After TICU, my month on the OB/Gyn rotation was pretty relaxing. And that's saying a lot, considering that I truly hated my OB/Gyn clerkship as a medical student, and that I consider Gyn to be the area of medicine which I least understand.
I'm sure I got a bit of favorable treatment since Karen is an OB/Gyn resident. But I also tried to work hard and combat the unfortunate stereotype that rotating ER residents are always watching the clock.
Most of the attendings were great. During my first week on the delivery floor, I caught 10 newborns and got some excellent teaching from the private attendings. There were also a few occasions when things moved along faster than expected and there was an urgent call for "any doctor" to a delivery room. I arrived moments later, threw a pair of gloves on, and caught the kid before any of the attendings showed up. It made me feel like I was actually doing something useful.
Overall, good schedule, good conceptual learning, good procedural learning.
Monday, April 26, 2010
Friday, March 05, 2010
Trauma ICU
Trauma ICU, aka TICU.
Ugh. Just thinking back to this month makes me cringe. My time there was just so painful. With the exception of my immediate team of residents, it felt like everyone there was miserable. All the time. I don't mind working hard. But I mind it when attendings mistake ridicule for teaching. Hence me not going into general surgery.
I did a bunch of subclavian lines,which was a good procedure to get comfortable with. I had the opportunity to do two chest tubes...until the visiting MICU resident stole one and the attending insisted the surgery resident do the other one. Grrrr. That was one thing I really wanted to work on while I was there. Since my other residents never screwed up their lines, there weren't any iatrogenic pneumothoraces giving us cause for chest tubes. I suppose that's for the best.
Most of the nurses were smart and reliable. Some were friendly and offered tips on dealing with different attendings. Some were loud, mean, and untrustworthy for reasons passing understanding. At least I made enough friends so that they would usually let me sleep an hour each night.
Anyway, there were no major screwups while I was covering the unit. No preventable deaths. And while I emerged as a more confident doctor, I'm not really sure what I learned. How to be a more efficient lackey, perhaps?
Ugh. Just thinking back to this month makes me cringe. My time there was just so painful. With the exception of my immediate team of residents, it felt like everyone there was miserable. All the time. I don't mind working hard. But I mind it when attendings mistake ridicule for teaching. Hence me not going into general surgery.
I did a bunch of subclavian lines,which was a good procedure to get comfortable with. I had the opportunity to do two chest tubes...until the visiting MICU resident stole one and the attending insisted the surgery resident do the other one. Grrrr. That was one thing I really wanted to work on while I was there. Since my other residents never screwed up their lines, there weren't any iatrogenic pneumothoraces giving us cause for chest tubes. I suppose that's for the best.
Most of the nurses were smart and reliable. Some were friendly and offered tips on dealing with different attendings. Some were loud, mean, and untrustworthy for reasons passing understanding. At least I made enough friends so that they would usually let me sleep an hour each night.
Anyway, there were no major screwups while I was covering the unit. No preventable deaths. And while I emerged as a more confident doctor, I'm not really sure what I learned. How to be a more efficient lackey, perhaps?
Friday, January 29, 2010
Pediatrics
Pediatrics floor month.
Since pediatrics was my very first rotation as a third year medical student, and it has now been (thinking...) nearly three years since that time, I'm due for some review. Yes, I already worked a month in the pediatric ER, but it's hard to really get a sense of "sick vs. not sick" if you don't see what sick kids really look like. And since H1N1 already hit (the peak was 3 weeks ago, maybe?), and we're at the near-peak of bronchiolitis season, I have to put on the additional "contact precautions" attire for nearly every patient I see during the day. I've done a few LPs during this month, mostly since I've done more of them recently than most of the other interns. Otherwise, lots of parental counseling regarding home antibiotic regimens, warning signs of more serious illness, etc. One parent was particularly hyper-vigilant. Her daughter had thankfully survived a bout of septic shock precipitated by a community acquired pneumonia, and she was terrified about bringing her home again. We explained the mechanism of septic shock over and over, and said that after 3 weeks in the hospital, she was back to her regular healthy self. I had to review the child's full set of labs, including some of the esoteric results we get from the lab that none of us really use (e.g., mean platelet volume), and explain to the mother that not every single value has to be perfectly normal before discharge (or that, in the average healthy person, not every value will be perfectly normal all the time).
Anyway, the pediatrics residents were generally nice and fun to work with. Overall, a good month.
Since pediatrics was my very first rotation as a third year medical student, and it has now been (thinking...) nearly three years since that time, I'm due for some review. Yes, I already worked a month in the pediatric ER, but it's hard to really get a sense of "sick vs. not sick" if you don't see what sick kids really look like. And since H1N1 already hit (the peak was 3 weeks ago, maybe?), and we're at the near-peak of bronchiolitis season, I have to put on the additional "contact precautions" attire for nearly every patient I see during the day. I've done a few LPs during this month, mostly since I've done more of them recently than most of the other interns. Otherwise, lots of parental counseling regarding home antibiotic regimens, warning signs of more serious illness, etc. One parent was particularly hyper-vigilant. Her daughter had thankfully survived a bout of septic shock precipitated by a community acquired pneumonia, and she was terrified about bringing her home again. We explained the mechanism of septic shock over and over, and said that after 3 weeks in the hospital, she was back to her regular healthy self. I had to review the child's full set of labs, including some of the esoteric results we get from the lab that none of us really use (e.g., mean platelet volume), and explain to the mother that not every single value has to be perfectly normal before discharge (or that, in the average healthy person, not every value will be perfectly normal all the time).
Anyway, the pediatrics residents were generally nice and fun to work with. Overall, a good month.
Wednesday, January 20, 2010
ER
I'm working in the adult ER this month. Finally! I'm excited to finally work in my part of the hospital -- although this is my only month here until May-June. I better enjoy it while I can -- TICU is coming up next month.
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