-graduate 2nd year resident)!!! I am so excited that I'm going to start rocking the above scrubs to work! The scrubs are called "Scrubs 2DYE4" and I made them this past week for my mother in law - who graciously modeled them for my camera - but I've got my own pair too. I don't care if doctors don't typically wear these kind of scrubs....I work in the ER where "everything goes!"

Last week I finished up my pediatric ER rotation. We rotate through this ER for one month each of my 4 years of residency. Since I was officially a PGY2, I got to carry the trauma pager which meant responding to all the high acuity patients. I found myself begging to get up to the helipad any time we knew the helicopter was coming...they were usually more than willing to let me escort patients down to the trauma bay. (I guess they aren't used to people as eager as me!!! Little did they know it just meant 15 min of a break for me while waiting for the copter! SUCKERS!!!)

Actually, I quite enjoyed having the trauma pager and getting to see the helicopters landing with my patients. I just really enjoy the ER and being an ER doctor....with all the copters, lights, and sirens that come with it!

I did have a few sad cases this past month, including 2 child abuse cases that will stay with me for a long time to come...as well as an 11 month old who came in after a car accident (he was NOT in a car seat OR a seat belt). But I also had some really sweet parents with super nice, well-behaved children.

The month was fun, but it was nice to score the whole last week off without any shifts.....basically a free week of vacation! We're down visiting Brandon's family now and having a wonderful time. Heading back to work will sure be tough though!!!

Man, I Love My Job!

Last month, I was stuck in the ICU.

Not that I didn't like it...I just felt really out of my element. People in the ICU are really sick - and unfortunately, lots of them die. I just felt uncomfortable...as if I didn't know what to do for them. In the ER, I can rattle off all the labs, images, and medicines I want for most complaints. But in the ICU, when the patients come up all hooked to ventilators and with multiple different lines running multiple different drips - I'M LOST!

I LOVED all the procedures I got to do though. And when I finally got back to the ER this month, my first central line was no problem.

Waking up every single morning at 5:01am got old too. I kinda like sleeping in sometimes!

But now that I'm back in the ER ER ERRRRR, I'm so much happier! I've decided in my head that I need to take full advantage of being just an intern and do as many procedures on my patients as possible. Even if I don't suspect something in the abdomen, why not roll the harmless ultrasound machine in there and take a look around. What patient doesn't like seeing their own organs on the screen? I know that I would want to know what my kidneys looked like!

And who knows what you'll see? Like the sweet gall stones I found on my patient with abdominal pain...(black area in the middle is the gallbladder....white balls inside are the stones!) I wasn't surprised at all when the official ultrasound came back saying "Cholelithiasis".


Today, I even got to reduce a dislocated jaw!

I work with such great people - and it is so refreshing being back "home".

Delivering Bad News

I had a tough night last night.

I had to tell a mother that her baby had cancer.

Certain things can mean a worse prognosis according to the attending I was working with. These include:
1) Male
2) Less than 2 yrs old
3) White blood cell count greater than 100,000

And there I was - telling the mother of a 16 month old baby boy with a white count of 144,000 that the reason he had bruises all over his legs was because he had leukemia.

I will remember that patient for as long as I live.

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!!!