No more medicine wards!

Today was my last day on medicine wards--ever! It was definitely a good feeling to be walking away, knowing I wasn't returning. No more long internal medicine rounds, no more cross-cover call... If I had any doubts about wanting to do preventive medicine instead of internal medicine (which I didn't), that would have cinched it.

I told my resident and fellow intern when I came in for rounds today that my goal was to get out before 11am, and even with following and having to present four patients, I left the ward at 10:55. Of course, I had to sign out to the on-call intern before the other intern on my team to do so, but I did it.


I did, of course, have an ulterior motive for leaving the ward, other than just wanting to get away from Ward 75 as quickly as possible. I realized the other day that I have worked every single Sunday this block, and thus hadn't been to church at all during Advent, which is my favorite season at church. So, I checked the Walter Reed website, and found out that the Protestant services at the chapel are at 11am (hence the goal leave time). After switching out my white coat for my winter jacket in my locker, I had to practically run across base to get to the chapel (and still came in late), but I did get to enjoy a nice Advent service, so that made me happy.




The afternoon was spent doing as little as possible, which included a nap on the futon (I have a very comfortable futon) before heading out to dinner with one my friends, who was celebrating the end of her month on urology, going into a month of ER, which for a surgery intern is practically a vacation--predictable hours, no call, no residents to make life miserable.

Tomorrow I begin PM&R, and will get one of my four weeks on that rotation over before heading for the airport on Saturday to fly home for Christmas. I can't believe it's almost the end of the year already, but I'm definitely not going to complain about how quickly it's going--the sooner I can be done with internship, the better.

Update

Okay, so I now I'm doing an absolutely horrible job of keeping my blog up-to-date, which kinda defeats the purpose of having one in the first place. Here's what I've been doing the last month or so:

I'm back on Ward 75, the general medicine ward, this time on Medicine Green Team instead of Blue Team. There's absolutely no difference between the teams, except which team room (office) is used. We, and the other medicine services, actually (there are five: gold, green, blue, white, and red), have been taking quite a hit every time we're on call. Being on call means that if someone comes into the hospital who needs to be admitted to a medicine, they go to the on-call team. The cap for admitting patients to one team is ten, and after that, the senior night float admits them to other teams. Everyone has been hitting the cap, which is a lot of patients, and we can't seem to get them out of the hospital. We're on call again tomorrow night, and still have nine patients on the board. That means if they can't discharge people today (it's my day off today), we could potentially have nineteen patients on Friday, which is far too many.

I have had a few interesting patients, though. There was one the last time we were on call, a nurse with a thigh mass who we essentially admitted so she could get an MRI overnight ("expedited work-up"). Well, the MRI read wasn't as good as anyone hoped, and we called ortho (whom she had already been seeing for this thigh mass, as she had had it for two months), and today they're taking her to the operating room to do a biopsy. In other words, after looking at the MRI, they're concerned in might be a bone or muscle cancer of some sort.

There was another, a ninety-year-old man who really liked to talk (and was very sharp, for any age, especially ninety; a former Special Forces captain during WWII and clinical psychologist during the Korean War, retired at major), and during one of our longer-than-necessary conversations, he asked if I had gone to USUHS. When I informed him that I recently graduated from Ohio State, he got an incredulous look on his face.

He graduated with a Ph.D. in clinical psychology from Ohio State in 1951. Apparently, Buckeyes really know how find each other.

For the most part, unfortunately, the patients aren't interesting, just frustrating, and I'll be very glad when I'm walking out of the hospital Sunday, because that will be my last day on Ward 75--forever.

As far as other aspects of my life, well, it's difficult to have a social life while working eighty hours a week, spending every fifth night in the hospital, and only getting one day in seven off. The one date I went on (blind date, set up by a friend), was a complete disaster. He asked how long I "have" to be in the Army and then started talking about how things will be different once I get out. At one point, I made some joking comment about something about my uniform, and he said, "Well, at least you don't have to wear it at work."

???

Just what does he think being an Army doctor is? When I told him that I do, in fact, wear my uniform almost every day to work, he thought that was the stupidest thing ever. So overall, he seemed to think being a doctor in the Army was the worst thing ever, and I must be counting down my days until I can hang up my uniform and be done with it for good. I don't know if I'll be hanging up my uniform in eight years--it all depends on the opportunities presented to me at that point. For what I want to do in my career, I may be staying in forever, and I don't appreciate some guy I just met assuming he knows otherwise.

In other words, no second date.

So, in the meantime, I've been pretty much doing all that I can to keep my head above water as I finish up this rotation, and spending time with my fellow intern friends whenever I can, which isn't all that easy, when it always comes down to getting schedules to line up. On Monday, I start on PM&R (Physical Medicine & Rehabilitation), so that will be a nice change of pace.

Training Day

Today I got another reminder of why military interns/residents make more money than our civilian counterparts: training, or more specifically, training day. Not pleasant.

Since we have all sorts of mandatory training, about once a quarter, they put together a training day, providing multiple lectures for the in-person training we have to do, and lists of the electronic training. And for some reason, these always happen when I'm on in-patient wards or at Navy.

I started back on Ward 75 (aka, hell) on Monday, and my first day of call is tomorrow. Since we're the day pre-call, we have a pretty light census (we only admit on days when the team is on call), which I thought would translate into a little bit more sleep, but when I opened the email last night informing us of training day, I knew that wouldn't be the case. The first presentation was Alcohol and Substance Abuse Prevention (ASAP) at 0600--required annually, by fiscal years. Then I ran back up to the seventh floor from the second (that's more flights of stairs than it sounds; we have half-floors, but that's another story for another time), to get vitals and lab results on my patients and start rounding. Then at 0900 was Equal Opportunity/Prevention of Sexual Harassment (EO/POSH) (required quarterly, for some stupid reason) back on the second floor, and then back up to the seventh to write my notes and try to get work done. And then 1000 was Patient Safety (annually, and pretty much just consists of people talking about what kinds of mistakes interns make when writing orders), then back up to Ward 75 to finish work and prepare to sign out to the on-call team. There was also Warrior Proficiency Tasks (or something along those lines), which is required annually for everyone captain and below, from 1300-1700, but I skipped that. It's cold and raining, and I wasn't in the mood to practice dissembling/reassembling weapons or practicing litter carries or any of that. They'll tag me for that later in the year, I'm sure, even though I just did all of that at C4.

I also spent a good deal of time in the last couple of days doing online training to prepare to go to Peru for my research rotation in February. I've done Antiterrorism and Survival, Evasion, Resistance, and Escape (SERE), neither of which can really be taught online, realistically. Really, do they think answering a few questions about being held captive is going to help if it happens (especially since medical personnel can't technically be held captive, according to the Geneva Conventions)? Government efficiency, I guess.

And tomorrow, the first of five calls for the month...

End of Ward 75, beginning of psych, and a new coin

I was on call in Ward 75 on Sunday, for the last time in block 2 (I'll be back there in block 6). It was a really, really quiet call (which is a very good thing), and I actually got sleep, but we did have a bit of excitement. Right after the med student returned with dinner (we one out to grab us food every time we're on call), we were all sitting around eating and checking things on the computer, and suddenly he jumped out of his chair and said, "Hello, sir!" Just my luck--I had just taken a rather large bite of food. I turned to see who he was talking to (thinking it was our attending), and saw Lieutenant General Schoomaker, the Surgeon General of the United States Army (ie, my boss, after the President and Chief of Staff), standing in our team room. He was walking around the hospital on a Sunday evening, just getting a feel for the place and a reminder of what really happens in Army medicine, at the very bottom of all the decisions he makes. So he stayed and talked for a bit, joked about college football (he went to Michigan; I was wearing an OSU tee-shirt), and traded internship stories. He was an intern before the 80 hour work week (obviously), but still recorded his hours, just out of curiosity. There was one week that he worked 158 hours. He still doesn't know how he did it. Then he gave us coins (above), and resumed his wandering of the hospital.

And just to put things into perspective about how nice we have it now, in Block 2, I worked a total of 260.17 hours, which is 65.04 hours per week.

Well, I was supposed to start on PCLS (Psychiatry Consult Liaison Service) at National Naval Medical Center (better known as Bethesda) on Monday, but as I was post-call in Ward 75, I didn't start until today. It's going to be a really laid-back rotation, especially after MICU and Ward 75. We currently have three patients and three interns. I showed up at 0730 and left at 1600, and maybe worked two hours. The rest of the time, I sat around and twiddled my thumbs. Tomorrow, I'm bringing some fun reading, and after work, I'm going to Barnes and Noble and seeing if they have a USMLE Step 3 study book so I can pretend to study while I'm at work. It's going to be a good month.

Team lunches and winning the game

Yes, I know, it's been pretty much forever since I last wrote a post--sorry about that.

Life on Ward 75 has been, well, pretty much like purgatory. You just have to bid your time here until it's time to move onto something else. We've had a few interesting cases, but for the most part, all I do is pretend to be a social worker and get people discharged and back to their retirement homes/nursing homes/back to their units.

Since the rotation is almost over (just one more night of call!), we had a team lunch yesterday--the attending, resident, two interns, sub-intern, and two third year medical students--at a Thai place in Silver Spring. The food was quite good, as was the conversation; with the exception of my fellow intern occassionally treating me like I'm quite useless (despite the fact that I have twice discharged all of my patients, a feat he has yet to accomplish), we had a really good team. The two med students we currently have are quite sharp and work hard, but have good senses of humor (of course, they thought I was joking when I told them that I gave low passes on their evaluations...)

Anyway, today I started the day with two patients, one with a fairly simple pacemaker placement, and one who had been admitted with high fevers and chills after returning from three weeks in Africa (we thought it was malaria, but those tests came back negative; he got better on his own, and we still don't know what he had). Both got discharged today, so I had no patients--that's what we call "winning the game" (the game being treating patients; winning being discharging all of them before the next night on call). So I won the game, for the second call period in a row :) My sub-intern calls me a discharging machine. That's certainly true. And because I won the game on Friday, and we aren't on call again until Sunday, I get Saturday off :) This makes me happy.

Not taking 'no' for an answer

One of the jobs of preventive medicine physicians is to tell colonels and generals--pretty much, people who outrank you by quite a lot--that they can't do something because it's too dangerous/stupid/etc. In other words, prev med docs aren't typically easily intimidated and don't really take no for an answer eaily. I guess I'm getting an early start on that.

Yesterday I was the only doc on the team (except the attending, who doesn't really count); the resident and other intern were both out. So I was taking care of all the patients, which fortunately, was only four, as well as our two new third year medical students. Unfortunately, I didn't have time to do anything educational, as I was spending most of my morning running aorund trying to get a patient discharged to a rehab facility. The transport was scheduled to come at 1400; at 1310, the nurse told me that the facility wouldn't take him. He still had a bed, but there was something about not having enough therapists. They social worker didn't bother arguing with them, so I called them and essentially said that I don't care about their therapists--if he has a bed, he's going. They had me write an order saying that it was okay if he didn't get therapy until Thursday, which I gladly wrote, and he got out of there.

I'm currently working on taking this not taking no for an answer to get the internship director to say that it's okay for me to go to Peru during my research month. Stay tuned for more details.

Anyway, it's been two and a half weeks on ward 75, and the vast majority of what I've done in that time is stuff that they don't teach in med school--social work. Talking on the phone with rehab facilities, setting up follow-up appointments, etc. For as exhausting as the MICU was, at least I didn't have to deal with any of this stuff associated with discharging patients. When we were ready to get rid of a patient, we just called the on-call medicine team and had them take the patients to their service, and then they could deal with all this discharge stuff.

Okay, enough of that. I'm going to go back to enjoying my day off, and by 'enjoying my day off', I mean waiting for my eyes to return to normal after being dilated for my eye exam, and then heading back to Bethesda in about an hour for another doctor's appointment. Fun, fun.

Welcome to Ward 75

I officially began my general medicine month (Ward 75) on Tuesday, after having been post-call on Monday. It's going to be a rough month.

To start with, my fellow intern is a jerk (and that's being polite). He thinks he knows more than I do because he's an internal medicine intern (which to me just proves how little he knows), because he went to USUHS (the military medical school), because he's just a jerk, I don't know, but he was trying to tell me how to put in orders, which I definitely don't need help with, as I probably put in more than 50 a day in the MICU. And he seems to think he's exempt from doing the 'scut work' (the little things that need to get done that have nothing to do with the four years we spent in medical school), for unknown reasons. He actually told off the discharge planner, which is probably his biggest mistake ever (don't piss off the person you're going to have to be depending on for the next three years), by saying, "I went into medicine to do medicine, and since starting this rotation, I haven't done any medicine, I've just been making all these calls to get this guy discharged, which is supposed to be your job, so tell me what you need from me that's keeping this guy from getting out of here." Yes, doing all that stuff is annoying (I spent half an hour being shuffled around the VA on the phone trying to get my patient's out-patient follow-up appointments scheduled today when I just wanted to go to sleep), but that's what being an intern is about. You don't do medicine; you do everyone else's scut work. They say to put an order in, and you say, "Yes, sir" (or "ma'am", whatever the case may be).

Anyway, enough about him (I'll probably be complaining more about him in the course of the next three and a half weeks). We also have med students, two third year med students from USUHS and a fourth year HPSP (Health Professions Scholarship Program, which is what I was--sponsored student at a civilian med school) student from the University of Buffalo. The third years aren't too bad for it being their first rotation (they've done four and a half weeks of their initial six week rotation), but to quote Scrubs (the most accurate medical TV show out there), a good med student is only who only doubles your work load. I'm pretty quick about getting my orders in and getting my notes written, but they're supposed to write their notes first, and then I'm supposed to correct them and sign them. Since they're still so new to note writing, it takes them forever to figure out what's important and what's not, so I waste time sitting around not doing anything, just waiting for them to finish their notes so I can get around to writing mine. It's rather frustrating.

Having a fourth year (a "sub-i", as I'm sure you remember from my experience in April), is actually quite helpful, especially when getting slammed with new admissions on call, which is what happened yesterday. Our team can take up to ten new patients a night, which is typically split 5/5 among the interns. With a sub-i, though, we had three people to split it between. We ended up taking nine (which is a lot; the team on the night before us took three, and two of those were transfers from the MICU, which come early in the day). I took four, my fellow intern took three, and the sub-i took two.

So that brings us to this morning, after dealing with these admissions and being paged from the nurses on patients from other teams (when on call, the other interns sign their patients out to me, so I manage them overnight only knowing what is on the slip of paper they hand me), it was time to round and get my work done on all five of my patients (four new ones, one from before). I thought I was getting rid of two, so I was frantically trying to get their discharges done (something we didn't do in the MICU; they just got transferred to the wards), and being shuffled around the VA trying to get appointments. As it turned out, neither was quite ready for discharge, so in addition to doing all that and getting them more or less squared away to go home, I had to go back and write a daily note on them and figure out how to get them medically ready for discharge, hopefully tomorrow (because I work for the government, nothing happens on weekends). Great fun.

I left the hospital after 29.5 hours of work (legally, I can't exceed 30), hit the gym (typical post-call activity to get the adrenaline running and keep me awake to drive home), then it was home for lunch before collapsing into my usual post-call coma.

And tomorrow, it's back to work for more Ward 75 fun.