Yes, it's been awhile since I've blogged. I lost my motivation during Peds Anesthesia at CCMC and the Thanksgiving holiday season, but I'll try to provide a quick recap.
CCMC was not a lot more down time than Adult anesthesia at Manchester Hospital. I had to compete for procedures with residents from Pediatrics and Denistry. Two intubations seemed like a good day. And that usually required a lot of running around between rooms. At least I was able to read a fair amount and almost finished the Secrets book for Emergency Medicine. I even learned a few things along the way. All in all though, my dexterity got up to speed on adults. The kids were easy and just helped build muscle memory.
The last week of Peds anesthesia I had my Dad and step mother in town, so that kept things busy; entertaining them and showing them a bit of Hartford. It was a very nice visit, but as with all family visits, a bit chaotic.
That led directly into my CICU rotation at Saint Francis Hospital. After my Internal Medicine rotation there, there was a bit of dread over Call nights and scut. Especially since my first and last nights of the rotation were Call shifts. In the end, I think the rotation was MUCH better than Medicine.
I learned a lot more that is relavent to EM about treating AMIs, CHF, arrhythmias, angina and post PCI patients. The faculty Attendings, Cardiology Fellows, Residents and even several of the non-faculty Attendings were great teachers. It was an order of magnitude better than medicine and debunked a lot of the stereotypes about cardiologists being ornary and demeaning. The nursing staff got on my nerves for the hourly calls through the night about mundane lab values or routine changes in vital signs, but even the Call nights were much better.
An added benefit is that I actually had some time to study on my own. I read some UpToDate articlesNEJM issues and some EM articles. It felt like the scut was reasonable (vs. all encompassing) and educational in short.
A good example is my night on CCU. I arrived at 8am Sunday to a pretty full service. The Saturday crew admitted 5 new patients to our service. We divided the patients up and got progress notes out in reasonable time. Then the Resident (moonlighter) and I transferred four patients off our service and admitted three new patients. This took us through about 8pm. I wasn't feeling great so I grabbed a late dinner and went to sleep instead of studying or watching a movie on my iPhone. I was called couple times through the night from the nursing staff but they were easily handled from my Call room. Things got a little crazy in the morning though. We had two admissions come in shortly before we were supposed to sign out to the day team (the normal CCU team of a Resident and 3-4 Interns). I would have normally stayed on as one of the Interns, but like the moonlighter, I needed to sign out get off to another hospital for my new rotation. By the time we got finished examing the new patients, getting histories, putting in orders and filling out the History & Physicals is was way past signout time.
I arrived at Hartford Hospital around 9am and thankfully the Psychiatry Attendings were understandable. I had a quick introduction and they sent me home to rest up post Call.
Now I'm off to two weeks of Psychiatry. Staring with a crazy day tomorrow. I have three hours of Psych evals, then a meeting regarding my scholarly project on the new EDIS implementation, then four hours of conference lectures, then a meeting on updating our International EM web pages, then swimming at the JCC with the boys, and finally stopping by West Wings for the 'night before' gathering with the following days' interviewees for next year's EM class. Whew!
The last month and a half has continued to reinforce my confidence in selecting Emergency Medicine as a specialty. The money, hours (lifestyle) and daily patient care are the best combination I can think of for me. It feels like a good fit and I'm continually motivated to improve my skills, learn more and provide provide better patient care.
Even the New England winter, thus far, hasn't dampened our spirits. The leaves are down, the frost is on the windshields every morning and we've had to buy some winter clothes (sweaters, coats, slippers, etc.), but the family is settling in well. Becky is excelling at the Hispanic Health Council, the kids are busy with honors classes, swimming and music and we are all getting in better shape. And Christmas is right around the corner...
Monday, December 01, 2008
Thursday, October 09, 2008
Anesthesia
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.
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.
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!
Saturday, August 23, 2008
Second Month
Well August isn't officially over, but I'm now on vacation! Time to relax, sleep and exercise.
This month started with two weeks of ED shifts, eight at Hartford Hospital, three at Connecticut Children's Hospital and one EMS ride-along.
The first three shifts were exhausting. For three nights straight I worked for the first in large EDs. It was a little overwhelming learning new processes, staffs, Attendings, charting, locations of everything, etc. Oh, and I got to take on stroke patient whenever they dropped in (no traumas yet). At least that is over. I've now worked in every ED I will work in during residency.
I am a bit disappointed that I didn't get many procedures in. However, I did manage to learn a lot. And I haven't been very good at reading this month, that's something.
I also had three nights in a row. The shifts were fine, but getting back into a good sleep cycle has been more challenging. My pool closed, unfortunately giving me an easy excuse to not work out. Next time I have a series of night shifts, I will try to use exercise a little better and see if I can get back into a regular day cycle easier.
This last week has been Dentistry. I've learned a lot about giving oral nerve blocks. I'm confident I can numb up any area of the mouth to work on lip lacerations, provide comfort for broken teeth or just to get a patient through until Dentistry (OMFS) can see them. It was also very easy hours. With my mom in town for the weekend that has been nice.
Finally, my biggest time sink this month ahs probably been getting my new iPhone up to speed and organizing my music collection into iTunes. The latter is an ongoing project. I have a bout 11 GB rated and organized with probably another 10Gb or so to go. It's a project long past due.
This month started with two weeks of ED shifts, eight at Hartford Hospital, three at Connecticut Children's Hospital and one EMS ride-along.
The first three shifts were exhausting. For three nights straight I worked for the first in large EDs. It was a little overwhelming learning new processes, staffs, Attendings, charting, locations of everything, etc. Oh, and I got to take on stroke patient whenever they dropped in (no traumas yet). At least that is over. I've now worked in every ED I will work in during residency.
I am a bit disappointed that I didn't get many procedures in. However, I did manage to learn a lot. And I haven't been very good at reading this month, that's something.
I also had three nights in a row. The shifts were fine, but getting back into a good sleep cycle has been more challenging. My pool closed, unfortunately giving me an easy excuse to not work out. Next time I have a series of night shifts, I will try to use exercise a little better and see if I can get back into a regular day cycle easier.
This last week has been Dentistry. I've learned a lot about giving oral nerve blocks. I'm confident I can numb up any area of the mouth to work on lip lacerations, provide comfort for broken teeth or just to get a patient through until Dentistry (OMFS) can see them. It was also very easy hours. With my mom in town for the weekend that has been nice.
Finally, my biggest time sink this month ahs probably been getting my new iPhone up to speed and organizing my music collection into iTunes. The latter is an ongoing project. I have a bout 11 GB rated and organized with probably another 10Gb or so to go. It's a project long past due.
Tuesday, July 29, 2008
Intern Picnic
Becky and the kids returned from a week in Seattle yesterday. It was nice to have some company, besides the dogs, in the house again. Most importantly, Colton got to have a birthday party with most of his cousins and two of his grandmothers, a tradition he loves.
Today is actual birthday, but the focus seemed like it was my Intern picnic. In the morning I participated in a suturing and splinting workshop at Hart Hospital that one of our Chief Residents put on. I made it back home just in time to make a few sushi rolls and pack the sushi making gear along with some extra clothes. Then we all hopped in the van and drove the 45 minutes to our Program Directors home.
UConn has a tradition where every year the new Interns show off a "talent" at a picnic during orientation. The picnic had to be postponed until today due to weather. And today was a beautiful day for it. Nonetheless, we Interns have spent a lot time trying to come up with something simple, entertaining and not too cheesy. Needless to say, in general medical students talents are primarily reading and test taking. So my idea was a quick presentation on sushi making, something I really knew nothing about a month ago!
I purchased a kit online that looked braindead simple and practiced once before today. I also purchased a decent rice steamer, fresh seafood and supplies (nori, wasabi, soy sauce, vinegar).
As we were forewarned the picnic started off with some good food and lots of people getting tossed into the pool. I finally tossed one of the chiefs in with myself, hoping that my self-sacrifice will the damage the Chief does to shift schedule in the next year for retribution. We played some volleyball, frisbee and bean bag toss, socialized with spouses and families and, surprisingly, kept the shop talk to a minimum.
The talent show went over pretty well. Everyone put in some effort and we all enjoyed some laughs. Then many of headed for work, or in my case, family priorities. Colton was desperate for his present and some play time. Moreover, Becky needed time to review paperwork and prepare for her first day on the job as Chief Admin Officer at a local non-profit.
Otherwise it has been a pretty quiet day. I've got two more shifts at the UConn hospital, then it's two weeks of Hartford Hospital Emergency Dept shifts, a week of denistry and a week of vacation. We're hoping to use the last week in August for a trip to see the Cape and Maine before the kids start school. So time to get some sleep, five days of shifts in a row is going to be pretty tiring, especially since the third through fifth shifts are all in EDs I'm not familair with; Hartford Blue Pod, Gold Pod then the Peds ED across the street.
Today is actual birthday, but the focus seemed like it was my Intern picnic. In the morning I participated in a suturing and splinting workshop at Hart Hospital that one of our Chief Residents put on. I made it back home just in time to make a few sushi rolls and pack the sushi making gear along with some extra clothes. Then we all hopped in the van and drove the 45 minutes to our Program Directors home.
UConn has a tradition where every year the new Interns show off a "talent" at a picnic during orientation. The picnic had to be postponed until today due to weather. And today was a beautiful day for it. Nonetheless, we Interns have spent a lot time trying to come up with something simple, entertaining and not too cheesy. Needless to say, in general medical students talents are primarily reading and test taking. So my idea was a quick presentation on sushi making, something I really knew nothing about a month ago!
I purchased a kit online that looked braindead simple and practiced once before today. I also purchased a decent rice steamer, fresh seafood and supplies (nori, wasabi, soy sauce, vinegar).
As we were forewarned the picnic started off with some good food and lots of people getting tossed into the pool. I finally tossed one of the chiefs in with myself, hoping that my self-sacrifice will the damage the Chief does to shift schedule in the next year for retribution. We played some volleyball, frisbee and bean bag toss, socialized with spouses and families and, surprisingly, kept the shop talk to a minimum.
The talent show went over pretty well. Everyone put in some effort and we all enjoyed some laughs. Then many of headed for work, or in my case, family priorities. Colton was desperate for his present and some play time. Moreover, Becky needed time to review paperwork and prepare for her first day on the job as Chief Admin Officer at a local non-profit.
Otherwise it has been a pretty quiet day. I've got two more shifts at the UConn hospital, then it's two weeks of Hartford Hospital Emergency Dept shifts, a week of denistry and a week of vacation. We're hoping to use the last week in August for a trip to see the Cape and Maine before the kids start school. So time to get some sleep, five days of shifts in a row is going to be pretty tiring, especially since the third through fifth shifts are all in EDs I'm not familair with; Hartford Blue Pod, Gold Pod then the Peds ED across the street.
Thursday, July 17, 2008
Loving EM
Well it's been about two weeks of shifts now. I'm starting to get the hang of the computer system, the hospital specific idiosyncrasies and how to survive eight hours of 100% focus. I've also learned a ton of medicine, procedures and interesting patient presentations.
All in all, my community hospital month is a great way to start residency. The attendings have been great. I'm getting lots of accolades from patients about my bedside manor and patient care. The attendings seem to believe I'm doing a good job as well. Best of all, I feel like I'm in the right place. If I end up practicing in a community hospital, I would be quite happy.
There's not as much trauma or opportunities to practice procedures, but the lifestyle is great and well suited to me.
Becky also got a job offer today, so that a financial relief for the family. It's just about the salary we were hoping for, but with much more time off than we expected. Again, I think the offer is very well suited to Becky and our family.
Now, I just have to solidify some good habits; working out 5-6 days a week and study most nights. With a sunburn from bodysurfing with the family at Naragansett, RI last weekend the former has taken a hit. And now, I'm boning up for a PALs course next week, so the latter has slowed down as well.
These are short term things so no big deal. The progress we've made here is great so far. I just hope that the kids get settled in with more local friends, Becky's job turns out as good as it looked during interviews and my last couple of weeks at John Dempsey Hospital go well.
All in all, my community hospital month is a great way to start residency. The attendings have been great. I'm getting lots of accolades from patients about my bedside manor and patient care. The attendings seem to believe I'm doing a good job as well. Best of all, I feel like I'm in the right place. If I end up practicing in a community hospital, I would be quite happy.
There's not as much trauma or opportunities to practice procedures, but the lifestyle is great and well suited to me.
Becky also got a job offer today, so that a financial relief for the family. It's just about the salary we were hoping for, but with much more time off than we expected. Again, I think the offer is very well suited to Becky and our family.
Now, I just have to solidify some good habits; working out 5-6 days a week and study most nights. With a sunburn from bodysurfing with the family at Naragansett, RI last weekend the former has taken a hit. And now, I'm boning up for a PALs course next week, so the latter has slowed down as well.
These are short term things so no big deal. The progress we've made here is great so far. I just hope that the kids get settled in with more local friends, Becky's job turns out as good as it looked during interviews and my last couple of weeks at John Dempsey Hospital go well.
Friday, July 04, 2008
First three shifts - and Happy 4th of July
Finished what I expect to be the hardest shifts of my career. Sure, the first few shifts as an attending will be stressful and chaotic, but at least I'll know how to help patients.
These first three shifts were crazy because you know no one, the computer systems and hospital processes are foreign, and you really don't know that much medicine (especially since each institution does things a little different).
However, the three shifts couldn't have gone any better. The Attendings were great; helpful, respectful and proactive teachers. The staff is very nice, while I feel like I hardly had a chance to get to know them. And it's all electronic, so there's very little written charting.
The best part is that I'm gaining a reputation already as the procedure guy. The first night I did a nice I & D, then an external jugular central line, then a three layer closure on a lip laceration. The second night I intubated a patient, then did a foreign body removal from a cornea (metal shavings). The third night I did a lumbar puncture. The procedures all went smoothly and were very confidence building for me.
The only thing I haven't done, and that I need practice on putting in plain old IVs. I plan on getting some practice this week, along with getting better charting on the IBEX computer system. The last night I was managing up to five patients at once, or trying to. It's hard to make sure everything is progressing on each patient while keeping up on charting and everything else. I missed that one patient's CT was delayed and one patient's blood draw kept getting messed up. Each situation resulted in two hour delays.
My feedback from the Attendings after each shift was very positive. And I think I learned a lot. It also gave me incentive to read up on patients cases and study more. One case may end up being my case report for the year. An elderly lady came in with a supposed drug reaction, but ended up having encephalitis! Some permanent synaptic connections were definitely made working up that patient.
I have today, the 4th of July off. The family and I went for a long walk with the dogs at a nearby park. We're trying decie if we should go see any firework shows since the clouds are low and threatening to rain. The walk was good exercise, and let me recover a bit from the last week of running, weight lifting and swimming. I'm a bit sore but happy to feel the body getting back into shape.
I guess I still don't know what to expect for the first week. But I do feel my first week has gone very well. I'm getting a little confidence and feeling confident telling patients or consulting specialists I'm one of the Residents. I couldn't have asked for a better start to residency.
These first three shifts were crazy because you know no one, the computer systems and hospital processes are foreign, and you really don't know that much medicine (especially since each institution does things a little different).
However, the three shifts couldn't have gone any better. The Attendings were great; helpful, respectful and proactive teachers. The staff is very nice, while I feel like I hardly had a chance to get to know them. And it's all electronic, so there's very little written charting.
The best part is that I'm gaining a reputation already as the procedure guy. The first night I did a nice I & D, then an external jugular central line, then a three layer closure on a lip laceration. The second night I intubated a patient, then did a foreign body removal from a cornea (metal shavings). The third night I did a lumbar puncture. The procedures all went smoothly and were very confidence building for me.
The only thing I haven't done, and that I need practice on putting in plain old IVs. I plan on getting some practice this week, along with getting better charting on the IBEX computer system. The last night I was managing up to five patients at once, or trying to. It's hard to make sure everything is progressing on each patient while keeping up on charting and everything else. I missed that one patient's CT was delayed and one patient's blood draw kept getting messed up. Each situation resulted in two hour delays.
My feedback from the Attendings after each shift was very positive. And I think I learned a lot. It also gave me incentive to read up on patients cases and study more. One case may end up being my case report for the year. An elderly lady came in with a supposed drug reaction, but ended up having encephalitis! Some permanent synaptic connections were definitely made working up that patient.
I have today, the 4th of July off. The family and I went for a long walk with the dogs at a nearby park. We're trying decie if we should go see any firework shows since the clouds are low and threatening to rain. The walk was good exercise, and let me recover a bit from the last week of running, weight lifting and swimming. I'm a bit sore but happy to feel the body getting back into shape.
I guess I still don't know what to expect for the first week. But I do feel my first week has gone very well. I'm getting a little confidence and feeling confident telling patients or consulting specialists I'm one of the Residents. I couldn't have asked for a better start to residency.
Friday, June 27, 2008
Settling in and Orientation
Our first in West Hartford consisted of unloading the MoveX truck that shipped our belongings to CT with the assistance of three of my fellow EM interns. we got very sweaty but finished the job before lunch. Becky and I bought two of them lunch, had a couple beers, then started the huge job of unpacking and settling in.
I will admit that there were many more hassles and obstacles than I anticipated. The blinds were removed, the humidity was stifling even at 75 degrees. The refrigerator was broken. And Becky's Monday morning interview went well, but only resulted in a second and third interview with no decision in sight.
On the plus side, the area is great and our house's location is perfect. We purchased new appliances at Sears around the corner, purchased groceries at Trader Joe's next door to it, played with the dogs at Wolcott Park a short walk away and started back into swimming at the Cornerstone Aquatics center 3-4 miles away. The packing certainly filled in my three days before orientation started. And the nights were spent buying supplies and putting together Sauder style furniture.
I was exhausted and a little down when we started orientation on Wednesday the 18th. However, my fellow interns turned out to be terrific. We've gone out for lunch, a beer or a dinner with spouses almost every day. I have had a great time bonding with the other eleven physicians in my class and look forward to growing into Emergency Physicians with them.
Orientation itself has been ok. I guess I shouldn't expect too much from the logistics of getting into four hospitals. I now have computer training, privileges and IDs for Hartford Hospital, CT Children's Med Ctr, St. Francis and UConn's John Dempsey Hospital. Moreover, I now have my ATLS and ACLS certifications completed. I was a little stressed about preparing for them and the written and oral exams at the end, but ATLS, especially, reminded me of how much I've learned thus far.
The worst day by far was today, our last day. We had to prepare for St. Francis's computer training with 6-7 hours of online lessons and quizzes. Then we spent another two hours onsite ( and paying $4 for the privilege) to go through a workbook of the same stuff overseen by an incompetent administrator that had no idea what we were doing. It was very frustrating. Children's in the afternoon was better, but more than a little boring.
Lat night Becky and I attended the PGY-3's graduation banquet. My class got a chance to know the outgoing seniors and see what they've done throughout residency. It was fun to see the awards that nurses, faculty and classmates handed out to them and the reasoing behind it. The kids also started a Lacross camp two days and are loving it. Becky said she's never seen them so sweaty. While it's very humid, the weather is still great for working out and playing outside this summer.
Now I have three days until I start seeing patients at John Dempsey Hospital at UConn. Three day to relax and get back into the student mindset. It's exciting and stressful. I'm going to have to wear business casual clothes with my new long white coats for the first few weeks until my embroidered scrubs arrive. It will be nice to be called doctor, but scary to look like an attending with one one hundreth their kowledge.
I will admit that there were many more hassles and obstacles than I anticipated. The blinds were removed, the humidity was stifling even at 75 degrees. The refrigerator was broken. And Becky's Monday morning interview went well, but only resulted in a second and third interview with no decision in sight.
On the plus side, the area is great and our house's location is perfect. We purchased new appliances at Sears around the corner, purchased groceries at Trader Joe's next door to it, played with the dogs at Wolcott Park a short walk away and started back into swimming at the Cornerstone Aquatics center 3-4 miles away. The packing certainly filled in my three days before orientation started. And the nights were spent buying supplies and putting together Sauder style furniture.
I was exhausted and a little down when we started orientation on Wednesday the 18th. However, my fellow interns turned out to be terrific. We've gone out for lunch, a beer or a dinner with spouses almost every day. I have had a great time bonding with the other eleven physicians in my class and look forward to growing into Emergency Physicians with them.
Orientation itself has been ok. I guess I shouldn't expect too much from the logistics of getting into four hospitals. I now have computer training, privileges and IDs for Hartford Hospital, CT Children's Med Ctr, St. Francis and UConn's John Dempsey Hospital. Moreover, I now have my ATLS and ACLS certifications completed. I was a little stressed about preparing for them and the written and oral exams at the end, but ATLS, especially, reminded me of how much I've learned thus far.
The worst day by far was today, our last day. We had to prepare for St. Francis's computer training with 6-7 hours of online lessons and quizzes. Then we spent another two hours onsite ( and paying $4 for the privilege) to go through a workbook of the same stuff overseen by an incompetent administrator that had no idea what we were doing. It was very frustrating. Children's in the afternoon was better, but more than a little boring.
Lat night Becky and I attended the PGY-3's graduation banquet. My class got a chance to know the outgoing seniors and see what they've done throughout residency. It was fun to see the awards that nurses, faculty and classmates handed out to them and the reasoing behind it. The kids also started a Lacross camp two days and are loving it. Becky said she's never seen them so sweaty. While it's very humid, the weather is still great for working out and playing outside this summer.
Now I have three days until I start seeing patients at John Dempsey Hospital at UConn. Three day to relax and get back into the student mindset. It's exciting and stressful. I'm going to have to wear business casual clothes with my new long white coats for the first few weeks until my embroidered scrubs arrive. It will be nice to be called doctor, but scary to look like an attending with one one hundreth their kowledge.
Six days across America
Monday morning we finished packing the minivan early and saying our goodbyes to our Glendale, AZ home. At four years, it was the longest Becky and I lived in one house together. The van once again showed how it was the ultimate vehicle when it comes to functionality. We had our luggage and camping gear packed into the Thule luggage carrier on the roof as well as stacked in the back with the third row folded down. This left just enough room for Cedar and Artemis our Golden Retrievers to curl up behind the boys' captain chairs in the middle row.
We also had the bike carrier in the 2" trailer hitch in back with all four mountain bikes aerodynamically positioned behind the van (LOL). Finally, our alternator had to really work this trip. We had the GPS, satellite radio, Xbox, dual screen DVD player and multiple rechargers (phones, Nintendo DS, iPod, etc.) all hooked up. As a bit of foreshadowing, the Xbox failed from the moment we tried to turn it on. We thought it died, but only upon arriving in Connecticut did we find out that the van couldn't provide sufficient power for it with everything else draining amps.
The trip started fine with a nice drive from Phoenix to the Grand Canyon. The boys got a bit restless as I kept wanting to jump out of the car for another photo opportunity. They and Becky had already seen it, and the former weren't overly impressed. The dogs and I had fun running around the vistas for a couple shots before jumping back into the running car (turning off the motor makes for a serious interuption to the movie watchers in back). We only needed to give the dogs one dramamine (Artemis) along the way. They were otherwise troopers.
A late start and my sight seeing put us in Durango just past dark. We managed to put up the tent (18' x 10') in the dark without getting into too many arguments or creating too many comparisons to the Waldos for the spectators who were for the most part all comfy in their campers.
The night ended up being very cold but all six of us slept fairly well the first night on the road. We peed close to the tent, stayed bundled up and only ran around when Cedar threw up near the head of Becky's sleeping bag in the middle of the night. We're assuming it was from the stress since he's been through this before and was fine from that point on.
Anyway, the morning was very cold, and it took us quite a while to take down the tent, find breakfast and hit the road. Once we did though, the spectacular Colorado mountains entertained Becky and I. The boys were in non-stop movie watching mode and only occassionally looked up to humor me with a; "oh, yeah, cool Dad." The highlight of the day was Ouray, known as the "Switzerland of America". It is a small city in a bowl of huge, rugged mountains surrounding it. It was one of my favorite landscapes in the whole country. Unfortuantely road construction severly slowed our progress North and East towards Boulder. In the end, we had to forego some of the scenery and take the main freeway going into Denver from Grand Junction. First, this made us appreciate not Matching into the family residency in Grand Junction. Second, we still got to see some great sights along the interstate. The canyons, Vail and the twisty roads around the Rockies kept me entertained in the driver's seat al day.
We finally made it to the Rocky Moutain National Park close to dark. Our site was right on Granby lake and the wind was blowing pretty hard. We frantically put up the tent before bundling up for a glass of wine under stars. The sky looked clear and the stars were beautiful, but Becky noticed some forboding stars on the horizon and jokingly mentioned how it would be funny if they were snow clouds even though it was warmer than Durango.
As fate would have it, we woke up earlier for our longest drive of the trip to light snowfall. In record time we packed the tent and hit road. Our GPS kept telling us to turn back towards the Interstate (I-70) and Denver, but I wanted to take the scenic shortcut over the Rocky Mountain pass taking us just North of Boulder with a straight shot to Highway I-80 and Nebraska. The Ranger at the park took our $20 and assured us that the there may be some winds on top of the mountain, but the pass was clear - and heck, it was June!
With a couple miles, the snowfall became a storm and visibility dropped to about 20 feet. About this time, we realized that the van's heater was broken. After all, it had probably been years since it had been used, the Fry's guys who installed our satellite radio looked pretty amareur. So in sandals, freezing temperatures and the air conditioner on to defog the windshield, we raced to the top of the pass only to find it had just closed!!
The only bright spot in our two hour frigid detour was seeing a whole herd of deer running down the mountain to escape the same snow storm. The three big buck, 7-8 doe and 4-5 fawn were a great way to break our dejection and frustration. Actually, one side benefit of the delay was that Denver rush hour was long gone by the time we drove through.
The rest of Colorado and the first half of Nebraska were smooth sailing. Luckily we were concerned enough about our delay that we made hotal reservations in Omaho knowing Dew Moines would be tough to reach not even considering we'd have to put up the tent at our camp site there. We realized how smart that call was not far from Lincoln, NE. The rain started coming down in sheets and I took the opportunity to tempt fake by joking how it would be wild to have Tornados and snowstorms on the same day.
Cars and semis started pulling over under the overpasses. But as long I could follow semis and see they weren't hitting deep water, I kept ok. It got so dark about this time (at around 5pm when it should have been sunny) that we switched to the local radio. That was when Becky and the boys got really nervous. Reports of flooded roads, tornados touching down and warnings to pull off all roads made for some stressful driving. Just past Lincoln I finally decided to pull over and see about stopping for the night. Even with only 20-30 miles to go until Omaho, I was getting worried. The first gas station and hotel off the interstate looked flooded so we headed to the other side of the overpass. There was a huge crowd in the station with a police officer making recommendations. I thought to myself how unprepared I was as a newly graduated doctor for any kind of disaster.
We stuck around for awhile until the rain lesseded a bit and we thought we'd try for a hotel nearby for the night. However, as we got started I realized the weather have improved significantly and the truck drivers were pulling out and hitting the road again. Not to ignore the Police Officer's recommendations, but the professional drives in CB contact with other truckers around the state seemed to be the safer bet. Becky kept in almost constant with her family through the whole thing and I still don't whether that helped calm or stress her out more. But in the end she didn't protest my decision too badly. We had little trouble following one semi the half hour to our reservation in Omaho.
Showers and beds were a nice way to start one of our shorter days. My cousins, aunts and uncles in Chicago were dealing with a lot of their own surprises so we drove straight through Illinois to Southbend, IN where Tucker and his family had just moved into their new house for residency. Their truck had just unloaded all of their belongings earlier in the day so, it was a bit chaotic but Tucker would never pass up an opportunity to help a friend. Not only did we get a nice dry place to stay for the night, we had a great time watching the kids and dogs play in their huge yard while we had a chance to talk as couple starting a similar big new adventure.
It was hard to leave the next day. We stayed way past the time I had hoped to get rolling, but the kids had a great time running around and playing. It was hard to separate them. Once we got rolling I realized the trip to Wellsburg, WV was pretty short.
We arrived at Great Aunt Gerry's 1911 mansion, Morningside, around 3pm or so. The boys and dogs had a great time exploring the huge place and settling into their own 1950's styled rooms. We all went for a swim at Gerry's son's house, the orginal housestead on the compound built in the 1850's. Then we went to dinner on the Ohio River. The rain followed us, but it was still a wonderful evening spending time with relatives we hadn't seen in a long time. Aunt Gerry had hosted a family reunion 12 years ago, when Connor was only five months old. That was the last time we had been out to Morningside.
Day six started slow as usual for us. We hit the road around 10am, pretty average for us. But we had a great time with Gerry and her daughter Tina over breakfast. The day's drive to West Hartford was pretty uneventful except for the almost constant rain and a close call. Becky drove most of the day so I study for my upcoming ATLS class. In hte afternoon she noticed a newly rolled over SUV alongside the road with several good samaritans trying to help out. I agreed we should stop and ran over to see if I, the barely graduated doctoc, could lend a hand. I located the driver and found him to be fine, walking around the vehicle and impatiently waitin for EMS to show. He politely refused my offer of assistance.
We arrived at our new house in West Hartford late on Saturday evening. After a nice 8-9pm dinner at Olive Garden to celebrete our arrival we camped out on the 1940's hardwoods of our new Cape Cod home.
We also had the bike carrier in the 2" trailer hitch in back with all four mountain bikes aerodynamically positioned behind the van (LOL). Finally, our alternator had to really work this trip. We had the GPS, satellite radio, Xbox, dual screen DVD player and multiple rechargers (phones, Nintendo DS, iPod, etc.) all hooked up. As a bit of foreshadowing, the Xbox failed from the moment we tried to turn it on. We thought it died, but only upon arriving in Connecticut did we find out that the van couldn't provide sufficient power for it with everything else draining amps.
The trip started fine with a nice drive from Phoenix to the Grand Canyon. The boys got a bit restless as I kept wanting to jump out of the car for another photo opportunity. They and Becky had already seen it, and the former weren't overly impressed. The dogs and I had fun running around the vistas for a couple shots before jumping back into the running car (turning off the motor makes for a serious interuption to the movie watchers in back). We only needed to give the dogs one dramamine (Artemis) along the way. They were otherwise troopers.
A late start and my sight seeing put us in Durango just past dark. We managed to put up the tent (18' x 10') in the dark without getting into too many arguments or creating too many comparisons to the Waldos for the spectators who were for the most part all comfy in their campers.
The night ended up being very cold but all six of us slept fairly well the first night on the road. We peed close to the tent, stayed bundled up and only ran around when Cedar threw up near the head of Becky's sleeping bag in the middle of the night. We're assuming it was from the stress since he's been through this before and was fine from that point on.
Anyway, the morning was very cold, and it took us quite a while to take down the tent, find breakfast and hit the road. Once we did though, the spectacular Colorado mountains entertained Becky and I. The boys were in non-stop movie watching mode and only occassionally looked up to humor me with a; "oh, yeah, cool Dad." The highlight of the day was Ouray, known as the "Switzerland of America". It is a small city in a bowl of huge, rugged mountains surrounding it. It was one of my favorite landscapes in the whole country. Unfortuantely road construction severly slowed our progress North and East towards Boulder. In the end, we had to forego some of the scenery and take the main freeway going into Denver from Grand Junction. First, this made us appreciate not Matching into the family residency in Grand Junction. Second, we still got to see some great sights along the interstate. The canyons, Vail and the twisty roads around the Rockies kept me entertained in the driver's seat al day.
We finally made it to the Rocky Moutain National Park close to dark. Our site was right on Granby lake and the wind was blowing pretty hard. We frantically put up the tent before bundling up for a glass of wine under stars. The sky looked clear and the stars were beautiful, but Becky noticed some forboding stars on the horizon and jokingly mentioned how it would be funny if they were snow clouds even though it was warmer than Durango.
As fate would have it, we woke up earlier for our longest drive of the trip to light snowfall. In record time we packed the tent and hit road. Our GPS kept telling us to turn back towards the Interstate (I-70) and Denver, but I wanted to take the scenic shortcut over the Rocky Mountain pass taking us just North of Boulder with a straight shot to Highway I-80 and Nebraska. The Ranger at the park took our $20 and assured us that the there may be some winds on top of the mountain, but the pass was clear - and heck, it was June!
With a couple miles, the snowfall became a storm and visibility dropped to about 20 feet. About this time, we realized that the van's heater was broken. After all, it had probably been years since it had been used, the Fry's guys who installed our satellite radio looked pretty amareur. So in sandals, freezing temperatures and the air conditioner on to defog the windshield, we raced to the top of the pass only to find it had just closed!!
The only bright spot in our two hour frigid detour was seeing a whole herd of deer running down the mountain to escape the same snow storm. The three big buck, 7-8 doe and 4-5 fawn were a great way to break our dejection and frustration. Actually, one side benefit of the delay was that Denver rush hour was long gone by the time we drove through.
The rest of Colorado and the first half of Nebraska were smooth sailing. Luckily we were concerned enough about our delay that we made hotal reservations in Omaho knowing Dew Moines would be tough to reach not even considering we'd have to put up the tent at our camp site there. We realized how smart that call was not far from Lincoln, NE. The rain started coming down in sheets and I took the opportunity to tempt fake by joking how it would be wild to have Tornados and snowstorms on the same day.
Cars and semis started pulling over under the overpasses. But as long I could follow semis and see they weren't hitting deep water, I kept ok. It got so dark about this time (at around 5pm when it should have been sunny) that we switched to the local radio. That was when Becky and the boys got really nervous. Reports of flooded roads, tornados touching down and warnings to pull off all roads made for some stressful driving. Just past Lincoln I finally decided to pull over and see about stopping for the night. Even with only 20-30 miles to go until Omaho, I was getting worried. The first gas station and hotel off the interstate looked flooded so we headed to the other side of the overpass. There was a huge crowd in the station with a police officer making recommendations. I thought to myself how unprepared I was as a newly graduated doctor for any kind of disaster.
We stuck around for awhile until the rain lesseded a bit and we thought we'd try for a hotel nearby for the night. However, as we got started I realized the weather have improved significantly and the truck drivers were pulling out and hitting the road again. Not to ignore the Police Officer's recommendations, but the professional drives in CB contact with other truckers around the state seemed to be the safer bet. Becky kept in almost constant with her family through the whole thing and I still don't whether that helped calm or stress her out more. But in the end she didn't protest my decision too badly. We had little trouble following one semi the half hour to our reservation in Omaho.
Showers and beds were a nice way to start one of our shorter days. My cousins, aunts and uncles in Chicago were dealing with a lot of their own surprises so we drove straight through Illinois to Southbend, IN where Tucker and his family had just moved into their new house for residency. Their truck had just unloaded all of their belongings earlier in the day so, it was a bit chaotic but Tucker would never pass up an opportunity to help a friend. Not only did we get a nice dry place to stay for the night, we had a great time watching the kids and dogs play in their huge yard while we had a chance to talk as couple starting a similar big new adventure.
It was hard to leave the next day. We stayed way past the time I had hoped to get rolling, but the kids had a great time running around and playing. It was hard to separate them. Once we got rolling I realized the trip to Wellsburg, WV was pretty short.
We arrived at Great Aunt Gerry's 1911 mansion, Morningside, around 3pm or so. The boys and dogs had a great time exploring the huge place and settling into their own 1950's styled rooms. We all went for a swim at Gerry's son's house, the orginal housestead on the compound built in the 1850's. Then we went to dinner on the Ohio River. The rain followed us, but it was still a wonderful evening spending time with relatives we hadn't seen in a long time. Aunt Gerry had hosted a family reunion 12 years ago, when Connor was only five months old. That was the last time we had been out to Morningside.
Day six started slow as usual for us. We hit the road around 10am, pretty average for us. But we had a great time with Gerry and her daughter Tina over breakfast. The day's drive to West Hartford was pretty uneventful except for the almost constant rain and a close call. Becky drove most of the day so I study for my upcoming ATLS class. In hte afternoon she noticed a newly rolled over SUV alongside the road with several good samaritans trying to help out. I agreed we should stop and ran over to see if I, the barely graduated doctoc, could lend a hand. I located the driver and found him to be fine, walking around the vehicle and impatiently waitin for EMS to show. He politely refused my offer of assistance.
We arrived at our new house in West Hartford late on Saturday evening. After a nice 8-9pm dinner at Olive Garden to celebrete our arrival we camped out on the 1940's hardwoods of our new Cape Cod home.
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