Friday, July 29, 2011

plastics

so now i've been on plastics for one week. got to a rough start, but i think things are smoother now. i'm the only resident on, so that means more responsibility, but also tons of OR time! i've finally gotten to scrub into cases and do some suturing (and of course a ton of retracting). i'm starting to get the hang of the different styles of the attendings, and am officially on texting basis with one of them.

this week has been tough, but i think next week will be better. it's always better after you know the schedule and what's expected of you. and i think that as an intern, i'm not expected to know or do everything perfectly, but of course i am expected to acknowledge where i'm wrong or need improving and fix it for next time.

i've heard that med school is like "drinking water out of a fire hose", but apparently the person who applied that phrase never went to residency. i know that i'm never going to know enough, but i'm looking forward to when at least i'll know how to do all the paperwork shuffles and all that kind of stuff. because knowing how to navigate the system saves so much time, and seconds are precious.

i was on call last night, and it wasn't that bad actually. i feel like i'm starting to get the hang of everything...i'm comfortable handling more and more on my own. i'm getting better at managing post op pain. people that need to pee? straight cath! haha! critical values? NOTED! people wigging out and spazzing? CONSOLED! see? not so hard...it's nice that i have excellent co-residents and i must say that overall i'm quite impressed with the nursing staff too.

so let me put these two last things down...today i got two compliments, and they made my day. thus, documentation on le blog for INTERNET ETERNITY. one of my senior residents told all the other ones during our administrative time that he thought i did a great job getting sign outs from all the teams, and that i "aggressively" sought out people to get sign out by calling them up and inquiring on their statuses. (we have been having some issues of people not getting/giving sign out to the on call folks, and i have made it a personal goal of mine to try and do good sign out and then when i'm on call to get good sign out. because how the heck am i supposed to know what's going on if i haven't gotten sign out?) so that made me feel good.

second thing...one of the patients we did a flap closure of a wound on had gotten his jp drain clogged up for whatever reason. i sewed the drain in, and i probably did it too tight so i thought that was the problem. the attending told me to go and fix it, so i gathered up my supplies, numbed up the patient, took out the old stitch, and did a little bit of blunt spreading at the incision. turns out, the incision for the drain was a skosh too tight, and my spread action worked wonders! the effect was immediate, we had drainage, and i was like YEAH I FIXED THAT SHIT! sewed the drain back in (looser this time), added some mesentery tape to keep everything in place and put the the dressing back on. called the attending, wrote my note. and i know that fixing a clogged drain is NOT the hardest thing ever, but it was something that i did by myself and felt comfortable and confident in doing so. and then this morning the attending told me "strong work on that drain!". yes. strong work indeed!

and since a lot of my days are spent going "omg i just screwed up" or feeling a bit overwhelmed, i try to focus on some of the good things that are going on. the joys of intern year.

and now i will go to bed soon, since being post call is AWESOME. but i have to work in the morning, alas. holla!

Monday, July 18, 2011

all in a day

you know what sucks? telling people they have cancer. actually, telling people they *might* have cancer also sucks. alas. someone has to do it and someone has to try to fix it.

also, i have seen so many boobs lately, it's killing me! breast surgery is definitely not in my future. obviously it's something i need to learn and i want to learn so i can treat my patients and help them overcome their illnesses, but to say "i want to do a fellowship in breast and devote my whole life to being a breast surgeon!", NO WAY. at least for now. ask me again in a couple of years. but the past few weeks i have seen perky boobs and saggy boobs, old boobs young boobs, wrinkly boobs, rotting out looking boobs, funky implant boobs...just too many boobs! and i'm just on a general surgery service! too many boobs!

anyone out there love jamaica tea as much as i do? i just can't get enough! (hibiscus for all you english-only folks.)

i'm going to go bed early tonight...today was a long day. rounding, clinic, anxiety, blah! but early is relative...probably that means around 10:30pm...up at 4:15am ugh. and i need to read on parathyroid and thyroid glands. joyful!

Saturday, July 16, 2011

and then there was internet...

imagine my happiness when i got home last night and found myself WITH INTERNET. omg. yay. FINALLY. now i can do questions and read and look up crap and play and all those other things AT HOME. and not have to stay at the hospital (in my call room) and do internetty things.

intern year so far so well. wonderful co-residents. getting a hang of the floor. i can discharge people. i can write orders. i've done 2 procedures...shaved off some warty things and did a punch biopsy. only been into the OR once to "watch" an excision of a melanoma and sentinal node biopsy (while scrubbed), but that's ok. the service i'm on, plus the weird timing of various courses that i had to do kept me out of the OR. plus i have to put out fires on the floor, right? in a week i'll be starting plastics where i'll be the only resident for the whole month. i think i'll get plenty of OR time then. it's all good.

i have found an absolutely fabulous vietnamese restaurant in town. i've been there twice in the last 3 days. the owner was like YOU'RE BACK last night, and i just laughed. and what's so nice about the hospital feeding me so much is that i feel like i can splurge a bit when i do pay for my own food...which is good and bad i suppose.

i am finding that i feel more in my element. i'm not perfect, and that will obviously take a while (ha!), so my goal for each day is "if i'm going to screw up, i want it to be on the least meaningful/important thing". so usually it's that i haven't called someone "fast enough" for my attending's liking, or i missed a form i was supposed to sign (but i'll get called about that by nurses or social work etc., so no problems really). i've gotten good at writing down my checklists, and thank goodness that we have a computerized ordering system so i can sit in one place and put in my orders anywhere. as far as i can tell i haven't made any medical errors, and i always call "up the chain". for example, on call, when i get paged, i go see the patient, formulate my plan, call an upper level (they told us to do this nearly 100% of the time for at least the first few weeks), confirm/change plan, and then enact plan and write a note. then i'll update that team's signout info online. the key is SEEING THE PATIENT. one of my co-interns already got a little burned for not doing that. lesson learned. the second key is already having my own plan. that way the upper level doesn't think i'm lazy and i can learn...maybe i have the correct plan, or maybe it should be changed, or maybe i'm right but that particular attending likes things a certain way. things that i wouldn't know necessarily, but i'm learning now.

in life outside the hospital news, my serrano pepper plant has been making peppers. which i haven't had a chance to eat yet. alas. and my bell pepper plant has FINALLY decided to grow a pepper, despite many flowers. the key lime tree is growing nice and bushy...apparently he really enjoys the new weather conditions. (that makes me happy, because i thought he was going to die a few months ago, and now he's looking so well!) the kitchen has been set up (first room i did), the bedroom is fine. no couches yet, so the living room area is just coffee tables and boxes, and the 2nd bedroom/office is still empty. H is making his way up here soon, so i'm really excited about that. and since this is my GOLDEN WEEKEND, tomorrow will be "cleaning day" and "making room for more crap day". yay!

today i'm going to go to some local markets with a few of my new resident friends. and then depending on if my friend A is up for a visit, i'll drive to visit her (about an hour away)...she's on a really busy ICU month so i'm going to leave the visiting up to her. a note about the markets...I LOVE THEM. there are so many around where i am so i just take my cooler with some ice and go ahead. bring cash, i've learned. i've been able to eat some of the best fruit and find some excellent cheese and all that fun stuff. maybe today i'll get some meat or something to cook for tomorrow. definitely will get some wine.

ok interwebs...i'm back online at home so hopefully the posts will be increased. and if there's anything you want me to talk about, just ask! thanks for bearing with me.

Sunday, July 03, 2011

first real day

just a quick post to document the following:

first order written: urinalysis with culture.

first script written: clotrimazole cream, apply to va-jay-jay twice daily.

seriously?

i thought my first script would be something PROFOUND, and i don't even know what a profound medicine would be, but not yeast infection crap. alas. such is the life of the intern.

so now i don't have to be back in the hospital until 6pm tomorrow for call. however, i'm in my call room (on my own time, not reporting this for duty hours durrrrrr) because i still have no internet at home. and i still have to do shit online. and i'm tired of having to pay money to use wifi at a restaurant. and i don't want to squat at someone's house to internet (even though my lovely co-residents have offered, i just hate being a burden). so i'm here. and i will stay here until i am starving and then go home to eat.

also, i swapped down a size in scrubs so things would fit better, but apparently i have a big ass. but the scrubs fit beautifully everywhere else. so now i have to decide...keep the "fits everywhere nicely but the ass" scrubs, or switch back to the "swimming inside giganto scrubs". at least with the smaller pair i never have to worry about the scrubs falling down after getting accidentally untied, but then it sucks to realize the reason they won't fall down is because the ass singlehandedly is keeping them up. joy.

work time! then eating time, then nap time? reading time? blah!