Maybe that title's too long, but oh well it describes how I am feeling :)
The last two weeks on trauma/burn, I've been working on the NICU floor (neurology ICU, shared by neurology, traumatically brain injured pts, and neurosurgery patients...many patients are candidates for multiple services). This normally involves getting there around 5 or 5:30, rounding on my patients and assimilating their information, and pre-rounding with my chief resident. Well, on Thursdays, I have a suture/surgical skills workshop/lecture from 6:30-8am. Last week, I went early, saw my patients, and pre-rounded before skills workshop, but this week I was feeling like I could slack a little (because my resident could care less if I'm there in the mornings...as long as I've outlined his notes for him the previous afternoon) and my sleep schedule was still kind of out of whack as per my previous post...so I just went to the workshop. Well, when I arrived back after my skills workshop, my scary attending was waiting for me, and my oh so competent and all-responsible resident was no where to be found. Turns out he was doing some cool surgery that definitely trumped the importance of rounds. So, back to my attending. She's been really nice to me, but has a reputation for creating a miserable work environment for most -- she's who you'd want to operate on you if you came in after a car wreck all sliced and diced, but she's not who you'd want to spend your free time with. I was told day 1 of the service (before I realized I'd be working with her for 2 weeks) that her name was "the trauma mama," that she would "put a saddle on me and ride me," and that she'd been known to dislike medical students for such reasons as "being too tall," "standing too close," or "clicking their pen too many times." That said, when I got back from my workshop and saw that it'd be just the two of us for rounds, she grabbed my arm, grabbed a piece of paper from the printer tray of the computer, and said "come on, young doctor, let's go round. write everything i say down so that you and hoffman (my resident) don't screw everything up." Of course this would happen on the day that I hadn't pre-rounded with my resident! I had very little information about my patients' overnight experience, much less any clue about the patients on the rest of the floor. So, nervously, I followed her and tried my very best to offer input, show chest x-rays at appropriate times, gather information and meticulously record the plan for each patient. When it was all over, I sat down and immediately rewrote my notes into cohesive bulleted plans (surgery "plans" are notorious for being fewer than 10 words, e.g. "vent wean, continue antibiotics for UTI, possible OR tomorrow." they must be brief and comprehensive, and these "plans" are how we communicate about patients in giant rounds [see previous post]). Feeling brave, I paged my resident. I nervously but swiftly ready my plans for our whole list of patients. As I hung up the phone, a former resident (one of the sweet PGY2's from neurology, my previous rotation) came over and said "Who was that you were passing off (telling plans) to just now? You sound like an intern!"
heart = warm. I had experienced some sort of rite of passage. 99.9% of the time I feel like any thought I have about a patient or his/her management has already been thought, acted on, and probably even second guessed by my resident. sometimes when you have that much of a safety net, it's hard to think that A) your thoughts matter, or B) that it's even worth having them/doing a good and thorough job, or C) that you'll ever be able to think and act as quickly and responsibly as your residents do (granted, I'm working with a chief resident...I find many interns very relatable.). but, because I was given responsibility, I was able to see/remember what I could do. I returned to work early today, convicted to do good, more thorough exams on my "brain dead, vegetable, circling the drain" patients. And I found that one of my patients, a fifteen year old girl who wrecked a car and put her sister into a similar comatose state, had improved drastically neurologically overnight.
And to think, I might not have noted that change had I not slept in and slacked off Thursday AM...
OK now for our feature of favorite clinical moments: This will read more like a bloopers reel...
-I called the lungs the liver while looking at a CT...WITH AN ATTENDING.
-I made the incision to put in a chest tube and an attending said, "Fran, that's a paper cut by scalpel." Needless to say, I did better the second time.
-I called the superior mesenteric artery the superior celiac artery...there is no superior celiac artery.
-I took scissors off a scrub nurse's table without asking (she seemingly wasn't paying attention)...rookie mistake. no children or med students were harmed in this incident, but it was a close call. we're buddies now, it's ok. I apologized for my grievous error.
-I saw a guy in trauma follow-up clinic who had a surgical history of a gsw (gun shot wound) s/p (status post) cardiorrhaphy (heart repair) with a clamshell incision. As I started to examine him, I saw his scar that spans his whole chest transversely. And yes, clamshell incision means he was opened up in half like a clamshell. Chief complaint in clinic? occasional shortness of breath (very minor). YOU GOT SHOT IN THE HEART AND OPENED LIKE A CLAMSHELL. he will likely always experience shortness of breath, but HE HAS BREATH. whew. pretty rad scar.
-I will include this as a blooper but I really don't know what to make of it... At least four or five times so far during my surgery rotation, I've been told that I'd make a good orthopod. that's what they call orthopedic surgeons. residents, attendings, and non-orthopod residents have made these comments. don't know if i should be insulted, complimented, or just ignore it.
that's all for now. hoping for some more funny stories soon :)