First week at UMass

Monday was an ok day. We had an excellent orientation of the ED software programs and the facility itself. However, I was the only student in scrubs. It made the program feel stuffy, especially when one of the Attendings pointed out that ties highly encouraged by the program's directors. First, who where's a tie in the ED!?! Kinda hard to jump in on a trauma in a friggin' suit! Second, I only brought my interview suit with two shirts!

After the students made our schedule for the first week, I decided to wear my new suit slacks and dress shirts only when I working with one of the PDs. I ended up getting the more conservative PD's only two shifts of the month, Monday and Friday. So I headed home after orientation and changed into my $1000 suit slacks vowing to send UMass a bill if I got blood and guts on them.

The facility is less than a year old. The $120M hospital included a new $50M ED and new offices for the ED department, some of which don't even have furniture yet. They did a nice job with the design. It's attractive and functional. The only problem I've seen so far is that the hospital beds are so full, the ED is becoming an Observation Unit.

The software is a little nicer than MUSC's, but has plenty of usability issues and glitches in its second version. Bottom line, they are still using paper charts for the foreseeable future. Unlike, MUSC however, the paper chart system is horrendous. It's a pain to find charts and make sure orders or being seen and acted on.

The residents are very nice. I've only met a handful of the 36, but they are helpful both on the job and in answering questions about UMass and EM. They seem very happy with the program. And they never wear ties in the ED! In fact, most of the attendings wear traditional "in the trenches" scrubs and casual clothes. I guess it's just the PDs and attendings involved in running the program that are stuffy.

Didactics have been pretty good. Wednesday conference involved five hours of lectures, case studies (M&M lectures), going over EM Board prep questions and small group break-outs sessions to work through case management together. Journal club Thursday night was well attended by residents and attendings, included dinner and had some great content on Pediatric Lumbar Puncture procedures. Today was my first morning shift, so I got to experience teaching rounds by one of the PDs on overdoses and found it very good.

The shifts have been very tiring. This is a very busy ED and I rarely get a chance to eat and take bathroom breaks. So far it's been a little too busy for optimal learning. The cool cases get snatched up and I never have time to peak in on them or procedures. My patients are either run-of-the-mill or very complicated. The former mean I don't get much attending attention and therefore don't learn much. The latter mean I have the patients all day and do a lot of babysitting between specialty consults and extensive tests. I'm hoping that as I take more morning and overnight shifts things will settle down a bit. I also think the 8 hour shifts make things more chaotic with a lot more turnovers and long stay after shifts to finish discharges. I usually stay 30-60 minutes after my shift tidying up paperwork.

Hopefully, when we finalize the schedule for the rest of the month on Tuesday, I can get some easier shifts.

As for cases, my luck seems to be hanging with me. I was able to help out on a paraplegic guy, probably homeless, who had his foot mangled by his girlfriend's chihuahua. They are both in wheelchairs, and probably sleeping on the street by their smell. He states that while sleeping their new puppy had a free meal of his left fore foot! The big toe was gone as was most of the next one and the flesh where bunions occur. I didn't stick around to see who won the debate about whether the patient should be admitted to Ortho or Plastics.

The other cases have been pretty standard. And while I'm out of practice working on adults, it coming back pretty quickly. Exhausted as I am, I'm enjoying the job which is very comforting this close to the Match.

Probably the highlight of the week had nothing to do with UMass. I received both my SLORs in the mail from the PDs at Arrowhead and MUSC. That was a relief. I immediately updated my ERAS applications to include them. A close second was winning an auction on Ebay for a new Phone/PDA since mine broke. Hate spending the money, but at least it's an upgraded model and I can have access to all my medical programs while on shifts.

Finally, the house I'm staying at is a nice old Victorian three story being remodeled by another 6th year student (MD, PhD). He and his wife, along with the two other renters are nice. It's a comfortable place with lots of room to study, store food, etc. My favorite thing is having a big room with a desk and wireless Internet access.

One week until I fly to Seattle to see the family and attend the ACEP Scientific Assembly Residency Fair!