Monday, April 26, 2010


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.

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?

Friday, January 29, 2010


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.

Wednesday, January 20, 2010


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.

Sunday, December 06, 2009



A relative easy month...mostly since we're not allowed to do much. It's understandable in a way, since the 2nd year ortho residents only get a few months of orthopedics their first year. I assisted with a bunch of fracture reductions and casting, "revised" a few finger amputations before closing them, and otherwise looked at a lot of films. Learned a lot conceptually, learned only a little in terms of procedures.

Saturday, November 14, 2009


I survived 4 weeks in the MICU, aka medical ICU. For the non-medical people, the MICU deals with serious "medical" problems -- e.g., bad pneumonia requiring a ventilator, bad cases ond H1N1, sepsis, kidney failure, cancer, other bad infections -- while there are other ICUs for post-surgical issues (surgical ICU aka SICU). There are also similar places for heart disease (cardiac care unit or CCU), traumatic injury (trauma ICU or TICU), etc.

It was a hard month. "Sleeping" in the hospital every 3rd night, aka working through the night every 3rd night, gets old fast. I'm glad to be done with it. But I also had a really interesting time, and I learned a ton. Lots of sick people requiring a lot of care = many opportunities to practice medicine. I placed about a dozen central lines and became much more comfortable starting patients on pressors than I ever expected to be. I also realized how Not Sick many of the so-called Sick patients I see on other rotations really are. If your kidneys are still working and your lungs aren't filled with fluid, walk it off. Or something like that.

We did have a half-dozen patients with H1N1 influenza. A few were really, really sick for weeks. Most were just semi-ill for a few days and then got transferred to the floor. Seeing patients who had been on a ventilator for over a week because of H1N1 certainly made me careful about always wearing a mask!

Next month: orthopedics! And a week of vacation! And Christmas!

Saturday, October 10, 2009

Internal medicine wards

Ahhh, medicine wards, aka the floor. Where things always I learned a lot this month, some of which will be useful in the ER, some of which will not. I did spend many, many hours walking through the hospital. And many, many hours on the phone with social work. I did have a few exciting moments, such as the Code Blue announcements that I ran to and during which I (occasionally) intubated patients in trouble.

I have the utmost respect for social workers -- in part because I'm absolutely terrible at the sort of things they work on. And despite the 75 hours/week I worked in the hospital, it seemed like I spent 15 hours seeing patients, 20 hours rounding, and 39 of the remaining 40 hours working on social work and discharge paperwork.

I had a patient this month who had been in the hospital for 6 months. But by the time I saw her, she wasn't sick. She was actually my favorite patient -- every day we'd spend a few minutes talking about her medical condition (a few aches and pains), her background (Broadway performer during and just after WWII), her daily breakfast (bacon was always overcooked), and the hospital-provided socks (not as warm as she'd like).

She had been admitted for a basic problem that only needed 2-3 days of treatment, but the neuropsychiatry team determined that she wasn't safe to go home by herself due to dementia. Her doctors contacted the social workers and case managers to get in touch with family members about having her placed in a nursing home of some sort. 2 weeks passed.

Oh, except she doesn't have any family members we know of. So we tried to have a guardian appointed for her. Another month passed.

It turned out the patient has a very close friend who knows about her dementia, so we tried to set things up to have her become the legal guardian. 3 weeks go by.

Except her friend is fairly poor, and it turns out you have to pay to process the paperwork to become someone's guardian, and the friend can't afford it. So then the hospital tried to pay the fees for the friend to become the guardian, but for some legal reason you can't do that, so then the hospital contacted the state government to somehow get them to approve it, or pay for it, or something like that, but then the state said they needed a physician to certify that the patient had dementia that would not respond to medical treatment, which I did, and then the social workers said it would be another 30 days for things to get approved.

When I checked the hospital census a month later, she was still there.

The surprising thing? Her 8-month stay looks like nothing compared to the patient who had been there for 3 and a half years.