Medicine Week 3 Residents Switch

September 25, 2010

Today is the first morning I have NOT been in the hospital in ages (ok, 13 days to be exact).  I still awoke at 5:30am feeling like it was time to get up, but I managed to get myself back to sleep.  So, I finally slept a full 8-hours, and then filled my morning with exciting activities such as cleaning the bathroom.  Glorious!

This week I got a cold,  a testament to not taking good care of myself (not sleeping and eating well enough).  I couldn’t justify using one of my 2 sick days to stay home, since I never had a fever or felt horribly sick.  Still there were a couple days when my energy felt so depleted, I even contemplated deleting this blog.  Now I am relieved to finally be on the mend, and it is amazing how feeling well changes one’s attitude.

I am still on the hospital wards right now, working on the same team.  However, this week the residents and other medical students switched teams.  So, I am working with a new psychiatry intern and third year medical resident.  It feels like a different team. I miss the other medical students, especially the 4th year student who was a gifted teacher.  She gave me more constructive feedback than anyone else has this year, and I hope she works with students in the future.

The psychiatry intern is a sweet woman from Saudi Arabia.  She is married and has a 3-year-old son who lives with her mother in her home country.  Every morning she Skypes with him before coming to the hospital.

The third year resident is energetic, constantly carrying a jumbo-sized iced coffee in-hand.  He is also an international doctor  who is extremely intelligent, but has some funny quirks such as reversing the pronouns “he” and “she.”  He spends time teaching us about managing medical situations, such as pulmonary embolism (a blood clot in the lungs) and myocardial infarction (heart attack).

Speaking of heart attacks, they are now becoming routine.  The first day I was working with the new resident and intern, we saw two… at once!  We had just discharged a patient who had been in the hospital for 3 days due to an MI.  She seemed to be doing fine, and was ready to go home.  Yet, no more than 10 minutes after we left her room, we were paged by the nurse.  She had dropped to the ground, and was having a probable heart attack!

We rushed to her room, started an IV and then received another page that a second patient on the same floor was having chest pain.  There was only one ECG machine, so we frantically tried to complete the ECG and stabilize the first patient so we could move to the next patient’s room.  This was a lot of excitement for our new team.

Now off to enjoy my one weekend day before returning to the hospital tomorrow for a call day.

1 Comment | 3rd Year, Family & Internal Medicine | Permalink
Posted by Liz

Medicine Week 2 Black Weekend

September 19, 2010

This weekend was my first “black weekend.”  This term means I worked every day, including the weekend days. So I’ll work 13 days in a row without a day off. I have the sensation that I’ve previously felt on vacation: disoriented from the days of the week because they all seem the same.  Yet, I am not on vacation.

I’ve spent many hours in the hospital, although the work is not terribly difficult.  My daily shifts are 10-14 hours each day (10 hours for 3 days, then on call for 14 hours the 4th day).   We did not get a high volume of patients during this “black weekend,” so I never felt rushed or overwhelmed.  My classmates and I even had a little time to study, and discuss diarrhea (while drinking hot chocolate of course, which is a medical student’s demented idea of fun, so you’ll have some idea how crazy I’ve become).

I like being in the hospital.  I would easily choose to spend 10-14 hours in the hospital over 4-6 hours in lecture any day.  The patients I am meeting and people with whom I am working are teaching me a lot.  But I’m exhausted, and the fact is that I’m not working nearly as hard as the residents.  Some days I wonder how I will have the stamina to continue these hours for the rest of my training.  Obviously my other activities (marriage, friendships, e-mails, blogging, art, cooking and sleep to name a few) will not get as much attention as I’d like.

According to regulations, medical students and resident are not supposed to be at the hospital for more than 32 hours in a row, but this shift limit will change to 16 hours by the time I graduate.  The weekly average is still going to be no more than 80 hours over week. My time in the hospital still averages in the 60-70′s.  Still this feels like a lot of time at the hospital, and not enough time to synthesize my knowledge with reading and contemplation at home.

I hope I’ll get used to missed weekends, but right now I can’t help dreaming of a day off.

1 Comment | 3rd Year, Family & Internal Medicine | Permalink
Posted by Liz

Medicine Week 1 MI

September 12, 2010

Last week pediatrics ended with a 3-hour examination (multiple choice of course).  I got my score report yesterday, although it took a minute to interpret.  There was a “raw score,” an “adjusted score,” a mean score, standard deviation, low/high scores, and a pass/ fail column which was blank with a star.  At first that made me nervous.  I expected large print, “PASS!”  But in small print at the bottom, the star was explained, “unless otherwise indicated, the score received is a passing score.”  Why do things always seem more complicated in medicine?  Well, one down, four more to go.

This week I went from working with babies and children to a new world, adult medicine, in which a vast majority of patients are older than 75.  Internal medicine is notorious for being the rotation that teaches the most.  It is 10 weeks, rather than 5, and most of the rotation is spent caring for admitted patients who suffer from cardiovascular, respiratory and gastrointestinal problems.

I am on a small team led by a second year resident, who is calm, kind, and has an admirable way of talking to patients.  Also on my team are two other medical students and a psychiatry intern who fasted for the entire month of Ramadan.  I was impressed by his faithfulness during such a difficult time.  I can’t imagine fasting right now.

I was only assigned two patients this week.  The most exciting experience was my first glimpse of an “MI” or myocardial infarction (a.k.a. heart attack).  She was a woman who had strokes and a previous MI.  Despite being mentally handicapped by her strokes, she maintained a witty sense of humor.

She began having a strange chest pain.  It only hurt when somebody put pressure on her ribs.  At first, we wondered if she could have bruised herself.  However, her hands and arms began to ache, which is a classic sign that makes doctors worry about MI.  We performed an ECG, and tested her blood for cardiac enzymes that become elevated with injury.  Sure enough, it became obvious that her heart was being deprived of blood.

Yet, she never became acutely ill, and the pain never seemed severe enough to signify a heart attack.  I learned an important lesson that day: people, especially women,  have heart attacks with a varied spectrum of symptoms, which may or may not seem severe.  I was taught this in medical school, but I never imagined how healthy somebody could seem until I watched this woman having an MI this week.

The week ended with feelings of exhaustion, just as I felt at the end of my first week of pediatrics (but no passing out, fortunately).  There is so much to get used to, long hours and never enough time to sleep.  Starting tomorrow, I have to work straight for 13 days without any day off.  I can’t promise a post next week, but I will try.

Leave a Comment » | 3rd Year, Death & Diseases, Family & Internal Medicine | Permalink
Posted by Liz

Pediatrics Week 5 Babies

September 1, 2010

This week I reported to work with one hope: that there would be at least one delivery.  There were two.  The first came in the middle of patient rounds.  The beeper went off, and I was surprised by how fast the residents started running toward the door.  I rushed to catch up, losing time as I squirted alcohol cleaner on my hands.

As we walked, they told me “it’s a 9-1-1.”  I had no idea what that meant, but later learned this is the term for any delivery that was unplanned.  Usually the pediatrics team doesn’t go to full-term, vaginal deliveries.  We are called at all C-sections, premature births, or when the baby might be in distress.

This time it was a premature vaginal delivery.  We rushed into the delivery room, and I was surprised to feel the mood change immediately.  Birth is so intense, and this delivery had gone fast.  The lights were dim and yellow, like a glowing fire.  The head was already out, and seconds after we arrived, the baby was placed on the warming table.  The residents were still scrambling to turn on the oxygen and suction dials on the wall.

There in front of us was baby, covered with white cream and smears of blood.  A 6-inch umbilical cord hung from him, and looked like part of a jelly-fish.  He looked up with big, blinking eyes.  I was frozen… WOW!

The residents immediately started rubbing him, squeezing his umbilical cord to take his pulse, listening to his heart, suctioning him, and then giving oxygen with a positive-pressure mask.  I tried to do something useful, which was impossible at first.  I smiled at dad who had come to observe us.  I listened to baby, but I didn’t know what to make of his raspy lungs.   He was having some trouble with his breathing.

Every few seconds, they would count 1-2-3 and in a coordinated dance, lift baby and change the cloth underneath so he would stay dry. Finally, we clamped his cord close to his belly, and dad cut it.  Then, we bundled him, and they let me, the medical student, carry this brand new bundle to his mother.  I handed her baby, and said, “felicidades” because she and her husband spoke Spanish.

The second call came during lunch.  Again, I dropped everything and tried to keep up with the residents.  In fact, I left my stethoscope on the chair!  This birth was also a premature vaginal delivery, but it was slower.  We had plenty of time to set everything up while mom was in the final stages of labor.  I was alarmed by the tubes they prepared, in case they needed to intubate the baby.  They checked the suction, and the oxygen bag.  This time I knew what to expect, so I got ready to help with the drying, rubbing and blanket-changing dance.

These were the first births I’ve seen since my brother was born, almost 20 years ago.  I barely remembered the chaos that happened right after my brother was born, but it suddenly came back.  There was lots of rubbing and suctioning, and I cut his umbilical cord a while afterwards.  He was swaddled in a blanket, and I held him and handed him to my mom.

Most of all, I was in awe of my brother, just as felt as I watched the newborns in the nursery.  There is something so special about new babies, new life, and the moment of birth, mixed with pain and joy.  I thought I was going a little crazy after spending time in the nursery.  I started looking at baby outfits on Google.  Then, I even thought about having a baby before I finish medical school… for about 30 seconds.

The truth is that starting a family during medical training is terribly difficult, especially for women.  I’ll explore this topic in a different entry soon, but for now I am enjoying the new babies, one of my favorite parts of pediatrics.  Getting to see something so sacred as human birth and newborns makes all my sacrifices seem worth it.

Leave a Comment » | 3rd Year, OBGYN & Pediatrics | Permalink
Posted by Liz

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