3 admits today. started at 8am, ate from 1-1:30, otherwise was on the go until 6pm. not complaining too much though cause i like staying busy. saw a 2nd year resident butcher a man's neck during a central line. lots of bleeding and 2 attempts later the patient had one in....

two interns today commented on my work, one said, "i hate to say it but your doing a really good job," and the other [the intern with asbergers] said i was the best student in the group because im thorough, efficient and are making my own A/Ps. that felt good.

I really want to bitch about these daily 11-12 hour shifts but I have no one to blame but myself

12 hour shift on friday makes for a boring and early to bed friday night

took out some staples today. it took like 10 seconds and a monkey could have done it but im still excited i got too.

then admitted a 30-something year old M with some major issues. his BNP was over 500 showing he was in heart failure...in his early thirties! he used to drink 30 beers a day from the age of 12 to 25 so that will do it. he also has some ridiculously uncontrolled diabetes and from it, his vision is almost gone and he is in renal failure.... in his thirties!! i have a feeling that this is the first of many of these to be seen in my career...

worked with a new intern today, she was impressed when i picked up a murmur, gallop and non physiologic splitting on this patient. she then asked me how i learned heart sounds so well and wanted me to email her the links i used to listen and learn them. thennnn she said she was going to steal me for the rest of the rotation to work with her :) things are looking up.

revelations

2 things i learned today:

1) the intern i have been working with is most likely autistic

2) the moment i cannot take care of myself and need to go into a nursing home I will sign a DNR

day 3

today was a better day. it started at 7am [like usual] for morning report. picture us all in a large room with a projection screen in the front and our attending standing in the middle of the room controlling the computer.  we started with the patient that i admitted yesterday, the spanish speaking lady. i was hoping he didnt bring up my H&P like he did yesterday [which he ended up yelling at the intern about. he started by pulling up her old echo records from her previous admission, it showed she had aortic stenosis. he then pulled up another cardio consult that said the same thing. "Now," he said, "lets see if the H&P accurately portrays this in the physical exam." he looked over at us [he didnt know i admitted this patient] and when he caught eye contact with me i said, "yes, i did." he smiled and looked surprised and said, "see, this is why i like med students. they always look happy about something." he pulled up the H&P and scrolled to the Cardiac PE and read out loud my documentation of it was read something like "regular rate at 85 beats per minute with a holosystolic murmur heard beast at the right 2nd intercostal space near the sternum." i got a lot of praise from him after he read that, it felt good. hopefully he remembers that for a long time. to be clear, this is something normally expected of me so im not sure why he found it so great but any praise from that guy ill take...

after morning report, we rounded on our patients and then did some other stuff. i had some down time waiting for an admit so i went to hang out in the ER and ended up helping 2 resident suture the lower lip of a 4yo girl who had fallen and cut it open pretty bad. i made friends with her and tried to calm her down as best i could but naturally, she was screaming her head off. she had some calm moments like when i asked her what her favorite color was and she said pink and we bonded over my pink clipboard and her pink shoes. but for the most part, she cried. hell, i would cry too and you put a large ass needle with lidocaine into me and then leaned over me with a needle for 15 minutes.

i had an admit after this on a lady with dermatomyositis. a pretty rare autoimmune disorder. that was kinda cool. then i went home, probably gonna go to sleep by 9pm again.

day 2...

yesterday was a bad day. yesterday was the first day of third year rotations that i drove home crying from pure frustration. i dont know if its some kind of hormone thing or what but the day just couldnt get any worse. this new hospital has the most melancholy staff and the intern i worked with today was a complete idiot and socially enept. that, along with the fact that i spent 4 hours admitting a patient because she only spoke spanish and she wouldnt stop talking long enough for me to hear the translator. she was also a very poor historian and her story was all over the place. when i was driving home i think it was the realization that i had to be there for 4 weeks that made me cry like a baby. its not the work because i have to work long days everywhere, its the fact that i have no one fun to talk or hang around. the interns are all depressed because their residency is terrible and the other 3 students i am working with are boring. people say you can do anything for 4 weeks...i better be able to get through this [not like i have a choice].

new everything

6 months of rotations and its always the same thing. just when you start to feel comfortable with the hospital and become friends with everyone you work with, you end the rotation and you have to move on to the next place.

its just like summer camp. you spend everyday all-day with new people and have some really good and some not so good times. you bond, learn new things and then at the end of it, leave with some new facebook friends. but really, you know you arent gonna talk to them very often anymore and its really just a quick hug goodbye and your off back to your normal life.

 today was my first day at a new hospital and it was a rough day. the last place i worked, the interns were fun to be around. they joked and laughed with us, all while teaching at the same time. we had a fun place to 'hang out' in between working and morale was high...the new hospital i am at is very different.

 the director/ chief of staff doctor is a real morale killer. we had morning report at 7 this morning and for the entire 1.5hours of going over patients, he pretty much just made the interns look and feel stupid. no wonder they all look like they hate their lives. the last place i worked the interns looked tired and overworked too, but they were still happy. no one goes into residency thinking its going to be easy, but when you have someone that makes you feel like shit all the time it really just adds to the stress of the situation. im hoping that i will slowly be able to become friends with these interns as i did the last ones so that my time here does not become completely melancholy. i really do miss my last interns and the friends i worked with there....

we spent the morning doing the obligatory orientation and learning the new system. we werent given very much direction, just thrown onto the ward and told to go see a patient. we also got to figure out the electronic medical record system on our own. went flustered around for a bit then gave up and had lunch around 1 [i was running on 1 tall starbucks coffee from 6:30 am...needless to say i was hypoglycemic and crumpy and about to snap at anyone that looked at my wrong]. we ate lunch and then i got a text from our intern about an admit from the ER.

 [side note: if its one thing i have begun to perfect...its adapting to new situations and environments without getting flustered. ive learned to be patient, breathe and just realize that at some point, im gonna do something wrong, screw something up, and get scolded for it. its just the name of the game and im prepared to apologize and move on. being a 3rd year is all about apologizing and moving on without taking criticism too seriously...but thats another topic for another day. lets just say my skin is a hell of a lot thicker than when i started this whole mess.]

they admit took a couple hours and then i dictated my admission history and physical over the phone. then i found out a resident was doing a central line down in the ICU so i jumped down to the first floor to see it. the other 3 students on my service were already there. they had just seen one done on a patient and then getting ready to do another one on a young guy who was under precautions for suspected TB. this was the first time i had seen a central line placed and it didnt go to smoothly. the pt had a big thick neck so even with ultrasound guidance, it was hard to get the needle into the jugular. we spent a while doing it and had to push 2mg of morphine while we did because of the pain we put him in [when i say we i mean the resident, we just watched and helped her]. its sad, but one of my thoughts was feeling sorry for this kid because he had such an unexperienced doctor doing it with no attending supervision and it could have gone a lot smoother if someone was helping her. when we were finishing up his heart rate was in the 200s and we had to push drugs to get it down. it wasnt as dramatic as it sounds but it wasnt an uneventful procedure either. i pray he doesnt get an infection but i would think the chances of getting one are pretty high. one of us med students got to suture the line down and i hopefully will get to do one in the near future [suture, not the central line. that shit is scary and i wanna see a lot more of them before i attempt one when im a resident. and ill make sure to have an attending there...] ok now im just rambling. i need to go to bed since i have to be back in the hospital again soon.