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.

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 to the Waking Life

Hurrah! I have survived my two weeks on night float. Everytime I tell someone that, they all sort of imply that it's amongst the worse things you'll have to do as an intern. My experience really wasn't that bad, overall. Perhaps some of that was luck, in that nobody died unexpectedly or suffered because of a massive mistake I had made. Or maybe I just had really decent nurses in the ICU who had my back.

My last two nights, unfortunately, were hell. I realize now that some of that was my own fault, for not knowing when to ask for help in managing tasks. (I also didn't know that I had the right to insist that my senior medical resident physically come down to help me when I needed it for complicated patient problems.) Both nights, my pager exploded at 7 pm with things to do, and many tasks were pushed aside because of acute patients in danger of hemodynamic compromise. As a result, I managed to piss off nurses in the telemetry / step down unit, upset a family because I wasn't able to call them when their family member passed away in the hospice unit two hours before, embarrass myself in front of the surgery team because my medical senior resident had foisted a bogus request onto me, and basically run around as though I was not in any kind of control whatsoever.

When I read back on that, it seems a lot calmer a description than what I went through. After the first busy night, I had a mini-crackdown because I found it so upsetting that everyone was looking to me as if I had answers that I clearly couldn't possibly have because I am just too dumb to be a real doctor. I was upset because someone was rude to me, something I should have been able to handle but instead took as a sign that I was totally on my own. I was glad to have made it through that first night, and was so sure that the evening after would be calm and quiet. Of course, it was just as much madness and it seemed like there was just no respite. On top of having an even more acute patient and multiple other pages come in, a nurse informed me 30 minutes before signouts in the morning that a patient had not received any fluids or food for a full day, and was now reporting severe dehydration. Of course, this patient was also scheduled for surgery, and when I asked them for help with a central line, I got yelled at for not bringing the matter to their attention sooner, and was stuck staying an extra 2 hours longer trying to rectify the many complications associated with the situation.

In fairness, I deserved that reaming. Looking back over the past 2 weeks, there were a lot of things that I overlooked or didn't consider, many fevers I didn't investigate fully, many calls for help I should have made but didn't. Everyday, I felt like the bar was higher, always unreachable. And after those two days, I drove home asking myself if this was what I really wanted. I don't like missing sleep, I don't like feeling gross and messy, I don't like feeling like I've messed up, and I don't like getting yelled at.

But after a few days of getting back to a normal sleep schedule, I remembered that I always doubt whether I want to do surgery when I'm post-call. I always hate getting pushed around or failing. And I love it that much more when I brush myself off and finally win. I love surgery, and I love that it's hard, and I love that it's not something everyone can do. I love getting asked something and realizing that I learned the answer without even realizing it. And ultimately, I chose this. So I've jumped off the cliff, and all I can do is hope for a soft landing.