Welp here I am. In the middle of Illinois on an amtrak train from Chicago to Springfield on a Wednesday afternoon. Its beautiful outside so its a pretty ride. A nice time to reflect on what the last month has been. I cant help but keep thinking how difficult this whole process is and how much stress I am under. I try to suppress it, try to relax, try to enjoy all the traveling but its the uncertainty of everything that keeps making me want to curl up in bed and sleep for days.
Physically I am out of shape and am constantly getting sick, which makes sense with all the stress and working in the ED seeing kids and adults come in one after another with fevers, pharyngitis, pneumonias, you name it. I am also working in a new city with new bugs/ viruses that my body has never been able to adapt to so im not suprised by my lack of fighting capability. Also, I have stopped working out all together and I feel so gross.
But emotionally, I am also out of shape. I just want to know where I am going. Its hard to live each day thinking /worrying about the future rather than living day-to-day. I am in Chicago, one of my favorite cities, and this whole month is kinda tainted with interviews and stress. I really really want to live here and go to residency in this incredible city but its just not that simple. Too many other factors are contributing. And i keep thinking, as much as I would love to go to Arrowhead and get incredible training there, what are the chances that I will meet a guy in the inland empire. Versus coming to Chicago and meeting a cute, smart, nice midwestern guy....which they have plenty of. This decision isnt just about where I will be trained best. It is about where my life will be best.
My 3 interviews in Michigan went well, but as much as I want to be excited about them, i'm not. A couple of the programs were great, the people were friendly and the hosptals nice. but when it came down to it, i know how unhappy I would be living in the middle of Michigan, far removed from a nice big city and loved ones. and really, im just not feelin Michigan.
Then, I had another interview in Michigan at a hospital in St. Joseph. It is right on Lake Michigan, 1.5 hours drive from Chicago. It was beautiful. Now this, this is a place I could get used it. The people were great and so was the location. So now I have another DO program I am considering. Its close to Chicago, so I could still come to visit and see familiar faces and its right on the lake so I can enjoy the time I have off. Its got me a little worried though, would I rather go here over Arrowhead? The little things are coming into play now too. The factors of free food, 8 hour shifts vs 12 hour shifts, cost of living, etc. I wish my mind wouldnt consider these factors but it has...and it constantly is. No day is ended until I ponder my choices whether it be on a train, car ride home or while falling asleep. Its exhausting. Im exhausted.
Wednesday, December 5, 2012
Sunday, December 2, 2012
Thursday, November 29, 2012
Resurrection Interview
This was it, the moment of truth. Interviewing at the program that I decided in November of 3rd year that I wanted to go to....
Wednesday, November 28, 2012
Lakeland Regional, Michigan
I worked Tuesday from 7am to 3pm and then walked to the car rental place, got my car and drove the 2.5 hours to St. Joseph, Michigan for my Lakeland interview. I missed the residents dinner that was planned for 6:30pm. I wish I would have gotten here sooner because when I got to the hotel that THEY paid for, I was in for a huge surprise I walked into the room to find a 2 bedroom suite with a Jacuzzi tub. Jackpot! I took a nice warm bath, at my late dinner and unfortunately had to go to bed pretty soon after I got there because we had to be at the hospital early. It was a long day and I had another long interview day ahead.
The interview day was really impressive. I have heard great things about this hospital on the interview trail and those people were not exaggerating. Its a brand new facility, right on Lake Michigan in a beautiful area. The hospital itself is nicer than most hotels I have been staying at. Waterfalls in the front lobby, gorgeous patient rooms, elevator music playing throughout the hospital. Honestly, I wouldnt mind spending 4 years in this place. I had 2 interviews and both went really well. When I sat down with the PD the first thing he asked my was, "So, how was Arrowhead and how is Dr. M.” Apparently they are good friends. We had a good chat and he, along with so many interviewers, mentioned my glowing letter of rec from Arrowhead. He ended the interview on a great note of “any program, including ours of course, would be very lucky to have you. You are an incredible candidate with tons of experience and glowing letters of rec.” That was a nice little ego boost, I'll take them when I can get them!
Its funny how interviews can make you feel completely inadequate or just the opposite, like a rockstar. I felt great after that interview and decided that this was a place I will definitely be ranking.
After the interview I got into my rental and drove back to Chicago. I had to get back by dinnertime because I had my pre-interview resident dinner for my Ressurection interview the next day! I won't lie, I was thrilled to get back to Chicago to interview for my dream program. But, Lakeland was a very impressive place that made a resting impression on me. Before I left, I spoke with the coordinator about setting up a shadow day while I was still close by in Chicago.
The interview day was really impressive. I have heard great things about this hospital on the interview trail and those people were not exaggerating. Its a brand new facility, right on Lake Michigan in a beautiful area. The hospital itself is nicer than most hotels I have been staying at. Waterfalls in the front lobby, gorgeous patient rooms, elevator music playing throughout the hospital. Honestly, I wouldnt mind spending 4 years in this place. I had 2 interviews and both went really well. When I sat down with the PD the first thing he asked my was, "So, how was Arrowhead and how is Dr. M.” Apparently they are good friends. We had a good chat and he, along with so many interviewers, mentioned my glowing letter of rec from Arrowhead. He ended the interview on a great note of “any program, including ours of course, would be very lucky to have you. You are an incredible candidate with tons of experience and glowing letters of rec.” That was a nice little ego boost, I'll take them when I can get them!
Its funny how interviews can make you feel completely inadequate or just the opposite, like a rockstar. I felt great after that interview and decided that this was a place I will definitely be ranking.
After the interview I got into my rental and drove back to Chicago. I had to get back by dinnertime because I had my pre-interview resident dinner for my Ressurection interview the next day! I won't lie, I was thrilled to get back to Chicago to interview for my dream program. But, Lakeland was a very impressive place that made a resting impression on me. Before I left, I spoke with the coordinator about setting up a shadow day while I was still close by in Chicago.
Friday, November 23, 2012
Loving this program
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!
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!
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...
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