Friday, June 29, 2018

What Residency Looks Like XXXIII: Call Rooms

Sometimes residency looks like spending the night in a hospital call room of questionable cleanliness  in which only half the lights and showers work, all so that you don't have to hike up the hill to the parking garage at 11pm, drive home, go to bed, and then turn around and do it all again in less than 8 hours. Thank goodness my bestie J.R. gifted me a sleeping bag liner for cool sleep and sweet dreams, as all of the beds had what looked like old, used linens on them. It is the only time I have slept in a call room in two years, and only because I was not actually "on call." In my experience, overnight shifts are typically too busy, or the call room is too far away, to get any rest in the hospital. What sleep I got would have been improved if the person in the suite nextdoor hadn't turned on the television AT FULL VOLUME in the room on the other side of the wall as the bed at 2AM and left it on for the rest of the night.


Tuesday, June 26, 2018

What Residency Looks Like XXXII: All Wet

Perhaps this should have gone in the bloopers list: one night I finished an emergency department shift at 10pm and had to hike up the hill to the garage in pouring rain. I got soaked from the knees down, despite an umbrella. The next morning my sneakers had not dried by the time I had to leave the house again for lecture, so I wore other shoes and brought the sneakers with me. After lecture, I attempted to go for a swim, but the gym had unexpectedly closed the pool. Closed pool = no towels. I hadn't showered and a shift for the rest of the day...and because the locker room was unlocked but empty, I ended up taking a shower and drying off in front of this mega fan au natural. Thankfully, my sneakers were dry by then, too.


Sunday, June 24, 2018

What Residency Looks Like XXXI: Second-Year Blooper Edition

I have a tradition of sharing bloopers from my clinical training in the summer (for old links see below). This time is no different. I just completed my second year of combined Internal Medicine and Pediatrics residency. I started in the pediatric emergency department and ended in the adult ED. In between I went to the juvenile detention center, saw infectious disease and neurology consults, spent a month improving my teaching skills, rounded in both the pediatric and adult intensive care units, and took care of patients of all ages in clinic and in the hospital. I share these lighter moments as a reminder that we are all human, and humans have the propensity to say or do some funny things sometimes.

Gordy Orange got his head scanned.

Resident Bloopers

10. Every time I had a 24-hour (or longer!) shift and forgot to turn off my bedside alarm. (Sorry, Dear Husband!)

9. The morning I had to run back to the house to retrieve the expensive reflex hammer I had accidentally dropped in the garbage can with the bag of trash I was taking out.

8. The time a clinic patient asked me if I had sent her prescription to the pharmacy and I replied, "Oh shit, sorry, I forgot" in front of the 5-year-old girl she was babysitting and had brought with her.

7. When I tried to make a joke but got the punchline wrong:
Me: I have the patients in rooms 6, 7, 8, 9, 10. Full house: I win!
Attending: That's a straight.
Fellow: Have you ever played poker before?
Me: Once?
6. That night shift when I followed my sign-out instructions and paged the special pharmacist, at home, at 3:30 in the morning, about a medication that didn’t need to be given until 11:30am.

"Smarty Pants"
5. The day in clinic I tried to order a medication (Depo Provera) to the pharmacy but only succeeded in placing the nursing order to have it given. The attending ordered the medication, so I deleted the nursing order. The attending wondered why it was taking so long for the patient to get the medication, and only much later did the nurse come back to ask why I had deleted the administration order, and did I still want the patient to receive the medication she had picked up from the pharmacy?

4. The morning I spent a frantic fifteen minutes looking for my hospital badge in our house and both cars before realizing...I was wearing it on my sweater underneath all my winter gear.

3. When I was seeing a gentleman in the ED who was complaining of pain when he peed and he yelled when I palpated his scrotum. I asked if it hurt there and he replied, "No, but you touched my kids. That's what I call them, 'the kids.'" He wasn't having pain there, he was just surprised.

2. The time in the pediatric emergency room that I guessed that the mother of a newborn baby with jaundice was East Asian and included that as a risk factor on the discharge paperwork I gave them and the father asked me, "Who told you the baby was Asian...?"

1. Once, in the middle of re-sewing a large-bore IV in the ICU, I realized that the suture I had grabbed from the supply room was attached to a straight, 3-inch needle. I had to stand there holding gauze over the opening in the patient's neck while Central Supply sent up suture packets with curved needles. For some reason they only stock straight needles in the unit, so it's not like I had grabbed the wrong package. I have never used a straight needle to place stitches on a human being before and didn't even realize this was a way in which I could screw up. And if that doesn't sum up the ridiculousness of residency, I don't know what does.

Wellness Week = Karaoke

Editor's Note: Nostalgic or new readers can look back on Med School Bloopers 1 and 2, as well as Intern Bloopers.


Friday, June 22, 2018

What Residency Looks Like XXX: Diagnostic Referral Codes

I have just completed a month-long rotation in the Emergency Department (pro tip: no one in medicine calls it the ER) at an urban, academic, tertiary-care center. I didn't see any traumas--the surgeons ran those. I saw some real emergencies--like heart attacks and strokes--but the attendings actually ran those. Most of what I did was basic primary care medicine. In fact, it reminded me of a joke on a Twitter thread by @GruntDoc, responding to the prompt, "Anger your entire speciality in one sentence":
(Walks up to podium at major Emergency Medicine conference)
(Taps mic)
Me: Really we’re all just glorified Family Practitioners with a CT scanner.
(Beaten to death with personally owned handheld sono probes)*
As a way to try to grasp what I actually did that whole month I was in the ED, I decided to tabulate the different kinds of problems I saw during one warm-weather month. The numbers don't add up to the total number of patients seen at the bottom, because some had multiple complaints. If my math is correct (and I'm not sure it is), then I admitted just over 1/3 of the patients I screened in the ED to the hospital.

heart attack  1
low blood pressure  4
high blood pressure  2
low heart rate 1
high heart rate  2

breathing problem  2
community acquired pneumonia  1
aspiration pneumonia  1
needs lung transplant  1
post lung transplant  1
pleural effusion  1

abdominal pain  3 (1 of these turned out later to be cancer)
nausea/vomiting  4
acute diarrhea  1 (probably typhoid acquired abroad)
chronic diarrhea 1
constipation  2
acute pancreatitis  2
perforated viscus  1
pooping blood  1
rectal prolapse  1
diverticulitis  1
proctitis  1

Lyme Disease 1
viral syndrome 2
Practicing foreign body removal.
strep throat  1
Sickle Cell pain crisis  2

allergies/allergic reaction  4
low blood sugar  4
high blood sugar  3
hepatic encephalopathy  1
medical problem unspecified  4

fluid overload  2
UTI  4
peeing blood  1

bloody nose  1
rash  2
cut  2
beaten up  1
burst varicose vein  1
accidental needlestick/blood exposure  2
dental abscess  3
other abscess  4
kicked in the chest  1
muscle strain  2
tendon sprain  4
broken bone  4 (femur, finger, skull, lumbar vertebra)
post-surgical complications  4
arterial thrombus  1

headache (migraine, IIH, post-LP)  3
VP shunt malfunction  1
head bleed  2
seizure  2
seizure-like event  1
pseudoseizure  1
stroke  1
near syncope  2
fall  4
spinal cord compression  1
unknown neurological condition  2
   (1 turned out later to have Creutzfeldt-Jakob Disease)
whiplash  1
pain  12
sciatica  1

psychosis  5
?panic attack/anxiety  2
accidental drug overdose  2
intentional drug overdose  3
alcohol or drug intoxication  5

corneal ulceration  4
conjunctival ulceration  1
subconjunctival hemorrhage  1
acute angle glaucoma  1
anterior uveitis  2
retinal hemorrhage  1
vitreous hemorrhage  1
optic disc edema  1
anisocoria  1

Procedures I did:
cardioversion  1.5
  (the second guy converted into normal sinus while my attending was consenting him)
opened an abscess  1
reduced a rectal prolapse  1
ocular lavage (I rinsed this guy's eye out)  1
suturing  0  (much to my dismay)

Patients admitted: 49/131

*My contribution to the Twitter prompt was this:
(Walks up to the podium at a major Internal Medicine-Pediatrics conference.)
(Taps mic.)
Me: It's true that MedsPeds docs are jills of all trades and mistresses of none.
(Cacophony of boos and jeers ensues.)


Sunday, June 17, 2018

Annals of Bad Housekeeping: Bathroom Edition

1st Folio: Dear Husband and I adopted a cat from the humane society a month ago (introductory post with photos coming soon!). She spent most of her first week hiding in our semi-finished basement, either behind some boxes or up in the rafters. One of the first clues that she had ventured to the first floor of the house was these dirty paw prints on the 1/2-bath sink, presumably leading to the fragrant bar of lavender soap. I thought our furry friends were supposed to leave paw prints on our hearts, not our porcelain fixtures.

2nd Folio: The upstairs bathtub faucet has dripped since we moved in two years ago. We immediately asked the landlord to send a plumber, who pronounced the situation hopeless, since the pipes are encased in the wall. About a month ago I decided to try to measure how much water was coming out of the faucet: about 2 gallons per day! I have tried to capture the water and re-use it around the house: in the Brita filter, for washing produce, and especially for watering the plants. Unfortunately, the aloe plant took offense to suddenly living in a tropical jungle rather than in an arid desert of benign neglect and promptly rotted at the stem.

Wednesday, June 13, 2018

What Residency Looks Like XXIX: Family

Since before we started residency, it's been rare to get all four of us in my cohort together in one place at one time. Thanks to J.P., M.K., and J.T. for humoring me in taking this cheesy "family portrait" in the ENT conference room after a lecture about mechanical ventilation. We may look like mater and pater familias with two spunky daughters, but we function more like cousins who value all the time we can steal to spend together.


Saturday, June 9, 2018

What Residency Looks Like XXVIII: Dirty Scrubs

Sometimes residency looks like starting your Emergency Department shift with pre-splattered scrubs. Is it blood? sh**? No, it's chocolate ice cream I tried to eat in the car on the way to the hospital on a hot day. Lesson (probably) learned.


Tuesday, June 5, 2018

What Residency Looks Like XXVII: Breakfast of Champions

Sometimes residency looks like chocolate ice cream before your night shift.