I love to watch procedures and try to get involved as much as possible. whenever i hear of something I asked the resident who is going to do it if i can help. this time, it was a third year resident who i have known since last year through Montclair clinic, Dr.S. I watched him put in the central line and it went flawlessly. he was very quick and impressive, nothing at all like watching the first year interns. it really does take lots of practice to perfect these things.
he asked me how much longer we had in the rotation and i told him another week. he then said, "ok, you should be able to do one before you leave." i was STOKED.
Friday, February 3, 2012
Thursday, February 2, 2012
ICU
we had a pt that was in the ICU this week. 40yo hispanic women who had breast cancer. she had treatment in Mexico along with a mastectomy but nothing helped, the cancer spread and when she got to us, she was on a respirator and not conscious. if you looked at her chest, her cancer had come out from her breast to her skin and was spreading all over her skin. it was a very sad sight. she had scar tissue from the surgery as well and the whole sight was very shocking.
i happened to be in the same area when the pulmonologist was reviewing her CXR and it was breathtaking. i had never seen such a dense x ray of consolidations. she explained that everything in her lungs was lymphatically spread cancer and that this women was going to die in a matter of hours or days.
her family was notified of all the findings and they decided to take her off the ventilator. there were 20-30 people in the ICU that day. they asked the family to leave and the nurses gave the patient morphine then took her off the ventilator. her vitals stayed up and the family was invited back into the room. about 3 hours later the patients stopped breathing on her own and died. i was not there at the time but did come back downstairs as the family was visiting and paying their respects. they stayed for a good amount of time after and then it was quite again in the ICU. she was only 40 years old.
i happened to be in the same area when the pulmonologist was reviewing her CXR and it was breathtaking. i had never seen such a dense x ray of consolidations. she explained that everything in her lungs was lymphatically spread cancer and that this women was going to die in a matter of hours or days.
her family was notified of all the findings and they decided to take her off the ventilator. there were 20-30 people in the ICU that day. they asked the family to leave and the nurses gave the patient morphine then took her off the ventilator. her vitals stayed up and the family was invited back into the room. about 3 hours later the patients stopped breathing on her own and died. i was not there at the time but did come back downstairs as the family was visiting and paying their respects. they stayed for a good amount of time after and then it was quite again in the ICU. she was only 40 years old.
Wednesday, February 1, 2012
nurses
i realize that nurses 'run' the hospital and that i should be really nice to them because they could make my life a lot harder. but some of them are really freaking mean.
Tuesday, January 31, 2012
email from school rotations coordinator. subject line: 'February- Burn Out Month'
Good afternoon Class of 2013,
February tends to be the medical student month of burnt out. The holidays are over and valentine’s day is depressing. You are bored with and or annoyed by your rotations. You’ve had at least one mildly traumatizing rotation and have likely had at least one major life change (break up, loss of a loved one, financial change, new child).
It is around this time when students relax into a place of snarky irreverence that leads to uncomfortable conversations with me. For those of you who are maintaining your professional skill set you may be struggling with a mild form of generalized anxiety disorder or depression. Unfortunately, this is normal.
There is a common sense approach to staying healthy and (sort of) happy…
Here is my list of recommendations for “How to avoid awkward meetings with Dr. White.”
1. Get some rest – sleepy students are grumpy students. And grumpy students act out.
2. Avoid sugar and carbs Monday – Friday. Nuts, berries and chopped veggies make excellent snacks.
3. Spend time with your non-medical friends. You are making each other bonkers – go get some perspective.
4. Plan a weekend away or a really fun date.
5. Make time for exercise. Stretch your neck and back daily and take the stairs.
6. Remember to say “please” and “thank you”
7. Continue to follow S – O – A – P format in your notes and presentations. “This fat guy needs more insulin” is not an assessment.
8. Ask for feedback at least once/week from your preceptor or resident.
9. Read about your patients each night.
10. Ask for help.
Hang in there. Spring is coming.
-Dr. W
February tends to be the medical student month of burnt out. The holidays are over and valentine’s day is depressing. You are bored with and or annoyed by your rotations. You’ve had at least one mildly traumatizing rotation and have likely had at least one major life change (break up, loss of a loved one, financial change, new child).
It is around this time when students relax into a place of snarky irreverence that leads to uncomfortable conversations with me. For those of you who are maintaining your professional skill set you may be struggling with a mild form of generalized anxiety disorder or depression. Unfortunately, this is normal.
There is a common sense approach to staying healthy and (sort of) happy…
Here is my list of recommendations for “How to avoid awkward meetings with Dr. White.”
1. Get some rest – sleepy students are grumpy students. And grumpy students act out.
2. Avoid sugar and carbs Monday – Friday. Nuts, berries and chopped veggies make excellent snacks.
3. Spend time with your non-medical friends. You are making each other bonkers – go get some perspective.
4. Plan a weekend away or a really fun date.
5. Make time for exercise. Stretch your neck and back daily and take the stairs.
6. Remember to say “please” and “thank you”
7. Continue to follow S – O – A – P format in your notes and presentations. “This fat guy needs more insulin” is not an assessment.
8. Ask for feedback at least once/week from your preceptor or resident.
9. Read about your patients each night.
10. Ask for help.
Hang in there. Spring is coming.
-Dr. W
trying to sound educated in dictations
Mike dictating in the call room with us all sitting around studying and trying to ignore him:
"pt took several ambien last night and was unable to be aroused by his wife this morning." -Mike
all of us start dying laughing and mike looks up, gets all confused, then puts the dictation on hold and asks, "what?" [not knowing at all what he just said].
after explanation, he said, "what! well how else can you say that?"
"well, you could just say 'patient was unable to be woken up by his wife this AM'...." -me
"oh. oops." -Mike
[i almost wish we didnt say anything so the attending could have read this and pointed it out in morning report tomorrow. hahaha]
"pt took several ambien last night and was unable to be aroused by his wife this morning." -Mike
all of us start dying laughing and mike looks up, gets all confused, then puts the dictation on hold and asks, "what?" [not knowing at all what he just said].
after explanation, he said, "what! well how else can you say that?"
"well, you could just say 'patient was unable to be woken up by his wife this AM'...." -me
"oh. oops." -Mike
[i almost wish we didnt say anything so the attending could have read this and pointed it out in morning report tomorrow. hahaha]
Monday, January 30, 2012
yeah...ummm
"yeah....um, I was just going to ask her that..."
-response any medical student will give when they get caught having not asked a question that should have
example:
[while walking to the patient's room with the resident]
resident to med stewie: "What is her height, we need her BMI."
med stewie (scrambling): "yeah....um, I was just going to ask her that..."
resident to med stewie: "did you ask her what she wants her code status to be?"
med stewie (scrambling): "yeah....um, I was just going to ask her that..."
and of course:
resident to med stewie: "Did you do the DRE?"
med stewie (scrambling): "yeah....um, I was just going to ask her that..."
-response any medical student will give when they get caught having not asked a question that should have
example:
[while walking to the patient's room with the resident]
resident to med stewie: "What is her height, we need her BMI."
med stewie (scrambling): "yeah....um, I was just going to ask her that..."
resident to med stewie: "did you ask her what she wants her code status to be?"
med stewie (scrambling): "yeah....um, I was just going to ask her that..."
and of course:
resident to med stewie: "Did you do the DRE?"
med stewie (scrambling): "yeah....um, I was just going to ask her that..."
don't fuck up
Today our hospital director [and apparently very rich doctor] rented out a room at Flemings steakhouse for dinner and fed all of the students, residents, and some local doctors. we all got off at 5:30 and were expected to be at dinner at 6:30 [we didnt have a choice, we had to go...i guess i cant complain since it was probably around $80 a person and it was an incredible meal]. he does this once a month and one of the residents told us he drops like $2,500-4,000 a month on it. his own personal money. kinda ridiculous.
kinda of an odd moment is when he had his lawyer friend talk to us for 45 minutes about how to avoid being sued, " because lets face it, most of you will be."
apparently its inevitable?
his first piece of advice: "don't fuck up."
his second piece of advice: "have a good bed side manner and even if you dont care, make your patient think you do. patients do like to sue doctors they like."
life lesson learned. thanks?
kinda of an odd moment is when he had his lawyer friend talk to us for 45 minutes about how to avoid being sued, " because lets face it, most of you will be."
apparently its inevitable?
his first piece of advice: "don't fuck up."
his second piece of advice: "have a good bed side manner and even if you dont care, make your patient think you do. patients do like to sue doctors they like."
life lesson learned. thanks?
Sunday, January 29, 2012
2 weeks down...
i worked 72 hours this week and 60 last week. im fucking tired.
yesterday the last thing i saw before i got off was a 40something year old lady being wheeled in on a gurney by paramedics, strapped onto a board with a c-spine collar on. she was crying and yelling. i read the EMS report:
"42yo F found laying on grass unconscious. when patient came to, she admitted to drinking 2 bottles of vodka this morning and then falling off her bicycle."
love the ED. you cant make this stuff up.
yesterday the last thing i saw before i got off was a 40something year old lady being wheeled in on a gurney by paramedics, strapped onto a board with a c-spine collar on. she was crying and yelling. i read the EMS report:
"42yo F found laying on grass unconscious. when patient came to, she admitted to drinking 2 bottles of vodka this morning and then falling off her bicycle."
love the ED. you cant make this stuff up.
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