I've been on adult anesthesia for over a week now. It has been a desperately needed recovery period from Internal Medicine. I've gotten some sleep, a couple of workouts in and seen my family a ton more.
Once I got familiar with Manchester Memorial Hospital and the OR staff, I've been able to go from OR to OR doing endotracheal intubations (tubes) and laryngeal mask airways (LMAs). The first few days I was learning lots of tips, but missing some tubes due to lack of confidence as much as anything. The last couple of days my confidence has gotten better and I've been getting the tubes placed much more quickly and gracefully.
It like I've learned my "feel" and my muscles have gained the memory and dexterity to do what I need of them.
Just as enjoyable, my days start at 7am and are typically over with by 2pm. I'm loving the time to get my head back on straight before I head back to Saint Francis next month for CCU. At the moment, I still have a couple days of adult anesthesia left, to build on my 20 intubations thusfar. Then it's off to CT Children's Hospital Center (CCMC) for two weeks of pediatric anesthesia.
Thursday, October 09, 2008
Medicine Month
It's been over a week since I finished my month rotation in Internal Medicine at St. Francis hospital, but I still remember much of it vividly.
The first was chaos. I couldn't log into systems, didn't know how to get anywhere or any information and the job as foreign to me as Tokyo. The worst part of the month though, was the incredibly inefficient use of time and lack of learning. At least I had a pretty decent resident and one good Attending.
I ended up arriving each day by 6am to pre-round on my patients. Since I was the only Intern on my team (there was supposed to by two to share the load) I had to write Progress Notes on 5-6 patients as quickly as possible. Usually I just got vitals and new labs/procedure notes by the time my Resident arrived at 7am (7:30am in my case since he was always late). So 7-8am was wasted repeating my previous hour or trying to understand what the heck the Resident was trying to achieve as he mysteriously entered orders.
At about 8:30am we officially rounded with the first Attending. This Attending was a total waste. Didn't learn squat, but ran around chatting with everyone. Finally, we had 9:30am Attending rounds where we actually saw patients, but only the Housestaff patients. This system made no sense and seems even now detrimental to patient care. It also meant that I typically any lecture prior to lunch so that I could finish up Progress Notes by the noon deadline.
After lunch, we ran around trying to nail down details, implement our Attending's suggestions for Housestaff patients and make treatment plans for Private patients' clueless Doctors. Sometimes we got new admissions or transfer patients around this time as well. What should have taken a couple hours and allowed to get out by 3-4pm usually got dragged out until 5pm or so. My Resident loved to chat, write book length notes and move at a pace that made it obvious he was in no rush to get home.
These were the weekdays, when I didn't have Call, which came every fourth day. Weekends I had off, but given Call I really only got one weekend off. The other three included Call time. Call was pretty typical with little sleep and a chaotic mix of admitting new patients and dealing with cross-cover issues for the other Interns' patients. The nurses were a mixed bag, with many calling me at all hours for inane questions.
Again, if we were efficient and hard-working we could have left by 10-11am most mornings post-Call. But my Resident was in no rush. He certainly provided exemplary patient care. But I usually was dragging myself around until 1-2pm the following afternoon. Shifts lasting 30-31 hours take a couple of days to recover from. Even I managed to get 3-4 hours of sleep it was fitful sleep in my shirt and tie frequently interupted by pages from nurses with questions that could usually be answered over the phone or with an order.
I expected the hours, resentment for the archaic dress code, hospital inefficiency and politics, but I was surprised by how little I actually learned the whole month. Time constraints, exhaustion, a bad teaching Attending and a Resident with little teaching experience are probably to blame. But it seems like an opportunity lost.
In any case, I've paid my dues. IM is behind me and I should never again have to be the Intern covering the floors over night. And every day I had that moment where I felt my decision to go into Emergency Medicine was validated.
The first was chaos. I couldn't log into systems, didn't know how to get anywhere or any information and the job as foreign to me as Tokyo. The worst part of the month though, was the incredibly inefficient use of time and lack of learning. At least I had a pretty decent resident and one good Attending.
I ended up arriving each day by 6am to pre-round on my patients. Since I was the only Intern on my team (there was supposed to by two to share the load) I had to write Progress Notes on 5-6 patients as quickly as possible. Usually I just got vitals and new labs/procedure notes by the time my Resident arrived at 7am (7:30am in my case since he was always late). So 7-8am was wasted repeating my previous hour or trying to understand what the heck the Resident was trying to achieve as he mysteriously entered orders.
At about 8:30am we officially rounded with the first Attending. This Attending was a total waste. Didn't learn squat, but ran around chatting with everyone. Finally, we had 9:30am Attending rounds where we actually saw patients, but only the Housestaff patients. This system made no sense and seems even now detrimental to patient care. It also meant that I typically any lecture prior to lunch so that I could finish up Progress Notes by the noon deadline.
After lunch, we ran around trying to nail down details, implement our Attending's suggestions for Housestaff patients and make treatment plans for Private patients' clueless Doctors. Sometimes we got new admissions or transfer patients around this time as well. What should have taken a couple hours and allowed to get out by 3-4pm usually got dragged out until 5pm or so. My Resident loved to chat, write book length notes and move at a pace that made it obvious he was in no rush to get home.
These were the weekdays, when I didn't have Call, which came every fourth day. Weekends I had off, but given Call I really only got one weekend off. The other three included Call time. Call was pretty typical with little sleep and a chaotic mix of admitting new patients and dealing with cross-cover issues for the other Interns' patients. The nurses were a mixed bag, with many calling me at all hours for inane questions.
Again, if we were efficient and hard-working we could have left by 10-11am most mornings post-Call. But my Resident was in no rush. He certainly provided exemplary patient care. But I usually was dragging myself around until 1-2pm the following afternoon. Shifts lasting 30-31 hours take a couple of days to recover from. Even I managed to get 3-4 hours of sleep it was fitful sleep in my shirt and tie frequently interupted by pages from nurses with questions that could usually be answered over the phone or with an order.
I expected the hours, resentment for the archaic dress code, hospital inefficiency and politics, but I was surprised by how little I actually learned the whole month. Time constraints, exhaustion, a bad teaching Attending and a Resident with little teaching experience are probably to blame. But it seems like an opportunity lost.
In any case, I've paid my dues. IM is behind me and I should never again have to be the Intern covering the floors over night. And every day I had that moment where I felt my decision to go into Emergency Medicine was validated.
Lot to catch up on, starting with vacation
Wow, time has really flown. It's already a month and a half since my last post. So I'll start where I left off and see how far I get toward catching up.
The whole family spent a few days in Cape Cod. Our hotel was a disappointment, but the area was, near the tip of the peninsula, was great. Next time we'll have to stay in Provincetown, a cool little tourist town a lot like Key West. Free spirits, great restaurants/shopping and homosexuals holding hands in their underwear. We also rode our mountain bikes on some of the beach trails. But the highlight for the boys was definitely swimming in the surf. The water was a little colder than Naragansett, but not too bad.
All in all, it's a place we'd like to return to with better lodgings.
Then we drove up to Freeport, Maine to see what everyone was talking about. I enjoyed shopping at the discount shops surrounding L.L. Bean's flagship outlet store. I was able to find a few winter clothing items at huge discounts, but the rest of the family didn't do as well. Then we went on a ferry trip to an artists' haven. It was funny in that we expected scenery and seals and all we got was rural village with a lack of services. We found a trail and walk and eventually saw some seals from the roof of the ferry on the way home, but it was a waste of a day. We even tried a fresh lobster meal at the coastal town the ferry started from. It was fresh, but we got kinda grossed out trying to clean our freshly killed lobsters. Again, a cheap substitute for Dungeness crab.
I don't think that Becky or the kids are too interested in getting back to Maine anytime soon. It may be that coming from Seattle and the Northwest, Maine isn't anything special. It's basically a poor man's Puget Sound.
At least we got to spend some time together and relax. I brought some medical reading material but got through very little. Instead, I slept well and managed to get in some good exercise. And all in all, I did manage to find some tasty seafood. The scallops here are fantastic!
The whole family spent a few days in Cape Cod. Our hotel was a disappointment, but the area was, near the tip of the peninsula, was great. Next time we'll have to stay in Provincetown, a cool little tourist town a lot like Key West. Free spirits, great restaurants/shopping and homosexuals holding hands in their underwear. We also rode our mountain bikes on some of the beach trails. But the highlight for the boys was definitely swimming in the surf. The water was a little colder than Naragansett, but not too bad.
All in all, it's a place we'd like to return to with better lodgings.
Then we drove up to Freeport, Maine to see what everyone was talking about. I enjoyed shopping at the discount shops surrounding L.L. Bean's flagship outlet store. I was able to find a few winter clothing items at huge discounts, but the rest of the family didn't do as well. Then we went on a ferry trip to an artists' haven. It was funny in that we expected scenery and seals and all we got was rural village with a lack of services. We found a trail and walk and eventually saw some seals from the roof of the ferry on the way home, but it was a waste of a day. We even tried a fresh lobster meal at the coastal town the ferry started from. It was fresh, but we got kinda grossed out trying to clean our freshly killed lobsters. Again, a cheap substitute for Dungeness crab.
I don't think that Becky or the kids are too interested in getting back to Maine anytime soon. It may be that coming from Seattle and the Northwest, Maine isn't anything special. It's basically a poor man's Puget Sound.
At least we got to spend some time together and relax. I brought some medical reading material but got through very little. Instead, I slept well and managed to get in some good exercise. And all in all, I did manage to find some tasty seafood. The scallops here are fantastic!
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