Wednesday, July 11, 2012

It's been a while...

So a few things have recently happened... I finished Cardiology with the most kick-ass last day of a rotation EVER, I went on a vacation road-trip with a girlfriend to visit my med school peeps in NJ/NYC (it's true...we DO vacation at times!), I've started nightfloat (I shake my fist at thee, nightfloat), and I've started reading The House of God. These are all things (minus my roadtrip) that deserve their own post (don't get me wrong - roadtrip was awesome), so I'm going to start with Cardiology....

-interpret-it-

Cardiology...wow! I had a great month overall, getting to meet and work with one of the groups of Cardiologists in town. They were all really cool docs who were really great teachers, and fun to be around - this (no matter what the hours) makes for a great rotation. I spent the majority of my month working with this brilliant guy who was just the kind of doc everyone wants to be one day; he loves his job, he loves his patients (and they love him), he loves his family (and they love him), and he is really good at what he does. He is an incredibly smart man, and I wanted to be like a sponge around him....I was truly baffled at the amount of stuff he knows (and remembers - the man was drawing out biochemistry pathways that barely look familiar to me, and I took biochem twice!!)! The thing I really love about the way he practices, is that he is really knowledgeable about the use of herbal and vitamin supplementation in medicine. Now this is a topic I am interested in - I try to be a minimalist with meds, and I like to use herbals and vitamins where I can.....patients like it, cause it doesn't feel as 'mediciney' as being on prescriptions, and it's usually cheaper, and there are a lot of things out there that have evidence to work with certain conditions (this is a topic for another day, I'm sure).

So anyways, my month with Dr. McSuperstar was great....we did rounding then consults, with procedures (TEE - an ultrasound down the esophagus to look at the heart; TTE - an ultrasound on the chest to look at the heart; central lines - putting a big line (kinda like an IV) into one of the larger vessels; Caths - where a tube is inserted in a big vein artery in the groin, then moved up backwards to the heart so that dye can be sprayed in to look at the heart vessels (for blockages, etc)....very cool; stress tests - having the patient on the treadmill, or having a medication given to them to see if their heart gets worked to see if it gets 'stressed' (chest pain = not enough oxygen, ie. potential blockages). It was great because we'd be bounding all over the hospital doing random things all day, which was perfect for my attention 'issues.' Most of the month was pretty routine though....not a whole lot of craziness going on, no really critical patients....mellow. Then my last day, I was with a younger guy, really nice (they were all really nice...refreshing after working with lots of the docs I encountered during med school.)

-code-blue-recovered-

My last day started at 8, and I met my doc in the ED; his 'rounding nurses' (the nurse practitioners who worked with the group, and did all the consults) welcomed me and said that one of the other docs (who was assigned to do the TEEs) wasn't there, so we'd be running two services today....busy, but manageable. So my doc came, we started rounding, then did a TEE, ran a code, did another TEE, and it was there that I had my  
'Awesomist Moment Yet.' 

The patient was an older gentleman who had afib (an abnormal heart rhythm that you can shock back to normal, but we need to be sure there's no clot in the heart first). So this guy was good - no clot, so they had the sticky pads set on his chest and tried to shock him. Nothing, twice. So my doc said 

"We'll have to use the paddles."

I looked at him with a look that I'm sure resembled the one that kids have on christmas, and I said "Can I shock him?"

The doc smiled at me, chuckled and said "Sure."

I was so excited! To this doc, and all the techs and nurses there, this was something routine for them....but for me, this was something I had wanted to do, dating back to the days when Dr. Green was shocking people on ER. It isn't used as much since the sticky pads are around, and I am itching to do anything that makes me live out these little fantasies I've had for so long. Like a kid at Christmas...
So they handed me the paddles, lubed them up, then I put the paddles on this patient and said

"Clear!"


Then I backed away from the bed (more like arched as much as possible since this guy was pretty big), and shocked him. Not even one bit anticlimactic. I can't help but giggle at myself right now as I think to just how excited I was right after. I think my smile was probably breaking my face, cause everyone seemed really amused by the whole situation. Really though, it was one of those 'make-me-REALLY-feel-like-a-doctor' moments.

-it's-stress-time-

From there we went to place a central line on an ICU patient, did a couple stress tests, saw a couple more consults, read a few EKGs and Echos, watched a carotid cath, and then to the ED for the first of THREE MIs (heart attacks) we would have that afternoon! It was organized chaos, and it was fantastic. 

Cardiology, I heart you :-)

-narrowing-


Monday, June 18, 2012

Perks of residency....

Monday, 12:30am, leaving my apartment complex I get pulled over by a hidden cop....

Me: "I'm so sorry.... I have a patient in labor and I'm on my way to the hospital."

Po Po: "Well that would explain why you pulled out quick and were going 55. You have a good night, take care of your patient, and be safe."

Me: "Thank you so much! I'm so sorry...I promise I'll go the speed limit the whole way..."

Po Po: "You just take care of your patient and be safe" *wink*


Full appreciation  for the FWPD :-)



 -best-excuse-ever-



**Note: I actually DID have a patient in labor....no foolin!**

Thursday, June 14, 2012

Psychiatry

I feel like this is one of the most stigmatized and truly misunderstood areas when it comes to disorders of the brain is psychiatry. It's sad really....better yet, it's really sad. People get judged for their conditions, and are ashamed and embarrassed about them. Many try to keep it a secret, and hate that they control their lives. Saying "I have schizophrenia" evokes fear from some people, and no matter how you cut it, it's not the same as saying "I have Kidney Failure."
  
 Schizophrenia, Bipolar disease, and many other mental illnesses can scare people 

They scare them because many don't understand what they are. Some think of what they see in the movies - people who kill, or are emotionally unstable, and are ranting crazy thoughts at all hours of the day. At times, this is reality. But with proper treatment, you may never know that those afflicted even have a disease. Even with proper treatment though, the medications that treat these disorders can cause so many other problems (more psychiatric disorders, movement disorders, weight gain, even lactation, grogginess, nausea, diarrhea...the list goes on), that it's no wonder there's such a high incidence of non-compliance. This is often why so many people relapse and end up hospitalized for their conditions.

When I did my psych rotation in medical school, it was inpatient, and my fellow students and I would just spend our days hanging out with patients; we played scrabble, ping pong, pictionary, did art therapy, 'movement class', group therapy sessions, and we would spend time just sitting and chatting with people. When you look at it, it's kinda like kindergarten, which I think is a little demeaning, but for so many people it works (others felt babied, and I don't blame them - everything is not for everyone.) I had some of the most incredible conversations with people, and and it was really a great way to humanize the taboo that is psychiatry. When you have an hour-long conversation with someone about their time as a spy for the US, getting chased by the KGB, who implanted their brain with a chip, and they have been 'tracked' and 'monitored' ever since, you get a sense that for these people, this is their life; these things actually happened. They have memories about these events that are as real to them as your 10th birthday is to you, and I find that truly fascinating....and truly sad. They may believe that their family members are strangers, and I remember a man who's wife had relapsed, flown from South Carolina to NYC, and she refused to talk to him on the phone: 

"I'm not talking to that a**hole," she said.  
"We divorced years ago and I want nothing to do with him. I'm with Anderson (Cooper) now, and he's going to have to deal with it!" 

And when I told him she wasn't up for talking, he said he was going to bring pictures to try and jog her memory. 

"I feel like I'm grasping at straws at this point," he said with such sadness in his voice. 

It was absolutely heartbreaking. 

Because they feel these things are real, and everyone around them feels these things are crazy, it's no wonder they often keep their thoughts to themselves. The voices in their head are like your conscience, but they can terrorize them....tell them to hurt themselves or other people. I met a 6-year-old once who was being told by her voices to throw her baby brother out the window. How does a 6-year-old have any insight to the fact that this isn't normal to hear voices? Or that they shouldn't listen? Note - this little girl was smart enough to tell her parents that she was hearing these voices and that they scared her, which brought her to the emergency room where I met her. She was the sweetest little thing with the most evil thoughts going through her head....it was hard to see when she was drawing me pictures of princesses and rainbows. It hurt to know what was in store for her future; medications, hospitalizations, likely institutionalization, and ultimately a life where she would feel different, misunderstood, and alone.

The neurotransmitters responsible to psychaitric conditions are all ones that need to be in a pretty perfect balance with each other in order to keep you 'level,' so to speak. Dopamine, GABA, Acetylcholine, Serotonin, Endorphins, Norephinephrine and Epinephrine are the big players, and if they are not in their proper proportions, then you can develop depression, anxiety, bipolar disorder, addictions, schizophrenia, dementias, OCD, not to mention the movement disorders that can occur as well (Parkinson's, Huntington's, Choreas, etc.) The basis of psychiatric medications is to add, subtract, or block these substances, but again, they do so much more than regulate mood that the side effects can be almost crippling. New drugs are coming out, and being researched every day, but since psychiatric disorders are like the 'red-headed step-child' of diseases, there's so much less money going into this research, cause there's little money to be made in psychiatry (no offense to red-heads - I've got nothing but love for my ginger peeps, but we know that saying!!) 

Again, sad. 

Around the country, state psychiatric facilities are being shut down because of a loss of funding, but the number of people who need these facilities is just increasing, since many are hereditary, so as the population increases, so do the number of people with mental illness. With no where to go, many end up on the streets if they aren't lucky, and essentially they get swept under the rug by society....if we can't see them, they don't exist. But we do see them. And people judge.... "they got themselves into that situation...." or "get a job like the rest of us." Sadly, it's just not that easy for many of them with severe diseases, and so many are unable to get out of that situation without medical help which is becoming less and less available to them. Psychiatrists are becoming over-worked, underpaid, and they are being stretched to their limits all over the country.  I don't know how they do it. 

This week, I saw an attending punched in the face by a gentleman who got very agitated without warning, and the attending just brushed it off....

"He can't help it," he said.  
"It's not him, it's the disease."

What a friggen champ. How many people can have something like that happen and not hold a grudge? You know those people you see on the streets, or in the subway who get up in people's faces, cursing and talking about the end of the world, and how we're all going to hell in a hand-basket? You see how people look at them with disgust because of not only what they say, but because most likely they are homeless, dirty, and they smell bad? Well I'm willing to bet that most, if not all of these people have some psychiatric disorder or another, and that look of disgust is misunderstanding. It's a lack of knowledge to why these people are the way they are and do the things they do. You can't argue with them, as I've seen many try.....it's harsh to say, and I mean no offense in saying this, but you cannot argue with crazy. There's no logic in their thinking, and they do not compute things the way you do....their brain chemistry is often too out of balance for that. I look at many of these people with sheer pity (as if that is much better), trying to imagine how they got to this point - I imagine them as a kid, growing up with (commonly) psychiatric disorders in their families. Many faced physical, emotional and sexual abuse. They likely had their mental illness rear it's ugly head in their teen years, or early 20s. They were in and out of hospitals, and were thus dependent on the system and those people around them. After a while those people around them got sick of dealing with them, and turned their backs, so when these people got subsequently hospitalized, they needed to be released to group homes, or even homeless shelters. They couldn't hold a job, so they couldn't afford their meds, and voila! There you have the agitated homeless man standing in your face shouting at you. It's like they never had a chance. 

Now this obviously isn't everyone's story, but it's a lot of the stories I've seen in my short time in medicine, and it kills me that people turn their backs like this, but I get it. I have met people with supportive families, but mental illness doesn't just affect the patients it afflicts, it affects everyone in their lives. They can turn into mean, abusive people who are trying on your nerves, and even if you are aware it's a disease, it's hard not to harbor ill-feelings towards them after years of dealing with it. Again, sad. The real people that are letting down these patients are not their families though (this is an important point), but they are the people shutting down the facilities that they need. Or cutting the funding to the hospitals so that they can accept less patients, and hire less staff. Hard to swallow in a country that's so obsessed with what's going on on other planets, that it puts these priorities above those in their own country.....just saying. If you ask anyone anywhere, I'm willing to bet that they think that human life and well-being is important, and a priority, which makes me wonder - do they consider these people humans? True, they may not be able to contribute to society at the same level as everyone else (although many can), and they may be a 'burden' on the system, but how are they contributing any less, or being any more of a burden than the person with diabetes, hypertension, morbid obesity and heart disease that sits at home collecting disability while smoking a pack a day and stuffing their face with McDonalds? The latter are doing it to themselves, while those with mental illness were (for the most part) born with their diseases.  
It's pitiful that no matter how you got there, your medical disease will usually gain sympathy over a mental disease in this country. 
Absolutely pitiful.

I know this is turning into a rant, and I didn't mean for it, but I just find the whole situation ridiculous, and heartbreaking. So many people with mental illness are lucky that they have loved ones to support them, and the financial means to keep things in order (Charlie Sheen, who also has the celebrity to avoid a psychiatric diagnosis as of yet, which I'm SURE he deserves). And many are lucky enough to have a mild enough disease that it doesn't interfere with their lives as much as those I've mentioned above. But what about those people who are alone, and who can't afford their meds, and because they can't afford their meds, they can't hold a job, so they can't afford their meds....one of the many vicious circles in medicine. The lack of foresight is one of the things I despise about this medical system, in that if a little more money went into the system to help these people stay out of the hospital, then they'd possibly have fewer relapses, and therefore need fewer hospitalizations. I met people in med school who had been in the hospital for six months or more. SIX MONTHS!! Do you know how much money that costs? I'm willing to bet it's gotta be at least the salary of a few more healthcare professionals, or at least a few residency positions. And that's just a couple people in one hospital! A little more money now could save a lot of money later....again, lack of foresight.

So the moral here - don't judge unless you know someone's whole story....which a lot of times you never will, cause sometimes even they may not be able to recall or understand it. Don't be rude to the crazy person on the train, or the homeless guy sitting on the corner....you have no idea why they're there or how they got there, so who are you to say that "they put themselves there."  

View mental illness as a disease, 
cause it is one

It is not a choice, and people cannot just turn it off as they please. If you have a mental illness (which aside from those mentioned, include anxiety, depression, mood disorders which are common), don't be ashamed or feel too embarrassed to seek treatment. You can try to run from these diseases, but unless dealt with properly, they can turn up when you least expect it and cause more trouble. If you want to keep it from your friends and family even, that's okay (although having people who understand and support you would be more helpful), but talk to your doctor about it. You can get treatment that will help you and make you feel better. And when you do seek treatment, please make sure it's not just medications - it's like putting a band-aid on a broken bone. Therapy and medication go hand in hand, and for many disorders, therapy alone is helpful, but I'm really not a fan of just medicating someone (especially in the oh-so-common anxiety and depression where you need to get to the root of WHY someone is feeling this way in order to truly deal with the disorder.) 

Note that I've only mentioned a couple of the disease that exist, but be it known that there are 331 psychiatric diagnoses on the icd-9  (coding) system, which all fall into many different categories, have different ranges of severity, and interfere with aspects of one's life in many different ways.  Because of this huge range, and the fact that many aren't as 'affected' as others, there are hundreds of people out there who may fit a one, but they haven't even been diagnosed yet (ahem, Sheen). Maybe you're one of them.....





Tuesday, June 12, 2012

Psychiatry quote and pic of the day...


"Those who battle depression are living in the past
those who battle anxiety are living in the future."

- Unknown



-duck-the-patient-punches-or-else- 


Saturday, June 9, 2012

I'm Allowed to Be Tired Sometimes

I feel like a lot of people think that a residents life is like Grey's Anatomy....or Scrubs....or House. Well, our life is not like those shows (although I've never watched Grey's Anatomy, no one in my program is sleeping with anyone else out of wedlock, and from what I gather, that's a good portion of the story-lines). Regardless of the program or specialty, we all must bow down to the all-powerful ACGME (the accreditation board), and follow their group of rules, some of which may seem silly and may seem to stand in the way of our getting the most out of our education. The most recent big 'shake-up' in ACGME rules was the big duty-hour change that came out before my intern year, and it states....

"Duty periods of PGY1 (intern) residents must not exceed 16 hours in duration....PGY1 residents should have 10 and must have 8 hours, free of duty between scheduled duty periods....Duty hours must be limited to 80 hours per week averaged over a 4 week period." 
(note: the last one applies to all years of residents)

Now duty hours are what we document....what we actually work is often much different. We are allowed to do what we want (ie. work extra hours) with our "free time," so long as it doesn't interfere with our work; for whatever reason, you may end up staying at work late (for a delivery, to finish an admit, to tie up loose ends), and your hours exceed the "allowed" time worked, but who's going to just walk out when they're in the middle of their work? I suppose some may, and that's their choice and their right, but then they end up with more stuff to do at home, or more stuff to do tomorrow, or (god forbid) 'dumping' their work on whoever is taking over (big no-no). I have no problem working long hours, and I don't mind putting in my time and even extra time; more time worked is more experience, and more experience is what EVERY resident needs. 

My problem, is that I feel like I'm not allowed to admit to being tired.....EVER! 

If someone asks me how I am, and I've worked six 12+ hour days in a row, with other stuff work to be done in my off time, plus regular life tasks (cleaning, feeding myself, laundry etc), and I end up sleeping only 4 or 5 hours a night, I feel like it's okay that I'm tired. But would I EVER admit that to certain people who work 'above' me (senior residents, attendings, etc)? Nope. Because then I would get the "you have no idea what tired is...." or "you have it so easy, I can't even believe you're complaining!!" or "when I was a resident we had to work 36 hours, then go to clinic, and walk to work in the snow, uphill both ways." I get it. Your life as a resident sucked. You were miserable, and my 80 hour week is a cake walk.  Now don't get me wrong....some of the attendings really had it hard....they did work ridiculous hours, and there were no 80 hour work weeks. But everyone who's a resident right now has had the restriction of an 80 hour work week, just like us (true story - it was implemented in 2003.) Ours just has us working less of those hours at a time, which (if any of you are good at math) means that we get shorter chunks of time off as a result.

 "How are you?"

I'm not complaining when I answer the above question with 

"I'm tired."

I'm just stating a fact. If you don't want to know how I'm feeling, then don't ask me. Sure, I'm not working 30 hour shifts and then rounding on other patients. But I also don't get post-call days in the middle of the week. The only post-call day I get as an intern in our program is on a Sunday after working 3pm Saturday till 7am Sunday.....so usually I spend my whole Sunday sleeping, and then I go back to work from M-F, so essentially, I have no weekend. Again, let me state clearly that 

I AM NOT COMPLAINING ABOUT THE HOURS....
(I'm trying to prevent any "you're a whiner" backlash here)

I just want to be able to say that I'm tired when I'm tired when I get asked how I am, and not get $hit all over for saying so. It's getting pretty old having to walk on eggshells and pretend that I'm feeling all puppy-dogs and rainbows when I'm exhausted (yes, believe it or not, MY 80-hour work week can be exhausting too), have work piling up, and haven't been able to do laundry or grocery shop in a week cause I have 'other things to do'. For those people who get all bent out of shape when the T word comes out of my mouth, you do realize that I didn't make the new rules, don't you? You do realize that there are a lot of interns out there that WISH they were in residency when we were working the long hours, cause that was also the time when we weren't being babysat...er, I mean supervised, at all times. Don't get me wrong, I get that the supervision is a necessity, and that's fine, but personally I would have given anything to have a chance to be on call alone as an intern without having a senior resident looking over my shoulder, watching my every move, and questioning the (usually appropriate) decisions I make (note: this is not our average senior, but it happens). When you were residents your extra hours and autonomy was a sink-or-swim sort of way of learning, so when you think of it, you guys had the opportunity to perfect your back-stroke by the end of your intern year more than we have. I would have loved that!

Bottom line: sometimes I'm tired, and if that pisses you off then I'm sorry, but I'm not sorry about that. I'm allowed to be tired. I'm allowed to say that I'm sleep-deprived. I'm allowed to nap when I'm on call and there's nothing going on, without being mocked about being 'lazy.' Every current resident has it easier than those above you, and you're allowed to complain, right? What makes you so different and special and able to process this feeling called 'tired' when I can't? Note - I can. And if you feel otherwise, then you'd better get some dip, cause you got a big 'ol chip on your shoulder. 



Always remember, there are people who are reading this who have never, and will never work 80 hours a week....and sometimes, they get tired too!


**note: all the quotes are from the ACGME website, and are applicable to all residency specialties and programs**

Wednesday, June 6, 2012

Murphy's First Law of Clinic....

The First Law:

If you are running late in clinic, you will most definitely encounter a patient(s) who requires a significant amount of your time, more of which they are scheduled for....This can include

1. Someone who has, but is not there for depression, and requires intervention
2. Someone who is a lot more sick then their appointment time may imply
3. Someone who walks in worrying that they are in labor at 32 weeks 
4. Someone who is impossible to interrupt/wrap up because they will not stop bringing up complaints they want dealt with in THAT 30 minute appointment after they show up 15 minutes late
5. Someone who has a mental illness that makes them not cooperate with your interview
6. Someone who is managed by 4 different doctors, on 25 different medications, and needs a "med review" in a 15 minute appointment

Note: I hit 6/6 today :-/ 


Thank goodness for fellow residents and nurses helping you out, and hello post-clinic wine....

-saved-my-ass-

Tuesday, June 5, 2012

Quote of the Day - Reminiscing my former life....

"The problem is not that I have too many clothes....I know people who have way more clothes than me. The problem is that New York apartments are not made for girls."

-Dr. V

**Anyone who knows who this came from will understand why this is so funny**



Monday, June 4, 2012

1818 miles apart...

I know it's been a while since I last wrote, and people have been asking me if I gave it up or got bored....No, I did not. Hubbs was here - FOR A WHOLE MONTH!!! Let me pause while I contain myself here. Anyways, I may be no expert on long distance relationships, but I do know that rule #1 is 

"don't spend time blogging when you can spend time with the love of your life that you never get to see"

So on that note, I figured I would share what it's like to be in residency and to have a long distance marriage. This is not a common situation for people in general, let alone residency, so I feel like there are few people out there that truly understand what it's like. You know how I know that? Cause everyone seems to pity me when they find out....."Oh man!! That must SUCK!!! I can't even imagine how horrible that must be?!!" Really?! Is that really what you think is going to make me feel "better" (assuming that I'm feeling bad to begin with) - hearing how horrible this must be??

Well, I have news for you - it's not horrible. It's not ideal by any means, but believe me when I say things could be WAAAAAAAAAAAY worse.

Hubbs and I met on our tropical island medical school paradise, about 4.5 years ago. We fell in love almost instantly, and he swept me right off my feet....it was fabulous. I knew I loved him 5 days after meeting him, we said it to each other on day 10, and on day 14 (which just happens to be my lucky number, even more so now) he asked me to marry him....this was the first "non-official" proposal, which would be followed 2 years later with a more formal and official one in Queens.

Anyways, so as this was Hubbs' last term on the island, we savored every moment, island hopping over Easter, playing cards on the our back patio with my roomies, having his home-cooked meals, and drinking rum and gingers with our friends who lived on the cliffs over the beach. I couldn't have imagined a more romantic place to fall in love. Most of our time was spent studying and/or in class (for him, not me), but every day when he finished class, he would come get me at the library, and we would sit on a bench behind the library and watch the sunset....our bench. Sometimes we talked, and sometimes we just sat quietly. There were times of stress where I would just cry and he would comfort me. Sunset bench times were some of my favorite times, and I would give anything to be sitting there with him right now.

And then. Then came the end of the term, and the beginning of Hubbs' state-side education. He was moving to NYC for his rotations, and I would be staying on the island another year. I was crushed. I cried a lot. I spent the first 6 weeks of our distance in Phoenix with my sister, and I spent 100% of my time thinking of him. I was miserable. When I got back to the island, I had school and my friends to distract me, and I even got to visit my man a couple of times through the term and at Christmas. Every time we parted I would cry, but each time got easier and easier, and eventually, the crying stopped, and I would be excited to get back to my life. When apart we would talk every day, sometimes for 5 minutes, sometimes for an hour. On occasion we would have skype dates, and would play games of 'higher-or-lower' with cards.

At the end of my island-time I moved to the big apple to be with Hubbs and life was good. We lived in Queens, and we had a great time together. Despite my new-onset sleep-fighting, we had no problems.....but man.....the sleep-fighting was a problem (for Hubbs; it didn't bother me!!) In March we found out that Hubbs would be doing his residency in Arizona - a LONG way from NYC. I was sad, and he looked forward to good sleep. It wasn't going to be easy, but we knew we could make it work. As he put it, we didn't have a choice. We were both in this for the long haul, and not being together was not an option.

So off he went to Arizona, and the desert that awaited him, only 9 short months after we had finally been reunited. I finished up my 3rd year rotations in NY, and then moved out to be with him while I studied for my board exams, and did my first 4th year rotation....3 months in total. And then back to NY for a couple of months. Then to Colorado for a month, then Arizona for another rotation, and then back to NY for my last three months of medical school.

Throughout all of this, I was applying for residencies, going on interviews, and deciding where and what I wanted to be when I grew up. Of course I wanted to be in Arizona with Hubbs, and I had a program out there that I'd rotated at, who took people from my school every year, and who had implied (via the Program Director) it was a sure thing. It was not; lesson here - don't trust anyone in the match.

And then came the match......and the scramble......and the signing of the contract that would have me out here in the mid-west, for another TWO YEARS of distance from Hubbs. I was crushed....again. I knew I could do it, and I didn't really have a choice. I kinda figured that I could reapply to the match the next year or try to switch into another program. Bottom line, I was not happy, and the biggest reason was that I was 'ready' to start a family - let me clarify this point by saying that emotionally, and physically I am ready, but fitting a baby into this life I  have right now? There's no way. I can't keep a plant alive (RIP 7 plants I've bought....I've since given up and gone silk/plastic) let alone take care of a baby; not really sure how people do that in residency. I would think a psych consult may be in order for them when that pee-stick turns positive.

Anyways, so yes, for those that have not already been made aware, I am baby crazy.....like certifiably so. I snuggle any kid I can get my hands on, and I really never want to put them down. When I log onto facebook and see yet another friend posting the growing belly photos, it makes me sad; not that I'm not thrilled for each and every one of them, but I want it...it's jealousy-sad. Not only that, but it makes me want to get into such awesome shape that I can do a reverse belly picture set....but I'm tired and lazy and full of excuses, so that doesn't happen either (note: recent infomercial purchase of "Metamorphosis: the body transformation system" is to begin tomorrow....Gwyneth Paltrow uses it, so I figure that based on what the infomercial says, I should be in full G.P shape in about 90 days....or else I want my money back!) Looking back on the turn of events that put me away from Hubbs, I see that even if together, there's no way there's a baby in my future during residency, so my biggest reason for feeling bad about being apart is a moot point anyways.

Now here I am almost a year after moving to my new home. Hubbs and I have seen each other periodically through the year (usually every 2-3 months), getting married last September, and having fun little trips when we have gotten together for visits (Vegas, Chicago, Toronto). And with the finish of my intern year and a year away from him, we have both had a bottom line solidified in us that we've told to a million people, explained to just as many, and is something that so few think about when considering people in our situation......and it is this:

Residency is a ridiculous time where you work, and when you aren't "working" you're doing other work for work, or thinking about work, or studying things for work, or charting things for work......in short, much of your life is consumed by work and work-related things. The ability to be able to focus 99% of your time and effort on yourself during this time is priceless, and Hubbs and I have both been afforded this opportunity. We get to chat every night, and see each other every few weeks, but for the most part, my time is my time, and his is his. If I get home at 7pm and have to chart until 11pm, I can have a pop-tart for dinner and fall asleep watching Southpark without worrying about what someone else wants to eat or watch. If I want to let my apartment get to a point of slovenliness that only frat-boys and farm animals have grown accustomed to cause I'm not in the mood to clean, that's okay. I can keep the thermostat at my ideal temperature, and my music on whatever band I want. There are parts of this distance thing that are truly delightful....and thrifty - you'd be surprised how much you can save on razors and shaving cream when you only shave your legs once ever couple of months ;-)

And one of the best things is that when Hubbs and I get together, we have a great time. We have fun because we have precious time, so we're always glad to see each other. It doesn't mean we don't miss each other when we're apart - of course we do. But why wallow in what you can't change when you can enjoy the benefits....there's an upside to most situations!

So most people don't see this....they just say things like those mentioned above, or they'll be like "Have you wondered if you guys will be able to make it work when you end up living together?" Please don't ever say that to me. I'm sorry, but all I have to say to people who make that statement is that they should bugger off. Seriously? That's like saying "Have you considered the possibility of your marriage crumbling when you live with each other?" We're not dating, we're married! We said vows and made commitments and I can't imagine my life without Hubbs, or his leaving the toilet seat up, his glasses being left all over the apartment, his piles of clean, semi-clean and dirty clothes, and his need to build a 'pillow-wall' in bed at night between us so that he can "protect" himself from my sleep-fighting. There's nothing about living together that we haven't encountered that would ever be a deal-breaker, and the thought that someone would think otherwise makes me wonder how quickly they would abandon their relationship (if they have one.) You don't throw something away if it doesn't work properly, you try to fix it, and you make it work. The only real issues we have had in our relationship are related to us not physically being together, so they are issues with a time-limit on them. They are resolving, and going away with each day that brings us closer to being permanently reunited, and there's not one doubt in my mind that we will grow old and live happily ever after. He's my fairy-tale prince who rode in on a junky silver Grenadian car, and swept me off of my feet....that will never change.

So that's my story on how I ended up in a long-distance marriage, and why it's not all that bad. We've been together for 1601 days today, and we've only actually been with one another for about 160 of those days, or 10% of the time....and yet I've never been so sure of anything or anyone in my life. I don't need him by my side all the time (even though I would totally LOVE that), and for now it's better for both of us and our careers to be apart. I have 13 months left on my own (395ish days, if anyone's counting), and when I consider that this is that last time I have alone in my life, it makes being selfish with my time all that much easier. In about 395ish days we will be back together......for good. No more distance. So don't pity us, feel sorry for us, or try to give us unsolicited marriage advice - unless you are in a long distance marriage and you are also in residency, you don't know what we're dealing with. We've made it work this long, and I would say that I think we are the masters in long-distance marriages. What doesn't kill you (or your relationship) only makes you stronger :-)


 -best-study-breaks-ever-

Sunday, June 3, 2012

Let the stupid pages begin again.....

**NOTE: NPO = nothing by mouth, ie. no food or drink

Nurse Silly-Question: "Hi Dr. T, it's Nurse silly-question. On that patient of yours (who just recovered from DKA, aka ridiculously high blood sugar and electrolyte imbalances), he's NPO to everything but water after midnight for an am cholesterol panel in the morning, and I just took his blood sugar (3 hours late) and it was 257 (high)....did you still want him to get his 75:25 insulin (daily scheduled insulin needed to keep blood sugars normal) that you ordered since he's NPO (despite the order that says to do so)?"

Me: "What time do they draw am labs here?"

Nurse Silly-Question: "5 usually....sometimes 5:15 or 5:30"

NOTE: most people on a regular schedule are NPO between midnight an 5:30am.  Is that a reason to hold insulin in a patient who's here because he needs insulin?????? Common sense PUH-LEASE!!!


-string-cheese-IS-significant-

Friday, April 27, 2012

Quote of the Week...

From an agitated patient who wanted to see a doctor, and thought since I was one, that he could see me, even though I told him I was not his doctor, and that his doctor was on his way up...

"This is all kinds of illegal, cause you took that docticratic oath thing....I'm going to sue, cause that's like legally brinding and stuff..."

You gotta love how legally brinding that docticratic oath is!!

Thursday, April 26, 2012

Nightfloat Haikus

Of Nightfloat I'm torn:
No rounding, but up all night.
It makes me feel old.

We sign out at six;
Ten patients, none critical...
Maybe I will sleep.

After dinner I chart;
Behind on work from clinic.
What else is new eh?

My senior's downstairs.
Left to my own devices
I feel important

I round to make sure
everyone has morning labs.
When done - to call room.

Holding the pager:
critical calls - I've had enough.
Try to sleep...I'm tired.

Midnight - 5 north calls:
"Your seeker wants more pain pills."
Tylenol per rectum.

12:30 - OB:
"Can you help with this section?"
I will...every time.

1:15 admit:
Was puking, but now better.
This person's not sick.

2am I'm paged:
99 is not fever;
Do not page again.

2:45 page:
"Can this patient have water?"
NPO means no.

3:20 - 4 north:
"Patient is constipated."
Only noticed now?

3:50 - I'm paged:
Stable patient; cough all day.
Why wait until now?

4am - Code Blue:
Epinephine doesn't work...
It rarely does....CLEAR!!

4:30 to bed:
Can't fall asleep; I'll get paged.
Infomercial time.

5 - 'critical' lab:
Potassium 3.1.
Are you kidding me?

5:30 admit:
Patient was there since last night.
ER shift change soon.

6:15 - breakfast:
Over easy, bacon please.
Healthy food next time.

6:50 - print list:
Real sleep is within my sight.
The team's almost here. 

7 - sign-out time:
The list is not very long.
No dawdling please.

7:30 - drive home:
My eyelids are so heavy.
Don't fall asleep.

I'm home now in bed.
A long night now behind me.
Many more to come.

It seems I complain;
I really do love my job.
Can't wait for new goats.


 **note - a 'goat' is an intern....only 67 more days of goat-dom for me!!**

Ridiclous Pages...

In our residency, we have a system where our clinic patients can page us after hours with problems they are having (not to mention the nursing home pages, floor pages, and pages from the ER for admissions). Now one would think that people would use this system as an 'emergency line,' so to speak. Well, one would be wrong on that fact. Some people page with legitimate problems....some are even serious, yet silly in the sense that people should be going to the ER immediately (ie. a kid who fell, hit his head, is bleeding, and has an 'indented head.') We get pages about questions that are ridiculous, and not emergencies. Some are even enough to make me say "you're paging me at 3 in the morning for what now?!" As the person on nightfloat currently getting some of these pages, plus some of the ridiculous pages that I get from nursing staff, pharmacies, etc through the night. I'd like to share some of the moments I (and one of my colleagues) have had over the past little while....

 -not-for-long-

**note....italics are what I am thinking, not what I am saying...**

Re: Testicle Swelling....2am call
Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
Pt - "Yeah, I'm calling because my left testicle is swollen!"
Me - "Oh my! Is it painful at all?"
Pt - "A little maybe.....not really."
Me - "Okay. When did you notice this coming on?"
Pt - "About 2 weeks ago."
Me - "And it's gotten worse tonight?"
Pt - "No....it's been the same for 2 weeks."
Me - And you decided to wake page me at 2am because.....wondering what's wrong with your testicle at 2am is keeping you awake and you didn't want to be the only one?!?!

Re: Patient's PCP....5am call
Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
Nurse - "Hi Dr. T. I was just calling to let you know...on the chart of patient X, it says that the PCP was Dr. Stephen Whats-his-name, but it's actually Dr. Philip Whats-his-name (note...Whats-his-name being the SAME last name).
Me - Thank you for notifying me on this amazingly important thing regarding this patient....I agree that this could not wait until morning when the day team rounds.

Re: Medication Question....4:30am call
Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
Pt -  "Hi there. I just had a question about one of the medications I'm on....What's Lisinopril for?"
Me - Not for your lack of common sense....would you like some Ambien?

Re: Clinic Patient in the ER....3:50am call
 Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
ER Doc - "Yeah hi. I have this patient in the ED who sees you guys in clinic. She came in complaining of some abdominal pain, and I just wanted to let you know that we will be sending her home to follow up with you in clinic."
Me - "Did you need me to come down there to see her or something?"
ER Doc - "Nope. Just wanted to let you know."
Me - Really? REALLY?!?! You do know that the CC function on dictations will notify us of what you just woke me up for, don't you??!!

Re: Allergic Reaction...11pm call
Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
Pt's mother - "Hi. I'm calling because my daughter had an allergic reaction this morning around 8. She ate something new, and got a rash on her neck."
Me - "Okay, have you given her anything for it?"
Pt's mother - "Yeah, I was seen in the clinic, and they gave me some Benadryl. They said she would be okay, but now I'm about to go to sleep and I wanted to make sure she wasn't going to die while I was sleeping."
Me - They said she'd be fine...I haven't seen your daughter....how on earth can I say with 100% certainty that she won't be fine without examining her? 

Re: Depression....12am call
Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
Pt - "I think I'm depressed."
Me - "I'm sorry to hear that....how long have you been feeling this way?"
Pt - "Months! I think I need something for it."
Me - "I understand. Have you seen anyone for this?"
Pt - "No....I always forget to talk to my doctor about it."
Me - "Okay....I'll be sure to send them a message. Is it any worse tonight?"
Pt - "No."
Me - "I have to ask - are you feeling at all like hurting yourself?"
Pt - "Oh no....nothing like that."
Me - "So you aren't feeling suicidal?"
Pt - "No. I just think that I should be on a medication for this, and I just remembered, so I figured I'd call."
Me - We do not have medications for ridiculousness.


Re: Patient's IV Orders....1:40am call
Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
Nurse - "Hi it's Nurse Ridiculous-question from the burn unit. I just had your patient Miss has-a-fever come up from the ED, and I saw that you had ordered IV fluids to be running at 75cc per hour. I just wanted to make sure that you wanted them running at that rate."
Me - No, I wanted them running at some other completely other rate....I was testing your skills in telepathy, and guess what.... YOU WON!!!! Stupidest call of the evening award, 2012.


Re: Orders....3am call
Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
Nurse - "Hi, it's so-and-so from such-and-such nursing home. I wanted to notify you about a critical lab that we got on a resident of ours, and I need some orders. He has a potassium of 1.6."
Me - "Okay. When was this drawn."
Nurse - "This morning."
Me - "Like this morning, or yesterday morning?!"
Nurse - "Well, I guess it would be yesterday morning."
Me - Glad to know our elderly are so well taken care of.... Idiots...

Not received by me, but by Dr. M
Pt - "Can I travel when I'm 7.5 months pregnant?"
Dr. M - "Our records say that you're only 12 weeks right now."
Pt - "I know, but we're talking about moving..."

And my ultimate favorite...Re: Pink Eye...9pm call
Me - "Hi, this is Dr. T from Family Practice....I was paged to this number."
Pt -"Yes, thank you for calling." (very flustered and anxious sounding woman) "I'm calling because the inside of my right eyelid is pink."
Me - What color do you think it's supposed to be..."Okay, are you having any pain?"
Pt - "No, no pain."
Me - "Okay, any discharge or watering?"
Pt - "No, nothing like that."
Me - "Any itchiness or redness of the white part of the eye?"
Pt - "No. Everything else seems pretty normal."
Me - "Any runny nose, congestion, sneezing or anything?"
Pt - "No. Just a pink eyelid."
Me - "Okay....well, what color is the inside of your left eyelid?"
Pt - "Hold on a second.....it's pink too!!"
Me - "Well, I think everything sounds pretty stable. If you think you need to, you could take a tylenol and..."
Pt - "Do I  need to be quarentined?!?!"
Me - No....but you may need a psychiatrist.... "No, I think you should be okay to follow up with your doctor on that at your appointment that is scheduled for tomorrow morning."



Moral of the story is
HAVE SOME FRICKEN COMMON SENSE!!!!

Just cause you have the right to page 24 hours a day, does not mean you SHOULD page 24 hours a day. Yes, I am most likely awake, yes I am working, and yes, it is my job to answer these pages, but do you really think I have nothing better to do with my time than answer silly questions you have in the middle of the night?? On Hubbs' recommendation, I am going to start these clinic phone calls with 

"Hi, this is Dr. T from Family Practice....you paged the emergency line - what is your emergency?"

And as for pharmacy and lab techs, and nurses who call me with stupid things in the middle of the night, you cannot complain if I ask questions or say things that make you feel like an idiot if you are doing things and saying things that make you look like one.