#mindfulmumbles

When I asked about major stressors mom said that her uncle had been detained by ICE during a raid, and they haven't seen or heard from him since. Mom is not  a citizen, and the girl is terrified that her momma is going to get taken while moms at work (mom works as a cleaning lady on the graveyard shift.)

This was the first time I saw this family and I just wanted to help them so much. I gave mom a code phrase that hse could include in an email to me at the clinic- should they ever really need help. I don’t know if that’s ethical and I’m sure my program would frown on it, I’m not even sure how I would help if the need arose. But I couldn't do nothing.   I feel my position as a native, white, professional gives me an advantage when it comes to helping these families, and I would risk a lot if it meant keeping my pediatrics patients out of foster care or worse, government detention centers.

Inspired by @snowandstarlight similar post!

5:00am: Alarm goes off, turn it off and rollover.

5:15am: Alarm goes off, time to actually wake up and get ready. Pack snacks, brew coffee, feed cats, and head out the door. Dress code is business casual. 

5:45am-6:00am: It’s still dark out, though there is a faint glow in the sky, drive to the hospital, listen to happy music, try to appreciate that I get the privilege and opportunity to train as a physician. Sometimes I read a copy of the Desiderata that I keep in my car.

6:00-6:30am: Read up on patients, divide the list with co-residents, eat breakfast and drink coffee.

6:30-7:00am: Patient handover with med students, residents, and chiefs. There are two seniors and two interns on our team. This is also when we get out team phone, that one of the interns carry. This phone is EVIL and rings all the time, and you must answer it and talk to whoever is on the other end and they will usually ask you to do something. This interrupts you constantly throughout the entire day. 

7:00am-8:00am: Pre-prerounding- Time to read up on patients, meticulously copy down numbers, start making daily checklists, call consults that are urgent from overnight, look at any new medical imaging, etc. Usually, each intern carries between 4-14 patients so this can take a while. This is also the time for pouring through charts of any overnight admits you picked up. If you finish this start pre rounds- when you go see and examine each patient, they're usually sleeping, but waking up the parents and hunting down the nurses to ask for updates happens daily.

8:00-8:30am: Morning report, an intern presents an interesting case, and then goes over some learning points, attendings are present to ask the presenter tricky questions about their topic.

8:30am-9:00am: Finish pre rounds, stuff pockets with spare supplies, and print an updated patient list for the attending. I

9:00am-12:00pm: Rounding. The team of med students, residents, attending, pharmacist and sometimes a nurse or social worker go to each patients room. Interns present the patient and suggest a plan, the seniors offer suggestions, and the attending finalized the plan. Sometimes there is some pimping and teaching about whatever illness the patient has. Then we go into the room and the attending talks to the family updates them and examines the patient. The senior resident stays in the hallway at the computer and places orders. Rinse wash, and repeat 10-20 times. During rounds, there are also interruptions and EVIL phone rings and discussions as we run into various consulting teams (usually nephrology and infectious disease on our service) to discuss our patients and ask for recommendations. During rounds is also when you perfect your daily to-do list for each patient.

12:00pm-1:00pm: Sit down eat a catered lunch and listen to a lecture on a peds topic. The lectures are really educational and usually useful and enjoyable. You’ve been on your feet for four hours so sitting down usually feels great. Frequently you will get an admission at the end of rounds or during the lecture and have to leave and miss out on lunch. The EVIL phone will also ring at least once during the lecture, making it difficult to pay attention.

1:00pm-5:30pm: Write notes, place orders, make phone calls, do procedures, admit new patients, teach medical students, answer phone calls, check up on patients from the morning, follow up on labs and cultures, write discharge summaries, update families, reassure the families that are anxious, eat snacks, cuddle babies or play with kids that are left alone, respond to any rapid responses or codes, listen to music ( senior residents choice), check in and make sure co-interns on my team and the others are okay, try to get as much of the work done as possible for the night team. Try to keep your spirits up as fatigue sets in.

5:30-6:30pm: Handover to the night team (one intern and a senior resident that also oversees the two other pediatrics team). About half the time I stay after sign out till 7pm or later  to wrap up my work.

6:30pm-6:45pm: Drive home, reflect on the day- the best part, worst part, and what I’m looking forward to tomorrow. Think of the things during the day that I’m grateful for. Make a conscious effort to leave work behind me when I drive past the post office.

6:45pm-10:00pm: Shower grocery shop, run errands, spend a half-hour reading about a topic on uptodate, or read peds in a review article, visit friends or family, watch tv, excercise.

What a whirlwind- but I adore my co-interns and my seniors.

I really couldn’t have asked for a better team- and they made a very hectic and stressful day manageable!

I did cortext the wrong person...twice. But if that’s the most embarrassing thing I do my first day I’m pretty alright with that! 

I placed my first real order- for Miralax! (the miracle drug!) and did my first discharge.

All in all much better than I feared.

I am starting to really feel the fatigue setting in

My last day of rotations was last Friday, of course having free time is really freaking me out. I have a lot to do and am road tripping to residency town tomorrow for a week or so to secure an apartment and maybe meet some co-interns and explore my new town.

I also have about five weeks to pack all of my stuff, I’ve already organized a moving truck and movers, my immunologist called I’m not mounting responses to my vaccines so I need boosters again before residency, and my car lease is expiring so I need to get my butt to the dealership (which I hate more than anything since they think because I’m a female I’m stupid and they try to take advantage, so I’ll need to make one of my male friends go with me). I should also see if I need to renew ACLS and spend some time with my momma (who is dealing with a recent cancer diagnosis and having surgery in a few weeks)

There’s just so much to do, but still way too much time to think! I’m getting nine hours of sleep a night and eating actual meals! I don;t feel guilty spending time on my hobbies and  I’m also spending lots of time with my friends, dating, and I’m going on a three-day vacation!

It’s all still such a whirlwind I don’t think the fact that I finished medical school and will be a resident in two months has even begun to sink in yet.

For these cases, we use twilight sedation, but it wasn’t strong enough and during insertion, this poor fellow was crying and begging us to stop. I was really upset and felt I should do something so I went and held the patient's hand and told him it would be over soon ( I wasn’t scrubbed or being useful in any other way). When I did this the attending gave me the meanest look and was cold toward me the rest of the day.

There’s really no point to this story except that my feelings were hurt, and I don't care how pissed you are for me comforting a patient that is in acute distress in a scary situation, I will always do so If I am free to. It was just such a puzzling reaction for the doc to have.

I think the attending was upset or thinking I was “siding” with the patient or blaming him, I’m sure he felt bad for the man as well. I wasn't- I knew he couldn't stop where he was and that the tube was necessary and he did order him more sedation as he worked.

Gosh, people are so confusing sometimes...