Have news for you 
but have not seen you around lately!
Well I am not dead or in jail… but something pretty close… RESIDENCY! This spring has been… um… lest just say “rather full”
In February, I was still caring for the “the Cherubs” as I call them, finishing up a 4 month block, specifically the “early ones” in the Neonatal intensive care unit! I really do not see myself in that milieu EVER on a permanent basis. As a resident, it was procedure city! 6 spinal taps, my youngest “hit†was a 24 week infant. 6 for 6 intubations, 4 good art line sticks, can now do TPN in my sleep (no seriously, I had “Cherub dreams†at least every third night… not nightmares but going over protocols and dreaming of treating seizures or working up sepsis or NEC ALL night long… confirmed by my wife who “took orders†from me on several occasions), no problems with ventilators = the back of my hand… assuming you want HFOV or IMV whether you need it or not. I think what makes the place so high tension is that there is usually NOTHING wrong with these babies except they show up too soon. Every single one of them will be intubated then extubated, worked up for sepsis or NEC on a weekly basis for up to 4 or 5 MONTHS. In fact if every single baby you have does not have a setback or CRUMP at least a little once every 10 days… LOOK OUT… because like a class gold fish they have a nasty proclivity to simply “UP AND DIEâ€â€¦Fine when you go home at noon, one the vent when you return at 8pm and DEAD by 4am.
It was then time to “do†some “grown-upsâ€
In March Internal Medicine “KU Hospitalist Service at WMC” otherwise known as “Med I”
In April “Nephrology†elective… the rub was the unplanned inguinal hernia repair and the week of recuperation. I got the distinct and uncomfortable impression from the residency coordinator (not a doc but a secretary) that I had PLANNED my strangulated bowel! Why? Because I was not directly admitted from the surgeon’s office at 5 pm but admitted at 4 am the following morning! Unbelievable you say? I got PROOF!
Original notification from my M/P coordinator
“Dr. Boyd is going to have a hernia operation on Tuesday morning. He
will need to be off work/rotation/call for at least 1 week. He is on
nephrology with Dr. Xxxxxx. He needs to be taken off a call and out of
clinic.â€
Reply from IM coordinator:
“Dr. Boyd needs to find another resident to take his call 4/15 and any
other call dates he will be out since I do not feel this meets the criteria to cover with the emergency backup systemâ€
Thank goodness the residency directors saw things differently:
My reply
The Nephrologists were the first to know, Xxxxxx is signed out to Yyyyy, and I notified her at the first sign of trouble before I initially saw Dr Ccccc in the primary clinic, I also called them from [the surgeons] exam room. As to the call business, I have spoken with Dr Gggggg [deputy program director], he has told me, “go be ill in peace†and he would “handle the situation  I am scheduled for 4:30 am Check-in for 9:30 am surgery at St Jjjj tomorrow, sorry for all the hassle but contrary to the opinions of some I did NOT PLAN this.
.
In April it was on to “KU Hospitalist Service at VCSF” known as “Med I”
In May, another "KU Hospitalist Service at VCSF†known as "Med IIâ€
I must say, VCSF KNOWS how to… lets say, “maximize utilizationâ€, I have not gone OVER the legal limit of 80 hours per week (averaged over the month)…. but by less than 2 hours for the four weeks. I have thrilled at the STRICT adherence to the letter of anything they do, possible only at a place run by “sistersâ€?. Reminds me of Catholic pre-school in an odd and peculiar sort of way… We get every SINGLE minute of those 86 hours, but of course not 10 minutes MORE.
OK, there is a bit more than 2 weeks until BACK to the “Cherubs†and the end of the “intern year†(PGY-1)
Medicine is still the coolest thing I have ever done!
Richard
Hey Richard, hope you are feeling much better! What a kick that IM coordinator is…loved your note back to her!
Having worked in a level 3 NICU this past year as a health unit secretary, I must say that it has been an experience. Pretty much we know that the real preemies will require much care just due to their extreme prematurity. The ones that are really scary are the older babies from 35 weeks to 40+ weeks, and those poor cherubs that come into the world already pumped with illegal drugs, alcohol and cigarettes. Nothing is worse than hearing a baby in nicotine withdrawal…you can’t soothe them for anything, and all you want to do is to offer them a drag!