First, I'm thrilled to see that Kris is in remission and her docs expect this is a cure.

I am loving this rotation, I must confess. I feel like a contributing member of the team. I feel like the work I do is worth something, that I'm learning a great deal, and that I really am capable of learning what I need to know. Let me tell you, this is so much more fun than the boring month on peds with no patients. I know it should be more enjoyable to have few patients and go home early, but I really prefer to be busy and productive.

We have a very baffling patient on the service right now. I didn't know what was wrong with the guy, but I kept peppering my intern with questions until he was able to help me articulate my vague instinct. Then, later on, I reminded the attending of our suspicion and he wrote orders for the test that would rule in or out my theory. Turns out my theory may be right! I couldn't have come up with this idea without my very smart and helpful intern, but I still feel pretty proud that something I advocated may wind up being the diagnosis for a very frustrating patient.

I'm glad I got assigned to this pulmonary service because it's given me some decent exposure to ICU patients.

My husband pointed out something interesting today. He said that it must be really upsetting to work with patients who bring their diseases on themselves. (ie emphysema due to smoking) I thought about it for a second and said that actually, I find the pedi cases more distressing. The reason is that in lots of the pedi cases I saw, it was the parent causing the child's illness. (malnourishment, not giving HIV meds, etc) That really upsets me because the child has no choice, no say in the matter. In the case of lots of adult illnesses, they are doing it to themselves. (not taking meds, continuing to smoke) So, they have a choice and they make their choices. Sure, it's very frustrating, but at least they aren't helpless in the face of abuse or neglect.

So now there's a 1% chance I'll go into adult medicine. :laughing: Okay, not really, but it's better than I thought it would be!

I'm so confused. I really feel like I'm enjoying this rotation more than Pedi! :boggled: I think it might just be because I'm more useful, do more, and am more challenged on this rotation. My pedi inpatient month was so quiet and so many of the patients were "social admits." There wasn't much for me to do. On the pulmonary service I am constantly looking things up, talking with patients, learning, or passing out asleep at night.

Plus, I have a better resident on this service. It's probably a little unfair to compare the interns since this intern is brand new and has all the energy and enthusiasm of someone who just got the title "MD," whereas the interns last month were just finishing their year and were all pretty much exhausted and ready to be done being interns.

I guess it's likely that I would have a similar experience if I were on a Pedi critical care team. Can't really compare the intensity of adult critical care with general pedi.

Some of the things I like about this service is getting a history and trying to puzzle out the source of the problem and then tailor labs and studies to rule in/out your theoretical diagnosis. Plus, there are the occassional bronchoscopies. I like procedures.

I think I might do an elective in pedi critical care instead of NICU. I've already got a research month in the NICU coming up in December.

It's all very confusing. I keep expecting to dislike certain rotations and then finding I like it much better than I thought I would. Not all that unusual, though. My 2 good friends who were completely certain they wanted to do EM are now looking at Gen Surg and ObGyn instead!

The attending I have this week has turned out to be much nicer than I heard. 2 other students in my class who had this service before me warned me about this doc. "He's a total jerk." The first thing he did when he met me on Monday was grill me about Parkinson's Disease and Progressive Supranuclear Palsy in a patient I had never seen before. Mind you, he's a pulmonologist! It's not that I don't know Parkinson's, but I was so taken-aback that my mind went blank when he asked me where in the brain was the source of the problem. The answer is the Substantia Nigra, but all my little "deer-in-the-headlights" brain could come up with was "Nigracans." :banghead: Something entirely different! (as in, Acanthosis Nigracans...) *sigh*

My saving grace, after this humiliation, is that while he was grilling the intern (who also struggled), I was making notes on my little card to look up PD and PSNP that night. (I do this for every question I come across to guide my learning) The doc turns back to me to tell me that I need to look this info up and I hold up my card with the note already made. *whew* That, at least, told him that I would be proactive about learning and that it wasn't okay to me to be clueless. Since that time I've done my best to look things up while riding on the elevator, etc, to try and anticipate questions he will ask me when I present a new patient consult to him.

I still miss about half of what he asks me, but I'm making a good faith effort and I'm not lazy or resentful. It's the best I can do. I wish I were like some of my classmates who seem to just remember every word that was ever spoken to us about every remote disease process in the books. But, I'm not. Best I can do is keep pushing myself to get better. Repetition leads to learning in this brain, much repetition! :laughing:

I think I wrote this advice from the first Pulm doc, but maybe I didn't. "Never go to sleep with a question on your mind. Find the answer. You go to sleep with one question one day, by the end of the week it's 7 and by the end of the year it's 365. The difference between a good resident and a great one are those 365 questions."

So what if I have more like 5-10 major questions a day, I'm doing my best to answer them!

So what's my family up to these days, anyway?

The kids are enjoying their summer break. The go to an overnight camp this week from M-F. They went to this camp last year and had a blast. The day they got home I picked them up from the bus and they looked awful! I asked what was wrong, what happened? (my heart in my throat) "we don't want to come home, we want to stay another week!!!" was my reply. :rolleyes: I did want to send them for 2 weeks this year, but it's just really, really expensive.

So today I need to be helping them pack their bags, get snacks, etc.

We're quietly recovering from volunteering at a local aquathlon this morning. It's a 2.5 mile run, 1000 meter swim, then 2.5 mile run again. I'm really in awe of these athletes! The kids get a kick out of seeing parts of the race. We had the water station at the finish line, so we got to cheer all the finishers and provide drinks for them. People were impressed at how efficient and organized the kids were. I'm proud of them for getting up at 6am to do it!

My daughter is starting 7th grade in a few short weeks. That's junior high in our district. I can tell she's nervous, but she's really trying to focus on the positives. She's been talking about decorating her locker and making a map so she can find all her classes on the 1st day of school. I'm so happy to see her proactively trying to solve problems instead of sitting in my room and crying. (she used to do a lot of that last year, poor kid) She has a couple of good friends now who are really nice, smart kids and who are just a little "zany" like she is. Creative minds and all that.

The boys will be in 4th grade, which is the oldest in elementary school here. Like their sister, they seem to be taking everything in stride this year. I hope I never have to move again before these guys are done with school. I swear it takes over a year for them to really settle into a new community. We'll see if we get that lucky with my residency match.

The kids are out of town and the house is so big and quiet! It's almost eerie.

Rotation this week and has been good and difficult at the same time. I've been given more ICU patients. I think this might be because I'm doing a better job and the attending thinks I can handle it. That's good. All three of my patients are in some degree of neurological deficit. That's bad.

Today I have listened to my attending discuss the very grim circumstances of several patients. I can't put into words how it feels to be on the medical end of that conversation. It also feels so strange to have patients and family members turn to me and ask me questions, expecting that I have some knowledge or insight to offer. What is even stranger is that I'm developing the tools to answer these questions and to feel competent talking to them.

I like this role, but I know it comes with a price too. There's an expectation of always being at your best game, always prepared, always on top of things or ready at a moment's notice to perform the most difficult tasks. For example, delivering the news of metastatic cancer when the patient catches the attending in the hallway looking at results in the chart. There isn't always time to sit down and plan how these conversations will go. Sometimes patients and family members don't react the way you would expect. It's not always tears, either. Actually, I haven't seen anyone cry yet. The most common reaction of the elderly patients I've seen get a bad diagnosis is a sort of resignation or just staring off into space for a while.

We deliver a lot more bad news than good news on this service. I guess that's the nature of critical care. What I do like about it is that if there's something that can be done, the critical care docs can do it. These guys are really, really smart and capable and cool as cucumbers. As a rule, they're also good with patients and families. So far, these docs have had the best bedside manner of and I've seen, including the pedi docs!

So, now that I'm getting reasonably comfortable and feel like I have something to contribute, it must be time to move on! :p On Monday I start a month of general medicine at the VA hospital.

Oh, and I've begun the training for the half marathon this coming January. My program focuses on lots of running at very easy paces for the base building. It'll be 23 miles this week, getting to a peak of 40 miles/week by mid-October. I didn't run that many miles while training for the marathon! We'll see if I can keep this up with the rotations and family.

One day at a time. :yes:

This is not a happy post.

We lost a patient today. He coded in the ICU this morning. My attending ran the code. It's the first time a patient of mine has died. He came into the ICU 2 days ago from the ER in septic shock. I took his history from his wife since he was intubated and sedated. I was present for several conversations with her.

Today I was there when we told her that we'd given him all the medicines we could give and that there wasn't anything more we could do. We would continue CPR for 5 more minutes and then stop if he hadn't come back by then. He didn't come back, although he did develop a heart rhythm that we could shock, so he was shocked 3 times, I think.

There were people everywhere, doctors, residents, nurses, respiratory therapists, pharmacists, a social worker and the chaplain. I was at the back of the room, feeling somewhat out of place and a little dazed by it all.

I was okay, though, until I looked at his wife and saw her tears. My eyes welled up and I almost couldn't hold back the tears. I managed. I was also present when the attending told her it was over.

15 minutes later we were down the hall and I was presenting the next patient and sitting in on the discussion of stopping her medical care and sending her to hospice.

Then, we visited the bedside of another neurologically devastated patient whose family is disagreeing on her care (support or no support). Lastly we went to the bedside of a woman who just found out yesterday that her pneumonia that won't go away is actually metastatic cancer, likely from a breast cancer 4 years ago.

They aren't my family members and I'm certainly not suffering the way they and their loved ones are, but I must say this has been one of the most difficult days I've had on rotations so far. Yesterday, taking care of these same patients, I would have said yesterday was the most difficult day.

Well, it's happened. A patient of mine has died while I was there. I'm sure it won't be the last time this will happen in my training. I hope it will get easier to keep the professional demeanor as time goes by. I think I did okay. At least I didn't cry or run out of the room.

Tomorrow is my last day on this service. I think I'm okay with that.

Tomorrow my kids come home from camp and I cannot wait to hug them all to pieces.

Last day on that service was very good. I actually got some closure with 2 of the ICU patients in that their families made decisions about palliative care. (Having patients in their conditions lingering on in the ICU is very difficult on everyone. We know we can't do anything for them, but we're not allowed to let them move on, either.)

The kids had a fabulous time at camp. I noticed a little more comaradarie and less fighting between them since they had spent the week hanging out with other people and not under each other's feet all day. They also came back with a new air of independence, which is nice.

Started the new service at the VA today. It looks like it's not going to be much fun. I was ignored and looked through by the outgoing intern and the upper level resident for most of the day. They didn't even introduce me when the new interns came by to meet the upper level. :rolleyes: Then, when I introduced myself I got "are you the only med student? I thought we were supposed to have 2. Oh man, we got screwed!" Thanks, thanks very much. I'm real happy about being the only med student on a busy service, too. It'll be scut, scut all day long.

We have night call tomorrow. Call on Saturday (that means no weekend for me) and night call again on my daughter's birthday. :guilty: She, lovely child that she is, just asked me to call her as many times as I could that day.

Well, I'm feeling very negative about this new service. Crabby team and no fellow med student to commiserate with. Oh well, it's only 4 weeks. It can't last forever! :p

Oh, I ran 23 miles last week! Began my day with 6 miles this morning. Hope I can keep this training up with the new service. I can tell there's going to be a lot of competition for my time with family, running, and sleep!

Thought I would post a happy follow-up to yesterday's distress.

The team was much nicer and friendlier today. Turns out no one will be asking me to run around and do blood draws on patients. (Which is good, because for some reason I'm terrified of this!) I'll be getting one new patient today.

Night call is different from what I expected. I'm at home right now because our call doesn't start until 5pm and none of the team hangs around after lunch until the patients start rolling in.

The best part about this is that I will be able to drop by next week in the afternoon on my daughter's bday to wish her a happy bday and maybe take her to lunch or something. What a relief!

I thought night call meant 7am-midnight. Instead, it's usually daily work from 7am-lunch lecture, then 5pm 'til new patient is "tucked away."

Things are looking up.

-One foot in front of the other

Well, this rotation is somewhere between the mood of my last 2 posts. :p It's not downright awful, and the intern isn't mean exactly, but it's not any fun either. There are 2 interns. One is very nice, talks with me and answers questions, sometimes cracks a joke or two and is generally pleasant to be around.

The other intern is anal and a micromanager. When I ask what the plan is for our patient, or some specific detail of the meds, etc, he tells me to read his note. The jerk is sitting at a computer 3 feet from me and can't be brought to explain his thinking on the patient's therapy? More irritating, however, is the fact that he won't let me present the patient to our attending. Most of the time, he just ignores the fact that I'm also following this patient and that I'm supposed to present him at rounds. When he does remember (or I'm aggressive and jump in before he does), he'll take over the minute I hesitate or have to think to answer a question. :goodvibes: The kids started back to school yesterday. (Where did the summer go???) The boys are the big cats on campus in 4th grade now. My daughter is in Junior High in 7th grade. (holy cow!!!) Everyone seems to be happy with their teachers and classes.

My running has been going well. I'm training for a half marathon this winter. I've run 18 miles already this week and will run 8 tomorrow. I've been waking up between 4-5am to run. Yes, it's a little crazy, but it's too hot in Texas to run at 7pm and I'm too tired anyway. My husband says since I started running seriously again my moods are much more level and I handle things more easily. I feel like, believe it or not, I have more energy and endurance for things like 12 days straight at the hospital. One foot in front of the other and all that.

Tomorrow is my day off. I plan to be very unproductive.

Only two more weeks with this stupid team. ( I also work more hours than most of my classmates at this hospital. *sigh*)

I do not like general medicine. :p

Oh yeah, and I did well on my Pedi grade! :goodvibes: Just got the score this afternoon. Can't wait to be back at the children's hospital. Too bad I have to wait 'til late November.

I haven't been posting in my blog for 2 reasons. One is that I've just been so busy with back-to-school type stuff for the kids, the rotation and my running.

The other big reason is that nothing has changed on this particular part of the rotation. The upper level and the one intern are still mostly condescending jerks. I still have to fight to get a chance to present "my" patients to our attending. I still get interrupted and cut off. I still get marginalized on a daily basis. I hate it and it's totally unnecessary. I have given a poor evaluation and feedback on the "anonymous" form for my team. How exactly is it anonymous when I'm the only student on the team??? :rolleyes: So, enough about those jerks. The new 4 weeks of the rotation start on Monday with a new hosp and new team. I just have to survive 4 more weeks and then I'll never take another general med rotation again! So there! :p

:rotfl:

My running and my family have kept me sane. I've finally given up the embarrassment of being the only person bringing healthy food to the hospital while everyone else eats the free pizza and Mexican food. I just can't do it. I don't feel good when I eat poorly, I don't run as well, and I get mad at myself when the scale invariably starts creeping up. It's a losing battle.

I guess I'm feeling rather defiant today, heehee.

Thinking about going to the AAP conference in October. Not sure what a medical student will do at a meeting like that, but it would be interesting. I've never been to Atlanta.

After this rotation is done in 4 weeks (4 weeks!), I'm taking a 4 week break from rotations. *phew* I've been going 90 to nothing (as my mom says) since January and I need a cooling-off period.

Med skool is hard!

I really, really don't get it. Seriously. However, it's working in my favor this time. :rolleyes:

Remeber how hard I worked on Pedi and how much I wanted to do well? I was so frustrated by my very-good-but-not-great evals which I was told were due to the fact that either I couldn't get an Honors designation because I was only a 2nd yr student or because the census was too low for me to "earn" Honors. Sheesh. I did High Pass that rotation, but it was very disappointing to be told I couldn't do better because there weren't more patients or I wasn't advanced enough yet to earn it.

So yesterday I was furious with my medicine team. When I woke up this morning I was playing confrontations over my eval in my head, worrying that I would get a poor eval because I didn't take enough initiative,etc, even though the opportunities were regularly taken from me. But, I reminded myself, the confrontations you worry about rarely actually happen. (at least for me, this is the case.)

So this morning my upper-level wants to go over the eval with me. I was really nervous! On a scale of 1-5 (5= Honor), he gave me all 4's & 5's. What????? But, but, I thought they hated me! He actually said some of the nicer things I've ever gotten on an eval. Suffice to say, I was floored. I was also internally a little embarrassed. I was just sure they were going to give me a poor eval. :goodvibes:

My other son is thrilled that school is back in session. He loves being in class and loves to learn new things. The other day we had a discussion about how the land masses would be named differently if the Panama canal was either not there or if it was a true bit of ocean between North & South America.