well, it's been some time since my last rant. 7 days to be exact. which is the same number of days i have left in the ccu. actually, it's 5 days: i have 1 more off day, plus one day "off" during which i will be taking an exam rather than going to work. so that makes it 5 days; 2 of those are post-call days where i go home by noon, and since i am usually so tired/delirious i almost enjoy the morning, that really becomes more like 3 days. but there are 2 call days, which can be horrible and never-ending, which brings me back to 5 days. i can handle 5 days. especially since it is now t-minus 14 days until i have 2 weeks of vacation!
i was on call last night. it sucked. not only was i sick, but 2 patients came after midnight, meaning i got basically no sleep. i thought that was bad, but then on rounds this morning the attending was not thrilled with the manner in which 2 patients were managed and insinuated that i was not such a competent doctor after all. not so much fun.
that didn't bother me too much, since it is quite easy to come in ex post facto and deride overnight decision making, but i did spend the few free moments i had this morning re-thinking some of the choices i made. the end result was that i spaced-out and lost my train of thought many times when discussing other patients, leading to paroxysms of gibberish coming from my mouth, which only further this attending's low opinion of my abilities.
so i did what anyone is my position would do: i took out my frustration on someone beneath me; in this case, it was a nurse and then a patient. the nurse was someone who paged me 3 times in a row to ask me about orders for a patient that wasn't even a ccu patient, so i knew absolutely zero about her. i was very pleasant the first 2 times, but at number 3...
the patient i yelled at was a 50 year old woman who was supposed to be discharged today and then return this thursday for an outpatient surgical procedure. she told me that she would need to stay until then because she would have no ride back to the hospital on thursday. i told her that she didn't need to be an inpatient for 4 more days, that bad things can happen in the hospital, etc., but she was unbending. i asked why she thought she couldn't get a ride and she said her husband worked early in the morning. what about friends? no one would do it, she informed me. i was livid. i asked if she really had no friends who would drive her to the hospital for a life-saving procedure? nope. how about a cab? she told me she lived too far away and that it would cost too much and that it would be easier for her to stay. this is when i told her that she needed to take some responsibility for her health and well-being and just because something was "easier" for her doesn't make it the right choice. i told her that there were people who were actually sick who needed her bed and the hospital was not a hotel.
i was so angry that i left while she was talking, telling her i would be back to discuss it later. these type of people make me hate-filled that i can't even type more about it. what is so irritating is that everything i said is true: a person shouldn't stay in the hospital if it is not necessary--some very bad things can happen. second, there are people who are acutely ill who do need her bed. third, the wasted health care dollars spent dealing with patients like her is astronomical and wasteful, particularly in this resource-poor environment. aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaahhhh!
i will update you on her discharge status tomorrow.
Monday, February 23, 2009
Monday, February 16, 2009
no. 31
14 days to go.
i'm not sure why i'm counting, since i am actually enjoying my month in the ccu. but it seems like the thing to do, possibly because when this month is over i have 1 week in a community hospital ED, and then 2 weeks of vacation. hooray!
one of the biggest indicators that i am content is that i don't feel as much compulsion to write. i think that when i am angry or unhappy i need the catharsis of putting my gripes into words. but right now, i don't really have any on-going discontent, so i don't have much to say.
although i am getting sick, which is fairly horrible. there are few things worse that being on call and being sick. i have 2 days to get better.
on that sentiment, time for some sleep.
i'm not sure why i'm counting, since i am actually enjoying my month in the ccu. but it seems like the thing to do, possibly because when this month is over i have 1 week in a community hospital ED, and then 2 weeks of vacation. hooray!
one of the biggest indicators that i am content is that i don't feel as much compulsion to write. i think that when i am angry or unhappy i need the catharsis of putting my gripes into words. but right now, i don't really have any on-going discontent, so i don't have much to say.
although i am getting sick, which is fairly horrible. there are few things worse that being on call and being sick. i have 2 days to get better.
on that sentiment, time for some sleep.
Wednesday, February 11, 2009
scientific progress goes "boink!"
this is a tough time of year for many people in the hospital. for interns, their first year is about 2/3 complete, which means rejoice! only a few more months of being the bottom of the doctor chain; but this comes with a price.
while intern year is stressful and awful in many ways, it is also great, and one of the reasons that makes it so is the obscenely steep learning curve--in just 8 months one's knowledge of clinical medicine probably increases by a factor of 100, at least. now that it is mid-february, most interns know what they are doing 80-85% of the time, and they can handle nearly all the mundane, routine issues that come up in daily patient care. perhaps more importantly, their confidence has increased exponentially as well. this means that they are no longer afraid to interpret information and make decisions based on this, and then tell people what to do.
this is a great feeling because after years of feeling lost in the endless sea of information they are finally able to make some sense of it all, to focus on and synthesize the salient data, ignore the chaff, and move forward. hooray!
the pejorative side of this issue is that interns still have to do all the mindless gruntwork at 8 months that they did on day 1, which is essentially data collection, presentation, and paper work that needs to be completed by an MD (when in fact it could be completed by a moderately-well trained primate). this is frustrating since they realize that they now have actual skills as a physician--they can think critically and independently--but are still doing what amounts to secretarial work.
this evolution is in contrast to the careers of nurses and, in reference to my prior post, often leads to friction. nurses are extremely valuable, and there are great nurses, especially in the ICUs, and they absolutely improve patient care, which leads to better outcomes for patients. but nurses are not doctors; they are not trained as such, and they generally lack the clinicopathologic knowledge that doctors have been building since the first day of medical school. the veteran nurses know quite a bit, but it is generally due too pattern recognition rather than a true understanding of pathophysiology.
this can lead to problems in complex, multi-factorial disease states, such as heart failure. in a somewhat simplified scenario, if the heart can only pump forward 2/3 of the fluid that it receives, the remaining 1/2 will back-up behind it, in places like the lungs, legs, etc. if some of the fluid is removed from the body, then there is less net fluid which the heart must pump, and this can relieve the backup (i am talking about removing the liquid component of blood, which is essentially a bunch of cells and proteins floating around in water).
seems pretty simple, right? well, it can be and often is, in say, 7 out of 10 cases. however, it can be significantly more complicated if in addition to the heart failure, there are other, co-morbid conditions, such as poorly functioning kidneys from diabetes, hiv, liver dysfunction from hiv medications and a history of alcohol abuse, peripheral vascular disease, and mild cognitive dysfunction from early multi-infarct dementia. not so simple now, as there are multiple reasons for this patient to have fluid derangements, and treatment is further complicated by the fact that target organs may not be responsive to medications.
as i said, in a basic case, the treatment may be medication x, but in the above patient, medication x may actually be harmful. and this is where doctors (and specifically interns) and nurses are at odds. the latter, in general, lack the complex knowledge and understanding needed to make the aforementioned decision about medication x. interns however, are beginning to realize that they, in fact, do posses the ability to grasp the nature of the situation, or at least the realize that it is not a simple case and the usual treatments may not work. furthermore, they now have the confidence to speak their mind and make decisions on their own;they are progressing, and this is difficult for nurses to except.
why? look at it this way: in july i was the the new guy; i didn't really know what i was doing (i know, i'm switching to the first person here). i lacked a great deal of knowledge and confidence. in some respects, the nurses know a lot more than i did, particularly when it came to completing many of the simple tasks that i was expected to do, even though they weren't things that really "required" an md to complete, that is just how they are done. jump forward to february and now i posses much of the same prosaic information about daily hospital operation that i formerly lacked but the nurses did not and the playing field is somewhat equalized. in addition, i have my 4 years of medical school, which have increased my fund of knowledge, plus 8 months of residency which has furthered both my knowledge and confidence.
can you see where this is going? every year it's the same process: interns come in green and timid and a year later they are seasoned and confident. three or four years later they may be attendings at the same hospital; now they are in charge. contrast that with the career of a nurse whose duties and leadership roles never really change (this is not totally true, as there are levels of nursing seniority, but nurses will essentially always be subordinates of physicians). at this time of year the transition is taking place for interns--i am taking a step forward, but the nurses are standing still. this is often difficult for them to except, particularly the ones who have been there for years as they have seen hundreds of us ascend from lowly interns to successful attendings, all while they have continued to do the exact same thing.
it is not always a problem--there are certainly arrogant interns just as there are needlessly cantankerous nurses--but it can certainly can be, as evidenced by my previous rant. 6 months ago i might have relented and just put in the orders myself, but at this point i call bullshit when i see it. i have the confidence to ask people to do things, but also, when necessary, to tell them to do it. therein lies the transition, and the true difference between doctors are nurses: at the end of the day, i can tell them what to do, and they cannot do the same. i am not a bellicose or capricious person, and i do not seek to wield power just for sake of doing so, but when it comes to medical decision making, that is what doctors do, and sometimes you must speak loudly in order to be heard.
i refuse to let myself be needlessly pushed around, although i realize that this sense is likely somewhat over-developed merely as a reaction to having been the lackey for the last 8 months. i am usually open to criticism and suggestions, but if someone is going to antagonize me by questioning my medical knowledge and judgment, they damn well better be able to back it up with a cogent, rational, and knowledge-based explanation which, sadly, nurses are generally not able to provide.
while intern year is stressful and awful in many ways, it is also great, and one of the reasons that makes it so is the obscenely steep learning curve--in just 8 months one's knowledge of clinical medicine probably increases by a factor of 100, at least. now that it is mid-february, most interns know what they are doing 80-85% of the time, and they can handle nearly all the mundane, routine issues that come up in daily patient care. perhaps more importantly, their confidence has increased exponentially as well. this means that they are no longer afraid to interpret information and make decisions based on this, and then tell people what to do.
this is a great feeling because after years of feeling lost in the endless sea of information they are finally able to make some sense of it all, to focus on and synthesize the salient data, ignore the chaff, and move forward. hooray!
the pejorative side of this issue is that interns still have to do all the mindless gruntwork at 8 months that they did on day 1, which is essentially data collection, presentation, and paper work that needs to be completed by an MD (when in fact it could be completed by a moderately-well trained primate). this is frustrating since they realize that they now have actual skills as a physician--they can think critically and independently--but are still doing what amounts to secretarial work.
this evolution is in contrast to the careers of nurses and, in reference to my prior post, often leads to friction. nurses are extremely valuable, and there are great nurses, especially in the ICUs, and they absolutely improve patient care, which leads to better outcomes for patients. but nurses are not doctors; they are not trained as such, and they generally lack the clinicopathologic knowledge that doctors have been building since the first day of medical school. the veteran nurses know quite a bit, but it is generally due too pattern recognition rather than a true understanding of pathophysiology.
this can lead to problems in complex, multi-factorial disease states, such as heart failure. in a somewhat simplified scenario, if the heart can only pump forward 2/3 of the fluid that it receives, the remaining 1/2 will back-up behind it, in places like the lungs, legs, etc. if some of the fluid is removed from the body, then there is less net fluid which the heart must pump, and this can relieve the backup (i am talking about removing the liquid component of blood, which is essentially a bunch of cells and proteins floating around in water).
seems pretty simple, right? well, it can be and often is, in say, 7 out of 10 cases. however, it can be significantly more complicated if in addition to the heart failure, there are other, co-morbid conditions, such as poorly functioning kidneys from diabetes, hiv, liver dysfunction from hiv medications and a history of alcohol abuse, peripheral vascular disease, and mild cognitive dysfunction from early multi-infarct dementia. not so simple now, as there are multiple reasons for this patient to have fluid derangements, and treatment is further complicated by the fact that target organs may not be responsive to medications.
as i said, in a basic case, the treatment may be medication x, but in the above patient, medication x may actually be harmful. and this is where doctors (and specifically interns) and nurses are at odds. the latter, in general, lack the complex knowledge and understanding needed to make the aforementioned decision about medication x. interns however, are beginning to realize that they, in fact, do posses the ability to grasp the nature of the situation, or at least the realize that it is not a simple case and the usual treatments may not work. furthermore, they now have the confidence to speak their mind and make decisions on their own;they are progressing, and this is difficult for nurses to except.
why? look at it this way: in july i was the the new guy; i didn't really know what i was doing (i know, i'm switching to the first person here). i lacked a great deal of knowledge and confidence. in some respects, the nurses know a lot more than i did, particularly when it came to completing many of the simple tasks that i was expected to do, even though they weren't things that really "required" an md to complete, that is just how they are done. jump forward to february and now i posses much of the same prosaic information about daily hospital operation that i formerly lacked but the nurses did not and the playing field is somewhat equalized. in addition, i have my 4 years of medical school, which have increased my fund of knowledge, plus 8 months of residency which has furthered both my knowledge and confidence.
can you see where this is going? every year it's the same process: interns come in green and timid and a year later they are seasoned and confident. three or four years later they may be attendings at the same hospital; now they are in charge. contrast that with the career of a nurse whose duties and leadership roles never really change (this is not totally true, as there are levels of nursing seniority, but nurses will essentially always be subordinates of physicians). at this time of year the transition is taking place for interns--i am taking a step forward, but the nurses are standing still. this is often difficult for them to except, particularly the ones who have been there for years as they have seen hundreds of us ascend from lowly interns to successful attendings, all while they have continued to do the exact same thing.
it is not always a problem--there are certainly arrogant interns just as there are needlessly cantankerous nurses--but it can certainly can be, as evidenced by my previous rant. 6 months ago i might have relented and just put in the orders myself, but at this point i call bullshit when i see it. i have the confidence to ask people to do things, but also, when necessary, to tell them to do it. therein lies the transition, and the true difference between doctors are nurses: at the end of the day, i can tell them what to do, and they cannot do the same. i am not a bellicose or capricious person, and i do not seek to wield power just for sake of doing so, but when it comes to medical decision making, that is what doctors do, and sometimes you must speak loudly in order to be heard.
i refuse to let myself be needlessly pushed around, although i realize that this sense is likely somewhat over-developed merely as a reaction to having been the lackey for the last 8 months. i am usually open to criticism and suggestions, but if someone is going to antagonize me by questioning my medical knowledge and judgment, they damn well better be able to back it up with a cogent, rational, and knowledge-based explanation which, sadly, nurses are generally not able to provide.
the straw that broke the sleepy resident's back
i have now completed 2 of 7 calls, and have 19 days left of ccu. hooray! in all honesty, i don't mind the ccu, i actually like, as i mentioned before. but i still dislike being on call, and my experience last night reminded my why--it was without a doubt the worst night i have had as a resident at my new program. in fact, i had flashbacks to my many unhappy calls as a surgical intern; ugh.
why was it so awful? it wasn't the new patients, since there were only 2, and they were straight-forward heart attacks; not much going on there. what really got me was the never-ending stream of completely inane questions and information i got from the nurses. literally, i was paged every 15 min from 1am until 6am. this is not an exaggeration either. and there was not a single incident that required me to see a sick patient; it was all garbage that did not require attention in the middle of the night. my favorite was a nurse who informed me that a unit of red blood cells that i had ordered for a patient at 245pm had not been given. it was now 345am; did i still want that transfusion? this sounds like a joke, but it is the truth, this is how medicine works.
i was barely able to contain my anger at this point--i asked the nurse, after a useless attempt on my part to figure out why this had happened, if she really thought that she needed to call me at 3am to ask me this question. she told me she didn't understand the question. so i rephrased, and inquired under what circumstances she imagined i might tell her that the blood was not necessary (presumably she knew that patient and why there was blood ordered--she was bleeding. not a massive hemorrhage, but loosing blood). she sputtered out some gibberish, obviously not sure what was happening. at this point i felt a little guilty for being terse with her, so i relented a bit and asked her what she needed from me--another order for the blood? clarification as to why we had ordered it? maybe she thought i was patronizing her because at this point she snapped at me informed me she knew the patient was bleeding (slowly) and in fact had just been with the patient who had informed her that she (the patient) was still bleeding, not 5 minutes prior to our conversation.
she did not relay this information in a friendly manner. at that point, i lost control. here is a summary of what came out of my mouth next, although admittedly my memory may have been clouded by my intense rage: so you are telling me that there was an order for a blood transfusion for a patient who was bleeding that was entered 12 hours ago but that was never given. and now you are calling me at 3am to ask me if you still should give it, when not 5 minutes ago you with with the patient who informed you that she was still actively bleeding? this is not the type of order that can be "overlooked" and is certainly not something that needs to verified after it has been forgotten. this was all conveyed at a very high volume.
once my rage was unleashed, it was hard to contain. i did the best i could for the next 2 hours, and had moderate success. once the other teams had arrived for the day, around 6am, i thought i would be unburdened, since most of the calls had been on their patients. oh how wrong i was. i got called around 630am and was told that a patient did not have any orders written for morning labs; the blood had been drawn, but there were no labels for the tubes so they couldn't be sent to the lab. she asked if i would enter the orders. normally i would be happy to, i informed her, but i was dealing with an active issue with one of my own patients and furthermore, the primary team was there son they could decide what they wanted. she asked me if i knew who the intern was. i told her it was either intern x, or y (i gave the last names). she asked if i know their pager numbers, which i did not. she then, in a rather snide manner, asked me how she was supposed to track down the proper person. i replied that i was sure that this wasn't her first day and that i was confident there were ways she could obtain the required information--for example, the blue sheets of paper taped-up at every nurses station that list the names and pagers of all the residents currently working in the ccu.
she then told me "nevermind...it's not that important. we just won't send any labs." my anger went to 11. i said (actually, i screamed; i was so angry that i was shaking) there is a solution, which is to call the physician who is taking care of that patient and find out what needs to be done. the solution is not to call the first person who's pager you have and then imply that you won't follow through if that person won't track down the responsible doctor; that is both irresponsible and negligent. you need to do your job, which is to discuss this issue with primary resident. i waited for about 5 seconds, during which time there was only silence, and then i hung up.
i felt another twinge of guilt and was about to enter the orders myself, when my pager went off again--fortunately this time it was about one of my patients, so off to work i went.
i'm sure this will all come back to haunt me, but this was one of the rare times when i completely lost my temper. i will try to do better next time.
why was it so awful? it wasn't the new patients, since there were only 2, and they were straight-forward heart attacks; not much going on there. what really got me was the never-ending stream of completely inane questions and information i got from the nurses. literally, i was paged every 15 min from 1am until 6am. this is not an exaggeration either. and there was not a single incident that required me to see a sick patient; it was all garbage that did not require attention in the middle of the night. my favorite was a nurse who informed me that a unit of red blood cells that i had ordered for a patient at 245pm had not been given. it was now 345am; did i still want that transfusion? this sounds like a joke, but it is the truth, this is how medicine works.
i was barely able to contain my anger at this point--i asked the nurse, after a useless attempt on my part to figure out why this had happened, if she really thought that she needed to call me at 3am to ask me this question. she told me she didn't understand the question. so i rephrased, and inquired under what circumstances she imagined i might tell her that the blood was not necessary (presumably she knew that patient and why there was blood ordered--she was bleeding. not a massive hemorrhage, but loosing blood). she sputtered out some gibberish, obviously not sure what was happening. at this point i felt a little guilty for being terse with her, so i relented a bit and asked her what she needed from me--another order for the blood? clarification as to why we had ordered it? maybe she thought i was patronizing her because at this point she snapped at me informed me she knew the patient was bleeding (slowly) and in fact had just been with the patient who had informed her that she (the patient) was still bleeding, not 5 minutes prior to our conversation.
she did not relay this information in a friendly manner. at that point, i lost control. here is a summary of what came out of my mouth next, although admittedly my memory may have been clouded by my intense rage: so you are telling me that there was an order for a blood transfusion for a patient who was bleeding that was entered 12 hours ago but that was never given. and now you are calling me at 3am to ask me if you still should give it, when not 5 minutes ago you with with the patient who informed you that she was still actively bleeding? this is not the type of order that can be "overlooked" and is certainly not something that needs to verified after it has been forgotten. this was all conveyed at a very high volume.
once my rage was unleashed, it was hard to contain. i did the best i could for the next 2 hours, and had moderate success. once the other teams had arrived for the day, around 6am, i thought i would be unburdened, since most of the calls had been on their patients. oh how wrong i was. i got called around 630am and was told that a patient did not have any orders written for morning labs; the blood had been drawn, but there were no labels for the tubes so they couldn't be sent to the lab. she asked if i would enter the orders. normally i would be happy to, i informed her, but i was dealing with an active issue with one of my own patients and furthermore, the primary team was there son they could decide what they wanted. she asked me if i knew who the intern was. i told her it was either intern x, or y (i gave the last names). she asked if i know their pager numbers, which i did not. she then, in a rather snide manner, asked me how she was supposed to track down the proper person. i replied that i was sure that this wasn't her first day and that i was confident there were ways she could obtain the required information--for example, the blue sheets of paper taped-up at every nurses station that list the names and pagers of all the residents currently working in the ccu.
she then told me "nevermind...it's not that important. we just won't send any labs." my anger went to 11. i said (actually, i screamed; i was so angry that i was shaking) there is a solution, which is to call the physician who is taking care of that patient and find out what needs to be done. the solution is not to call the first person who's pager you have and then imply that you won't follow through if that person won't track down the responsible doctor; that is both irresponsible and negligent. you need to do your job, which is to discuss this issue with primary resident. i waited for about 5 seconds, during which time there was only silence, and then i hung up.
i felt another twinge of guilt and was about to enter the orders myself, when my pager went off again--fortunately this time it was about one of my patients, so off to work i went.
i'm sure this will all come back to haunt me, but this was one of the rare times when i completely lost my temper. i will try to do better next time.
Saturday, February 7, 2009
post call addendum:
22 days to go.
it's now post call day number 1 for me. i have to admit that last night wasn't too bad. only 2 new patients, although one of them did come at 3am, right in at the height of the time i could have been sleeping. i was not so excited when my pager went off and i called back to find that there was a new patient. ugh, i thought, there goes any chance for sleep. thus, when i was laying down at 408am, hopeful that i'd get a few hours of sleep, i was both surprised and gladdened.
how did this happen? how can a patient get admitted in just over an hour? well, i'm going to tell you. in the ccu, things run somewhat different from other intensive care units, as i discovered. many patients who come to the ccu have had heart attacks, and many of these people go to the cath lab prior to coming to the unit (that is the place where angioplasty is done and stents are placed).
this particular gentleman also had an intra-aortic balloon pump placed:
this all sounds very complicated, and in some ways it is, but the end result is that most of these patients arrive with their definitive treatment already carried out; furthermore, there are numerous studies which have looked at the best way to treat these patients for optimal survival. therefore, there is not much thinking and decision making that needs to be done when they arrive--in essence, they come pre=packaged. this isn't to say that there is no value in this experience for me, because there is, as i need to learn what is done to these patients and why, but it is easier to deal with these patients when they arrive because you are not spending time trying to figure out what is wrong, rather, you are treating them.
this is how it differs from other areas in medicine, and particularly the medical icu, where patients are essentially train wrecks who arrive with many problems, nearly dead, requiring copious time and energy to figure out what is actually going on--which is what takes the most time--before they can be treated.
in addition, since there were only 2 new patients, i actually had time to read about their conditions and our treatments so that on morning rounds i actually felt like i could speak intelligently about what was going on.
so as much as i can't believe i am saying this, i actually enjoyed myself!
day 6 beings in just 10.5 short hours; time for sleep.
it's now post call day number 1 for me. i have to admit that last night wasn't too bad. only 2 new patients, although one of them did come at 3am, right in at the height of the time i could have been sleeping. i was not so excited when my pager went off and i called back to find that there was a new patient. ugh, i thought, there goes any chance for sleep. thus, when i was laying down at 408am, hopeful that i'd get a few hours of sleep, i was both surprised and gladdened.
how did this happen? how can a patient get admitted in just over an hour? well, i'm going to tell you. in the ccu, things run somewhat different from other intensive care units, as i discovered. many patients who come to the ccu have had heart attacks, and many of these people go to the cath lab prior to coming to the unit (that is the place where angioplasty is done and stents are placed).
this particular gentleman also had an intra-aortic balloon pump placed:
this all sounds very complicated, and in some ways it is, but the end result is that most of these patients arrive with their definitive treatment already carried out; furthermore, there are numerous studies which have looked at the best way to treat these patients for optimal survival. therefore, there is not much thinking and decision making that needs to be done when they arrive--in essence, they come pre=packaged. this isn't to say that there is no value in this experience for me, because there is, as i need to learn what is done to these patients and why, but it is easier to deal with these patients when they arrive because you are not spending time trying to figure out what is wrong, rather, you are treating them.
this is how it differs from other areas in medicine, and particularly the medical icu, where patients are essentially train wrecks who arrive with many problems, nearly dead, requiring copious time and energy to figure out what is actually going on--which is what takes the most time--before they can be treated.
in addition, since there were only 2 new patients, i actually had time to read about their conditions and our treatments so that on morning rounds i actually felt like i could speak intelligently about what was going on.
so as much as i can't believe i am saying this, i actually enjoyed myself!
day 6 beings in just 10.5 short hours; time for sleep.
Thursday, February 5, 2009
hell of the south.
no, i'm not talking about my brother's wife or toxic her family. what i am referring to is my new place of work for the next 28 days: the cardiac intensive care unit, or ccu, which is located in the south pavilion of my hospital. actually, it's only the next 25 days since i started last tuesday, and then minus the 4 days i'll have off it's only 21 more days, which really isn't that much.
being in the ccu is both good and bad. it's good because it means that i survived my internal medicine month, and good because i am halfway through the 2 months in a row of call, and good because at the end of this month i have 2 weeks of vacation. and it's bad because...well, i am on call again every 4th night. other than that, i guess it's not so bad, although there is the potential.
i am trying to be positive, which i know is contrary to the theory i espoused earlier, but i'm getting a little tired of being cranky all the time. so i am going to give the whole positivity thing a shot. on that note, i will describe some of my positive experience from internal medicine. the first thing, and what made it tolerable, was that the people were fun. everyone was pretty mellow and easy-going. some might see this as a euphemism for "lazy" but this is not true! there are some of people out there who word hard when it is necessary, are quite intelligent, do their jobs well, but don't take themselves too seriously. i was fortunate to work with some of these folks the past month--one of them is destined to be a Chief Resident next year, so she is obviously no chump (you get selected by the faculty for this position from a class of about 50 or so).
we worked hard, did well by our patients, and got the hell out of the hospital when the work was done. there was a tacit agreement that we all liked medicine, wanted to learn, but that we also wanted to enjoy our personal lives, so we should all work together to make sure everything was completed in a timely and proper manner; but there was no needless standing around or staying at the hospital until an arbitrarily determined "appropriate" time (deemed by many to be at least 4pm, sometimes as late as 5pm). sometimes it is necessary to stay late, as people are sick and need care, but there is no reason for 5 people to stand around with their thumbs in their ears when all their work is done and nothing is happening. there is almost nothing that will throw me into a rage as fast as time wasted in the hospital when i could have been anywhere else. fortunately, this was not a problem for these like-minded individuals, and i was grateful.
anyway, this is heading into a negative direction, and that is not in fitting with my new MO, so i must desist, as we all know where this attitude leads.
being in the ccu is both good and bad. it's good because it means that i survived my internal medicine month, and good because i am halfway through the 2 months in a row of call, and good because at the end of this month i have 2 weeks of vacation. and it's bad because...well, i am on call again every 4th night. other than that, i guess it's not so bad, although there is the potential.
i am trying to be positive, which i know is contrary to the theory i espoused earlier, but i'm getting a little tired of being cranky all the time. so i am going to give the whole positivity thing a shot. on that note, i will describe some of my positive experience from internal medicine. the first thing, and what made it tolerable, was that the people were fun. everyone was pretty mellow and easy-going. some might see this as a euphemism for "lazy" but this is not true! there are some of people out there who word hard when it is necessary, are quite intelligent, do their jobs well, but don't take themselves too seriously. i was fortunate to work with some of these folks the past month--one of them is destined to be a Chief Resident next year, so she is obviously no chump (you get selected by the faculty for this position from a class of about 50 or so).
we worked hard, did well by our patients, and got the hell out of the hospital when the work was done. there was a tacit agreement that we all liked medicine, wanted to learn, but that we also wanted to enjoy our personal lives, so we should all work together to make sure everything was completed in a timely and proper manner; but there was no needless standing around or staying at the hospital until an arbitrarily determined "appropriate" time (deemed by many to be at least 4pm, sometimes as late as 5pm). sometimes it is necessary to stay late, as people are sick and need care, but there is no reason for 5 people to stand around with their thumbs in their ears when all their work is done and nothing is happening. there is almost nothing that will throw me into a rage as fast as time wasted in the hospital when i could have been anywhere else. fortunately, this was not a problem for these like-minded individuals, and i was grateful.
anyway, this is heading into a negative direction, and that is not in fitting with my new MO, so i must desist, as we all know where this attitude leads.
Subscribe to:
Posts (Atom)
Posts
