First day off in 33 days! Hello sunshine :)

Wednesday night turned into a later night then it was supposed to be.....I got an admit at 9:30pm and headed to room 18 in the ER. i was told by my resident that the pt was a symptomatic anemia pt with a Hg around 4. so, i walked i looked at the chart and that was what i found, went into the room and started my interview. I was just finishing up my H&P on her at around 10:30pm when the ER attending came into the room and said hi, who are you? I told him i was the family medicine student that was admitting his patient and he said, "think you have the wrong room because I just called medicine to admit her. there is another anemic pt in room 20 that is probably yours, i would go check that out." welp, i left the room feeling like a complete idiot only to find out that my pt had  been switched to room 20 and this pt had the same problem, symptomatic anemia with a Hg of 4. god damnit. i ended up spending a hour with a patient that wasnt even on our service. got done around 11:30pm having gotten to the hospital at 10am.


Today I was on day admit so we rounded in the morning and then had the day to kinda do whatever basically waiting for admits. so, i decided to use my time wisely and spend it in the ER. I saw my old friend Krista from SDSU who was doing her ER rotation and hung out with her for the afternoon.  i ended up seeing a halo be put on to a man's head to stabalize his C spine fracture and then started an IV on another patient after asking the nurse very nicely if I could. hit it in one try, did a pretty good job i think. the nurse said i did a great job knowing this is only the 2nd one i had done.

waiting...

Well, day 3 of family medicine which is not family medicine, it is internal medicine. We admit patients, round of patients, follow them to discharge. Granted, I am sure I will continue to learn a lot and this will help me for fourth year but the hours suck. Monday I left "early" (around 4 but still had a 7 hour day). I was feeling sick and ended up throwing up in the ER bathroom right before I was going to do an admission. I left early which probably wasn't the best first impression on my team (4 med students and a resident) but whatever, I felt like shit. When I got to work on Tuesday I heard the students saying "we got slammed with admits" only to find out they added 4 patients- meaning they each did 1 admit. I'm not sure if it's just this service or what, but I've rounded, admitted, consulted on a lot more patients...by myself. i didnt feel too bad about leaving after that.

Tuesday I worked 8am till 4pm which was great. But sadly, this is the shortest shift I will have and it won't happen often.

Today I am working from 10am to 11pm. Got here at 10, wrote notes (I had 1 patient...not too crazy) rounded at 3 to 4:30 and then sat in the residence/student lounge and waited for admits.

Tomorrow I will do the same shift, 10am to 11pm. Then I have Friday off, work 8am to 8pm Saturday then off on Sunday. Then we start nights next week, 8pm to 8am.

I'm not really enjoying it but maybe I will later once I get the hang of it. Haven't done or seen anything too exciting yet

Family Medicine Inpatient

"FMI, or as i like to call it, FML" -resident

bittersweet

Wednesday was pretty remarkable as I did an I&D basically by myself and got to use the Bovie [the cauterizer]. that was a major power trip :)

Thursday Dr. B came back and we met him at clinic in the afternoon. There, we followed up with the gastrectomy patient from last week [the one in which i had my arm in her abdomen] and the lipoma man. I got to see my sutures and they looked pretty good. We took them out and Dr.B joked that my side looked better than his side [which obviously wasnt true but it was nice for him to try to boost my confidence]. This was my last clinic day.

Friday we had several breast lumpectomies and then we put in a central venous port for a women that was going to need constant venous access for her chemotherapy. I got a ton of suturing experience that day; did sub-cuticular running, sub-cutaneous running, and more vertical mattress'. I am proud to say my hand did not shake at all with nervousness on all of these! even the PA noticed and congratulated me :)

Saturday morning was my last surgery and it ended in a perfect way, a lap chole. I first assisted with Captain to my right and it was a very quick and easy gallbladder removal. Ironically enough, after the surgery, I found out that we had just operated on the circulating nurses girlfriend...the nurse that was in the room the whole time. All the joking everyone was doing with him before and during the surgery made a lot more sense when Captain told me this. For example, when Dr.B asked before the surgery if the preg test came back negative...

Today I went to the hospital, rounded on my patients and after meeting a new doctor [and getting her contact info to hopefully do a rotation with her], I was done. Surgery was over and it was a bittersweet feeling. I honestly loved the rotation and cannot explain how much confidence and strength it gave me as a student physician. But at the same time, it wore me down and by the end, I was mentally and physically exhausted. Doing this for 5 years in a surgical residency is out of the question. I would love it but I do not think I am strong enough for it.

I will have the chance to be in the OR again during 4th year because I have to do a sub-internship for 4 weeks.

limericks by Fanga

There once was a girl named dot

On horses she liked to trot
To do EM (??) = internal strife
Making choices that last all her life!
A crystal ball may assist in her plot.
-Fanga

Last week of surgery...

Thursday was our last surgery with Dr. B before he left the country. We removed a very large lipoma from the neck of an old man. we started out by slicing the superficial skin all the way around and under his chin. after lots of dissecting and digging out the fatty mass, we began to close up. Dr. B started on the right side and I started on the left side and he had me do vertical mattress sutures until we met in the middle at the chin. It was great practice, I put in at least 20 of them. It was def frustrating at times as I was just starting to get the hang of the instruments but it was very very fun.

Friday we started working with Dr. E who works more than any other doctor I have worked with. It was good Friday so I got the night off since I had to... go to church.... after church, I went to joey and laura's birthday party and got home around 2am. Saturday I got up at 6am and was in a lap chole by 7:30. I had no idea that this shift would end up being around 18 hours long....if I had known, i might have gone to bed a bit earlier.

Sunday was Easter and I got the afternoon off. Monday I joined another doctor and the Captain for an exploratory laparotomy for a SBO. It was on a patient that I admitted and had been following for more than a week and it was a great way to see the whole course from her admit, hearing her symptoms, doing her PEs, looking at her imaging and labs, and then being able to actually see the anatomical reason she was having all of these problems. Surgery went long, about 4 hours, and when they started to close the doctor suggested I go talk to the family and tell them everything was OK. Since i had met the family several times, I was happy to go outside to the waiting room and explain that everything went great and the biopsies done during the surgery were all benign. They thanked me a ton and treated me like a key part of the surgical team. A very cool experience to end 'my patients' journey.

To note, during this surgery was when I decided as much fun as surgery is as a specialty, it is not for me. It was a 4 hour long surgery and though it was not boring at all because we were searching around in this women's pelvis and I got to touch intestines, see her uterus, where the sigmoid colons sits, etc etc....there were several times when I just about lost my patience and drifted off. I dont think i have the stamina and patience to do surgery's like this. it would be very hard to start a case thinking it will be quick and then you can get home to your family/friends for dinner after only to find out when you open that things are much complicated and you are going to be there for hours longer than you thought...having no say in the matter. I enjoy my free time and though it is a tremendous job to have because of the healing power and abilities you have, I think i will stick to ER. It has the procedures and fun patient interaction but with a set time shift.