Chicago is incredible. Its the perfect city. A great mix of nightlife, good fun people and midwestern feel. Living here for residency would be a dream come true. And the program I am working at would be a wonderful place to train. Such a diverse mix of patients, pathology and trauma mixed it. I am getting good feedback from residents and faculty and have a really good feeling about the program. One of my favorite attendings has a mix between cocky, abrasive, and teddy bear ish-ness. His bark is much worse than his bite. After a few shifts with me he said, “I like you. your smart. I would be OK with you coming here for residency.” Coming from him, this is a huuuuge compliment.
Dr. V is our student coordinator and hes awesome. So great to work with. Incredibly smart, nice [and pretty darn good looking too]. Every attending and resident I have worked with has been a pleasure to be around and learn from!
On the flip side, I just got my eval from the program I worked at in Brooklyn and they did not think I did as stellar. Its a weird feeling because I also had great feedback from attendings and residents but obviously something went wrong. To be honest, its not somewhere i would want to go but im still bummed. Actually i am a little angry also considering i worked so hard and spent a lot of time and energy to get a good eval and it turned out to be mediocre [at best]. Morale of this story is you win some, and most definitely lose some!
Friday, November 23, 2012
Tuesday, November 20, 2012
First ED Intubation
I did it! The first of what will eventually be a daily normal event in my career. I intubated a patient in the emergency department. I did it with the attending behing me and many people watching, waiting for me. Not to mention the patient that was de-sating on the gourney... Here's a detailed account of an event I will NEVER forget:
He came in by EMS gasping for air. As we hooked him up to the monitors and got IVs started on him all he could say was “im dying, please don’t let me die.” He looked like crap. He was using every accessory muscle he had to breath and even still satting in the 80s. Dr. R told me to sign up for him, he was going to be my patient. We discussed what was going on with him and what we were going to do with him. First we will try bipap lots of nitro, lots of lasix and then if he still is not improving we will probably have to intubate him. After giving him 30 minutes on bipap and lots of medications later, he was still not improving. I was sitting in the front charting on a computer when Dr. R walked up to me:
“Dorothy, we’re gonna need to intubate your patient.”
“Ok. Yeah I agree, he still looks like crap. So, what kinda blade do you like to use?”
“Doesnt matter to me. Your the one thats gonna be doing it.”
[huge smile on my face]
“Have you done this before?”
“Ive done an anesthesia rotation and intubated in the OR but not in the ED. This was be my first”
“OK well lets go. Theres a first time for everything and this might as well be it. ”
We walked into the patient's room and there were a couple nurses, the respiratory therapist, Dr. R, me, and of course the worsening patient. I tried to remain calm and not let my heart rate sky rocket but it was inevitable, i was pretty nervous. I got my equipment together, checked the light on my blade, got a 7.0 ET tube and put in my stillette. Got my ambu bag ready and we discussed what meds we were going to use. The whole time Dr. R was being his normal, semi-abbrassive self [which i was pretty use to at that point, i knew it was all a big act]. He was trying to make it a lil more stressful just to see how I dealt with the situation i think. We were about to push the meds and everyone went quiet and I had at least 7 pairs of eyes on me by this point.
Dr. R leaned over to me and not too softly said, “Im only gonna say two things to you: if you dont see the chords, dont try to pass the tube. and dont fuck this up.” [he then smiled and that was his way of letting me know he was there to help if i needed it]
“Yes Sir”
We pushed the Etomidate, then the Succ, we waited for him to de-fasiculate and then it was showtime. I saw his chest stop rising and no more condensation on the ambu bag. I took it off and confidently put in the Mac 4, lifted up towards the corner of the room and then looked for the chords. It took about 15 seconds [which felt like eternity] and I heard Dr. R say "what do you see?"
"epiglottis” I pulled back a little bit and then said “tube please.”
“you sure you see them?”
[in a much more confident and authoritative voice] I said “Yes, I see the chords, tube please”
I didnt take my eyes off the chords and someone placed the ET tube in my hand. I slid it in and watched it go between the chords. I gently took the mac blade out, hooked up the CO2 monitor, someone inflated the cuff and we watched for color change.
“good color change” -resp therapist announced
Dr. R took the blade and looked to make sure the tube was placed in the right spot.
“yup she got it. good job”
Thats all he said but i knew he was proud of me. I did it. I intubated my first patient in the ED, on my first attempt ever. Damn i felt like a rockstar.
and so my career as an ED doc has begun...
He came in by EMS gasping for air. As we hooked him up to the monitors and got IVs started on him all he could say was “im dying, please don’t let me die.” He looked like crap. He was using every accessory muscle he had to breath and even still satting in the 80s. Dr. R told me to sign up for him, he was going to be my patient. We discussed what was going on with him and what we were going to do with him. First we will try bipap lots of nitro, lots of lasix and then if he still is not improving we will probably have to intubate him. After giving him 30 minutes on bipap and lots of medications later, he was still not improving. I was sitting in the front charting on a computer when Dr. R walked up to me:
“Dorothy, we’re gonna need to intubate your patient.”
“Ok. Yeah I agree, he still looks like crap. So, what kinda blade do you like to use?”
“Doesnt matter to me. Your the one thats gonna be doing it.”
[huge smile on my face]
“Have you done this before?”
“Ive done an anesthesia rotation and intubated in the OR but not in the ED. This was be my first”
“OK well lets go. Theres a first time for everything and this might as well be it. ”
We walked into the patient's room and there were a couple nurses, the respiratory therapist, Dr. R, me, and of course the worsening patient. I tried to remain calm and not let my heart rate sky rocket but it was inevitable, i was pretty nervous. I got my equipment together, checked the light on my blade, got a 7.0 ET tube and put in my stillette. Got my ambu bag ready and we discussed what meds we were going to use. The whole time Dr. R was being his normal, semi-abbrassive self [which i was pretty use to at that point, i knew it was all a big act]. He was trying to make it a lil more stressful just to see how I dealt with the situation i think. We were about to push the meds and everyone went quiet and I had at least 7 pairs of eyes on me by this point.
Dr. R leaned over to me and not too softly said, “Im only gonna say two things to you: if you dont see the chords, dont try to pass the tube. and dont fuck this up.” [he then smiled and that was his way of letting me know he was there to help if i needed it]
“Yes Sir”
We pushed the Etomidate, then the Succ, we waited for him to de-fasiculate and then it was showtime. I saw his chest stop rising and no more condensation on the ambu bag. I took it off and confidently put in the Mac 4, lifted up towards the corner of the room and then looked for the chords. It took about 15 seconds [which felt like eternity] and I heard Dr. R say "what do you see?"
"epiglottis” I pulled back a little bit and then said “tube please.”
“you sure you see them?”
[in a much more confident and authoritative voice] I said “Yes, I see the chords, tube please”
I didnt take my eyes off the chords and someone placed the ET tube in my hand. I slid it in and watched it go between the chords. I gently took the mac blade out, hooked up the CO2 monitor, someone inflated the cuff and we watched for color change.
“good color change” -resp therapist announced
Dr. R took the blade and looked to make sure the tube was placed in the right spot.
“yup she got it. good job”
Thats all he said but i knew he was proud of me. I did it. I intubated my first patient in the ED, on my first attempt ever. Damn i felt like a rockstar.
and so my career as an ED doc has begun...
Sunday, November 18, 2012
Chicago!
Done with Michigan...for the time being. Now I am in Chicago starting a new rotation tomorrow at a program that I have been wanting to to go since last October. Its a perfect mix of community medicine in Chicago with a great mix of rotations through the city. I am really excited and ready to work my ass off. If I could get into this program, I would be thrilled.
Its gonna be a rough month because I have a bunch of interviews scattered through the month. Actually I only have 2 days the entire time I am here to enjoy the city because every other day I have off I am traveling/ doing interviews. I am already exhausted and so sick of this process but it is still just the beginning. All my ACGME interviews are starting and this is where it really starts to count.
Here goes...
Its gonna be a rough month because I have a bunch of interviews scattered through the month. Actually I only have 2 days the entire time I am here to enjoy the city because every other day I have off I am traveling/ doing interviews. I am already exhausted and so sick of this process but it is still just the beginning. All my ACGME interviews are starting and this is where it really starts to count.
Here goes...
Monday, November 12, 2012
Interviews 3,4,5 coming up!
This week is gonna be rough. Flying to Detroit tomorrow, interview at Botsford on Wednesday, interview at Henry Ford Macomb on Thursday, interview at Genesys on Friday. Then flight to Chicago on Friday. Then starting my new EM rotation on Monday.
Im tired just thinking about it...
Im tired just thinking about it...
Airways; A little less foreign
Last day of anesthesia. It took 7 weeks and I finally feel more confident about the airway. Granted, I still have a lot to learn and I am not going to get difficult airways, but I know how to ventilate and intubate properly. I intubated someone this morning and did everything myself, from pre-oxygenation, bagging, to tubing. It was incredible to see how far I have come. Its an adrenaline pumping couple minutes and one day, I will be doing it alone as an attending in a much more emergent setting.
My entire career will be spent improving on these skills. I am very fortunate to have gotten a wonderful teacher who taught me a solid foundation on saving someone's life.
My entire career will be spent improving on these skills. I am very fortunate to have gotten a wonderful teacher who taught me a solid foundation on saving someone's life.
Saturday, November 10, 2012
Interview Season
"Interview season: zero money, hurts to be social, gaining weight from dinners, suit starting to smell funny, developing a DVT from traveling.... All for a job that pays less than minimum wage for 4 years." -Jessie
Friday, November 9, 2012
Great Week!
This week I saw my first open heart surgery
I saw egg retrieval from a woman's ovaries and then under a microscope, I saw those eggs get fertilized [in vitro fertilization]. I saw a fetus be created!!
I did several propofol sedations by myself [or at least, with Dr. G by my side "taking orders" from me]. I became much more comfortable with conscious sedation and think I will be able to do this very confidently in the future [thanks to him.]
I am so glad I came back for another 3 weeks, it really helped give me more confidence and experience in techniques I will be using in the ED [except for the open heart surgery and IVF. those are just for fun :)
I saw egg retrieval from a woman's ovaries and then under a microscope, I saw those eggs get fertilized [in vitro fertilization]. I saw a fetus be created!!
I did several propofol sedations by myself [or at least, with Dr. G by my side "taking orders" from me]. I became much more comfortable with conscious sedation and think I will be able to do this very confidently in the future [thanks to him.]
I am so glad I came back for another 3 weeks, it really helped give me more confidence and experience in techniques I will be using in the ED [except for the open heart surgery and IVF. those are just for fun :)
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