Hurricane Jill

Saving lives one breast at a time

It’s really too bad I don’t want to be a plastic surgeon. These guys are pretty laid-back, and it’s a much nicer lifestyle. I went in at 7:30 today, and left at 5pm. Those are practically banker’s hours by comparison to my last rotation. Or at least Internal Medicine hours. And there are parts of the skill set that are similar, like the microsurgery. And the patients generally have better outcomes, and even if they don’t it’s almost never catastrophic.

The patients would drive me nuts, though.

Plastic woman

And so the joy of trauma surgery is over for the year. I have some posts I haven’t published from those months, but nothing on the scale of my OB rotation. I actually did enjoy most of it, in a Stockholm Syndrome kind of way (I keeed, I keeed.), and I learned a lot. Most of what I learned has to do with the nuts and bolts of how social services are provided in my city, county and state. And nuances of drains and lines and PT and OT, and how to tell “sick” from “not sick” despite the numbers. But I did get to be a real surgeon a few times.

From what I gather, I actually got to do quite a bit more in the OR than most of my fellow interns. Enough so that if somebody needed an I&D in the OR and there was no one to supervise, I could do it. I could do a simple umbilical hernia with minimal assistance, and with a bit more assistance a simple open appendectomy. I could do a simple skin graft without much help, although I like the grafting part much more than the harvesting.

And I’m not a big fan of wound vacs, but out of necessity I’ve learned to do them well enough.

It’s funny how much of a bonding experience it is to be fellow interns with someone. You don’t quite realize it at the time, but afterward when you run into them again, it’s like seeing an old friend. I would hate to be in a program where I was always the only intern on a service. Having people to commiserate with makes it all a little easier.

I actually liked my entire team, but it’s a different kind of friendship that develops when one person is supervising the other. And then there’s always the situation where someone gets blamed for something, and rolls the blame on down the hill. I understand why people do it, but I try my best not to perpetuate that kind of thing. As I see it, my job as an intern is to take care of the students as well as the patients. I help the students look good, and try to keep them from doing things that make them look bad. Most of the time I fix the plans in their notes, along with any typos and misspellings, and then sign my agreement rather than writing a separate plan after theirs. If I didn’t have to fix anything, I insert a comment about it being an excellent note. If something goes wrong because someone beneath me did something wrong, I take the blame and deal with that person myself. Because it’s a pretty effective corrective tool to be able to say to someone, “I took the heat for what you did, and it was bad. Don’t do it again.” Pretty much anyone with a shred of decency will respond to that.

So now I’m on plastic surgery, which is a whole different ballgame. There are basically three major patient populations we deal with: cancer survivors, the traumatically injured, and the people who just want to look better. All very high-maintenance. Also there’s lots of clinic.

But there are some things I like about it. For one, there’s a lot of OR time. Secondly, aesthetics are important, and being able to make an incision look nice has some value in this field. Also the patient load is pretty low, and the patients are usually healthy. Very high-maintenance interpersonally, but medically very healthy.

In any event, I have two entire months of this, for a total of three months of plastic surgery this year. That’s more plastic surgery than the plastic surgery interns get. And immediately afterwards I have the first of my neurosurgery months. So if you want a nice-looking craniotomy scar, try to wait till late November or early December to have your subdural hematoma.

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As a postscript, I read a thing today where Tulane’s IM program director blamed Katrina for the decline in the proportion of Tulane graduates choosing internal medicine from the classes of 2006 and 2007. Katrina actually had nothing to do with it. The class of 2006 had already chosen their fields when the hurricane hit, and by and large were already not planning to stay in New Orleans for residency.

And the class of 2007 was overwhelmingly surgical from day 1. If anything, more people from our class went into IM than had initially planned to do so.

There’s a contrast in the numbers mostly because the class of 2005 really clicked with him, and I think more of them went into medicine than would have otherwise because of it. I can’t speak for the class of 2006, but I know that opinions in my own class ran the entire spectrum, with the equilibrium point definitely on the skeptical side. We respected him, but many of us were turned off by the slavish worship of the class of 2005.

The other thing that’s not quite as stated is that by and large it was not the medicine residents who led the clinical diagnosis groups in Houston. The class of 2007 carried at least half of that load, if I recall correctly. We also carried a substantial portion of the 1st year medical interviewing groups and some of the ethics small group sessions as well. My class helped carry his program’s teaching load so that he and they could focus on their own survival. But nowhere was that mentioned. And it’s not like he wasn’t given the opportunity to mention it. He was specifically asked about the role and fate of the students. Twice. And both times his answer made it clear that he wasn’t involved and didn’t really care enough to know.

Res ipsa loquitur.

Toxic

Yep, that was me today. Not only could I NOT get out of the hospital last night, but I went in at least 45 minutes earlier than usual this morning because of the patient load, and I still wasn’t ready for rounds. Our census doubled over this past Saturday night, and despite a number of discharges, was actually larger on Monday morning due to all the transfers from ICU on Sunday.

And that’s the part where being day float sucks the worst–when you’re taking call, your chief and your R3 are always there with you. They know the patients and can answer the questions that inevitably arise over the course of the day, or if it becomes clear that the plan from rounds is either inadequate or things have changed significantly.

As the day float person on a weekend, it seems like rounds are barely over when, poof! The team is gone and you’re left with the humongous to-do list and no one to assist or clarify or change anything that needs changing.

It’s true that a great deal of learning happens when your seniors aren’t there to be your crutches. And I welcome that, I really do. I like making decisions about patient care. That was the whole reason I went to med school. The issue is that when the service is that large, I simply can’t get done all the things I feel it necessary to do personally. There are things I don’t mind signing out, but when it starts to become everything I was supposed to do for that patient, something has to give.

No doubt I’m still inefficient. But not that inefficient. I’ve lost all compunction about giving verbal orders, and I routinely computer-stalk my patients. But there are things that are best judged by going to see the patient and interacting with them and whatever family members are present.

Also I’m convinced that a great deal of this supposed “inefficiency” stems from being the one who actually has to generate so many of the documents required for patient care. I believe I have personally killed a small forest. Anytime I’m not writing some note for the chart, or filling out some kind of form or other, or drawing/filling in little boxes with To Do items next to them, I feel like I’m slacking. I can honestly say, I’ve never worked this hard before in my entire life. Well, except in retail pharmacy, and while that was equally taxing physically, it was far less so intellectually.

But at least I get to go to the OR on occasion. I would seriously go postal if I were a medicine resident.

Except that I all-too-generously switched my OR week with a fellow intern who’d not gotten to go to any cases the week he was assigned. I felt like it wouldn’t be fair for me to have three whole OR weeks, and he would only get a day or two. So instead I have almost zero OR time this entire month. It was the right thing to do, but I am seriously hating my life right now anyway. Because the corollary of not being in the OR is that I’m on the floor, which is what leads to the staying late–to make sure the day’s work gets finished, etc.

So it’s a vicious circle. And now I’m fairly certain that my chief thinks I hate him, and that the students think I’m a total bitch.

But dammit! if they would all just quit asking me questions and expecting me to know the answers, I wouldn’t be in such a bad mood. Grrr.

OK, now I’ve vented.

Batting clean-up

I’m so ready for this rotation to be over. Not that I don’t like my team, because I do. They’re a great group; I’m just having a rough week outside of work, and I’m unusually cranky because of it.

Every day, like clockwork, things seem under control until all the other interns are gone. Then at 6pm or so, there’ll be some kind of emergency that keeps me in house till at least 8 pm. It’s really getting old, particularly since there’s a long list of things I need to do once I get home. And it wouldn’t be so bad, staying late, if it weren’t always totally preventable. Somebody will forget to do something that absolutely has to be done that day, or like today, some patient gets sent to the floor when it’s still a crapshoot whether they’ll remain stable or not. And then they don’t.

And I’m extra cranky this week because I’ve lost my cell phone. I have no land line, so I’m basically without any form of telecommunication till I can get to the AT&T store. Which also means I’ll have to agree to another 2 year contract in order to get a decent price on a new phone, and I just don’t know if that’s a good idea.

And I’m cranky because it’s application season again, and I haven’t decided whether to apply again and lose a year, or circle like a vulture over the vacancy listings in the hope of finding a PGY2 spot. I have absolutely nothing new to add to my application, except the fact that I’ve managed to survive three months of internship without killing any patients. Or myself. Or my fellow residents. Is that worth anything? Also my manuscript was published.

I actually do like my job, tedious as all the associated paperwork is. I just feel stuck in a rut with regard to the rest of my life, and I haven’t figured out the solution yet. Well, and it also kind of sucks to be stuck cleaning up other people’s messes when I really need to be cleaning up my own instead. Even though I normally wouldn’t mind.

Hi y’all!

I got my very own DEA number today. Not just a suffix for the hospital’s DEA, but my very own number. How exciting is that?

OK, not very. But as someone who used to demand that other people write theirs on prescriptions like they’re supposed to, it’s kind of cool to have my own. So I tried to add it up according to the verification trick they teach us in pharmacy school, and either I’ve forgotten the trick, or it’s a big ol’ lie. Probably the former.

As an aside, I can tell I’m getting more comfortable in my role as an intern, because the southern drawl has crept back into my voice. Now that’s something people probably don’t know about me, but it’s a dead giveaway–I only speak with a drawl when I’m not focusing on my words or editing the content of my speech.

What IS that yellow glowing ball up in the sky?

It’s been a while since I last posted. Not that I haven’t tried. I just got too sleepy the couple of times I started to write something, and decided to go to bed instead.

So I’m on Day Float this month. Which means no call, hooray! And two weeks in, I’ve finally caught up on sleep and feel human again. And it’s a beautiful day outside, so I’m going to take my glow-in-the-dark pale self and go hang out by the lake.

Sleep vs. laundry: the intern’s dilemma

It’s two AM and I’m doing laundry. Another couple hours and it’ll be time for work.