I mentioned a few days ago that we had close to emptied the floor and were a bit more relaxed in the morning. It was nice, but like all things, it didn't last. There's not much you can do about it on trauma. Why did he take a kitchen knife and saw off his hand? Honestly, he probably couldn't even give a good answer for that one. Or whomever told him that shaking hands with a moving train was a good idea should be slapped. But not slapped too hard... we don't need another trauma to roll through those trauma bay doors. I was covering for one of my teammates today, and was just supposed to round. Instead, ended up setting a new personal "record" for time rounding. Aiaiaiai, what ya gonna do? Gonna have to get up even earlier tomorrow. At least it's back to the weekday with almost the whole team back in action.
Much love!
Sunday, August 28, 2016
Thursday, August 25, 2016
Estoy cosiendo.
Took a 15 year old girl to the OR today. She'd had surgery a few days ago and her belly was left open. Really something quite easily could have been closed at bedside, but the patient asked for it, so we took her to the operating room and to the tune of roughly $60 a minute closed her wound there. My attending asked for the stapler and is about to go to town!
Me: Excuse me, but Dr. Karev! We can't use a stapler!!
Dr. Karev: Why not?
Me: Because she's a 15 year old girl! We can't leave that kind of scar!
Dr. Karev: There's no scar with staples. Why? What are you going to do? Close it subcuticular?
Me: Definitely!
Dr. Karev: What? You think you can close it fast?
Me: Definitely!
Dr. Karev: Well... then we close it your way, but we race! Start from opposite ends and see who's the fastest!!
So in the end, we both got what we wanted. We closed it with sutures, and we closed it fast! Only trouble with that is had I been allowed to close the whole thing unrushed... I could have made it look so much prettier!! It's so unsatisfying to look back at the scar, and know it could have been so much prettier!
Much Love!
Me: Excuse me, but Dr. Karev! We can't use a stapler!!
Dr. Karev: Why not?
Me: Because she's a 15 year old girl! We can't leave that kind of scar!
Dr. Karev: There's no scar with staples. Why? What are you going to do? Close it subcuticular?
Me: Definitely!
Dr. Karev: What? You think you can close it fast?
Me: Definitely!
Dr. Karev: Well... then we close it your way, but we race! Start from opposite ends and see who's the fastest!!
So in the end, we both got what we wanted. We closed it with sutures, and we closed it fast! Only trouble with that is had I been allowed to close the whole thing unrushed... I could have made it look so much prettier!! It's so unsatisfying to look back at the scar, and know it could have been so much prettier!
Much Love!
Wednesday, August 24, 2016
Estoy despierta.
Five minutes in the morning is incredibly precious time for a surgery resident. As an intern they have to develop an efficiency that can be primarily based on observation with seemingly minimal objective input. If not caught in conversation, those five minutes is enough to have a full assessment on multiple patients. Armed with an expected picture based on vital signs, In's/Out's and labs, in addition to the sign out report obtained from the night resident, a surgery resident can enter a room, wake up their patient, saw two lines, push on their belly and make a quick exit. On to the next. And the next. And the next.
It's not exactly something that comes naturally. It's learned. I remember in my case specifically one particular month as a brand-new intern when my chief would leave a patient's room, turn to me, and ask if the patient had a foley catheter. ??? or what were the intravenous fluids the patient had running. ??? And after enough times you start to automatically notice IVs, tubes, drains, wounds, drainage on the bed, patient's position in the bed and level of comfort, ease of breathing, feel of their skin.
The faster a surgery resident learns efficiency the better. And with an increase in efficiency, the more they get to sleep.
My co-intern on the trauma service this month is actually a Urology prelim resident. Two days ago was an excellent discharge day, during which we emptied the floor quite a bit. Super nice to not be so incredibly rushed in the mornings. And yet for some random reason, both my co-intern and I woke super early and made it to the hospital to be on the floor by 5am. Why on the one morning when we could have at least a good 15 extra minutes of sleep, we woke way earlier than necessary, I have no explanation. Those 15 minutes, so precious in the mornings. Life is just full of surprises sometimes.
When I woke up extra early this morning, I was terrified that I had actually overslept. The adrenaline rush that causes, and then the subsequent relief felt when realization comes, there's no going back to sleep after that anyways.
Much Love.
It's not exactly something that comes naturally. It's learned. I remember in my case specifically one particular month as a brand-new intern when my chief would leave a patient's room, turn to me, and ask if the patient had a foley catheter. ??? or what were the intravenous fluids the patient had running. ??? And after enough times you start to automatically notice IVs, tubes, drains, wounds, drainage on the bed, patient's position in the bed and level of comfort, ease of breathing, feel of their skin.
The faster a surgery resident learns efficiency the better. And with an increase in efficiency, the more they get to sleep.
My co-intern on the trauma service this month is actually a Urology prelim resident. Two days ago was an excellent discharge day, during which we emptied the floor quite a bit. Super nice to not be so incredibly rushed in the mornings. And yet for some random reason, both my co-intern and I woke super early and made it to the hospital to be on the floor by 5am. Why on the one morning when we could have at least a good 15 extra minutes of sleep, we woke way earlier than necessary, I have no explanation. Those 15 minutes, so precious in the mornings. Life is just full of surprises sometimes.
When I woke up extra early this morning, I was terrified that I had actually overslept. The adrenaline rush that causes, and then the subsequent relief felt when realization comes, there's no going back to sleep after that anyways.
Much Love.
Thursday, August 18, 2016
Estoy marioneta.
The annual U.S. healthcare cost is over 3 trillion dollars. This comprises over 18% of our entire Gross Domestic Product. And is greater than the healthcare cost of all of Europe combined.
Where does this come from?
I see first hand a huge drain on the system when navigating through patient's plans on the Trauma service.
Our reliance on pills is unfortunate. Pills to go to sleep, to wake up, to think more clear, to dull the senses... it goes on and on. I would really dislike it when I'd get paged at night about a patient wanting something to sleep. As a third year intern, I handled that page much better than as a first time intern. I would make myself sound really smart and elaborate the risk of sleep aids. It would put a cabosh on the requests fairly quickly. That's not to say I never gave any, but I'm pretty sure the nurses were smart enough to figure out when I would and wouldn't and respected that. Along with our reliance on pills is the tolerance our body manifests. Chronic abuse lowers a body's threshold to stimuli and in effect by dulling our pain eventually makes us so much more sensitive to the acute pain. Now try to control that pain... it's like trying to dry off your dog while standing out in the rain.
And don't get me started on insurance... My list is filled with names of patient's literally sitting there waiting for insurance authorization to be discharged so they can finally get on getting better. And those 2, 3, 5, and 8 extra hospital days... who's paying for those?
And then you have those patient's who flat out abuse the whole system entirely. We see this quite often in our inmates. You learn quickly that you can never tell your patient when discharge is planned if said patient is an inmate. It's amazing what they will manifest to stay longer in the hospital. I took a patient to the OR today after she had ripped open her own wound and stuck metal buttons (which she had bitten off her hospital gown) and her own feces in it. I cleaned her out and packed it, couldn't close it again due to her own contamination. This isn't the first time, not by a long shot, and it won't be the last. Our New York taxpayer's dollars hard at work.
Really, I just want to do my job. I want to be challenged and learn something everyday. But on trauma... one learns more of the ugly underbelly of the system than is in general desirable.
Much Love.
Where does this come from?
I see first hand a huge drain on the system when navigating through patient's plans on the Trauma service.
Our reliance on pills is unfortunate. Pills to go to sleep, to wake up, to think more clear, to dull the senses... it goes on and on. I would really dislike it when I'd get paged at night about a patient wanting something to sleep. As a third year intern, I handled that page much better than as a first time intern. I would make myself sound really smart and elaborate the risk of sleep aids. It would put a cabosh on the requests fairly quickly. That's not to say I never gave any, but I'm pretty sure the nurses were smart enough to figure out when I would and wouldn't and respected that. Along with our reliance on pills is the tolerance our body manifests. Chronic abuse lowers a body's threshold to stimuli and in effect by dulling our pain eventually makes us so much more sensitive to the acute pain. Now try to control that pain... it's like trying to dry off your dog while standing out in the rain.
And don't get me started on insurance... My list is filled with names of patient's literally sitting there waiting for insurance authorization to be discharged so they can finally get on getting better. And those 2, 3, 5, and 8 extra hospital days... who's paying for those?
And then you have those patient's who flat out abuse the whole system entirely. We see this quite often in our inmates. You learn quickly that you can never tell your patient when discharge is planned if said patient is an inmate. It's amazing what they will manifest to stay longer in the hospital. I took a patient to the OR today after she had ripped open her own wound and stuck metal buttons (which she had bitten off her hospital gown) and her own feces in it. I cleaned her out and packed it, couldn't close it again due to her own contamination. This isn't the first time, not by a long shot, and it won't be the last. Our New York taxpayer's dollars hard at work.
Really, I just want to do my job. I want to be challenged and learn something everyday. But on trauma... one learns more of the ugly underbelly of the system than is in general desirable.
Much Love.
Saturday, August 13, 2016
Estoy cubierto de lodo.
As a resident, there is an unspoken, non-acknowledged role you play in the patient-physician relationship between your Attending and your patient. They think it's just them and their doctor. The patients, that is. They think they have a direct relationship with their primary doctor, the one who takes care of them. But they don't see behind the scenes. For good reason, as behind the scenes, more times than not, is an all-out mudpie-to-the-face chaotic mess. and No. One. wants to deal with mess. That's the unspoken, non-acknowledged role of the resident. Clean up the mess, without leaving a stain on the Attending, and most definitely without letting the patient even hear a single mudpie kersplat!
It's a very, very unfortunate role, as it usually takes up +66% of a resident's time, yet holds about 0.025% educational value.
The only way to change this: stop throwing mudpies.
Came upon a very random patient interaction the other day. I was taking care of an elderly patient's ostomy. I push a little conversation at times like those, aid in distraction for all involved. So when some water spilled on the patient and he exclaimed "Many are cold, but few are frozen" I snatched at the conversation starter and asked him to elaborate. To which he responded, "many are called, but few are chosen." I'll admit, it caused me to pause. I'm not used to doors held wide open, makes me think there's a trick waiting behind it or something. In the end, it wasn't a long conversation, didn't need to be as I finished my task soon enough. But it makes me wonder what he thinks about lying in bed all day. He had no conclusion to the statement at that time, maybe I should ask again...
Much Love.
For many are called, but few are chosen. Matthew 22:14
It's a very, very unfortunate role, as it usually takes up +66% of a resident's time, yet holds about 0.025% educational value.
The only way to change this: stop throwing mudpies.
Came upon a very random patient interaction the other day. I was taking care of an elderly patient's ostomy. I push a little conversation at times like those, aid in distraction for all involved. So when some water spilled on the patient and he exclaimed "Many are cold, but few are frozen" I snatched at the conversation starter and asked him to elaborate. To which he responded, "many are called, but few are chosen." I'll admit, it caused me to pause. I'm not used to doors held wide open, makes me think there's a trick waiting behind it or something. In the end, it wasn't a long conversation, didn't need to be as I finished my task soon enough. But it makes me wonder what he thinks about lying in bed all day. He had no conclusion to the statement at that time, maybe I should ask again...
Much Love.
For many are called, but few are chosen. Matthew 22:14
Sunday, August 7, 2016
Estoy feliz!
Blogging to you from the road this Sunday afternoon. Interstate 80, to be exact, making our way back through Pennsylvania towards the East Coast. Weekends like these fill me to overwhelming with their reminders of God's blessings to those who love Him.
This weekend was the wedding of Jason Koch to Anita Schlatter in Junction, OH. Anita being my friend and sister to Regg and Bev Beer. At the idea of seeing my family from Mexico I asked for the weekend off. Unlikely chance for an intern, I know, but figured no harm in at least asking.
Schedules came out on Friday, July 29th and I had no call scheduled for the weekend! Next step was to then find out the rounding schedule, so I texted my trauma chief. Once again, figured no harm in at least asking. And to my utter surprise, my chief, said sure, no problem! So it was Saturday, July 30th and I found myself with an entire Saturday and Sunday off for a wedding in Ohio!
Next step, Ohio. How to get there and back again in semi-ok condition to then go back to work Monday morning. Enter Marcy B. And Amanda V. In a matter of minutes we had a decision and a plan. The three of us, a rendezvous in Pennsylvania, a road trip, a wedding in Ohio and lots of coffee.
And here we are now, on the last leg of the journey. Let me quick recap and bring you up to how we got here. Friday afternoon Marcy got off work early in Ellington, CT and got a ride to Danbury, CT. I left work as soon as I could and headed up to Danbury where I met up with Marcy and the two of us headed West. We stayed overnight in Pennsylvaina where the following morning Amanda joined us. (She had been vacationing with her family all week in PA.) The three of us then continued on together. Marcy had arranged the accommodations for us, so Amanda and I had the pleasure of making new friends of the Laukhuf's. We went to the wedding singing at the fellowship hall Saturday evening, and I got to hug Bev and Anita and talk with Tucker about riding his bike. For church, we went to Latty for morning service and I got to see Alexis (Gasser) Stoller. Then over to Junction for the wedding and another round of hugs. We made a quick stop after church to load up my trunk with three bushels of peaches for a sister back in CT, and then East bound. Marcy has been manning the wheel while I've had some time to close my eyes in the back seat.
A church is not a building. It is a family of believers. It is loving a brother or sister without ever having met them before. It is built on joy and not dependent on happiness. It is the support group we run this race with. I love my church. I live far from them, but my desire to protect them is not lessened by the distance.
We are about back to where we left Amanda's car in PA at which point she and Marcy will head to CT and I to NewYork. I am so thankful for God's blessings in allowing this weekend to take place.
Much Love.
This weekend was the wedding of Jason Koch to Anita Schlatter in Junction, OH. Anita being my friend and sister to Regg and Bev Beer. At the idea of seeing my family from Mexico I asked for the weekend off. Unlikely chance for an intern, I know, but figured no harm in at least asking.
Schedules came out on Friday, July 29th and I had no call scheduled for the weekend! Next step was to then find out the rounding schedule, so I texted my trauma chief. Once again, figured no harm in at least asking. And to my utter surprise, my chief, said sure, no problem! So it was Saturday, July 30th and I found myself with an entire Saturday and Sunday off for a wedding in Ohio!
Next step, Ohio. How to get there and back again in semi-ok condition to then go back to work Monday morning. Enter Marcy B. And Amanda V. In a matter of minutes we had a decision and a plan. The three of us, a rendezvous in Pennsylvania, a road trip, a wedding in Ohio and lots of coffee.
And here we are now, on the last leg of the journey. Let me quick recap and bring you up to how we got here. Friday afternoon Marcy got off work early in Ellington, CT and got a ride to Danbury, CT. I left work as soon as I could and headed up to Danbury where I met up with Marcy and the two of us headed West. We stayed overnight in Pennsylvaina where the following morning Amanda joined us. (She had been vacationing with her family all week in PA.) The three of us then continued on together. Marcy had arranged the accommodations for us, so Amanda and I had the pleasure of making new friends of the Laukhuf's. We went to the wedding singing at the fellowship hall Saturday evening, and I got to hug Bev and Anita and talk with Tucker about riding his bike. For church, we went to Latty for morning service and I got to see Alexis (Gasser) Stoller. Then over to Junction for the wedding and another round of hugs. We made a quick stop after church to load up my trunk with three bushels of peaches for a sister back in CT, and then East bound. Marcy has been manning the wheel while I've had some time to close my eyes in the back seat.
A church is not a building. It is a family of believers. It is loving a brother or sister without ever having met them before. It is built on joy and not dependent on happiness. It is the support group we run this race with. I love my church. I live far from them, but my desire to protect them is not lessened by the distance.
We are about back to where we left Amanda's car in PA at which point she and Marcy will head to CT and I to NewYork. I am so thankful for God's blessings in allowing this weekend to take place.
Much Love.
Monday, August 1, 2016
Estoy vuelve a sumar a los vivos.
Back on days! I can not describe how excited I am. I just about put a thousand exclamation points behind the excel file title for each of the teams on August 1st when I updated their lists last night. But, then thought about the next resident coming onto night float after me and deleted them.
Moving onto the Trauma team for the month of August. I started writing notes while still on night float so that after rounding this morning I could head out. Made a quick stop at the store on my way home, so didn't get home terribly late, but didn't really matter. I was still exhausted. Slept like a rock until my caffeine headache woke me up mid-afternoon. Was so busy last night, hadn't thought to get my second cup of coffee. Thankfully the remedy is easy enough, it just takes time to kick in. So excited to be back on days!!!! Really happy!
Much Love.
Moving onto the Trauma team for the month of August. I started writing notes while still on night float so that after rounding this morning I could head out. Made a quick stop at the store on my way home, so didn't get home terribly late, but didn't really matter. I was still exhausted. Slept like a rock until my caffeine headache woke me up mid-afternoon. Was so busy last night, hadn't thought to get my second cup of coffee. Thankfully the remedy is easy enough, it just takes time to kick in. So excited to be back on days!!!! Really happy!
Much Love.
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