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Surgery Residency Diary, Mom of 2

9 years 7 months ago #75069 by cardiacrn1
So today I was off. I got home yesterday around 330pm post call, did a few things at home and by 630pm I was in bed, exhausted. I slept till 340am and it was nice knowing I was off today so I slept till 6am. I went to the hair dresser, got braided, came home took a nap and then started reading. It's good to read, reenforces.. anyway, I had a patient who came in, 50 something year old with ESRD on hemodialysis. BP was 245/135 and HR 122, his pupils were so constricted I could not even do a fundus exam. When he arrived his mentation was intact, slight headache and nausea; nothing too alarming. First CT was negative but later during the night he became confused, combative, had to be placed in restraints. I spoke to my attending who wanted a repeat CT, consulted ICU which was good coz he needed ICU care. Being a novice I ordered "CT brain stroke protocol" not realizing that an order like that would activate the stroke team....ooooops. My resident shouted at me.. Oh well, I figured no harm was done, my guy got his CT pretty fast:) At least now I know, I am there to learn and so I made a mistake but it did not put the patient's life at stake. So, will be on call again on Friday, Q5 is not so bad this month. Retiring early today, have a good rest of the week to all.


Remember, the days are long but the years are short.- Elizabeth Cooperstein

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9 years 6 months ago - 9 years 6 months ago #75245 by cardiacrn1
So time really flies when you are busy. I am chronically exhausted now. Call comes to quick, I was on call on Wednesday and it was busy. I am on call again tomorrow, this is my last week on internal medicine. My last call, I admitted a 50 somethng year old with Stage IV lung cancer, mets to the brain and left femur. Its so sad, he is in so much pain. He is not ready for hospice yet, still fighting, which makes it so difficult because his blood pressure is 90s at its best and the minute you give him dilaudid, he drops to 70s. I hate to see him in pain (he's already on 100mcg fentanyl patch, ER morphine 30 Q8hrs), but dropping pressures into the 70s for someone who is full code makes me nervous. He is now getting palliative radiation therapy to his femur, he's not stable enough for chemo but he is not ready for hospice.. so sad.. My other patient is a 30something year old male status epilepticus, he got valium 10 on the ambulance without resolution, a total of 16mg of ativan in the ED and was loaded with 1gm dilantin.. CT showed a brain abscess.. this guy was shot in the left eye in the late 90s when he was 20 years old and somehow the fracture he had predisposed him to this.......craziness..

One of my interesting patients is a 30 something year old female with scleroderma, sarcoidosis, severe pulmonary hypertension.. On physical exam she had a very loud P2 and a pansystolic murmur that increased with inspiration. Its so sad, here she is young with her life ahead of her and cant walk to the bathroom without being very short of breath.....So, I had a guy in his early 90s, generally healthy who was put on lasix, HCTZ, lisinopril by his cardiologist two months ago for increased bilateral lower extremity edema. When he went to see his doctor for dizziness, his BP was 80s/40 so he was sent to the ED. The guy when I saw him was dry as a bone. His Cr was 6.1 BUN 87.. THis is one of those success stories that makes you smile all day; we discontinued all his diuretics and ACE-I and put him on IV NS at 150cchr, In 48hrs his Cr was down to 1.2.... It was nice!!

So this morning I get up at 630, get ready for work and go to the hospital in my jeans and a nice brown top. I was thinking it was going to be a relaxed day, afterall it is sunday. I arrive a little before 8, get my coffee and hear a code blue being called over head. I just about dropped my coffee when I realized it was my patient. I ran up the stairs to the seventh floor and low and behold the on call team was coding my patient. She was in her 90s, but her daughter wanted her to be a full code. Three days ago she stopped eating and I was pushing for family to reconsider her code status as she was deteriorating, but its ok, they wanted everything done for their mother who was almost 100 and we respected their wishes. Today was my first time talking to family about death face to face as a physician. In this case, the daughter was glad that we did everything we could for her mother. It was sad and I cried too, I felt for her; her mother was her best friend. So is life.....

Its been great learning, I am feeling a little more comfortable, its amazing what three weeks of intern year will do for you, its seems as though I have been doing this for months...So, off to read, I am off on Wednesday and will be going to see my hubby for a day:)

ciao..until next time my friends.

Remember, the days are long but the years are short.- Elizabeth Cooperstein
Last Edit: 9 years 6 months ago by .

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9 years 6 months ago #75495 by cardiacrn1
So, internal medicine is over and I am 1/4 way through my first month on general surgery. One note before moving to surgery, One of the calls on IM, we had a 30 something year old female who came in as a direct admit from her pcp's office. She had noticed that she was bruising easily and had petechiae all over her body and inside her mouth. Her periods were very heavy last couple of months and she was feeling very run down. No history of recent illness. When her physician checked her CBC her platelets were low....sent her to the hospital, we checked her labs and she had platelets of 2...first thing you do with a patient like that is literally run to the lab and get a peripheral smear to rule out TTP as this can be extremely fatal very quickly. After we all took a deep breath, cleared by peripheral smear, we started her on steroids, ordered more autoimmune labs.. final diagnosis - SLE... of course in a patient like this you want to r/o HIV infection too. That was my life as an intern on IM, one month of residency down and 59 to go.. oh why i love surgery so much I dont understand..

Surgery is back breaking work. From the time I arrive at 5am until I leave at 6pm or 7 or if on call the next morning at 11 (which is the latest you can leave to be compliant with the '80 hour work week rule'), I do not get a moment to sit down. The consults keep pilling up. The pager keeps going off. Each night I have been on call so far there is at least one case that needs to go to the operating room. The work is hard, you are working with very different personalities (stereotypical surgical personalities), its exhausting. When I am in the OR though, I remember why I am there. If I did not get the opportunity to be in the OR like a lot of other interns in big residencies, I would be so discouraged. I wish my husband wasnt so far away, they say the first two years of surgical residency are the toughest, I am seeing how that is. I pray that the Lord carry me through these first two years because I know I can not do it on my own. If you believe in God, please send a prayer up for me, I can use all the prayers:)

My first night on call, I was called down to the ER for a 50 something year old gentleman who came in with abdominal pain and constipation. I went down to see this guy, he was the classical picture of a small bowel obstruction, huge abdomen up to the ceiling, vomiting. CT showed a mass in the cecum and of course small bowel obstruction, and hypodense lesions in the liver suspicious of metastatic disease. Poor guy, never seen a doctor because he does not have insurance..I saw him around 2am, he was ready for the OR by 4am as he was boarded for 7am....I wish I had been on the case but I was post call and it was going to be a long case and I had floor work to finish up.

The last time on call I had a 50 something year old lady I was called to the ICU for a consult.. she was a heroine, coccaine, alcohol abuser who came in with upper and lower GI bleed. GI scoped her and found multiple huge gastric and duodenum ulcers, they could not stop the bleeding with sclero/epi...I took one look at the lady and knew there was nothing we could do for her. Her children which are good resepectable members of society (both in their twenties have families, jobs, trying to make something out of their lives) were sitting in the room and told me a little about their mother and what a hard life she lived. She was on a propofol drip, versed drip, 400mg Q4hrs of dilantin, Ativan drip and still continued to seize. Albumin was 1.1, you do not want to take someone to the OR with an albumin <2.8 some texts say 3.0....these patient have a very high mortality. She was receiving blood, at this point she did not have active gross blood, slow bleed and hg was 7s and she was getting blood. We would watch and wait until she was stable for OR which we knew she would die before that happened. She coded that night and died. so sad..

My last consult before we left, 22 yo female with stage IV colorectal cancer with mets to the lungs, liver, and bone. She already had a total colectomy and ileostomy in '07 when she was diagnosed, she had a b/l pneumonia and the ICU team could not wean her off the vent so we were consulted for a tracheostomy and PEG tube..I cried when I saw her, so sad..Here is someone younger than me dying of cancer like this. THis was my second patient in early twenties with stage IV colon cancer in the last 5weeks. She has FAP, most people with FAP have a total colectomy by age 20, she was diagnosed and had mets by age 19 though she went for annual colonoscopies from age of 14...

I am off today, need to catch up on some discharge summaries and reading. Thanks for reading and have a great week. Hang in there ladies, its temporary, however difficult it might be it will come to pass.


Remember, the days are long but the years are short.- Elizabeth Cooperstein

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5 years 6 months ago #94755 by cardiacrn1
I am back!!

I have been thinking about getting back to blogging. I used to really enjoy it and it was a nice outlet and I enjoyed talking to other moms in medicine. Anyway, so much has happened in the last 3 years. So I was in a categorical residency in general surgery in MI, my husband matched in NY. I thought eh, its just 5 yrs it will go by fast, half way through my intern year I realized it was too difficult for me I wanted to be with my husband. It's much more difficult for neurosurgery to relocate to I decided to relocate. My program director was amazing and very understanding. So I finished my year, gave up my categorical spot, got a prelim surgery position in a NYC hospital which is all that was available and my program offered me a categorical spot for the next year. So its been a long detour, I basically did my intern year 3 times. Very worth it for me because I am with my family and I can't see myself doing anything else. My marriage and family will always come before my career. So where am I now? I just started my 3rd year of surgical residency and my husband is now in his 5th year. The plan is still the same, I want to do abdominal transplant surgery, my kids are older, daughter is almost 14 in 3 weeks and baby boy is 11. When I started medical school they were 6 and 3.5. Time does not wait for anyone. Hope to share my journey with you all. Have a great and productive week.


Remember, the days are long but the years are short.- Elizabeth Cooperstein

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5 years 6 months ago #94823 by cardiacrn1
I have been struggling with being a perfectionist. I was always the kind of kid who wrote in pencil so that I could erase if there was a mistake. My handwriting is impeccable and everything has to be just right. I tend to be very thorough and double check and triple check everything. When closing after a case I am teased by the OR staff that I have the best plastic closures; my patients are for the better but I have to learn to let go of perfectionism. I realize that I can not be perfect but unfortunately I don't know how to get over it. When I make a mistake I beat myself up and it really depresses me.

Today I was holding the consult phone. When you have the consult phone, you respond to the traumas as well. I went down to an overhead trauma activation and I was the one who went to go and look at X-rays before transporting the patient to CT. I got a call while I was starting to look at the X-rays for an emergency consult for a cold leg on the floor. This is a vascular emergency- if in fact it is a cold leg. I got distracted and did not communicate with the rest of the team that the patient had a right main stem intubation and left the trauma to go and attend this consult. The patient was saturating 100% and doing fine, and got pan scanned, that was when my attending realized that the ET tube needed to be adjusted. I feel terrible, because I am always on top of things and I do not allow myself to make mistakes. It is really hard for me to accept that I am not perfect.

Anyway, it was a long day. I am on 24 hour call tomorrow. We will see what tomorrow has in store for me. I truly enjoy what I do and even though residency can be difficult at times, I can not imagine myself doing anything else. I have realized that my love for hepatobiliary is getting deeper and deeper. I really enjoy seeing those consults and coming up with a plan for surgery, I get excited. I hate trauma and vascular- though I do love doing AV fistulas and bypasses.

I am waiting for the OR schedule to come out so I know what cases I am doing tomorrow so I can prepare. There is nothing I hate more than going to the operating room unprepared. I love putting my attendings in a position to teach me. Something I realized early on in my training is that you have to take responsibility of your own education. I have to read as much as I possibly can, there is absolutely no substitute to reading surgical textbooks- as dense as they are. I have to make every effort to be in the OR not only for my assigned cases but to either double scrub in cases I won't be doing for another year or two or just watch and learn. And as much as I am tired at the end of the day, I have to make time to go to the skills lab for at least 45 minutes 4x/week. Well, thats that.

Until next time.. Ciao-

Remember, the days are long but the years are short.- Elizabeth Cooperstein

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5 years 5 months ago #94897 by cardiacrn1
19 hours into my call, when I had finally gone up to my call room on the 8th floor to lay down even for a few minutes coz I had been constantly going and my eyes were so tired I was starting to see blinking lights, the trauma team is activated. I spring out of my uncomfortable twin bed with hospital sheets and blackest as well as a dark blue fleece blanket I bought the last time I was at the airport. I slip into my danskos and flip on the light switch and without bothering to straighten my hair, I grab my white coat, trauma shears and a pack of juicy fruit gum(I have a stash on my desk for my call days) and I speed walk to the ED. Mind you, the ED is on the other side of the building on the first floor. Anyway, I get there and the trauma has not arrived yet.
"What's coming in?" I ask one of the nurses in the trauma bay.
"Gunshot wound to the leg," she says as she gets her IV starter kit together.

A few minutes later, the EMS roll in with a 20 something year old guy. I quickly look at the patient who is clearly in extremis, (one of those things that you will know it when you see it without someone actually telling you.) Trauma is so simple, I hate being on trauma service or trauma team but it is quite simple. A, B, C..

I asked the ED resident who was already at the head of the bed to intubate the patient who was minimally responsive, diaphoretic, ashen. His initial blood pressure was 124/90 but he deteriorated very quickly. His blood pressure dropped to 70s, my colleague was placing a left sided chest tube as I placed a right femoral cords. We activated the massive blood transfusion protocol and fired up the rapid transfuser. FAST exam showed fluid in the belly and a cardiac tamponade. BP at this time had dropped to 60. We needed to stabilize the patient and take him to the OR, CT surgery was on the way. My chief did a sono guided pericardiocentisis and BP came up to high 80s, low 90s. We took the patient up to the OR and he got a sternotomy and exlap. He is in the SICU now, I really hope he makes it.

Remember, the days are long but the years are short.- Elizabeth Cooperstein
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