Tuesday, July 7, 2009

On-call, post-call, pre-call

When you're on call every third night, you're always either on-call, post-call, or pre-call. So I was on-call Sunday night. Things started pretty slowly--we had rounds, wrote our notes, and then kicked back and watched our patients and waited for the pages to start coming in. There were a few random pages about fairly simple problems throughout the afternoon, but nothing that took any longer than a few minutes at a time to deal with, so I was starting to get bored. I spent a lot of time in the transition year call room, where two of my fellow transition year interns (one pre-anesthesia, who is in the cardiac care unit, and one pre-physical medicine and rehab, who is on OB/GYN) were also hanging out with their equally slow afternoons. I discovered the hospital cafeteria doesn't have anything good on the weekends (when Subway is closed), and was going to order pizza with the internal medicine interns on call, but we were too late on the uptake (pizza place closed at nine, and we didn't think about it until 8:50). Then, right at nine, my resident paged me and told me to get to the ER, and things went non-stop from there.

Two unresponsive patients came in within five minutes of each other, which is never a pleasant situation. One just had surgery three days before, so the surgery team came and handled him and ended up taking him to the SICU (surgical intensive care unit). The other had been in asystole (flat line) or PEA (pulse less electrical activity; electrical impulses go through the heart, but it can't contract enough to push blood through the body) for 45 minutes, which is a pretty bad situation. We ended up getting a pulse again and getting him on the ventilator before moving him up to the MICU, where they had to get him somewhat settled in before going down for a head CT. Since I knew that that would take an hour or so, and it was already 1:45am, I reminded the nurses to page me when they were ready and went to lie down in the MICU call room. Then an hour later, it was time to take him to CT (with me ventilating with the bag-valve-mask as we rolled him down the hall and into the elevator), and then back up to the floor. The whole process took about an hour to get a five minute head CT (which was pretty ominous looking when we saw it at rounds on Monday morning). Then when I got back, I had to deal with being sleep-deprived and trying to explain the events of the night to the family. It wasn't until I finally got to lie down again that I realized how scary this must be for them; for me, it was another random unresponsive victim who came in and will never wake up. For them, a few hours before, he was walking around and talking, and now he's in the ICU, on a ventilator and all sorts of IVs, and some doctor they've never met is trying to tell them bad the situation is.

It was a banner night. Then I went back to bed until the pages with the morning lab values started coming in.

At rounds on Monday, I was grilled about the electrolyte abnormalities in the acute kidney failure of one of my patients (and stumbled through the answers), and then after writing my notes, was out of there. I decided to hit the base gym before going home, which was a really good idea--it completely woke me up so I could drive home. Then I made lunch, did some cleaning, and went down to the pool, where I promptly fell asleep. I probably would have stayed that way (ending up rather burnt) if one of the general surgery interns hadn't paged me asking if I wanted to do dinner. So I changed, took the Metro into Bethesda, and enjoyed the 1/2 priced bottles of wine at Olazzo (their Monday happy hour special) with some surgery interns (I spend a lot of time hanging out with surgeons, for some reason). And then it was back home, where I went to bed early in anticipation of getting up to go in for a "work day" today.

"Work day" means you go in, see your patients, learn everything that's happened to them in the last 24 hours, and then round (which took forever today, for some reason, but I did get to look impressive by properly interpreting an EKG), and then write notes and get to noon conference (which was cancelled today). After leaving the hospital, I met with one of the fourth year preventive medicine residents about on-going research projects that I could join, and then headed home for a run. I've just been lounging around since, will probably go to bed early again tonight, because I'm pre-call.

Friday, July 3, 2009

Three down, 362 to go

Yesterday I started my first shift as a doctor--in the MICU (Medical Intensive Care Unit)--and today at noon, that shift ended. Nothing like a 30-hour on-call shift to say, welcome to the field of medicine.

On Wednesday night, I got a call from the on-call resident saying that since I was on-call on Thursday, I didn't have to worry about showing up until 8. So on Thursday, I got up, showered, dressed in civvies, and headed for the hospital, where I changed into scrubs and my white coat (a long white coat now, which is a little weird), which is my 'uniform' while I'm in the MICU. Since it is a uniform, uniform standards apply, which means that my hair had to be up, etc. It also means that for some guys, they have to shave their five o'clock shadows while on-call.

Anyway, so I arrive to the MICU around 7:30, to discover that I should have been there at 6, because I was assigned a patient. Fortunately, my resident bailed me out and went with me to see the patient while explaining how things work in the MICU.

Rounds, of course, took forever. It's internal medicine; they like to round. And they like to throw around big words and quote studies and whatnot, so after a year of living the easy life as a fourth year medical student, it was feeling rather intimidating. After rounds, I asked one of my fellow interns if I could go somewhere and cry. He laughed and said there was too much to do to have time for that (which was true). We also have a Oral/Maxofacial Surgery resident (dentist) on the team, who is somewhere between an intern and a resident in terms of responsibility. It was pretty funny; at one point, I asked him what sort of clerical error allowed me to earn an MD, and he replied that at least I spent the last four years in medical school, and that I should just imagine doing all of this after four years at dental school. He had a good point.

I wrote a note on Facebook about my on-call experience. Because I'm too lazy to type it twice, I've copied and pasted it here:

So here are a few things I learned in my first on-call night as an MD:
1) After four years of wearing a short white coat and knowing that everyone around you knows that that means you have no responsibilities, it's a little weird to be in a long white coat. It took me a few hours for it to actually sink in that that's what I was supposed to be wearing and that nobody was going to get me in trouble for impersonating a doctor.
2) For military personnel, scrubs are a uniform while you're in the hospital. That means hair must be maintained to uniform standards (short for guys, above the collar/in a bun for girls). It also means that when on call, a lot of guys have to, at some point in the night, shave.
3) After the fiftieth page about blood pressure, you start to feel comfortable handling that alone without calling the senior resident.
4) ICU-trained nurses are AMAZING. I'm serious. When a patient was beginning to circle the drain, it took me about three seconds to realize that my job was to stand out of the way, and when the nurses asked, "Ma'am, do you want to give _____?" the proper response is, "I'll go put that order in right now."
5) Non-ICU trained nurses working in intermediate care, on the other hand... not so amazing. See point three about answering pages about blood pressure.
6) Doctors at Walter Reed wear their pagers clipped to the front of the scrubs top instead of at the waistband of the pants. This isn't to look cool. It's so when you're getting these constant pages, all you have to do is glance down to see what number you need to call back.
7) You very quickly learn to recognize the phone numbers on your pager of the units/nurses that will keep you up all night. See points 3 and 5.
8) At WRAMC, they have a policy where patients who are on a monitor must be accompanied by a doctor whenever they leave the floor. All ICU patients are on monitors. That means that when Mrs. X is going down to her MRI at midnight, the intern gets to go with her and sit there until it's time to go back.
9) The computers in the MRI suite don't have the program necessary to write patient notes. So while sitting there while Mrs. X is getting her MRI, there's nothing to do (assuming she doesn't suddenly crash), and notes that have to be written aren't getting written.
10) It's not Gray's Anatomy (well, I knew that point already). The on-call rooms are used for sleep, storing things in lockers, and grabbing thirty seconds to wolf down a meal at 0300 that was supposed to be dinner the night before. Nobody has the time or energy for sex while working. At least, I hope not. I caught an hour and a half of very interrupted sleep (see points 3, 5, and 7) on one of the very uncomfortable beds in the Transition Year call room, and I don't want to even think about when the sheets were last changed.
11) Brownies stolen from the Internal Medicine work room at 11pm taste really good at 4am.
12) White coat pockets are large for a reason. That way, in addition to carrying around reference books and patient notes, you have room for food, gum, chap stick, and a water bottle. And a stethoscope, if you get tired of wearing it around your neck.
13) After awhile, answering the phone, "This is Dr. Hesse, I was paged," loses its novelty.
14) You realize, sometime around 0200, that you almost know what you're doing, and maybe you didn't waste the last four years of your life in med school after all.

A few other things that I didn't add to the list that I just thought of:
1) Leaving the hospital after being indoors for 30 hours makes you feel like Rumpelstiltskin. You have no idea what day it is or why it's sunny outside.
2) When you don't know what day it is, it makes getting around a military base a bit difficult. This really only applies to today. Since the 4th is a Saturday, the 3rd is a training holiday, which meant the hospital gym was closed (and thus, there went my plans of working out after work), the road from the parking garage to the main gate was closed, and the 16th Ave gate, which I usually take, was also closed. To get from the garage to the main gate on a weekend or holiday (the only gate open), you literally have to drive all the way around base, and for everyone who has ever driven on a military base, you know that that's easier said than done--roads aren't gridded, they're narrow, and there are stop signs and speed bumps in seemingly random places. Now imagine doing that after working for 30 hours (when you're as impaired as someone who is legally drunk). All sorts of fun.

Anyway, that was my first day as an intern. I have tomorrow off (I'm planning on watching the fireworks from the Washington Monument), and then I'm on-call again Sunday (another 30-hour shift... yipee). Only three weeks of this, and then it's onto general medicine wards (which I'm not thrilled about, either).

Saturday, June 27, 2009

A little piece of Americana


So, the last few days have been a mixture of mandatory and non-mandatory fun. Thursday night, a group of us headed over to NNMC at Bethesda to go bowling (yes, the hospital base has a bowling alley). The first two games were rather pathetic, but I somehow managed to win the last one (with a whopping 126... doctors apparently don't bowl). We did have clever specialty-specific nicknames, though; I was Malaria, the pediatrician was Croup, neurologist was Guillain-Barre, urologist was Priapism, and the surgeons (there were three) were Abscess, DRE, and Train Wreck (which really wasn't all that funny considering the recent train wreck on the Metro). And if you don't know what any of those nicknames mean, you probably don't want to.

Anyway, Friday was 'mandatory fun', with a required picnic. It was ninety degrees and humid, so nobody stayed very long. Then we had Army vs Navy games in the evening. I don't know if I remember any of the names of the Navy interns, but it was fun to hang out when them.

Today was the DC BBQ cook-off (or some such thing) on Pennsylvania Ave, so some of us headed down there (and one surgical intern managed to get lost in downtown DC for over an hour before he found it). After waiting in a ridiculously long line to sample not-so-good food, we bought some really barbecue before deciding to head over to the Mall to see what was going on around there. The Smithsonian Folklife Festival was winding down for the evening with some traditional Welsh music, and the husband of one of the surgery residents brought a frisbee, so we found ourselves throwing a frisbee around the National Mall as the sun was setting over the Washington Monument with the sounds of fiddles and whatever else was being played in the background. If that's not Normal Rockwell enough for you, I don't know what is.

Wednesday, June 24, 2009

Navy In-processing

It's been twelve days of in-processing and orientation, and today I got to take all that fun to National Naval Medical Center--NNMC, better known as Bethesda. Yeah, not so much fun.

Actually, the day started back at Walter Reed, where I got my official Department of the Army (DA) photo taken (haven't seen how it turned out yet), followed by a visit to the official computer people to inform them that I have been using Essentris (the in-patient computer system) for the last two years and therefore don't need to be trained on it. Fortunately, they agreed, gave me my new log-in and password, and sent me on my way, right over to the library so I can do my HIPAA training (yeah, definitely not fun). And then I went home, changed out of my class A uniform (greens, which I wore for the DA photo), back into my ACU's, and then got on the Metro and headed over to NNMC.

There, I picked up my in-processing packet in building 8, deck 2 (2nd floor; they don't realize that their hospital isn't a ship); then it was over to building 2, deck 1 to get my NNMC ID and parking pass, over to building 10, deck 2 to get put into the computer system, then building 1, deck 5 to do all sorts of computer training, including over an hour of 'command training' on the computer. Fortunately, the computer modules give you the option of taking the test without going through the slides, which probably saved three or four hours. Finally, I finished all of that "incredibly useful training", and headed back to building 8, deck 2, where they declared me in-processed. Then I went back home and have been fairly lazy since.

Saturday, June 20, 2009

PT test


We had a height/weight check and diagnostic (meaning it doesn't count) PT test today as part of in-processing. I was measured at 64.75 inches (two inches taller than I am in real life), which meant that I was within Army standards on weight, and didn't have to be taped (specific measurements used to calculate body fat). That was the first time I didn't have to be taped, so I was pretty happy. Apparently, they did that with quite a few people, because I was talking to some other girls who usually have to be taped and didn't have to this time.


It is rather unfortunate that the PT test is just a diagnostic, because I ended up scoring 297/300 (it would have been a 310/300 if they used the extended scale). The PT test is two minutes of pushups, two minutes of situps, and a two-mile run, and is scored on a scale that goes up to 100 in each category. For women my age (22-26), 100 points is 46 pushups, 80 situps, and 15:36 on the run. I did 44 pushups (97 points), 81 situps (I forgot to stop after 80; 101 points on the extended scale), and ran two miles in 14:20 (112 points on the extended scale). I was really surprised with the run, because I've never ran two miles that quickly. I was the second fastest female, which was pretty exciting for me. Afterwards, a number of girls asked if they could go running with me, so they can prepare for the real PT test in October. So now I just need to keep up with my current level of fitness (well, exceed it on the pushups) to get a perfect score on the real PT test in October.


After that, we had to quickly (very quickly) shower and change into our ACU's for a 0930 formation (although our company commander didn't show up until 1000, which made us mad that we rushed through getting ready and didn't grab anything to eat in order to show up on time). Then it was two hours of suicide prevention lectures (fun, fun, and not really all that applicable to people who have graduated from medical school--after psych lectures and psych rotations, there was nothing there we hadn't already had drilled into our heads), and then I ran over to the commissary to get gas (much cheaper than off-post) and do a little bit of grocery shopping before heading home, where I'm currently sitting around in half a uniform (ACU pants and my undershirt), because I'm too lazy to completely change. I think I'll take a nap soon. We have a social activity tonight in Bethesda (yay to social events I can take the Metro to...), and I want to be well-rested for that.

Wednesday, June 17, 2009

Being in-processed to death

So yesterday and today I... did more in-processing. It's a little insane.

Yesterday we had our Class A (green service uniform) uniform inspections, to make sure we're all squared away for our DA (Department of the Army) pictures next week. So we show up, get our TB skin tests placed (no, that doesn't have anything to do with uniforms, but it happened), and sat around with rulers and uniform guides making sure things were straight and properly aligned to the buttons and seams. Then, we all stood in company formation (that was entertaining, getting 65 or so interns into a company formation) at attention while a first sergeant and three lesser-ranked sergeants walked up and down the ranks with their own rulers and making adjustments. It was all sorts of fun. Then we changed back into our ACU's (Army Combat Uniform; camouflage) and went back to the auditorium to be in-processed some more.

Today it was more of the same (only without the uniform inspection). There's an all-morning mandatory training for everyone in-processing into Walter Reed, regardless of rank or position, so that's where we were. They were pulling us out four at a time to meet with personnel about making sure we had all the proper documentation to calculate time in rank (pretty easy for me; captain with zero years in rank. Other people, those who had service before med school, were quite a bit more complicated). Then a few of us snuck out (after going over the Army's regulations on HIV in great detail while at Madigan, I didn't need the dumbed-down lecture about) and got our new CACs (Common Access Card; combination Army ID and key to computer systems). I like the picture on my old one better, but I'd rather have the rank of my new one :)

I actually got to take off early today (around 12:30), because the class was scheduled for BLS (Basic Life Support? I have no idea; we just call it BLS. It's pretty much just CPR). Anyway, I'm current on that, so I didn't have to stay (yay). No such luck tomorrow, though; it's ACLS (Advanced Cardiovascular Life Support), which expired two months ago. I'm glad for the refresher though; I'll probably have to use it quite a bit in the ICU when I start there in July.

Sunday, June 14, 2009

Furniture

I've been slowly unpacking and adding furniture to the condo; 'slowly' because I'm both lazy and tired from sitting around doing nothing all day. Anyway, today it was the desk and coffee table.

My desk. I've been adding more clutter to it since I took this picture. And yes, that is one of my dining room chairs.

The couch and coffee table. And yes, that's a giant pile of flattened moving boxes in the corner. I wish I knew someone who was moving out so I could get rid of them, instead of just sneaking them to the trash/recycling room on the floor and hoping that nobody notices (I have to imagine that my neighbors are getting pissed at the extensive number of flattened cardboard boxes I've been dropping off...).

So, I still need to buy rugs (I found some at Target that I like) and assemble the entertainment center, but I might wait until I can buy the TV stand to do that.

Tomorrow, ridiculously early report time. Fun, fun. At least there won't be much traffic at 4:30 in the morning.

Saturday, June 13, 2009

More moving, and more hurrying up to wait

Here are a few pictures from the moving process:

The box maze of the living room. I could have had the movers unpack them, but since I had no idea where anything should go, I figured I should probably do it myself. Now, everything's been unpacked, and I haven't noticed anything broken or missing yet, so I'm happy.

A bunch of junk that had gone in my car. I somehow managed to fit 400 pounds of stuff in my car. I'm kinda proud of myself.
Anyway, onto other things. I'm now two days into in-processing/orientation. Yesterday was a long and painful day of, guess what, hurrying up and waiting. The best part had to be when we were told to hurry back from lunch to return to the classroom for in-processing at 1245. By 1345, we were all very confused and wondering what we had missed, because nobody came in to tell us what was going on. Finally, our company commander (who is also a captain, which makes for a frustrating situation, for both her and us) arrived to say that they heard forty-five minutes before that parking was running late. We were all rather upset that nobody had the common courtesy to tell us that before we sat around doing nothing for an extra hour.

And to make matters even more fun... We had to come in today to meet with finance. Well, finance finally showed up half an hour late, and then proceeded to run through a checklist of documents we would need for when we meet with finance again on Monday. Finally, one of my fellow interns raised his hand and told her that we already went through that sheet yesterday, and we all brought the proper documentation and were ready to fill out our forms. And of course, they weren't ready for us to be ready. So, in other words, we had to come in a Saturday for nothing. We were all happy about that.

We do get a day off tomorrow (yay...), but then have to report at 0500 on Monday. We're pretty sure that means that we're going to have a "surprise" drug test, because nothing else happens at 0500.

Wednesday, June 10, 2009

Movers, Part 2

The movers dropped my stuff off today, which was a really fast process--I think they were only here for an hour (not bad when you're talking about getting stuff from the loading dock to the 12th floor). I had the option of having them unpack stuff for me, but since I'm still figuring out where everything is going to go, I opted for doing it all myself.

Oh, my goodness, I have a lot of useless junk.

I have more room (in terms of square footage) here than I had in my basement/dungeon in Columbus, but I had a ton more storage space, so now I have all this stuff that I let accumulate, and no idea where to put it. I've already run three boxes of stuff over to Goodwill (in addition to the box before I left Columbus), and I've found more stuff that will be joining it. That is a definite downside to using movers--instead of figuring out what you want to keep before you move, you have to deal with it when it's already at your new place.

Anyway, I have pictures on my camera of my condo filled with boxes, but the cables connecting said camera to the computer are in one of those boxes, so they'll get up eventually (maybe).

I still have yet to buy living room furniture (couch, coffee table, entertainment center, rugs). I know what I'm going to get at Ikea, but they were out of my couch, so I have to wait until it comes in. Fortunately, this Ikea delivers, so I don't have to try to figure out how I'm going to get a couch in a Jetta :) I found rugs I like at Target, but I figure I should wait until my place doesn't look like a maze of brown boxes before buying rugs.

Good news--the Comcast guys are coming tomorrow, so I'll have TV and not-stolen internet! In a perfect world, they'll come early tomorrow and Ikea will have my couch in, so I can go and buy my stuff and have it delivered tomorrow (have to buy it before 4pm for them to deliver the same day). Then I can be more-or-less (well, less, let's be honest) settled in before starting orientation on Friday.

Monday, June 8, 2009

Movers

The movers are here, which means I'm camped out on the couch in my living room (not my usual sitting place, as my roommate already pointed out), trying to stay out of their way. I'm impressed; they've been here for two hours, and have already managed to pack up everything I own, something that would have taken me two days and a lot of swearing.

Anyway, not much of note has happened since hooding and commissioning on Thursday (and eventually, I may get those pictures up, but I think everyone's seen them all anyway). I've had a few dinners/lunches with people I'm going to miss when I'm gone, and pretty much spent the rest of the time sitting around, being a bum and enjoying my last week of freedom. Yes, last week--my report time is 0600 at Walter Reed on Friday, June 12. Uniform of the day: ACU (they sent us a schedule for intern orientation, complete with 'uniform of the day' for every day). It's a little intimidating, but I think I'm ready. Before then, though, I have to survive driving to DC tomorrow, unpacking my car, getting to Ikea to finish buying furniture, and having the movers bring my stuff on Wednesday. It's going to be a busy week.