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Life. Not Terribly Ordinary.
A flame of interesting in a dark room of tedium
Recent Entries 
24th-Jun-2008 10:48 am - Moving up and away
Meeeeep!  Meep-meep-meep!
I've all but decided to leave LJ behind and move to Wordpress. There's nothing in particular that's prompting this (I really don't pay attention to all the politicking that goes on here so that's certainly not it) but I'm just looking for something new and different.

When I make the move, I'll let you know.
23rd-Jun-2008 10:17 pm - Whack-o-nutty
Are you fucking kidding?
Holy nutter.

I haven't worked a lot this month, but when I've been at work, I've typically been getting my ass kicked. For example: I saw only four patients today but I'm as tired as if I'd taken care of four times as many patients. The morning was slow and then the afternoon was quickly taken over with by trauma.

Trauma always gets everyone's blood rushing. Our girl was stable but she was a bitch of a stick. I was trying to place IV's in anywhere I could find a vein but was not having much luck. One of the nurses got one but it didn't draw for shit (we needed it to draw to be able to send off stat labs). Another nurse tried an arterial stick but it was nothing spectacular. I grabbed a 16g needle and found her femoral vein on the first shot. That felt good.

Right after I did that I had to run and sew up a very cute kid's knee. His dad was awesome in keeping him distracted. I had to put in a couple of deep stitches before the surface ones and because of his dad and a beautiful thing called LET.

While all of this was going on, I was managing a kid with hypoplastic left heart (fully repaired) who came in with what sounded to everyone like a TIA. Fucked. Up. Thankfully my favorite cardiologist was on and came over at 6 PM and did an echo and sat down and went over stuff with me. He rawks.

And after all of this, the head trauma attending bitched out the daytime peds ER attending for not calling a trauma consult sooner than he did. The daytime peds attending is known for being incredibly fucking slow and would rather teach than actually, you know, SAVE SOMEONE'S LIFE. It's unfortunate because he's a great doc and is incredibly knowledgeable but there's a reason we're all PALS certified here and it's not just to get the cool laminated pocket card. He was trying to rationalize why he didn't get a trauma consult when she rolled in. The trauma attending reminded him of ER trauma protocols and that under no uncertain terms should a patient involved in a trauma who is intubated at the scene not get a consult. Thank you, Dr. F, for repeating what I was saying in the trauma bay and for doing it less nicely than I was.

I finally made it home around 7:30 tonight. I'm totally failing at going to the gym. I need to get better at making this part of my routine. I keep saying, "Next week will be better" but it never is. I just need to man up and do it and let my husband fucking cook for once.

I've also realized I haven't been writing that much. My creative self is flagging quite a lot and it helps me sleep easier at night. Plus, when I can inspire someone I admire, it helps to stoke the fires.

Moment of Burrito:

12th-Jun-2008 12:29 am - Family photo
Why I'm a doctor
These are the people with whom I toil.

Today was bittersweet. It was our annual graduation dinner. I remember some of the graduating residents when they were med students. It's both happy and sad and honestly, I'm more happy than anything.
9th-Jun-2008 06:12 pm - Hit of the summer
House getting his groove on.
You heard it here first, bitches.

Good to see they still have all their old dance moves.
6th-Jun-2008 03:00 am - All this time...
Manny bein' Manny
Another exciting night here in the ER. We're down to two patients...and there's two of us residents on. And one of them is going home as soon as I can get a nebulizer set up for her. I don't know if we'll be able to handle it.

Since I've been tagged by Paige, I might as well take some time out of my busy evening to do this now.

Ten years ago
I was on the verge of turning 20. I still thought my soon-to-be-boyfriend who ended up becoming my husband had cooties. I had just finished my sophomore year of college and thought I was hot shit. I was probably panicking about taking the MCATs.

Ten months ago
I was doing my last two weeks of night float and preparing for the last two weeks of adolescent. I was probably looking forward to the State Fair and Counting Crows.

Ten days ago
I was working my first ER shift since September. I think I had clinic and was probably bitching about naughty patients.

Ten minutes ago
I was joking with one of the residents from the adult ER. We went to medical school together and we joked that we were having our reunion right here in the bullpen.

Ten minutes from now
I will likely be searching the internets for more time-wasting measures.

Ten hours from now
I will hopefully be sound asleep. My days and nights are all monkeyed up.

Ten days from now
I will not be working! I'll probably be doing something mundane around the house.

Ten months from now
Who knows. The block schedule for next year hasn't come out yet. Suffice it to say that I'll be nearing the end of my third year of residency and preparing to become chief resident.

Ten years from now
I'll be working as a pediatric hospitalist. Hopefully we'll be either in our next house or building it. And maybe, just maybe, my medical school loans will be paid off.

Those that want to do this should consider themselves tagged. :)
3rd-Jun-2008 10:22 pm - All the more curiouser
Why I'm a doctor
One of the many things I like about my job is that there's always something different going on.

I'm in the ER this month (15 shifts in five weeks...I practically have almost two weeks of vacation this month, except it's spread out over many, many days) and yesterday was a fairly busy day. There was your run-of-the-mill crap and then the interesting stuff.

An example of a conversation I had many times yesterday:
Concerned parent: My kid has fever/runny nose/cough/earache/etc.
Me, after examining kid: Your kid has a viral URI. Is your doctor's office not open today?
CP: Yes, it is, but I figured I'd wait less if I came in here.
Me: Interesting, because your pediatrician's office is across the street and since I work there, I know they take walk-ins during the afternoon.
CP: Oh, well, I figured I'd come here.
Me: *forehead bleeding from smashing it against clipboard*

I sewed some forehead lacs yesterday (not mine). And then, I diagnosed something I've never diagnosed before. A baby came in as sent by his pediatrician for "funny shaped head." His head circumference had been crossing percentiles on the growth curve and it was a little concerning. No shit, Sherlock. I made my diagnosis based on the story (it's always been that way, he's developing totally normally) did my exam and got a CT of his head to confirm it all.

He has craniosynostosis. His sagittal suture is almost completely fused.

I've taken care of kids with this after surgery in the hospital but I've never seen one pre-operatively, so to speak. Pretty cool, eh? He'll be fine once they fix his noggin.

I only had clinic today. All of my patients showed up - a frakking miracle. And of course, my two most complicated ones of the day were last. The second to last one is a teenage boy I'm treating for ADHD. However, a lot of stuff has come up in the six months since I've seen him - he's shoplifting, he's breaking things, he's torturing the cats.


I spent a great deal of time with him and his step-mom today and there's this whole social drama/mess undercurrent I wasn't even aware of. Oh, and the kid is refusing any kind of help whatsoever outside of medication (needs ADHD meds, will consider other meds, but flat out refuses to go see a counselor/therapist/whatever). I think that's what he needs more than anything but he's so reticent to the idea that even if he goes it probably won't work. Therefore, I'll be seeing him on an at least monthly basis. Hopefully he'll get so sick of me he'll want to talk to someone else. :) He trusts me and (sort of) listens to me but JFC, he's a teenage boy. I found myself getting incredibly frustrated but when I step back and look at it all, I think I made some inroads with him today.

Teaching day in the morning, then home for a nap because I start my first of four-in-a-row overnights in the ER tomorrow. Joy!

Moment of Burrito: "Looks like I picked the wrong week to stop sniffing glue." - Steve McCroskey, Airplane! (thanks fes42!)
29th-May-2008 08:09 pm - Work-a-billy
Why I'm a doctor
Home from another exciting shift in the ER. I diagnosed constipation - twice! I saw a girl who was arrested on Monday and came to the ER today because she had pain in her back from when the cops pinned her to the floor. She's been in pain for four days but came in today for "documentation" of it. Mind you, her doctor's office is a stone's throw away from the ER. There was other crap but that crap floated to the top.

Inspired by Dr. Caron's blog post today, I provide you with the inner contents of my bag.

In the upper left corner, you've got my bag, cough drops, OTC cold medication (that isn't working for shit), and some ibuprofen. Moving clockwise is my PALS card, pocket guide to resuscitation, wallet, coffee mug, and an article on a clinical decision rule about getting CT heads in minor peds head trauma. On top of that article is a random piece of paper (oh, it's the d/c summary on a patient I saw in the ER today), my prescription pad and my patient cards from the ER. To the right of that is some kleenex, my water bottle, and my sunglasses case that my friend Amy bought me for my birthday last year because I kept dinging up my sunglasses in my bag.

Just below that are some highlighters, hand sanitizer, and my inhaler (damn cough!). Moving more clockwise is my ID badge and pager (always attached to each other when they're not on me so I can find them easier), my stamper, and some lotion. Then we have my beat-up Maxwell's (held together only by the binder clip at this point), two month-by-month calendars (no idea why!), some gum, a handful of pens and my calculator.

Continuing to move clockwise you will find my "random shit" folder - it contains filler paper, procedure cards, articles, and lists of articles for the lit search I did for the research I'll be starting in a couple of months (God and program director willing). On top of the folder is my iPod and earbuds, some Kiehl's lip gloss, a list of people who owe me money for the PL-3 gift, and a sample of Eucerin Calming Creme I'm using on my bright red nose (thank the nurses for taking pity on me).

Things that are usually in there but weren't: my phone and my stethoscope. My phone is on the desk by me and my "ears" were around my neck when I came home so they ended up...uh...somewhere.

After dumping my bag, I didn't realize how much crapola was in there! What the hell do I need TWO calendars for?

I'm off to do something about this cough. It's either that or cough myself into a pneumomediastinum. Bleah.

Moment of Burrito: "It's so much easier to suggest solutions when you don't know too much about the problem." - Malcolm Forbes
19th-May-2008 10:00 pm - Who's your cancer survivor?
Ortizzle love.
The reverse gooch on Lester worked!!!

Tell me, Yank-mee fans, when was the last time a cancer survivor pitched a no-hittah for y'all?
14th-May-2008 09:26 pm - Meeting for a meeting
Why I'm a doctor
Tomorrow we have the first meeting of the education committee for the Golisano Children's Hospital at University Hospital. While the tasks ahead are daunting (we essentially have to restructure the way we do things and have it ready to roll in a year's time), I can't tell you how freaking excited I am to be involved in this.

It's finally hitting me that in a year, I'll be working in a brand new hospital that I helped develop.
13th-May-2008 09:34 pm - Sanity slowly seeping away
This is what I think.
This every-fourth-night call business is freaking killing me.

Last week, I was on call on Sunday and since we have to stay through the end of rounds when we're post-call, I left work at noon on Monday. I came home and slept a few hours and then got up and did various things. I was on call again on Thursday and while I was home and in bed by 10:30 Friday morning, I slept until 5:30 PM and went back to bed at 9:30 PM and slept straight through until 9 the next morning.

Think I was tired?

Other than sleep on my first full weekend off in nearly a month, I went to a surprise birthday party for a friend (which was also a congratulations on getting engaged party, as she got engaged on her 30th birthday the previous weekend) and bought my mom some shrubbery for Mother's Day.

I was on call again last night. I started out the night with three patients. I ended up with five (of the two admissions I had, only one of them was truly ill) and still only managed two hours of sleep at work. My day went something like this:

0515: Alarm goes off. Hit snooze.
0525: Snooze.
0535: Snooze.
0545: Snooze. Realize I still have to make my lunch. Roll out of bed.
0645: Leave the house for work.
0700: Get sign out from the overnight resident.
0730: See the one patient I'm following, talk to his mom.
0800: Note written.
0801: Wait for attending. He's notoriously late.
0830: Still waiting.
0900: ARGH!!
0905: Dr. H shows up. It's his first day on service for a two-week stretch so we have to go over the four patients we have in detail.
0940: Done with rounds, write orders for the asthmatic to get transferred to the floor.
0941-1200: Twiddle thumbs, read articles, watch You Tube with Nick.
1200-1300: Palliative care lecture with Dr. C. Makes me want to get boarded in pediatric palliative care. Wonder if I have to do a fellowship for that.
1300-1310: Chat with secretaries in office.
1310-1600: More You Tube, more thumb twiddling, more articles to read.
1600: Get sign out from departing residents, as we were doing jack-ass shit.
1600-1800: Work on PL-2 survival guide. Check e-mail eleventy billion times.
1800: Get called to ER to eval kid for possible admission.
1820: Decide kid looks much better after a combivent and that he doesn't need my services at the moment.
1820-2300: More biding my time.
2300: Get called to ER to admit trauma patient, whose idiot brother took the car out for a joy ride when mom and dad weren't home. Kid was in the backseat (wearing his seatbelt, thank fucking god) but the car got t-boned and it took about 30 minutes to extricate the kid. He's sick but stable.
0000: Get kid settled upstairs, places tubes and drains in every orifice, and talk to parents. Dr. H is still in-house so he comes by for a peek.
0005: Quick bedside rounds on the kiddos and Dr. H is off to home for the night.
0015-0200: Time-biding.
0200-0300: Now I lay me down to sleep...
0300:...until the night float resident on the floor tries unsuccessfully to buff and turf one my way. Yes, the kid has a weird congenital anomaly but he's awfully damn stable and doesn't need my services. What do you mean you don't have beds? I'm looking at the census right now and you have PLENTY of them. FOAD!!!
0305-0315: Attempt sleep.
0315: Fail. Get called to ER to admit a kid with a different weird congenital anomaly who has a VP shunt infection.
0400: Call shenanigans on neurosurgery resident, who essentially told me I was too dumb to understand what they were going to be doing for this kid. Listen, Dr. Douchebag, you will be too busy fucking nurses in the call room tonight to take care of this kid. That chore will fall to me. I need to know what you're going to be doing in case I need to call you away from your nightly in flagrante delicto to tend to this child. Also, I'm sorry that you turned into a total dickhead when you became a neurosurgeon, because you used to be nice. I feel sorry for your wife.
0500: Get kiddo settled, talk to mom, change fucked-up orders written by Dr. Douchebag.
0530: Attempt sleep.
0535: I AM FULL OF FAIL. Pharmacy calls to ask about my newest admission's home meds. Between my lack of sleep induced psychosis and the horrible accent (one of our old nurses called this pharmacist Won Hung Lo) I have to ask him to repeat everything twice, which has the charge nurse in stitches by this point.
0540: Attempt...aw, fuck it.
0600: Round on patients.
0605-0700: Tidy up sign out sheet, check e-mail, read news feeds.
0700-0730: Sign out to day team. Have never been more happy to see them in my life.
0730-0800: Time for breakfast of champions. I usually never eat more than some toast or cereal post-call before leaving work, but desperate times call for desperate measures - French toast and bacon.
0830: Start whinging about how Dr. H is always late and that he'll be very late today because I last woke him up at 4 AM.
0910: Hooray Dr. H for showing up early!
0940: Finish rounds and head home.
1000: In bed, flip on SportsCenter, and snooze.
1500: Wake up, call husband.
1530: Drag ass out of bed, as it is seemingly nice outside.

There you have it. A day in the life of a PICU resident.

There's other things about which I want to write, but not tonight. I'm going to sit outside.
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