"Is it just me or is it unnatural to have to be asleep by 8pm?" -Tan

Thursday at 11am:

While eating lunch Nicole looks at her watch then looks up at me:

" I know, don't say it. It's still the AM" -me

"yeah. so wait, that means I'll be able to go home in about...24 hours" -Nicole
[ps lunch at 11am is the norm when you wake up at 4:30]


"why do you like to torture yourself? -nurse
"[long pause]what do you mean?" -me
"why did you go to med school?" -nurse
"i ask myself that everyday..."-me

"its like the show ER without all the dialogue" -one of the 10 people crowded outside the patient's room who was coding

First code blue

before i could even set my coffee down this AM we heard a code blue announced over the speaker system in the hospital and a couple of us went to check it out. it was an old man who's BP dropped. after giving him some bicarb he came back, he didnt need any CPR or epinephrine. a couple hours later while i was seeing my patient another code blue was announced. after finishing up with a quick physical, i went down to the 2nd floor to check out the code. it was an old man with no previous history of cardiac problems. they gave him a couple rounds of epi and were doing CPR. this is the first time id seen CPR and man is it rough. this mans body was going through hell. the daughter was called and asked to continue until she got there. a couple of the interns asked us if we wanted to do CPR and i shyed away and let victoria and darron do it. i figured its my first time seeing it, ill take in the experience and then jump in on the next one. unfortunately, with all the geriatric patients we have in the hospital, im sure there will be more in my next 3 weeks there. when the daughter eventually got to the hospital she didnt go into the room, she just asked that we stop and let her father die in peace. im sure that was best because if she saw how rough the code really is, she would have been much more upset than she already was.


the interns let us go at noon today, saying it was our christmas present. i went home and slept for a good part of the afternoon. this week was exhausting. i hope i get used to these work hours soon.

Found out this morning that Dorothy died last night before we could even send her home to be with her family. sad and very scary how quickly she went from stable to dead...

Went in at 6am and found out Dorothy, my 86yo patient, went downhill fast overnight. When i saw her yesterdy, she had dementia like she has had for many years but she was still able to respond to my questions. the only problem with her was her morning lab values showed a decline in her kidney function. we got a renal consult yesterday and they decided to leave her in the hospital for one more day. so instead of sending her home we kept her for another night expecting to discharge her today. well, when we came in at 6am this morning to get our patient assignments, our intern told us she was transfered to the ICU. they did stat CT abdominal scans on her because she was complaining of stomach pain. after doing the scan we found out she had cancer all over her liver. it must have been there for a year or so and she hadnt shown any symptoms until now. She was transfered from the medicine ward to the ICU and her family decided to make her DNR.   When we rounded [the first time we did so on the wards] my attending spoke with her son and daughter and they decided to bring her home and give her hospice care.  it was such a quick decline and it left us all wondering how the hell she had been asymptomatic up until now.

After eating lunch, nicole and i went with one of our interns to a skilled nursing/rehab facility a couple blocks from the hospital. our attending helps run it and takes care of lots of patients there. Twice a week he sends his interns [and us] to write progress notes of some of the patients. i did a note on a lady with dementia, arthritis, bipolar disorder, etc etc. She was sweet but had a lot going on. anywho, went spent a couple hours there and left around 3:30. it was the shortest work day i had yet [9.5 work day is short these days].

IM Day 2

the day started at 6am at the hospital [actually at 4:30 when i woke up and commuted to work]. myself, nicole and one other student met with the 2 interns on our service and we divided up patient progress notes. we have all morning to write their notes except we have to come back to the conference room for a case presentation lecture at 7:30. the case is presented by the student that did overnight call and he talks about the patient he admitted. today it was a 49yo M with abdominal pain for 3 weeks. there was obviously a lot more to the case but once we got to building a differential list, we went around the table each saying a disease. as we were finishing up the case and getting ready to work on our notes again, an intern stopped us and said, "for the rest of your career you are going to be asked for differentials. if you ever get stuck, say cancer or thyroid disease. they always work." good to know...

couple thoughts:
-one of my patient's today was named Dorothy. she was 86, confirming the fact that i am the only person under 80yo that has the name.
- the hospital i am in has a pretty big residency program and there are 12 interns in each year. i am still trying to figure out which of the interns are hooking up and which hate each other.
- a bunch of the interns today were talking about the christmas party they are having tonight, its gonna be fun to see them all hungover at 6am tomorrow
-i just got really excited when i found out i can download an iPhone app that is the same program that i use on my computer to study for boards. this made me really excited then made me confirm to myself that i am a huge nerd

Being the chick's again

Monday 2:00pm
We got to the hospital for orientation at 8am. there was around 20 of us medical students starting either internal med, family med or surgery. we listened to more lectures about professionalism and proper handwashing, then took a tour of the hospital. while looking at the ORs and surgery lounge, a surgeon that has obviously been a surgeon for a very long time [imagine grey hair and long white coat] needed to walk through the group and he just laughed and said to the tour guide, "are these all the new chicks? hello chickens," and walked right through the sea of short white coats with 'deer in headlights' faces. it was very appropriate for, lets be honest, we were all starting new rotations in a new hospital and were all pretty nervous. he just chuckled along, obviously having cracked himself up.

after that we got split into 2 groups and we met our attending around 11. Nicole is in the same team as me and word on the street is that we got the cool laid back attending. When he came in for rounds I found out why people say so. He was wearing jeans and our rounds took place in the resident lounge while we occasionally chatted with people that would stop by (compare this to the other group that does rounds starting at 9am on the wards and has to be on their feet walking around until 1ish). I was concerned at first that I wouldnt learn a lot from him since it's so casual but i think the decreased anxiety in the situation will really help us stop worrying about looking bad and just focus on learning medicine. It's always nice to have an attending who's goal is to make you feel smarter not dumber. Though, I'm sure making us feel stupid makes us study harder...

I admitted one patient in the morning. She spoke only Spanish. I think this is gonna be a trend...




Monday, 8pm [having finally sat down to relax]

First day down... I forgot how much the first few days of rotations suck. Its pretty difficult to get familiarized with a new hospital, new paperwork, new residents, and new attendings all while remembering that you are here to do a job and use the stuff we learned in school. I swear the first day always reminds me of how far away I am from being a competent and independent physician. How people remember everything amazes me. Only thing that makes me feel better is knowing everyone else feels the same way.

 The first week of every rotation is a steep learning curve. Trying to remember all the common medicine you should know but forgot. Then trying to not look as bad when you dont remember stuff by spouting random facts about the disease process or treatment plan.
For example, I admitted a patient today who came in from the ER with chest pain and back pain. She had a history of a ton of heart problems [CAD, atrial fib, valve replacement-- she basically had a plastic valve in her heart, a re-plumbing surgery for her heart and a pacemaker to make sure it doesnt ever stop because sometimes, it just decides to stop]. After seeing her labs I decided the patient was hyponatremic and that we needed to give her IV fluids. Next logical question from the intern was "ok, how much?" in my head went a few thoughts like "shit i dont remember, shit why cant i remember, shit what should i say, oh god now i am turning red, uh oh now ive paused for too long and he knows i dont know, shit he knows im incompetent." so after a long pause i say, "we should give her normal saline but im not sure how much because i know the pediatric equation not the adult one." next logical question from the inter was, "thats fine, its similar, what is the peds one and we can talk about how its different." well, again, lots of thoughts ran through my mind and i was already a lil tachycardic at this point and i couldn't figure it out so i just smiled and said "im gonna need to look that up but one we do that we should...." i rambled off some information so we didnt end the discussion on my obvious lack of knowledge.

i make this sound bad but it really wasnt. the intern we are working with is a really sweet guy who is really enthusiastic about helping us learn. i think its more the need to show you belong there that makes us all anxious when asked questions. its like "i studied a lot these last two years, please think i am worth teaching!"

we finished up the day at 5:30 and it took me an hour to drive home in traffic. tomorrow, and every other day after that we have to be at morning report at 6am. its still dark at 6am.