Dr. Procrastinista

A lot has happened since I last posted when I was an R2!

Now I am an attending.

I bought a house.

I moved to a different state.

I am still procrastinating a lot (I take boards this month and haven’t really been studying much).

I have a huge garden and am planting all the vegetables.

I bought a car (the first time I’ve ever bought a new car).

Just finished my required neurology rotation and it was okay but not my jam. I learned stuff about strokes and I had some cute patients. 

Luckily I switch to outpatient today and then I am going on vacation in two weeks. 

Ugh. I am on the neurology service and I have my first 28h call tonight. 

I’m covering stroke, epilepsy, wards, and all the new admissions. I’ll be by myself overnight. 

Spent an hour explaining Pap smears and why she needs one to a patient using a Kinyarwandan phone translator. She was very much not interested in it. The best I could get was, “maybe tomorrow.” Even though today was the day we specifically designated for Pap smears for all of our refugee patients, she wasn’t having it. 

Then, my attending comes in and says “I will buy you chicken from the food cart if you let us do your Pap smear today.” That is all it took. 

I have to go to an eight-hour (!!) computer training today to learn their terrible EMR with a bunch of old physicians who have never used a computer before. 

i’ve been on “jeopardy” for the past 1.5 weeks and it’s been magnificent. i’ve only been called in twice. 

i have been enjoying all this free time --

- rushing to broad street after the eagles won (yay!!), then quickly running away because it got a little too crazy down there

- taking my dog to all the dog parks and watching him have the best day of his life, every day

- reading! currently on “zen and the art of motorcycle maintenance”

- trying to lose the weight i gained as an m4, am down 8 lbs over the past 50 days and almost at my goal. this consists of making lots of fun recipes and spending way too much $$ at whole foods and trader joes

- midday naps with my dog and cat laying on top of me 

Not as terrible as it sounds. 

Although I did pronounce someone dead last shift. It was strange, and I did it in front of his 10 family members. I have an electronic stethoscope which has a lot of background noise, so while I was listening to his heart for 60 seconds I kept second-guessing myself. ?What was that, was that a heartbeat? I pinched his nail bed really hard and he didn’t move, but what if I didn’t pinch it hard enough? The worst part was asking if they wanted an autopsy afterward. 

Another annoying thing is I didn’t get as many procedures logged as I wanted to. As in, I got no procedures logged. There was a central line insertion I could have totally done, but my senior was lame and said he didn’t want me to do it because a PA told him she was worried about me doing it since the patient had really bad pulmonary hypertension? And then yesterday I could have done an A-line on a patient, but the fellow was like “that is not a priority right now.” This was being said while I was sterile and literally had the probe IN MY HAND and was about to stick the patient’s wrist. I seriously needed 5 more minutes.  Then I pack my bag to go home, and she changes her mind and says we need an A-line ASAP. But that she “accidentally” ruined my sterile field. So I go and set up all my stuff again, and then the nurse tells me I can’t be doing a procedure right now because she’s signing out the patient because it’s change of shift. I had just about had it at that point, so I just left.  

But really, it wasn’t SO terrible. Really! I learned stuff about hearts. Since I was on night float, I didn’t have to present my admissions to any attendings or go on any long-ass rounds.  I learned about different ICDs and about VADs and I liked most of the nurses a lot. 

Wake up 10 AM

Walk dog along the trail for a half hour, let him sniff whatever he wants. 

Go see Lady Bird in theaters!

Make chicken tikka masala for my boo (his favorite). 

Clean up. 

Sleep. 

Intern year wasn’t *so* bad until this past month.  

It started with a 2 week night float rotation, where I was responsible for cross-covering 40-50 patients and admitting up to 6 patients a night.  I had a senior resident for back up, but I usually did most of the admissions. My sleep was so interrupted. I would get home at 8 am, take my dog out, and fall asleep until 4 PM. Get up, have dinner (breakfast?) and rush to work again. I felt terrible. 

Now I am on the pulmonology service, and the people are SICK.  My favorite patient died last night from ARDS. She crumped SO fast. Earlier in the day I was having goals of care discussions with her, and she wanted to hear more about hospice but wanted to be full code until today, when she could see her son. She died in a horrible way and it could have been a better death if she didn’t remain full code overnight. I hugged her goodbye when I left work last night because I thought she would die. And she did. 

On this service, I have to wake up at 4 so I have time to walk by dog and get to work and preround on 10 patients and write notes for all of them. I present them all on rounds. I discharge those that I can. And I admit the new ones. Again, I have a senior resident for back up but she is very hands-off unless a patient is decompensating. I’ve never had so much responsibility in my life. I’m glad she’s pushing me, but it’s taking a toll on me. 

I also get paged about once every 3 minutes. I’ve yet to go to the bathroom without getting paged or a phone call while I’m in there. I don’t get to go to conference. I don’t have breaks. I can’t even get time to go downstairs to our cafeteria to buy a coffee. 

It’s been very hard. Very, very hard. 

I’ve been on general medicine night float for the past week, and I have a “day off” which is really just a night off.  I’ve learned some things. Mainly, I learned that I hate night float. I’m in charge of cross covering about 50 patients and usually one of them is peri-death.  I also admit patients until 5:30 AM.  

My senior is a pretty serious guy and we don’t have much in common, so it’s not the most socially stimulating rotation. 

My schedule looks like this:

7 PM-7 AM -- work-- get paged about anything from family meetings (no I will not be hosting a family meeting at 3 AM for a patient I’ve never met) to hypotension to pain (oh my gosh so many pain pages). 

7 AM - 830 AM -- get home, feed animals, walk my dog (I got a puppy! more on that later!) 

830 AM - 4 PM -- sleep

4 - 630 - wake up, drink coffee, walk dog, get ready for work, repeat

Haven’t had much time to do anything else, not even cook. 

I have an empty census. It feels weird. Not sure that MICU is for me.   

We have had three HLH patients  in the past two weeks (how does that even happen?!). We had a multifocal Castleman’s patient. So many onc patients. So many transplant patients. 

We had CF patients, we had a SCLC-associated hyponatremic patient (with Na of 109!).  We had an HSV encephalitis patient. We had a malaria patient! The list goes on. 

Worked 105 hours over 7 days in the MICU .

Finally got a day off. 

I spent it:

Sleeping til 10

Baking a carrot cake

Shopping for lightweight profesh clothes! I love H&M. 

Cleaning my fish tank!

Shaving my legs!

Doing 3 loads of laundry!

And about to celebrate our 2-year wedding anniversary at a swanky restaurant.

Was yesterday. I started on the MICU and my SENIOR WAS OFF for the day. It was mayhem.

4:00-5:20: wake up. Freak out. Take a shower. Read about patients on Epic. 

5:20-5:30: Bike to work. Continue to freak out. 

5:30-7:30: Round on my patients.  Try to make sense of what in the world brought them to the MICU.  Three were vented, and I could tell that one was on his way towards getting intubated. Freak out some more. 

7:30: Forgot to sign on as covering provider.  I do that. Ten seconds later, I get hammer paged about things and I have no idea how to respond. 

7:30-9:00: We have teaching.  I can’t even focus on what the guest is talking about. I keep getting paged and run in and out of the work room to try and figure things out.  I somehow manage to call two consults on patients I barely know about.  One of the consultants is snippy on the phone. I run to the bathroom and cry for a couple minutes.  Then I wash my face and realize that there is no paper towel in the bathroom, so I have to wipe my face with toilet paper. Proceed to pull flecks of toilet paper off my face.  I’m late for rounds now. 

9:00-2:00: Rounds.  I struggle to talk about these patients and their plan for the day. I get pimped a lot. Mostly softball questions, but still. The attending is pretty nice.  And the fellow is very kind. 

2:00-7:00: Learn very quickly that if I go near any of the other seniors they will give me a million stupid tasks to do.  I already have a to-do list of dozens of things. I hide at a nurses station and answer pages, put in orders, and actually finally get stuff done. I’m already getting the hang of things, sort of. I go and meet the families. I run into my program director, who gives me a bunch of candy.  Two patients die. I update the sign-out.  I text my absent senior: “I survived.”