Thursday, January 13, 2011

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.

Tuesday, January 11, 2011

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.

Saturday, January 8, 2011

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.