Wednesday, March 2, 2011

Somebodys trash is

You should have seen my class when we got our pagers during 3rd year orientation. It was like little kids on Christmas. Everybody was asking for your number and paging you and playing with the different ringers during our lectures. One might think medical students should have some professionalism, but this was a big day. People were going to need to get ahold of us, we had become an integral part of patient care.

Looking back is laughable. The big hospitals need 3rd years like you need another hole in your head. And still, even months in we all would get excited about actually getting a page. The residents will tell you that you hate your pager when it starts going off all the time. They're wrong, you hate it once you realize the person on the other end actually needs you. No, not needs you to save a life, needs you because, despite being physically capable of doing everything they want and need to, you as the doc need to check a box on a computer or write down what to do and how to do it. The best is when they need you to scribble your name next to something they already did and claimed you told them to.

I'm still not to that point yet. But being the only person except the attending means I get to write the notes, the orders, see the patients before the doc at 0 dark 30, I just need an extra signature and a scribble for coding and legal purposes. Also, being a student and not a nurse or scrub tech means that as long as the doc is there I can cut and suture and all kinds of shit. He'll, there's things I can do without a doc around, like tear out an NG tube (though nurses can do that too). Though I'm not needed, I'm a lot less dead weight than at my larger institution, which means if my doc is needed, I'm at least expected to be there

So what does all this jibber jabber mean? It means for the first time, after a 13 hour shift I went to sit down and the overhead sounds "Dr. Schmo please call xyz" and I wasn't all twitterpated with excitement. I hope you caught the Bambi reference for it's two disc blu ray release coming up.

Tuesday, March 1, 2011


So my school likes to send students away to work with doctors in more rural settings one on one and usually you wind up living at th hospital or a nearby hotel. It's better for really getting some experience as to what living life in that specialty might be like some day. The first two weeks I spent doing one of these rotations in surgery I forgot my running shoes and was rather bummed at my lack of workout prospects. This week I almost did it again but I turned around 15 minutes into my drive to get them. It also turns out this week is the busiest yet, with two back to back 12 hour days and 6 cases scheduled for tomorrow on top of 3 nights of call. I'm starting to see why some docs find it so hard to practice what we preach...

BTW the pizza I had to pickup because the cafeteria was closed is fantastic

Time for some quick anatomy lessons

Ms. Rep was in today to make sure nothing went wrong with her company's mesh if we used it during an esophageal repair...

Ms. Rep, looking at the laparoscopy screen: What is that big vessel there running down by the esophagus?

Attending: You mean the aorta?

Ms. Rep: Oh...

Thursday, February 24, 2011

One step forward, two steps back

So I was on a case a while back. Patient was elderly (I mean like super elderly) and had a ton of problems which after a weeks stay in the hospital were getting better. She was coming off her broad spec antibiotics, she was eating, her pain was gone, the only thing we couldn't get her to do yet was get out of bed, which apparently won't stop you from getting the boot from a hospital anyway. Everything was good, until I came in the morning we were going to d/c her and she had spiked a white count. No fever, no tachycardia, just a 5 point jump in her WBC's overnight.

I about shit a brick. I had literally the night before written a note stating "watch out for C. diff colitis due to broad spec antibiotics and frequent watery stools," and C. diff is one infection that can hit without prompting a fever. On the contrary, Mrs. Super old also wasn't doing much and we had fluid overloaded her once during her stay, so she was having some atelectasis and effusions (google it if need be) so my attending was afraid of pneumonia (the elderly apparently don't need either a fever or white count to have an infection, thus I'm staying away from geriatrics). Chest x-ray was ordered and another round of different antibiotics was started.

Later that same afternoon, we visit the Gerry's chart to see what her x-ray showed, and my attending finds a progress note from the primary on her case that states BOLUS OF STEROIDS WAS GIVEN YESTERDAY. For those in the crowd that don't know this one I'll save you the trip to your search engine: steroids=white count elevation. Fuck me sideways Martha, I really wish I had this piece of information when I looked at the chart 15 hours after the bolus was given.

This showed two aspects of medicine that need to be addressed. One is doctors' handwriting. The whole reason this progress note wasn't on the charts is because the attending likes to dictate or type them and put them in later, making sure they're legible. But they're daily progress notes, which should be in the chart THAT DAY. Granted, it was an oversight on my team's part as we didn't flip through the couple sheets of orders to find it, but still. Can we not have something that lets us be legible AND have notes on the chart the day they're written? Trying to be legible shouldn't cost a patient mistakes in treatment and a delay in getting the hell out of a hospital bed.

Wednesday, February 23, 2011

I might have LOL'd

recently seen on gchat->

friend: do anything exciting lately?

me: no
me: unless you count cutting people open and playing with their guts exciting

morbid? maybe a little. insenstive? GTFO

....and for the record, I find it very exciting. So much so I don't care about pulling 12-16 hour days without lunch(suck on that one unions)