I literally just got here. Just trying to eat my Mac and cheese. He has been on our list for 4 months. I think this is the first time he has been outside in weeks.. I hope tonight is busy. wtf are we even doing here, yall?
Edit: Probably going to die. But still in the “doing everything we can” stage. Hence why still in hospital instead of home.
Gave Jarrod a Reese’s today at 3AM as he was sweeping around us, so concerned with being in the way. Like bro you are not in the way, you are working harder than I am right now just waiting for this CTA to come back. He is so sweet, asked “wait can I have both?” Like…these people are so under appreciated. Remind them they have value.
I came in at 7 PM. We immediately had two cervical checks, an active laborer ready to push, an admission pending for ACS rule out, an OB triage to evaluate, and a Peds patient ready to be discharged. Spread super thin between just me and my senior running the medicine, obstetrics, and pediatrics services. 10PM roles around, we never actually ran the list. Just finished the delivery (NSVD, no lac repairs FTW) and we get two simultaneous secure chat messages:
Fucking divide and conquer.
Senior is an R2 needing C-section numbers for OB fellowship plus it’s her continuity so I take the rapid. Caveat to this plan is if SHTF, senior is tied up in the OR. Let’s hope that doesn’t happen (this isn’t foreshadowing, shit did not hit the fan, it thankfully started to calm down until like midnight but that isn’t as fun of a story).
I go to the rapid, she is now stable on 6L, previously on RA. Some new pulmonary congestion and bilateral lower extremity edema, +/- chest pain (Lost in translation through French interpreter). Her wells score is 9, so I get the CTA and venous duplex given, dimer not needed but also going to be positive anyway given sepsis and all the things. Low likelihood of ACS based on exam, but she has some risk factors so let’s get an EKG and a trop given the tachy. Well if I am getting blood, let’s do a BNP for the leg swelling/congestion and a BMP because I don’t know but feels weird not to?
CTA and Venous came back reassuring with no evidence of PE/DVT, though imaging did show diffuse pulmonary edema with potential superimposed evolving pneumonias. Trops and EKG were normal. BNP moderately elevated. BMP consistent with her septic diabetic self.
Ultimately confident she is probably not actively having a PE. I have no clue why she had this episode. I ultimately decided to just give her 20 of lasix and add closer I/O monitoring. Was it perfect? No. Was it life or death “I’m a hero” moment? Nope. Was I confident? Absolutely not! But as it just me in the room with the nurses, RT, Lab, and xray asking me questions and the patient came out of it alive, stable, and laughing because I thought her red mouth was blood instead of jello stain? Yes, that was me. The doctor.
Met one of my new patients whom I am her PCP. 73 year old woman with zero filter, apparently.
My badge photo/website photo is my residency application photo (ie. Professional). I am wearing hospital scrubs in clinic and probably need a haircut/some beard trimming. Thought I still looked OK. Apparently I am a let down irl.
Patients are brutal.
I hate the ICU. Get me back to my clinic weeks please.
I have seen her in clinic once a week the last 4 weeks. She was supposed to have a scheduled C-Section this morning at 7:30. On Friday I told her “I’ll see you at 7 on Monday morning! I’ll be with Dr. OBGYN first assisting on your surgery.” She thanks me, says I have been great, she elected to transfer both me and her future baby to be her PCP and so on. Great relationship, supposed to be my first continuity delivery. Me loving my job.
Checking the list on Haiku this morning while pooping at 4:30 AM before biking in, I see her name there. That’s a little weird, she shouldn’t be at the hospital till like 6ish. I then look at the newborn list (our inpatient L/D also manages inpatient Peds and NICU). “Baby Boy, Continuity” right there at the top of the list.
This woman had the absolute audacity to go into labor on the same day she was scheduled for a C-section. In standard multip fashion, she was at 6 cm by the time she even got to the hospital, elected for TOLAC since she already made it that far and it was game over.
I went into her room at 7:30, she is feeding little guy. “Broseph, you had your baby about 4 hours too early!” She laughs and sarcastically apologizes despite her exhaustion. Both of them are super happy and healthy ready to transfer to mother baby. I don’t get my continuity delivery, but you know what? I get an awesome set of two gender-neutral bros for patients the next three years.
Continuity is awesome. I wish med school had more of it.
When speaking with the parents I need the translator (obviously required to use) but up until about 6 years old I have noticed I can just vibe with the child linguistically. I was surprised I understood when the adorable 4 year old told me her toenails are the same color as her mom’s. Honestly, bilingual peds visit is kinda great for learning more Spanish.
Jokes aside, it is a huge position of trust to be responsible for sensitive moments and most often private topics. Remember to be respectful, y’all. But also, don’t go into full spectrum primary care unless you are OK with the non-L/D portions of women’s care. It’s like a LOT of primary care.
We are only a month into residency but it is strange how noticeable the differences between those who were well prepared and those who were not is. Obviously none of us are performing at a super independent level, still asking seniors a shitload of questions, and just overall being idiots, but it’s still fairly obvious there are people running all over, visibly stressed/non-talkative, staying late for notes, not confident in independently finding answers to their own content-oriented questions, and so on.
We are about split evenly between MD and DO, and our 3 MDs who went to large academic centers you think would be less prepared for small hospital primary care but we are the ones carrying more patients, finishing on time, grabbing lunch for the other interns when they are still busy etc. vs only 1 of the 4 DOs is doing the same. The other 4 residents are consistently staying an hour after night team has shown up, complaining about doing notes at home/in basket questions , missing group hangouts as they don’t prioritize their own well being. It doesn’t seem to be an MD vs DO thing, more so a “went to a med school with an affiliated hospital” discrepancy. Are yall experiencing something similar?
In 6 months none of this will matter as we will all be on the same level, but just wanted to gauge if the wide range in preparedness is the norm and if there is anything those of us who are a little more efficient (still idiot though) should be doing other than just checking in with our co-residents to make sure they are doing OK?
What are your fun patient quotes?
First day, PT/OT didn’t see him despite orders placed at 7AM. Whatever, not his fault. Second day “I haven’t pooped with this opioids and my tummy hurts” poops at 6:45 PM and claims to not have a ride. 2 days in the ED. Today…I signed his discharge orders, still in the ED. Just checked the list on Haiku while at home because I hate myself and bro is on the floor now with no documentation as to why he is still there. He is admitted for an outpatient problem. Young…no other PMHx….wtf yall. Why are some patients just…..that way….
My triceps hurt because the angle prevents using body weight, my forehead hit the xray, my brother in christ stopping chest compressions every 20 seconds so you can advance your balloon defeats the purpose of the chest kcompressions, these fuckin nurses flopping their arms on the stomach instead of cracking ribs, wtf is this
Really and truly, the expectations for a new intern are so incredibly rock bottom. It is such a relief. With that said, it is well needed. I forgot I peaked over a year ago.
Other highlights:
My PD called me a “Buff guy” unprompted during ACLS.
Edible umbilical chord stand ins
I asked a nerd medicine question in a very non-nerd specialty and now I have been labelled the QI project guy
PD individually handed each intern 3 shots of fireball and said last one done works Christmas nights (joking maybe?)
“You’re going to work 80 hours a week and have barely any time for yourself” seems to have been thrown at us for years, but honestly it’s like for every rotation that has 80+ hours a week, there is an outpatient rotation that barely hits 40 hours a week. 20 days of PTO, they work with us super well to make appointments happen, overall the median hours per week this upcoming year looks to be about 55 and the average to be about 60. Which sure, that is worse than full time but it’s really not world shattering? Is all the doom and gloom about hours mostly derived from those in surgical specialties?
And this is at a program in my specialty notorious for being on the higher end of difficulty so far as programs go….