Happyland, USA

It's always hard to imagine that places exist in which people simply live happier, but they do.  I mean, truly, deeply, genuinely happy.  It's downright enraging if you live in a place like New York, because it makes you feel like your anger is unnecessary, and New York is the sort of place in which anger is in your bones and leaching it out would make you weak, barely able to stand.  To be in a place that is happy is to imply that happiness, like melancholy, is a place one inhabits, can get stuck in and finally break free of.

Despite having just taking a vacation in June, I was scheduled for another for the second half of September.  I barely gave any thought to where I wanted to go or what I wanted to do, because the last vacation had been so recent and I really didn't need a mental break the way I did last time.  I toyed with the idea of hitting India or just bumming around home, when my best friend M suggested I see my friend C in California.  C, who I have known since I was twelve and is a member of my core girlfriends, basically left home at age 18 for college and simply never looked back.  She has done world tours on a shoestring (and now ties a sari better than I can), tracked tortoises in the Nevada desert, performed field research in the Galapagos and finally settled in Santa Barbara for grad school.  She is terribly clever, and quite simply one of the best and most patient people I know.  I hadn't seen her properly for about two years, with the exception of all-too-brief evenings together when she happened to come home.  She was only just in the process of setting up her SB arrangements when I asked her to come by and visit.  Needless to say, she was all over it.

The thing about California is that, despite the casualness which everyone tries to exude, it is a land of extremes.  As I write this, I am in an airport shuttle on a highway wisely nestled between steep, chopped hills and the rolling, foamy sea.  A mist has settled over us, masking the red sun, and giving the eerie illusion of a Maine november.  At every turn is Latin cuisine that makes you wonder why anybody in New York even attempts mole chicken, or wine that makes you drop $80 on a cross-country shipment without thinking twice.  The nerds at Lenovo throw a seriously wild party, the roads move at 85 mph without the slightest hint of impatience, and everywhere you turn, someone is bending over to extend you a courtesy that you didn't even ask for.  It is, as they say, easy living.

But, spending time here long enough, one wonders what the difference is.  Does it really boil down to year-long sunshine?  Temperate weather?  The knowledge that a hazy morning really will burn off into clear afternoon air, every single day?  In principle, I don't believe in running away as a method of resolving an issue, although I am a person who often feels the urge to run / turn her back / cut things off when she isn't happy.  But the more I travel, the more I wonder whether New York, with all its neuroses and dissatisfactions, is really the place for me.

Waterworld

I'm not sure if it's true in other parts of the country, but New York loves to hype up natural disasters.  This past winter, the various dumpings of snow led newscasters to label the winter storms with such monikers as "Snowgate" and "SNOWMAGEDDON!!!"  It led a lot of people to stop taking weather reports seriously, as well as the Fox News team in general.

Somehow, the dude upstairs had something else in mind this week, though.  Post-call last week, I woke up sometime in the afternoon to feel a rumbling.  I assumed it was the local freight train that comes through once or twice a day and gives my apartment a mild vibration, but when it intensified and became more irregular, I briefly woke up and thought to myself "Hmm, must be an earthquake.  Okay." and went back to sleep.  My first earthquake ever, and I missed it!!  It wasn't until a few hours later when I hit Facebook that I realized that the earth had moved from virginia to connecticut, with everyone else super-excited for The Great Quake of 2011.  (A guy in Brooklyn even had it tattooed on his arm.)  Of course, there was much mocking to be had - a number of pictures circulating "documenting" the destruction, which depicted a lawn patio table set with one plastic chair mildly knocked over.  Still, it was exciting.

That is, until the news team seized on Hurricane Irene, steaming up the Eastern Seaboard.  It was apparently the first hurricane to directly hit the NYC area in several decades, although I remember many summers of very intense thunderstorming and flooding because of the residual tropical storms coming from the Caribbean.  I've seen NYC panic before, but people began to act like the end of the world was approaching.  My friends all posted pictures of people lined outside the Trader Joe's, beating each other down for the last biodegradable container of wasabi peas, while my parents brought in the goldfish from the pond and stocked up on sandbags from Home Depot.  My own home base became a part of the mandatory evacuation zone, and so all 40 patients had to be removed from the facility, as well as a number of my co-residents who lived in the area as well.

But for me, it became an exciting chance to hole up and go back to basics.  My new boyfriend Z asked me to spend the weekend safely ensconced together, so I "evacuated" him from the Upper East Side and we drove together to Brooklyn, to spend it with his friends J&J, a fabulous couple about whom enough sweet things cannot be said, as well as his close friend S.  We hung out, ate pizza, watched Star Trek, played Settlers and Starcraft (I took a nap for that last part) and just had a million laughs.  Around 3 am, we went up to the roof to watch the hurricane kick into action, and as the wind blew the trees over and the rain poured sideways, I started to feel infused with an incredible awareness and connection to the force we were witnessing together, something I rarely feel since leaving the windy streets of Chicago.  We woke up the next morning to eat bagels, lazy around, and take bets on who would be able to escape their Monday morning responsibilities.  (I wasn't.)

Like the storm, I came into the weekend with an intense fever pitch and left in a calm, deeply contented state.  My neighborhood had a downed tree or two which smushed a few cars, but we were otherwise well for the wear.  The home base hospital still hadn't opened, but maintenance crewed and residents began trickling in.  Everyone showed up to work more or less in one piece, and we resumed the work of the day without a backwards thought.  Except for the occasional twig out of place, we had all moved on.      But in my head, I treasured having two whole days to feel gratefulness and even joy.

Death and Birth

It's been about a week and and a half, and my return to Shmeens has started a bit smoother than I expected.  Considering how tense and nasty everyone was acting the last time I was there, I clamped down and tried extra hard to be sweet to everyone I spoke to.  I encountered a nurse or two who I had gotten into throwdowns with, and thankfully they didn't remember me, so I was able to start over with them and act extra grateful (even if all they were doing was a basic task).  I would have tried to do this anyway, since I was scheduled to spend a lot of time at Shmeens, but I had a separate reason for doing so.

Without revealing too many details, it is looking a bit likely that my home base hospital may close.  Sadly, this is the story not just for our facility but for many many others in the metropolitan area.  It seems to be a clusterfuck of a situation, for lack of a better word, because all of the hospitals' debt is being called out at the same time that corruption in the governing hospital systems is being called out, at the same time that the state is unable to provide funding despite acknowledging a need for hospitals in underserved areas like ours.  There has been a lot of rallying on the part of the community and doctors and nurses to save our facility from a terrible fate, but I fear that it's just too late for what seems to be a done deal.

The kind of pall this sort of event throws on everyone, it's hard to describe.  When we first heard news (which wasn't even news), the nurses went into a super-chicken mode in which they basically screeched and clucked the news to anyone and everyone who would hear, even if there wasn't anything definitive to report.  There is so much sadness that everyone feels for the community residents, many of whom cannot seek medical help elsewhere because of economics and geography.  The attendings have all gallantly tried to roll up their sleeves to help, but of course must think of their families and so are quietly exploring jobs elsewhere.  Everyone agrees that it's a tragedy of Greek proportions.

This, of course, puts the residents in an uncomfortable position.  Because of the nature of residency programs and spots nationwide, when a program shuts down, residents don't lose their positions - they are typically redistributed to other programs (who happily take on the $150,000 value + resident labor) and the spot is later lost after the resident graduates.  In other words, while the hospital closing creates drama as far as where we will all go, we are not in the same boat as everyone else in terms of job security, and it's hard to look everyone in the eye when they're struggling and we aren't.  This is especially true of the surgical program, because our director is working hard to preserve the program itself as a living structure - to do this, we are trying to shift our home base to Shmeens.

We are very fortunate because we already were spending so much time at Shmeens, running their service and staffing their OR, that the program disseminating would be a massive blow to them.  Additionally, Shmeens once had a residency many years ago and lost it, and there has always been an interest to re-acquire one if possible.  All of our attendings there have been exceptionally supportive of the plan to relocate permanently, and seem excited to have us.  The chairman in particular has shown a lot of enthusiasm to further develop our program and utilize affiliations to create new outside rotations that we can add to our roster and boost our academic strength.  And fortunately, we already share one attending with the home base, to help ease the transition.

I'm not really sure of how I feel about it.  Or rather, I know how I feel, but then I'm overwhelmed by guilt about it.  Our program will have an easier transition by far than the other residencies at the home base, and they are still fighting to stay open.  One in particular will likely be split into two programs, a travesty because that program is quite coveted in the area because of the specialty it trains for.  On my part, I almost wish closure would happen as soon as possible so that we could all move on with Shmeens, but the reality of that would mean expediting the loss of nearly a thousand jobs in a relatively poor area.  Being at Shmeens where it feels safe, I'm taken away from the tragedy and heartbreak.  I don't want to go back.

I'm gonna, gonna lose my baby / so I always keep a bottle near

Amy Winehouse died today, aged 27.  I think it's pretty obvious that it was from her completely unchecked alcohol and drug addictions, but I'm sad nonetheless.  Music got me through a lot of the very low points of medical school, and Amy Winehouse's music really expressed much of how I felt.  I know that she was often falling down drunk at live performances, so I'm including a clip here to show that she really and truly was a talented girl who just couldn't get it together in the end.

Amy, sorry it didn't work out for you.  We'll miss your voice and your soul.

Today's "Oh, crap!" moment of the day is brought to you by justthetip.com

Monday night, 10 pm, on call.  While rounding in another part of the ICU, my intern gets a page that one of our post-op patients is desatting.  She desatted earlier in the day, but we got her back with aggressive suctioning, so my intern leaves to try this out.  2 minutes later, I walk in.

Me: Whoa, she's down to 78%?  That's worse than before... and her pressure's dropped!
Intern: Oh, yeah.
*my friend E, the medical resident on that evening, walks in with his intern*
Me: E!  Oh, thank god.  Listen, she desatted earlier but we got her back with suctioning.  I'm going to bump up her O2 and attach this ventimask while I suction her.  Wait, that's not a ventimask... do we have anything else?
Nurse: Can't you see that I'm BUSY?!  (Gets back on phone)
E: Ok, let's get a second O2 sat monitor, this thing is jumping around and I'm not sure if it's working.
Me: Great idea.  Hmm, this really isn't getting better.  I'm going to sit her up.
Intern: She's only satting 60% now, on this new machine.  And her pulse just dropped to 50.
E: *listening to chest* Nurse, page respiratory - we need a proper mask.  She's not getting adequate ventilation here.
Me: *nearly hysterical* Holy shit, her sat's now 50%.
E: *silent*
Me: *silent*
Us: *simultaneous realization that two 2nd year residents are in charge and nobody more senior is coming to help us*  Uhhhhhhh.....
*300 years pass*
Respiratory: Did someone page respiratory?
Us: OH THANK GOD YES SHE NEEDS TO BE INTUBATED RIGHT THIS VERY SECOND OH GOD OH GOD OH GOD!!!
Respiratory: Ok.  Move.  *Intubates*
Me: Mrs. Jones?  Can you hear me?
Mrs. Jones: *big smile*
Sarada's Ass: Wow, I don't think I'm going to be able to pass stool for days now.

Samaritan Woes

I think it's pretty reasonable that, after awhile of training in medicine, a person starts to imagine scenarios where they get called in to serve.  Usually it's the airplane scene, where someone starts to have chest pain at 30,000 feet and the airline hostess gets on the intercom and says something like "Is there a doctor aboard?" or similar nonsense.  Most practicing physicians say they really dread these kinds of situations, because of the lack of equipment needed and lack of control over the situation.  (Not to mention, the extreme obligation it places on the physician who is escaping an insanely busy practice to get just a few days away with the family.)

It never occurred to me that there would also be an extreme sensation of terror upon getting involved with this type of scenario.

Last night, after lazily laying about all day and watching Hindi movies on Hulu, I got dolled up to meet a girlfriend for dinner and drinks.  I was already running late when I got out of the subway in the West Village and was walking briskly along when I saw a crowd of twenty people surrounding a body lying on the sidewalk outside a shop.  Getting nervous, I asked one of the women standing there what happened, and she said that they just saw this guy lying there and someone had called EMS.  I asked if anyone had checked him to make sure he had a pulse and was breathing, and she said no.

My heart dropped out of my chest.

"Are you kidding me?" was really all I could say.  I crouched down next to the guy, put my purse down next to me, and started getting my hands all over him to look for a pulse, breath sounds, responsiveness, anything.  Another woman asked me if I was a doctor.  "Oh shit," I thought to myself with increasing horror, "I am.  Oh, god."  I realized in a moment of further panic that I didn't even have a stethoscope, and just put my ear to his chest to see if his breathing was appropriate or junky.  I got lucky - he wasn't tachypneic or tachycardic, and sounded pretty clear - he seemed to really have just passed out.

He suddenly got up, and it became apparent that this guy was chronically intoxicated.  We sat him in a chair and I pulled off his hat to check for signs of head trauma, as he reached into his pocket to roll a cigarette (or "cigarette").  He was oriented but clearly confused, as he told me that he had simply tripped going down a few steps into the shop (but somehow fell on his back, above the staircase).  EMS showed up and pulled on some gloves before touching him, and a creeping grossness overcame me as I ran to the bathroom to wash my hands and arms, and soak a paper towel in rubbing alcohol to clean off my left ear as I tried hard not to think about scabies.

My friend showed up on the sidewalk, in the meantime, with a shocked look on her face as I came out of the store looking as though the world had just ended.  We walked away, while EMS tried to coax the guy into their truck so they could take his vitals, and went about our dinner plans.

On the way out of the last bar of the night, we passed an EMS team evaluating a young man completely passed out in front of a garden apartment.  I kept walking.

PGY-2

Things I have learned during my first week of being a 2nd year surgical resident:

1) Having an intern is like having a kid.  I'm just so anxious for how well they're doing.  I stay awake just thinking about it.

2) My residents were actually snooping behind my back when I was an intern and checking charts and stuff!!  No wonder they could always tell when I was lying.

3) Being a resident makes you feel POWERFUL.  Until someone asks you to do something and you remember that you don't know squat.

4) ...but the title sure does count for a lot, as snoop dogg intern points out (from 1:05)

Divine Secrets of the Surgical Sisterhood

When you choose to go into medicine as a woman, one phrase that you hear a lot is "old boys' club".  It's a reference to the fact that medicine, for centuries, was one practiced by men alone, a fact that was sharpened during the 1950's when the advances made by women were repressed in favor of a return to old time values.  It also references the fact that men, for centuries, have always formed fraternities in one way or another, a way to bond and speak as equals on subjects of substance and importance, and to form friendships, connections and networks for the benefit of all members.  Nowadays, the phrase "old boys' club" infers, due to negative connotation, a professional or social group into which women could be belong based on credentials but cannot because they are not male and therefore not welcome in the fraternity order.

It is a sad fact that women don't seem to have the same natural propensity towards fraternity as men, especially in fields that men have historically dominated.  Of course, the concept of sorority and womens' groups is an old one, but they typically form naturally for the benefit of social friendship, not professional advancement.  Those that exist for professional advancement often have a forced feeling to them, and the ones that have persisted through time exist only in reaction to a negative situation (such as being shut out of male groups).  One would think that, as a minority in certain professional circles, women would band together, help each other out, and act as mentors for each other.  One would especially expect that of the kind of women who have acted as groundbreakers, plowing a path for the rest of us to follow.  But it is not so.  

Dr. Karen Sibert is an anesthesiologist practicing in West Hollywood, CA.  She wrote a well-publicized editorial to the NY Times bemoaning the groves of women training in medicine, only to leave to devote time to family and lifestyle balance.  She includes a number of factual flaws in her argument (ex: she claims that residents don't pay tuition and instead receive a salary, but neglects to mention that repayment of medical school tuition starts in residency while being paid less than minimum wage for a 90 hour work week), and criticizes a pre-med college student for wanting to know about anesthesia as a specialty with regards to work-life balance.  She essentially argues that to be a doctor, one must commit to it to the exclusion of all else, as all men do, or society at large suffers the consequence.  She argues that women are selfish to enter the field and expect such things as time off, end of shifts or part time work, because they suck the precious national resources going into training doctors.

The undercurrent of this editorial is that women must suck it up, not complain, and not ask for anything different in terms of equity.  I am sure that, as a women who graduated medical school 30 years ago and had no other women to band with, this method worked for her.  She has become hard core and old school.  And, truly, I admire her for it.  I've met (heck, we've all met) tough-as-nails female physicians who trained when they had no other companions mentors or encouragement and threw themselves in head first to learn medicine for a higher cause.  It's something I could never do, and have undying respect for.  But there's a broader issue of humanity in medicine - I myself have encountered more than a few older female surgeons who do fantastic work but are a nightmare to be around.  They are, nearly as a rule, nicer to boys than they are to girls.  I never wanted to believe it, but I have encountered more manipulation, lying, sexist and judgmental attitudes at the hands of female surgeons than I ever have at the hands of my male surgical attendings (why by and large have been nothing but encouraging, patient and kind).  

The reason I feel that it's a time-related issue is that, when I look at my senior surgical residents, I don't see any of these traits at all.  I belong to a residency which is at least 50% female, and most of the other programs I applied to were similarly stocked.  The girls I work with are tough and smart, but also look out for me.  I don't get treated any differently than the boys, which is how I know that I am being treated the best I can be.  When I go outside of my residency cradle, I am always shocked at the slightest hint of gender discrimination because it's simply not how I was raised.  At the risk of putting all older female attendings in a box, I argue that the act of training in an all-male world has created a certain type of creature.  Brilliant, tough, smart, but also unable to trust anybody but men.  I believe that the female attending throws younger female doctors under the bus because she forgets her obligation to them.  She is jealous that so many things she had to fight for, her residents can take for granted.  The ability to even consider part time work as a doctor to be with her children?  That was a pipe dream in her day.  Having to be a thousand times better just to be considered at all?  It's the exception rather than the rule now. When she works with men, she's back on familiar territory, she knows how they will behave and react.  On some level, it probably even makes her feel special inside, to be above so many men who were once above her.  But female residents, they throw a wrench in that calculation.  And she forgets her obligation to mentor, guide and protect because she never had those things herself.

Like gay marriage and outdoor smoking bans, changes in this behavior will only come with time.  The female attendings like Dr. Sibert won't change their attitudes, they'll just retire at some point soon and be replaced by many more females who trained under more balanced circumstances, with respect and concern for each other.  Our network will come because we all worked with each other, remember our seniors with fondness and respect, and bond over a common experience.  As much as Dr. Sibert wants to flap her arms about the change in priorities in medicine, the fact is that, very soon, she'll be under our care and not over our heads, and we'll all be able to form the sorority we deserve without her stopping us.

Life as you know it

Hooray for vacation!!  I'm back in the states, after a week off in London and a few days off here and there at home.  I won't go on too much about the trip itself, except to say that there was lots of shopping, drinking and laughs.

Oh, baby.

But here's something that struck me - in the course of meeting many of my sister and cousins' friends, I wound up talking about my job.  A lot.  Probably a certain amount of that was just desperation and gratefulness at having the chance to get away that it almost seemed unreal.  A significant proportion was also residual pain from the way that I had been professionally singed on my last rotation, by some people who I had underestimated in their ability to put personal gain above team duty.  But the thing that drove it the most was the fact that I work so many hours at this one job, and so many people that I met just couldn't comprehend it.

It's a fact of life in the UK that work hours are very severely limited.  It's a culture that is hardly hedonistic compared to the rest of Europe, but by American standards can seem outlandishly fun-oriented at times.  To have several drinks with colleagues, to travel, to spend time together, to shop during the lunch hour, these are all things that are assumed by many to be a regular part of life on a weekly or even daily basis.  Even for doctors, the work-hour limit is about 50 hours per week, just over half of what American residents are limited to (and often work over).  So while discussing my job with people, the shock and horror I experienced at describing a standard 85 hr work week was overwhelming.

I used to encounter this sort of attitude years ago, when I was in medical school and dating around.  People would ask what I did for fun on weekends or holidays, and the response of "I'm studying" used to baffle people.  Later, when I started rotations, I would gripe about having to get up so early when the rest of the world seemed asleep, or having to travel so much in such an unpredictable manner.  But eventually, I took solace in knowing that I wasn't the only one.  It enabled me to get off my high horse when I realized that investment bankers work 90 hour weeks too, and while they have bonuses larger than my entire salary, they also have to do it all in a suit and tie, and deal with way bigger assholes.  Embarrassingly, it took me 3 years to figure out that the guy at Dunkin Donuts serving me my latte had to get up at 4:30 in the morning, too.  And my dad chided me for complaining about the frequent travel - nearly all consultants do the same, and they have to do it on planes.  I gradually started to feel that my situation wasn't special, and that allowed me to tone down the pity party I was throwing for myself at working so long for so little.

It is easy to feel jealous that I do not belong to a culture, or a world, in which lifestyle and experience are the focal points.  I certainly turn green at the thought of my friends, who casually meet up with each other with little notice and maximal enjoyment.  But, the fact is, to make those lifestyles happen, these people all picked jobs where they more or less sit at desks, deal with vague concepts and handle a level of office politics that I am, paradoxically, protected from in many respects because the people I work with just don't have time for petty grudges.  I would never be happy in those circumstances, and the few rotations I went through resembling such work had me bored out of my mind.  I didn't pick it because it didn't suit me.  I feel healthier in some ways, doing a job that keeps me occupied for the majority of my time.  I feel healthier in a job where I walk a lot.  If given the option of living the London lifestyle or not, I probably wouldn't pick it if I had to stay with it the rest of my life.  And that's just the way it is.

LDN

Things I have learned in the past 36 hours:

1) The aisle seat is NOT preferable when you are sitting next to a woman who ate NYC street food before getting on the plane.

2) They have Ben and Jerry's vending machines dispensing little mini-pints of ice cream at the Heathrow airport.  I live on the Eastern seaboard, how come we don't have that???

3) Gherkin is a far better name for this.

4) I am truly addicted to my Android.  Last night, I realized I was going to have to go a whole week without TMZ and I nearly had a heart attack.

5) I did not drink enough on Memorial Day, otherwise I would not still be feeling all that wine I had last night :/

The Pressure Cooker

I had dinner the other night with my med school friend T the other night, and we got to talking about how residency changes you.   There's the usual stuff, like how you have to force yourself to stay in bed past 9:30 am because your body is just so used to getting up early, or how I suddenly wear much more formal and girly clothing when I have the opportunity to, to make up for lost time.

But there's a major thing that changes in everyone, perhaps some more than others, in a way that I wish I could avoid.  We all become meaner.  By this, I mean my patience is shorter, my expectations are unreasonably higher and my shoot-from-the-hip reflex is quite a lot sharper.  Things that I might have let slide years ago, like a friend flaking out on me for a scheduled hang-out suddenly become massive transgressions.  I get into fights with people whom I have barely even disagreed with in the past.  I hold everyone to a standard which, to me, is totally reasonable but everyone else seems to think is unachievable.  Looking at myself from the outside, I can see a thin fishing-reel line connecting me to the young obnoxious attending I will soon become.

The origins of this are obvious, of course.  All you have to do is take one 24 hour call in which the pager goes off non-stop, the ER gets mad because you haven't seen the new patient with a chronic leg wound while you are managing two life-and-death emergencies in the ICU, the medical resident calls you with five new consults (none of whom she has the name, medical record number, room number, original chief complaint or labs back) all while your student gives you attitude when you ask him to collect the vitals, and you will see what I mean.  Nobody can be that nice when all of this is happening.  It just isn't possible, and if it was, it would disadvantageous because it would allow everyone else to walk all over you.  Part of working in medicine means triaging the emergent from the urgent from the routine, and having to say "no" or "not now" sometimes to a person who doesn't want to hear it.  Soften your heart here, and you will pay for it in spades.  Being mean allows you to be efficient, and sometimes that is the only virtue that will save you during a bad call.

Unfortunately, the trade-off is that this behavior becomes so hard-wired in you that you can do it instantly at any time of the day or night, without thinking, and you become a nasty bitch to everyone else who drops the ball for a brief moment in everyday life.  Even while on vacation, feeling more relaxed than I have in several months and quite happy with my life, I took my mom to town for butting in where she didn't belong (nothing new, of course), I spanked my friend for re-engaging in a toxic relationship, and my sister for not having my travel information ready to go.  In my head, everything I've listed here can be thoroughly defended to a T.  I'm exceptionally sure that I was in the right, the other person was in the wrong, and a cold hard look at the facts means nobody else will disagree.

But they will, because I wasn't nice about it.  I didn't give anyone a break.  It's true others dropped the ball, but "Can't you just chill out?" is a phrase I hear a lot.  Not surprisingly, it isn't one you hear in surgery - the expectations are set for me in advance by my seniors, and the bar is high.  I meet it only because someone told me I had to, and that's how I learned to be good.  I can't chill out anymore.  Even when I think I'm being chill, I'm not.  It's like I've turned into a vicious deer, one always ready to jump and run when a car shines its headlights on me at 2 am, but not before I've bitten the front bumper and dented the passenger side.  And as a result, I lash out at people in response to their failures, regardless of whether that's the best way to affect change or not.

I can't tell you how much I hate this about myself.  It's like having an awful argument in my head all of the time.  I feel like if I relax, it means I'm dropping my guard.  Not just with other people, although that's certainly a consideration, but many times with myself.  If I get chill and relax, I won't be as good as I am, and I'm already not that good.  If I tighten it up more, I'll just lose more people in my life because I'm not fun to be around.  Whether I use a knife or cautery, I'm still making someone bleed.  Is it better to take the attitude of "as long as it isn't me"?  I'd like to say no.  But "as long as it isn't me" is how you survive in a residency.  You can see how the vicious cycle goes from here.

An attending once told me that perhaps it was all from lack of confidence.  I thought it a ridiculous idea at the time, because one of the major criticisms I get is that I am overly confident.  In surgery, confidence is a positive trait because it is better to be confident and wrong than to be indecisive, because surgery is about making a decision and committing to it.  But perhaps the attending was right.  When I stitch, I am a better stitcher if I can take a deep breath and relax my hands.  I am a better resident on call if I can take a deep breath and remember that everything always works out by the time the morning arrives.  One could argue that these are exercises in confidence, and the lack of confidence in me manifests itself as tension, which of course leads to anger.

If it's true, I don't feel so great about it, because confidence in the greater scheme of things comes with time and experience and knowledge, things that I can't wait for.  If I wait for those things to arrive, I may become so hardened that I can't go back, like an abscess you sat on and now has to get I&D'd in the operating room instead of the oral antibiotics you could have taken weeks before.

What I realize is that I need (and I can't believe I'm saying this) a medical solution, and not a surgical one.  I need a way to stop the stress before it gets so bad that someone has to cut me to keep me from cutting someone else.

Back From the Dead

Alright, this blog needs a reboot.  Actually, I needed (and got) a reboot and by extension, this blog will be rebooted.  So I'm coming back, with a vengeance, and I'm re-committing myself to that thing I love, which is surgery / griping about surgery.  Be prepared!

Since I last posted back in March, I went back to Shmanhattan for a 2 month surgical rotation.  Suffice to say, it was eventful and I learned a lot.  I'm going to be posting about individual themes of that rotation in the coming days, including politics, women in surgery and being an asshole (referring to myself here).  But before I get into all of that stuff, I'm going to take a break for a moment and post about a major life event.

I broke up with my boyfriend of three years.  (Oh god, this sounds so 1990's MTV-angsty.)  It was a big deal.  The relationship had degenerated beyond all possible repair, and I had turned into this terrible person who had lost all of her spark, strength and excitement for life, not to mention being completely consumed with heartbreak and anger.  It was bad.  I finally got to a point where I demanded a solution from my boyfriend, one I had been asking for for months, but at this point wasn't going to do anything.  And while talking to my friends and family, I realized that I was reaching for this solution not because it was the best one, but because it was the only one.  I had literally exhausted all of the options, and given all of the chances, and not made one ounce of progress.  It was killing me.  It wasn't working.

I was heartbroken that it couldn't work, and wouldn't work, and I ended it.  But if I'm honest with myself, I have to report, on paper, that I am infinitely happier.  I haven't looked back for one second.  I look forward to each day, and to meeting new people, and to starting a new relationship with someone else.  I see my friends and family again with regularity, and I know I did the right thing if I felt more alone and neglected in my relationship than I do now that I am actually single.  I feel completely taken care of by my loved ones, in a way that the relationship could never fulfill.  I feel completely taken care of by myself.  I am, in short, back from the dead.

And that's really all there is to say about that.  My 2 week vacation started yesterday at 5:05 pm, and I am flying to London on Wednesday to see my sister.  I'm thrilled at my life and what it has, and excited (but scared) that after my ER rotation in June, I will be a second year surgical resident.  I survived.  But more importantly, I thrived.  And in 4 short years, I will have arrived.

Infectious Disease

I've been fairly lucky this year health-wise.  Barring a nasty bout of food poisoning during my last day at Shmeens, I've really stayed rather healthy.  But all streaks must come to an end, and I caught a co-intern's cold during my last week of in-house surgery.

Now, I wasn't actually that mad about it, because I get a semi-annual cold at minimum and I was karmically due.  However, I am not the world's healthiest girl, and I am an even worse recoverer.  My entire body usually feels as though lying on my back with my arms and legs crinkled in the air with the occasional twitch would be the best course of action, and I typically walk around muttering "I just want to die" about three times an hour to reaffirm this.  My ears are blocked up, so everyone thinks I am ignoring them when I really just cannot catch a word, and I get irritable.  I am constantly hot and sweating, which is quite a feat for someone who is perpetually freezing.  Even more amazingly, I have lost my appetite and and started skipping lunch today in favor of the closest thing I could get to an IV bag full of green tea.  I am constantly exhausted, but having trouble sleeping because of the mega-doses of Sudafed that I have been popping to dry up my congestion, so I am taking Benadryls by the handful as well.  My asthma is flaring up, and I spent all of last night coughing and choking on gobs of yellow phlegm.

I am, in short, the perfect intern to be starting her rotation on Infectious Disease this week.  The irony's pretty obvious here, since I probably shouldn't be walking around sniffling and dripping and sneezing and coughing on people who are already deathly ill.  I'm never afraid of catching C. Diff or Acinetobacter or Klebsiella from the patients, but I figure they really don't need my cold.  But, in medicine, we really don't get sick days, so I've been dragging my ass in and trying to make up for my sorry state by actually wearing all those gloves and yellow gowns and masks that we're supposed to wear all of the time in the isolation rooms.

Or maybe I should be aiming to catch a little C. Diff to go with my cold.  At least, then, I'd lose weight.

Kindle Lovin', Contract Hatin' kind of woman

Yes, it's yet another I-heart-technology post.  Because....

I LOVE MY KINDLE!!!!!  <3  <3  <3

It's white and pretty and super duper lightweight.  I think I need to invest in a shield or cover of some sort, because I'm really planning to use the crap out of this thing.  I've been blowing through Pride and Prejudice, which is a novel that I still have trouble reading the second time around, but have no issue listening to and laughing with in the car.  I decided to get back into my medical leisure reading, so I downloaded "Walk on Water" and I'm trying to figure out how to get "The Spirit Catches You and You Fall Down" in an electronic version.  I also want to get some review books on there, in the vain attempt to get myself to read more on surgery when I have the spare time.

In other news, I had a relatively tiring call followed by a tortuous Friday conference, but I really woke up when we received a lecture on negotiating contracts for your first job as an attending.  I know that contract clauses is kindergarten stuff to some people, but I have to say, they do NOT teach you this stuff in med school, and they should.  It is shocking to discover that someone can tell you that you're not allowed to work within a radius of their practice if you wind up getting fired from there.  I couldn't believe that there are doctors out there who will promise you a partnership or ownership in their practice if you last a few years with them, but then will back out when you ask them to put that in writing.  Apparently, they can do things like fire you without cause, keep you from giving your phone number to patients when you're leaving, make you use vacation time for continuing medical education events + travel, not guarantee medical leave for pregnancy, force you to work all the weekends and holidays without fair distribution, make you a partner but not give equal rights and vote in business decisions, and even tell you that you'll work in one office and mandate you to go to a different office miles away.

The whole thing seemed so sketchy, and a little isolating because I realized that the only person who will look out for me in this process is me.  And maybe my lawyer, obviously.  But aren't there any decent doctors doing decent business out there?  These people were all once residents too - where's the nostalgia, the camaraderie, the sense of fair play?  Why do I feel like, just as I will have worked hard for five years to prove myself worthy, I will have to go back to playing in the dirt?  WHY CAN'T WE ALL JUST GET ALONG???  It's a little frustrating, and disheartening, to hear that you could work so hard and still only get offered bad deals hidden by a good name.  I mean, it was great that I heard all about this from a lawyer who was also a good teacher, because now that I know this stuff, I can make proper decisions.  I can be empowered  and actually negotiate my salary and contract terms, and not become yet another woman who is smart and clever and talented and still gets paid less than men who aren't as good.  Having this information puts me in the driver's seat, and that's a positive move in the right direction.

But I feel distasteful about it.  It just means that, yet again, I can't trust people as much as I'd like to.  

Go Shorty, it's your birthday

Today, I am 28 years old!!  (And now, the requisite DAMN I'M OLD, WHEN THE HECK DID THAT HAPPEN).  I love celebrating my birthday, and getting calls from everyone and feeling overall popular.  Yes, it's all about ME.

The odd thing is, I tend to have a little anxiety around my birthday, only because I get very sensitive and insecure and then read everything into things going wrong.  On my 18th birthday, I got a seriously crampy period, then spent the day at home because it was a snow day (I know, why was I complaining?), and then stayed moody the whole week even though my parents had been meticulously planning a surprise birthday party for me at my favorite restaurant.  I read into slights, like who didn't post on my wall on Facebook (what do you mean, you didn't have internet access in rural Kenya??) or who didn't call, which is so ridiculous because I have so many friends and family who love me no matter how many birthdays or special occasions I forget or can't be there for.  So, this year, I decided to take a different route.

I didn't have the best start.  I had asked the nurses to hold off calling me, but instead I spent all of Thursday night chasing nothing-calls.  After finishing my night shift on Friday morning, I went straight to my weekly surgical conference and then to a Long Island surgical conference for a poster competition.  I had brought a blanket with me, vainly thinking I could find a quiet lecture hall to sleep in, but instead spent the day camped out by my poster and trying to stave off my impending grumpiness.  I managed to get an hour or two of sleep Friday night, but then woke early Saturday morning to manage a patient who became so agitated and disoriented in the ICU that she tried to run out completely naked, as her oxygen saturation dropped to 70%.  By the time my sister called at 8 am for her annual early morning birthday call, the only response I could muster was "GAH, it's too early!!   TOO EARLY!!!  AT WORK!!!!  Call me later!!  GAAAAAH!!".  I had to call back later and apologize for being so cranky.

But once I came back and slept for a few hours, I felt like a totally new person.  My dad called to say that he had sent me flowers for my birthday, and my landlord confirmed that my birthday gift to me (a designer dress) had arrived at my apartment.  My boyfriend surprised me with a Kindle so that I could travel and read, which I am still so excited about that I'm having trouble naming it.  (The best I have come up with is Kenny the Kindle.  It needs some work.)  My best friend and her boyfriend called to sing me happy birthday (with the promise of helping me to download books for free).  And we're going out tonight for dinner and a movie, during which I plan to drink a terrific glass of wine and go to bed at a normal hour.

And so, I am breaking my streak.  It's happy birthdays from here on out =)

Dumb and Dumber

Ah, yes.  The night float.  It's that special time of year when your only task is to keep-the-patient-alive-for-God's-sake.  The night float is what separates the men and women from the boys and girls, and this applies to both interns and nurses.  So, with great love for all of the amazing nurses who are truly super-competent (and save my ass generously and frequently), here is a list of the top five dumb and dangerous things I have observed the nursing staff doing.

1) Calling to find out about discharging a private patient, since the family was waiting to take him home. The nurse told me she couldn't find any of the paperwork, and that the family was getting very impatient.  When I came down to check, all of the paperwork was completed and paperclipped to the front of the chart, along with all of the prescriptions.  "Oh," was all she could say.

2) Calling to put an IV line in a patient with massive edema, who already had a working line.  When I went to the bedside, the nurse insisted that the line was gone because she couldn't draw back.  A reasonable point, except that 2 different IV solution bags were still dripping away without any issue.  The nurse then pointed to the arm being swollen as a sign that the line was infiltrated.  Except that the patient was swollen all over. As a bonus point, she had refused to try the line herself.

3) Calling to visit a patient who cut himself shaving, and had unstoppable bleeding.  I asked the nurse to tear off a piece of toilet paper and stick it onto the cut, and hold pressure while I walked over, imagining a massive torrent of blood gushing out of the patient's face.  When I got there, I discovered an extremely loose ball of toilet paper marginally taped to the patient's quizzical face.  I tore off a tiny corner and stuck it directly on the 1/2 mm wound, then held pressure for 2 min, and found the bleeding to have magically stopped.  I walked away wondering why the nurse hadn't thought of that, since how to stop a shaving cut is something I learned from my dad, not something I learned in the trauma bay.

4) Tapping me on the shoulder every two minutes to ask about how much insulin to give a patient whose blood sugar was 457.  This is a reasonable question, except that I was pushing on the chest of a patient who was coding at the moment.

5) Removing the saturation monitor from an acutely ill patient.  I was called to the bedside of an end-stage AIDS patient for severe respiratory distress.  The patient already had dementia, so he couldn't tell us what was wrong, but he was breathing at an extremely fast rate, and only saturating 75% on the monitor.  I increased the oxygen flow rate as high as I could, then told the nurse to keep a strict eye on the monitor while I stepped out to call my senior medical resident about the situation.  When I came back, the monitor was gone and the patient was breathing even worse.  I asked her in a panic about the monitor, and she told me that she had given the nurse's aide permission to take the monitor away and use it to check vitals on the other patients on the floor.  The kicker was that every other patient on this floor was hooked up to a ventilator machine, and therefore did not need an oxygen saturation monitor because the ventilator monitors that for you.  This patient wound up getting intubated because his respiratory failure was so severe.  He died a week later.

You're The Boss

Sunday, 10 pm on the floor.  A nurse reports that her patient is refusing his blood pressure medication for the second night in a row.

Me: Hello, Mr. Logical.  I understand you have a concern about your medication tonight?

Mr. Logical:  Yes, doc.  I'm allergic to it.

Me: Oh, really?  What sort of reaction are you having?

Mr. Logical: I don't like how I feel when I take it.

Me: Hmm.  That's not quite an allergy, but ok.  What do you mean, you don't like how it makes you feel?

Mr. Logical: It slows my heart down.

Me: Yes, that is an expected side effect.

Mr. Logical: Exactly, an allergy!

Me: No, an allergy would be something like a rash or your throat feeling tight.  This medication is supposed to lower both your heart rate and your blood pressure.  That's what the attending wanted for you.

Mr. Logical: But I don't like it!  It's the same damn problem I had with that other medicine, hydralazine.  He tried to get me to take that one too.  But I refused.  I'm allergic.  *smiles triumphantly*

Me: Sir, a lowered heart rate is not an allergy.  I understand that having a lower heart rate might be a strange sensation for you, but I'm looking at your vitals and your heart rate is quite high.  A lowered heart rate in your case would be better for you, not dangerous.  And your blood pressure most definitely could use some lowering, too.  Having a high blood pressure is very dangerous for your body.  Do you want to maybe think about trying this medication?  Otherwise, we can try a different one, like clonidine.

Mr. Logical: No!  I won't take that one either.  They tried to get me to take that before.

Me: So basically, you don't want to take any medications to lower your blood pressure.  You prefer the sensation of high blood pressure and pulse.

Mr. Logical: No, I'll take something.  I'm just allergic.  Make sure they put that on my wrist band.

Me: *sigh*

I-C-London, I-C-France

I'm beginning to have the strangest feeling that my internship is already slipping from my hands.  I always have this sort of feeling around February, the knowledge that winter is nearly done and time is passing right in front of me.  The trees are still bare, but I can see tiny knobbly bits protruding from the tallest twig branches, and I know that in a month or so, real buds will appear and I will be just a few short months from forever ending my internship.

I shouldn't feel sentimental about this at all - after all, internship is That Dreaded Year in the life of all doctors, the year that you are supposed to hate and feel as though you can never get back and so on.  And it is, and I am mentally "done" with the silliness of tylenol orders and 3 am falls and patients demanding dilaudid instead of morphine.  I don't feel like I have to rush to the bedside for every little thing anymore, and I can recall how to write for potassium without looking it up and I can tell whether the nurses really do need my help with an IV line or if they're just being lazy.  But... it's over so soon.  I can't believe it.  The infancy of my career is nearly done.  I feel like I should have taken more pictures.

I've transitioned from my last two weeks on the ICU into the night float, where I'm continuing to cover the ICU and a few other floors.  Despite some very questionable nursing calls, I've had quite an easy week taking care of things, mostly because my nurses are terrific and organized and know what they're doing.  I keep waiting for patients to die (I am covering the critical care unit and the hospice, after all) but for some reason I have been extremely fortunate and sleeping a reasonable amount, which translates into hours at home during the day to relax and do exactly as I wish.  I came into the night float really dreading it, since I was pretty sick of it by the end of two weeks the last time I was on it (and that was with terrific weather in July), but I have been taking my vitamins and bringing my laptop in with me, and I find that a warm room + 4 seasons of Battlestar Galactica on dvd has made for a very pleasant experience.  I am most definitely dreading next week, as the other intern and I will swap floors, leading to lots of late-night troponin blood draws and EKGs and imaginary chest pain calls.  This won't be all that bad, except that I must also go in for an eye appointment and a surgical poster presentation conference post-call next week, all the day before my birthday.  I then have to start two weeks of surgery in-house the day after my birthday, but hey, at least I have it off.

As part of my planning for the coming months, I have finally kicked off a few things that I had in the works for some time.  The first is that I have scheduled myself for Lasik for March, which I am really excited about because I JUST CANNOT DO EYEGLASSES AND CONTACTS ANYMORE.  It really isn't so bad, it's just a massive hassle and when I already feel so unpretty on-call and post-call because I have to wear glasses, it brings my self-image down, and I would love to continue to feel good about myself as I go forward in surgery.  I scheduled it with the same guy my dad went to, and my parents are helping me out with cost, so things should go smoothly and I hopefully will not end up blind and transferring into a specialty where eyes are not required (like psych).  I should be good and recovered by the time I head back to Shmanhattan Hospital for two more months of surgery, which should be a ton of fun since I will be back in the city for the spring.  This time, I will make a greater effort to go out and hit TopShop, because shopping for pretty fun clothes genuinely does make me feel better about myself.

I am also putting things into motion for my spring vacation, and I am trying to juggle a trip to London with a second trip somewhere in the US, maybe Chicago or Texas or something.  I had such an awesome time in Memphis that I really would love to do another southern trip again.  Nothing is set up yet, but I'm just enjoying that I can actually move forward with planning all the fun stuff I had been holding off on for so long, because I am done with my exams and can really take control of things instead of acting like I am a victim of my own specialty.  The best part is that I just discovered Groupon, so once my dates are set, I plan on London spa-ing myself in a bad way while my sister and cousins are working.  We're toying with the idea of at trip within my trip, maybe to Paris or Scotland or Dublin, with the goal of getting smashed and just having an awesome time.  But really, if I come back with a semi-British accent as I typically do, that will be more than enough for me.

Back at the Ranch

Nobody seems to believe me, but I am really really happy to be back at my home base hospital.  After 6 weeks away at two different hospitals, it is thrilling and relieving to be back where everybody knows your name, and people say how they missed you and how nice it is to see you again.  It seems shocking to the other interns, but the nurses really are nicer at our hospital, and you miss that when you go to other hospitals where you have to go into a 20 minute explanation as to why you don't know where the 4x4 gauze is kept in the stockroom before anyone will lift a finger to help you.

It's also really great to be back with all of the other interns in my year.  It's odd to me that I missed them, but it was so nice to be among other people my age who knew me and liked me and joked with me, instead of competing with me for cases or hanging out amongst themselves.  I'm back on the surgery rotation, and this time it's with another surgical intern as well, so I'm enjoying the chance to actually work with my co-interns now that we're all coasting towards an all-surgical 2nd year.  We're all getting our contract renewals for the coming year, and it's so shocking to think how my internship is already more than half over, and I am actually surviving and smiling at the same time.  I'm excited to see who will join us for the next year, and a little nervous at the prospect of actually being in charge of people under me.  I've struggled a little with productively instructing and directing the students that rotate with us, and I've decided to make a better effort to observe the various methods my seniors use to motivate and teach them, so that I can help foster smoother teamwork, and not just scare them into hating surgery.

I only have 2 weeks on this surgical rotation, and all I can think about is how overwhelmed and busy I felt when I was doing surgery in August.  At times, I was in tears from the exhaustion and disappointment in myself.  And now, I keep finding myself with nothing to do, and wondering how I ever thought this same surgical rotation was insane.  I've had a few nights where things got a bit busy, like big cases going into the OR and the senior pager I held exploding with consults, but we managed it.  It might be that I found ways to cope, or that I simply was so busy at the other hospitals that this now seems a snooze in comparison.  Or maybe it's that it's easier to remember that, whatever happens, the call will always end at some point, and I can get things done in time.  In other words, there's less reason to panic than there was before.

This surgery thing, I think it's actually doable.  Hmm.  =)

The January Blues

Ahh, winter.  There's nothing like it.  I love this time of year, it's when the air is crispy and you become more appreciative of sunshine (and feel the effects of neglecting your vitamin D / calcium supplements).  I love winter very much, it's when the whole world can feel transformed in a few hours to a white wonderland, into which you wander with oversized hats and crocheted scarves.  But, every year, I start getting very depressed around January, most likely due to a combination of lack of exercise, vegetables, sunshine and generalized explosion of personal problems.  I always get blue around this time of year, and I never figure it out until I'm well deep into it.  This year, I heard snatches of Billie Holiday on the radio singing "Gloomy Sunday" and I finally figured it out.  I have the blues.

It's a magical time of year for other people, too.  The roads are slushy, the sidewalks are icy, the wind is knife-like.  Not surprisingly, so are the people in the hospital.  I first noticed it with the nurses back at Shmanhattan - every time I smiled back at a nurse or wished them a nice day, I only got stares or dismissive expressions.  I thought, at the time, that it was because it was a fancy Shmanhattan hospital, and people are just ruder when something is nicer.  But then, I remembered that I live in Queens, where drivers routinely stop at red lights and then careen right on through anyways.  So that couldn't be it.

It was the end of the day, and the surgery team decided to get together and do table rounds in the resident lounge, to review the day's events and update the patient census.  I had been holding the on-call pager since I had the least number of patients, but instead became the busiest person because I received non-stop calls on the most ridiculous things.  When I presented the day's events for my patients, I was met with underhanded comments which indirectly mocked my hard work to get done what I could.  I kept my mouth shut, and observed that multiple similar comments were being made around the room, with everyone giving off a sour face and nobody appreciating anybody else's efforts.  In the middle of these tense rounds, a nurse decided to page me multiple times regarding a patient needing a medication.  I spoke with her and clarified that this was a patient who was already discharged and merely awaiting a ride home, and that she was in no acute distress, just needing a renewal of a medication for pain.  I tried to tell her as politely as I could that we were rounding, and that I would send someone up to write the order renewal as soon as possible, but her only response was "Well, my patient is in pain, and that's all that matters".  I received the same page from the same nurse twice more, still while rounds were occurring (and conveniently increasing the anger of my seniors), who finally sent me upstairs to sort out the matter.

I found the nurse and tried to pull her aside from the nurses station to discuss the issue privately, and remind her that residents cannot leave rounds just to address one patient's needs unless it is an emergency.  She instead responded by avoiding my eye contact, and repeating her same lines over and over, without listening to me at all.  I said that we should discuss the issue as a group, and for the first time ever, I got into an actual tiff with a nurse requiring a nurse supervisor's intervention.  The supervisor was extremely professional, listened to both of us and tried to assuage the nurse's concerns.  I explained as best as I could that we were responsible for many patients, and a proper uninterrupted sign-out round is essential to maintaining safety and continuity of care.  Instead, she avoiding my eye contact again, looking away at the ceiling, much like a 7 year old.  I finally had to conclude the session by reminding her that the extra order was now written, and walked away without any peaceful resolution effort on her behalf at all.

I felt terrible.  Normally nurses love me, because I try really hard to be as polite as I can and show appreciation for their patient advocacy.  I went home feeling upset and wondering if I could have handled things differently, but seeing that the nursing supervisor agreed that I had escalated the issue in an appropriate way, I couldn't find any different avenue.  I started to wonder if there was something in the water the following morning, when our team met to review surgery content material.  I didn't even know what the tension was about, but suddenly I looked up from my patient list of to-do's to see two residents making tense loaded comments to each other.  I left the room to assist another intern with a blood draw just as shouting commenced in front of a room of students and residents from other programs.  It was embarrassing.  I just couldn't figure it out.  Even if people have legitimate reason for disagreement, to argue in front of people you set an example for in a hospital is just crazy.  That tension extended to the remainder of the day, to the point where I could feel items not being mentioned in sign-out just to avoid further conversation.

I think everyone needs to take their vitamin D.

Welcome to Shmeens

I was going to start this post by saying how awesome it was being home post-call for the snowstorm, but as it turns out, it won't get started until I'm already asleep.  Not that this should matter at all, but I'm all holed up in my jammies with my Belgian cocoa dusted truffles and glass of milk and bucket of korean wings and kimchi (awesome combination, I know) and dammit, I want me some snow.  I continually have great things to say about my house and neighborhood, and the latest in that list is that I live one block from an old subway rail line, which in this area runs above ground and transports freight only twice a day.  So I have a ready-made garage under which to park my car, and my neighbors and I will all be able to pull out in the morning without having to additionally dig out the car.  Hooray!!  No damaging the car paint with my shovel this time =P

I woke up yesterday morning to a sweet text from my chief resident, wishing me luck on the upcoming Shmeens rotation.  I feel that I have a lot to prove these two weeks, as I am the only intern from my program being sent here, and I want to make a good impression.  Fortunately, all of the other interns I rotate with seem both capable and nice, and I even ran into a med school friend's boyfriend, who I had forgotten was doing his traditional rotating internship year at Shmeens before starting anesthesia next year.  I really expected the service to be rough and rigid, like a bigger boot camp than my home base hospital, but instead it turned out to be oddly casual.  There were no lunchtime or evening rounds, since the OR was so busy that it simply wasn't practical.  There was minimal pimping, and I didn't get yelled at for the many simple mistakes I made (most of which came from being so disoriented in the hospital, since I had never been there before).  I kept asking the interns when the other shoe was going to drop, and getting blank stares in reaction.

The hospital reminds me a lot of my home base, in that it is neither wealthy nor prestigious, but it is bigger and attracts a reasonable number of patients.   I couldn't believe that in one day, they had two appendectomies, one strangulated hernia (into which a third appendicitis seemed to have perforated and caused abscess formation), one EVAR for AAA repair, two sub-total thyroidectomies, and a million other routine cases.  I'm really looking forward to my non-call days, when I hope I can scrub on a few of the smaller cases and get some more experience.  In that sense, I'm becoming more and more sad that I'm not spending more time at Shmeens, and I'm getting really excited to come back as a second year resident.

So, for now, it's ominous clouds and Gilmore Girls re-runs for me.  Laugh, but know that I have everything I need in my little hole.

Closing The Gap

Yes, yes, I know, I have been inconsistent yet again.  But I'm baaaaaaaaaaaaack!!  (Hmm.  Creepy.)

I've spent the past month at Medium Class Shmanhattan Hospital, which is an outside rotation that my program arranges for us to attend a few months each year.  I state that it is Medium Class so as to avoid confusion with those Super Duper Fancy Shmancy Manhattan hospitals, which of course, I will not get to go through.  But for me, it is in fact SUPER DUPER because nearly anything looks brand spanking new next to my home base hospital.  (But I love oldies!  OLDY BUT GOODY!!)

It's a place that many of my senior residents wax poetic about, because it has things like an EMR and several operating rooms and lots of cases.  And overall, I had a pretty good time rotating there, from a surgical standpoint.  But it wasn't quite what I expected.  For starters, at my base hospital, being on call is busy, sometimes overwhelmingly so.   But the other interns don't chill out while you're working your ass off - they help, because we're The Team.  In contrast, I was only on call a few times for the month at MCSH, but each call was more or less torture.  The pager just explodes with consults and clarifications and so on, and you are fielding all of them while also running the patient list and trying to discharge people.  You hope that the many other surgical residents milling around will help you, but unfortunately, they don't always.  You have an army of students to help you, but not all of them are motivated to stick around in case you need a spare hand to grab paperwork or help patients walk after a procedure.  The nurses were shockingly worse than at my home base hospital - I actually got called several times because I had ordered a medication or a blood test, and the nurse wanted to know if I wanted it.  One could make the argument that this is just an example of a nurse wanting to be thorough, but when it happens 18 times in a day (literally), it gets a little old.  Read the fine print, lady, I want what I want.

I also drew the short straw and rotated during the holidays, during which there were noticeably less patients and cases to see.  The 40-50 cases my co-interns were seeing wound up being more like 20 for me.  Of course, being an intern, it doesn't really matter as much, but it still would have been nice to Do A Fricking Appendectomy like my co-intern did, or scrub on any case bigger than an elective hernia procedure (like an exploratory laparotomy), like others did while on call.  Of course, getting to assist in small cases is good for an intern, it's how you get your feet wet.  But there were days where I didn't get a single case at all, and other interns got 3.  By the end of the rotation, I started getting a little grumbly about a lack of equity when it came to case division, and finally got fed up when I had a bad night on call during which some residents refused to help me divy up the work.

So, I'm done now.  Because of a complicated issue involving intern supply at another outside rotation hospital, I have been switched off of my upcoming rotation with surgery at the home base to do two weeks of surgery at a large Queens hospital, a place that no intern from my year is assigned to.  Onwards and upwards to the next new thing, I suppose.

Hmm.  Now I need a name for the Queens hospital.  Maybe it'll be Shmeens.