Sophomore Stories

I thought I would take my time tonight and post some comments on my second year of residency. Last year I wrote a post on my original blog "Do They Have Squirrels in Buffalo?" wrapping up my first year. So here we go through the second year:

Essentially, I started off my second year in July as an "unofficial, but acting in the capacity of" second year. Since I was hired late in the medical year, I still owed another month of internship. But, in essence I was acting as a second year. I spent the majority of the month getting ready for all the activities of second year, such as taking ATLS (advance trauma life support), a base station course (where we learn to give medical direction to EMS providers, learning about Mercy Flight, and learning to drive real fast in our SMART (specialized medical assistance team) vehicles, while at the same time dealing with summertime pediatric dramas. Oh, and I became a vegetarian "For the Animals!" in a 30 day pledge.

The next month I was on my EMS (Emergency Medical Services) rotation. I spent my time with firefighters, doing several runs with the EMT supervisors, and I got to fly in a helicopter for the first time with Mercy Flight. The other part of this rotation is being the resident for the local Poison Control Center. Whenever there's a drug overdose, we get called. We then call our attending who guides us through the correct treatment for all the drug overdoses we're going to face as E.D. physicians. It's learning through experience.

The next month had me reliving life as a surgical resident. During your second year of surgery, you spend a great deal of time in the ICU. Emergency medicine residents spend a month in the trauma ICU at ECMC. It was fun going back to the pimping, and the early morning rounds. I really enjoy the ICU and had for a time considered a fellowship (an extra time after residency for more advanced training) in critical care. But, I think by the end of the month, I really did look forward to getting back to the E.D. and did not regret my change in careers at all.

The next month was spent learning about ophthalmology, dentistry and radiology. Mornings were spent with the dentists learning to provide anesthesia to the mouth, and afternoons were spent looking in people's eyes. Not a very exciting month, but a nice 9 - 5 kind of month with weekends off and no call. I did get to work a Buffalo Bills' game providing medical support to the fans in one of the clinics at the stadium, so not an overall bad month.

Of course, October is when we made the move from J-land to, for the most part, Blogger. I had been chosen as the representative to the national residency organization (EMRA), and I was able to attend my first national conference back in my old stomping grounds of Chicago. I then spent the next month working at one of the suburban hospitals in the area. I learned a lot, and I got a new pair of shoes!

My next rotation took me back to the drama that is ECMC. I know I have mentioned several times that most of us really enjoy our rotations there. The system is a lot easier to deal with, and the patients are a lot less medically critical. So, let's see, what happened...? Thanksgiving came and went. I continued to be a vegetarian. I worked 5 days straight and had some interesting tales to tell. I went home to California for an early holiday.

I then did the "Swing Month" which is not as exciting as it sounds. Basically, we split our time between ECMC and Buffalo General. I spent 15 of my shifts at ECMC and 2 shifts at Buffalo General. Sounds about evenly split. Oh, yeah, and snow came to Buffalo and started the winter off with a bang. Christmas came and went, and I made you all take the Resolutions for New Year's Oath.

I then started my official second year rotation at the Children's Hospital and tried the best that I could not to catch the RSV and other bugs children were flocking to the E.D. with at the time. I failed miserably and took it into my next rotation in the Pediatric ICU where I spent a great deal of time writing notes, and not so much time doing anything else.

Of course, I must take a moment to remember the 50 who died when Flight 3407 crashed on final approach to Buffalo Niagara International Airport. I was on scene as a member of SMART providing support for the workers who had the dangerous task of removing the wreckage as others worked to collect their remains.

My husband and I celebrated our first wedding anniversary at a great little B&B in Pennsylvania near Gettysburg. We then spent the next couple of days exploring the battlefields (mostly on the Confederate side since my hubby is a Son of the South), followed by a trip to Lancaster where my interest in quilting began to develop. Who knew it would blossom into a new hobby?

I finished my rotation at Buffalo General and spent my vacation that month in Florida visiting the Everglades and the Florida Keys. A very nice way to take a break from things medical which was good because my next two months were going to be purely hellishish.

The Ortho Service: two months of pure immersion into orthopedic surgery. You spend two weeks on the Hand Service working in the clinic and going to the O.R. Then you spend five days on the service, take a 24 hour call, and then another 5 days on the service. After that marathon 2 weeks you flip over to nights and become a vampire for a month. I learned to set a lot of broken bones, and I learned to sew a lot of messed up hands and feet. I learned how to complete an amputation. I did get to go to the second national conference in New Orleans which broke up the month very nicely. And, I was already used to staying up during the night which played into the festivities nicely.

My final month was spent as an elective in the Medical Examiner's office, and I have shared a lot of the tales and stories which were encountered during my month there. It was a light relaxing month, and I even had time to do some additional ride along time with Buffalo's Finest on Rescue 1, and to provide back-up in the SMART car.

Wow, what a year. This year, I will spend 90% of my time in the emergency departments of Buffalo General, ECMC, and Women and Children's hospitals. I do have spend one more month, a "make up month" which is a carry over from my second year at the suburban hospital again. I'll be looking for a real job this first part of the year. By the time 2010 begins, I will be looking forward to my graduation, my new job, and a new and exciting chapter in my life... Hope we all make it there together, and thanks for being here for the journey!

I've Been a Bad, Bad Blogger....

All right. So it's been a while.

Let's recap:
I finished my time in the pediatric ICU. While controversial, I still maintain the idea that sometimes just because we can do something to prolong life doesn't mean we should. Also, I did get to see one child placed on ECMO (extracorporeal membrane oxidation); sort of a mini-heart/lung bypass machine but not within the sterile confines of the O.R. Big and scary.

I completed my month-long rotation at the main hospital BGH. This time, not so bad. If you remember back to last year, I was rating my days in the number of beers I needed to get over the shift. This time, I don't know... maybe it was the responsibility. Maybe it was knowing more than I did last year. I actually sort of enjoyed it. And, I learned a lot. Maybe I'm just growing up academically.

After three weeks at the "General", I took my vacation, and tonight just returned from the Miami area of Florida were I spent the last week. A couple of things that I learned: the Everglades are awesome, alligators are an important part of the ecosystem of the Everglades, I continue to not like foreigners who travel because they're just rude, and I think I would be suicidal on a cruise if I had to be on the boat for longer than a day. Oh, yeah, and Key Lime Pie... tasty!

So, tomorrow I start my two months on the Orthopedics' service. It starts with two weeks of Hand Surgery. I'll have a better idea in the morning of what that entails. Hopefully, something new and interesting to blog about. It will take some time to catch up with everyone else's blogs, so forgive me if I haven't posted recently.

Have You Googled Today?

So, my PICU (pediatric ICU) rotation is winding down. Just one more 24+ hour call left on Saturday, and then it will be over. I plan to write a wrap up of the month on Sunday night. Today, though, post-call from the PICU, I was thinking about how much Google has changed the way I live.

I got an iPhone for Christmas. It's a fancy little gadget. Lots of buttons. Lots of memory. An ok camera in a pinch. The ability to play movies and games wherever I am. And, the all important, 24/7 connection to the internet and Google. I didn't think much about it until we took the trip to Gettysburg a couple of weekends ago.

My husband had planned things out for the most part. The route, how long it would take, etc. We used the GPS map (which, by the way is GoogleMap) on the iPhone to confirm where we were and check traffic conditions. As we got closer to the town where the bed and breakfast was we looked for a place to eat and were able to bring up a menu.

On Saturday, we used the map to guide us around the monuments in Gettysburg. When we had a question (like where were the Confederate monuments and where were the Confederate soldiers buried since they didn't seem to be at the National Cemetary - most were left on the side of the road since they were considered "traitors" but a group from the Hollywood Cemetary in Richmond, VA worked to collect them and transported a great number of the over 18,000 Confederate soldiers buried there) we would Google. We found the wax museum at the American Civil War Museum by Google. We checked out various places to eat and looked up the history of the Farnsworth House Inn.

Now, when we watch movies, we Google. We're planning for "Life after Residency" and have been Googling everything from real estate to where to mail order chicks. We've looked up draft horses for sale and have learned how to sheer sheep. We also have seen how to sheer an Angora rabbit and how to spin our own yarn.

During rounds in the PICU, I have pulled out my iPhone to check when diseases were first discovered, how to treat diabetic ketoacidosis, and what the water content is of, um, BM's (bowel movements - otherwise known as your poop. Which, by the way, is 75% water; just in case you wanted to know.)

Google has certainly changed the way I am living. So, how has Google changed your life?

Everyone Has a Story to Tell

I know that I haven't written in a while. Despite my best efforts, I caught the "Pedi Flu." Pronounced Pee-dee, as in pee-dee-atric medicine. So, I have been snuffling and coughing along with my patients. I finally started feeling better this weekend, just in time to start my new rotation tomorrow... the Pediatric ICU. I've heard a lot of things from my colleagues, not a lot of which are positive, so we'll have to see.

I thought I would take the time tonight to wrap up this last month by talking about some of my more interesting cases. Interesting in this aspect - in college I was a journalism major because I found people's lives fascinating, and I wanted to write about them. I get to learn a tiny bit about my patients in the 5 minutes I have to interview and examine my patients. Sometimes I am just left to wonder what their home life must be like... or maybe I don't want to know... still...

Dx: CO exposure
So, we've had a flurry of these as the weather temps dip, and people start burning stuff in their fireplaces or wood-burning stoves to keep warm. Also, kerosene generators and space heaters can add to the problem. I had a mom come in with her three boys. She said the boys had been getting sick off and on over the last 2 weeks. The day before she thought she had smelled gas. She didn't know who to call, and that morning, she called her mother who told her to call the gas company.

When the gas company man arrived, he found two gas leaks. He told her to call her landlord and then get herself and the kids to the E.D. to be evaluated. While I examined her children, she told me about all the phone calls she had made to her landlord, and how she was still trying to get him to fix the leaky ceiling and clogged toilets. I turned and asked her about flushing the toilets, and she said that you had to use the plunger every time and that they were usually backing up.

Now she didn't know how long it was going to be before he would get the gas fixed. I put the two smaller kids on oxygen and wondered if I was going to have to do a social admit for the kids. After I came back in an hour and rechecked their levels, I asked her about her kids' safety and where they were going to be spending the night, she assured me that she would be going to her mother's until the gas could be fixed. She also said she had recently qualified for Section 8 and would be able to get another apartment.

I found the kids knitted hats that had been donated to the E.D. I counseled the mother about stopping smoking. (Smoking will elevate your CO level.) And, I sent them off into the night.

Dx: acute stress reaction
A mom brings her 5 year old son who has been acting strange, hearing voices, acting out in school, and falling behind because the school sent home a note. In the course of my interview and the subsequent psych interview, we learn that the mother had her mother and a sister die in a violent manner in Philadelphia.

The mom had a cousin who lived in Buffalo and was planning on getting married. She asked the mom to be in her wedding, and the mom felt the need to get away. So mom moves to Buffalo with her cousin and brings her two young sons. Five year old son misses dad and cries on the phone every night when he's talking to him.

So cousin gets into a fight with her fiance, and in the course of "needing my space" she kicks the mom and the kids out. So, mom goes to live in a homeless shelter with her two boys and ends up there for about 6 weeks. Somehow, mom manages to get Section 8 which helps her to find a new apartment, but locks her into a lease. Mom can't break the lease or she loses a lot of money. She can't get back to Philadelphia. And, now her five year old is hearing voices.

When I talk to him and ask about his friends in school, he tells me that no one wants to be friends with him. When I ask him if the voice in his head is an imaginary friend, he tells me that who would want to be friends with him. That's about the time that I felt a CT scan wasn't going to do this kid as much help as a psych consult would. Psych was able to hook the mom up with social services who would see about assisting her in getting out of her lease and moving back to Philly. That will ultimately be the cure this young boy will be needing.

Well, it's bedtime for me. I'll be rounding on a new set of patients in the ICU in the morning, and I am sure that there will be many more stories to share. Until then...

Under Pressure

I never thought about the change that would happen in six months.

I just started my next rotation at Women and Children's Hospital. After almost two months working at ECMC, I think I was ready for the change. However, I didn't expect quite the change.

If you've been following my blog, you know that I have already done two rotations as an intern at WCHOB. And, despite the fact that I really don't like kids, I actually enjoyed them. It gave me a chance to do some preventative medicine - which I think is very important, a chance to teach - which I love to do, and, for the most part, I learned a lot about pediatric acute (and some not so acute) emergency medicine.

However, starting on Monday morning, I was the "senior" emergency medicine resident. Suddenly, it wasn't about "what does this child have?" it was about "how are you going to fix them?" Having not seen anyone under the age of 16 for the last 6 months, I really found myself rusty in my diagnostic skills, and with the added pressure of making more complex decisions about their health care, I was really at a loss my first shift.

What did not help was the fact that it was Monday. In January. At the height of RSV and flu season. And, I had an intern that had never been to WCHOB before. And, we started the morning with a trauma. A sixteen year old girl T-boned on her way to school at 45 mph. She ended up with a subdural hemorrhage. By the time we finished assessing her, we had four new patients on the board, and the fun was just starting.

I felt like an intern, trying to get used to the system again. Trying to manage the patients. Trying to just feel like I wasn't sinking. We got more residents in over the next 4 hours, but the whole system was just overloaded.

At one point we had all 26 rooms full. They opened another section of rooms (+6). And the waiting room had about 20 people waiting. The computers crashed, the nurses were surly as they were being pushed to their limits, and ambulances kept bringing people in.

We had the comic "E.R." moment when everyone was running around, a barely-breathing baby is brought into the back and starts being coded, the ambulance rolls in with another child turning blue despite ventilation, and the noise level rises to fever pitch. The baby is taken to another room so that the blue child can be rolled across the work station to the now vacant code room, and there's the rush and flurry of the respiratory therapists pushing ventilators as the radiology techs push around their giraffe-painted x-ray machines.

I left that night with 4 patients waiting to go to the Pediatric ICU (PICU), another 5 or waiting for admission, and a full board (20+) in the waiting room to be seen. You don't learn in that environment. You just try to survive and not let anyone else get hurt.

My next shift was a little better. At least I was able to think about my patients more. Review my disease processess. Come up with a plan before presenting to the attending. Not to mention, I actually knew the attendings. One of our complaints about WCHOB is that we're working with pediatric attendings who have completed a fellowship in Pediatric emergency medicine. We're guests in their house.

They've hired a whole group of new graduates, none of which I had worked with before. Not that it makes a whole lot of difference, but you get used to how an attending likes their work-up and presentation. You know who lets you fly and who keeps a close rein. I guess I could have almost called this posting "Out of my comfort zone."

Sigh. It was just the first two days. I work tonight (which is another problem, since we don't schedule our residents we get whatever schedule the pediatric chiefs come up with which doesn't always make sense or take into account shift time changes.) I know I will be able to get back into a rhythm. And, I know that by the end of the month, I will be a lot more comfortable with what I am doing in my new role.

Just in time to start my PICU month when the fun begins anew!

Until then, we'll see what interesting stories that don't involve coughs, colds, vomit, diarrhea and parents that should need a license before they're allowed to procreate we can come up with.

As for the video above. I like the way they combined two of my favorite shows "Grey's Anatomy" and "Scrubs" And, I like the song....