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.