Hi folks,
I arrived in Charlottesville after a somewhat harrowing moving experience. My fiance and I had all of our stuff in boxes (about 250 of them!
. We were told by the moving company that we would be loaded on Monday. I thought,“No problem, at least I will be in my new place and I will have a day to get things under contol.” At 0600h on Monday, they called to say that they couldn’t move me until Tuesday morning at 0700h. Yikes! That means that I have to move and show up for orientation on the same day!
We got everything moved and I was about 15 minutes late for orientation. I hate to be late for anything that involves surgery. My fellow first-years are totally cool. The hospital is beautiful and very wired. We do almost everything by computer. The orientation for the MIS (Medical Information System) is a two-day affair. We signed up for health insurance and I picked the only DO in the book (in honor of Dave and all the other great DO’s out there).
I have run into a couple of folks that I did medicine rotations with at Washington Hosptal Center. That seems such a world away because Charlottesville is so beautiful.
And speaking of Beautiful!!! Mary T. Bois-Byrne sent me a beautiful graduation present that I can’t wait to put to good use. I will post a photo so you all can enjoy it. 
I am not going say what my beautiful present was but the photo will reveal it!
I am very excited and I love this place. There are two anesthesia residents doing their PGY-1 year in General Surgery. They are great! We have a good tight group. There is one gunner whom we have re-named the “babe magnet”. He is letting his insecurity show.
“I think we are going to have a good time, Goose” said by Maverick on arriving to Top Gun school.
Hi folks,
I am at the end of my second night of call and my fourth day of being a resident. So far, I have had a total of 7 hours of sleep in the past 4 days. I have to be on the ward by 0445h in order to see all of the patients and get everything organized by the time my chief resident comes in to round. I have never been able to get home from the hospital before 2130 hours. The other intern that is on the vascular service with me has been pretty slow to pick up the comuter system so I end up doing most of the orders and patient care chores. I am too Type A to stand back and not get it done when my patient needs something.
I am also challenging myself to read at least 30 minutes per day. So far, I have not made it but tomorrow is a different day. I ended up discharging 13 patients today which meant that I had to dictate their charts and get all of their orders into the computer so they could get home. My college did not discharge any patients! He just moves more slowly than I do.
I have had two patients have myocardial infarctions on my watch. I know how to completely handle these people who are trying to die on me! 
I also am completely comfortable calling my chief resident. He is the greatest with teaching and most everything else. He has so many teaching pearls for me everyday. I really love this place even though I am dead tired. I was born, put on this earth and ordained to be a surgeon!
Study hard and work hard. I never thought I could ever function with so little sleep and still be useful. I find it totally surprising that when one of my patients is in trouble, I have a sixth sense about it. I can calmly step back and assess the situation to get the most positive outcome. This is the greatest career on earth!
another great post Nat - you continue to inspire us and keep us hopeful for the day we’ll be joining you.
Lisa
Hi folks,
I can hardly believe that I have a slow day. So far: I got up at 0300h to read at least 30 minutes over morning coffee. I showered, dressed and got to the hospital by about 0445h. I spent from 0445 to about 0545h pre-rounding on my patients. I generally check with the night nurses to find out if there are any issues that they would like to have addressed in rounds. I try to answer any last minutes questions if needed. From 0600h to 0700h we are generally rounding with the team. The team now consists of a Vascular Surgery Fellow, a Chief Resident, a third-year resident, two interns (me) and a fourth-year medical student. The nursing coordinator for the unit always rounds with us to help address any discharge/nursing issues. She is just great. After rounds, I either get my orders written and check labs or I go off to clinic. What I do depends on if I am post or on call. If I am post-call, I get to discharge patients and then go to the clinic; if I am on call, I get to do orders. Today I got a break and I got to discharge patients but hang around on the floor where I am typing this message. 
After taking care of all orders and patient care needs, I try to grab breakfast of lunch, depending on how long it takes me to get things done. I can’t believe how much I have learned to manage in just one short week! I am very comfortable with AAA post op patients and angios. The angios are pretty interesting because they can have a variety of conditions. I still haven’t managed to get into the OR but that time is coming.
By the time I have all of my admissions and post-procedure patients tucked away, it is time for evening rounds and addressing any unmet issues. I always pick a night time (2130h) when I just call the fellow or the chief and ask all of my non-pressing questions. If I don’t have any questions, he doesn’t get a call.
If I am not on call, I get to leave the hospital at 1830h or after rounds (which ever is later). I do the same thing over again. It sounds like a long day but it goes by so fast. I am learning so much in such a short period of time. My senior residents are good teachers and very willing to teach. As I said before, this place is great. Everyone has been really nice and very helpful. I try to be polite and say, “Thank-you” at every opportunity.
And since you asked, there is no day that I do not have to come into the hospital for at least a couple of hours. Welcome to the world of medicine and surgery! Until I get to vacation, I do not get a single complete day off. 
Time to check radiographs!
Nat you just have no idea how much it means to me to be able to read your very enlightening posts. Please keep them coming as time permits for they truly give me a glimpse of what someday I may/could be doing.
Dr. Nat…hi!
This thread is great to read…glad you’re getting settled in Charlottesville and UVa Health Systems…I was truly impressed when I visited 2 summers ago. It’s on my list to AMCAS.
Glad you liked the you-know-what! And I’d love to see a photo, when you get a moment. Like I might have said in my note to you: I’ve saved e-mails, articles, and related tidbits of pre-med --> med school --> residency & beyond that I think are useful and astute in some way. When I look at what I’ve saved from OPMs, many of the e-mail suggestions and comments were yours…so my thanks! Mary
Dear Nat,
One thing that will amaze you, this time next year, is how much faster you will be at getting the work done. Believe it or not, you will go home in time for dinner on non-call days.
Keep posting when you can so everyone can see the steep learning curve, how fast interns get good at what they are doing.
And keep up that positive attitude!
| Quote (Elizabeth Westphal @ July 01 2002 8:23 pm) |
| Dear Nat, One thing that will amaze you, this time next year, is how much faster you will be at getting the work done. Believe it or not, you will go home in time for dinner on non-call days. Keep posting when you can so everyone can see the steep learning curve, how fast interns get good at what they are doing. And keep up that positive attitude! |
Hi Betsy,
As a matter of fact, I have had three patients go into CHF crisis on my watch. One had a MI and the other just doesn't have much of a left ventricle left. In each case, I have been able to get the ball rolling with chest film, oxygen, EKG and blood draws before I call my chief resident.
The important thing that I have learned in a crisis situation is that these are valuable experiences. When the crisis happened for the second time, I was armed and ready to go into action. Every patient encounter is an experience. I am even getting better at the dreaded dictations.
It is July 4th and I have a couple of fairly sick post-op patients on the floor. My chief is a phone call away but I have checked everyone and I am contemplating heading down to the call room for an evening nap. I have one set of blood tests that I would like to see before I actually turn in for the night. It would be good to be rested for a change.
My residents tell me that I am progressing. I am working out a system to remember all of the little details. The real teaching goes on when you get a patient who illustrates a teaching point. I have two pre-ops that are ready for tomorrow's surgery. It has been a good night so far.
Hi folks,
Finally after 12 straight days of q 2d call, I have a complete day off. The census on my floor dropped to 5 patients, all pretty stable, and my chief told me not to come in to the hospital today. Finally, I am not feeling the least bit sleep deprived. I have survived on naps, thankfully. 
The downside to this wonderful day off is that I have a ton of reading to get done. I have been given the assignment of covering three services for night call beginning tomorrow night. I am covering thoracic, vascular and cardiac from 6pm to 6am for the rest of the night. I am the only intern that has to cover three services at night. My superiors think that I am doing a great job but this new challenge might be a little much. I am determined to dive in and hold my own. There is always a second-year in house in the TCV/PO Intensive Care Unit so I am not alone. My chiefs will be just a page or phone call away. My job is to get the ball rolling on any ward emergencies and keep everyone beating and breathing until the morning. I am also dependent upon my fellow interns not to dump on me but to give me a decent sign-out. Anyone who is very sick, is going to be in the TCV/PO Intensive Care Unit under the care of a second year anyway.
It is the start of my third week and I am still thrilled with my ability to learn and take care of patients. All of the observations and lectures of third and fourth year come back when I need them. You learn this job by doing and by keeping yourself very organized. I write down everything no matter how trivial. Getting admissions and post-op orders is becoming second-nature to me at this point. I am even beginning to anticipate what my patients will need and get it ordered.
The nursing staff is the best! They help me at every turn. I don’t have to worry about getting things like repeat labs after blood transfusion etc. They will put the orders in and will call me frequently before I am getting down to the floors to check. All of my patients are on two floors that are seperated by four floors. I am getting lots of exercise with the steps. I have lost ten pounds since starting and will probably lose more.
The hospital food here is awful for me. When I am on call, I have learned to stick with fruit and yogurt. The grease-burgers and fries will come back to haunt you in the middle of the night. I have also learned to steer-clear of things like “Indonesian Chicken Stir-Fry” too. Too spicy and too greasy for good napping in the afternoon. Just as Betsy pointed out, each day I become more efficient with my floor duties and get my work done faster. I am still not getting home before dinner on off-call nights but this will come.
Well, back to the books!
Thanks for the posts as well-I’ve been on a little hiatus during my move and trying to get my new computer running all while working but, things are going well. Reading about your CHF patients was quite interesting-I work on a ward that deals primarily with chronic but acute CHF patients as well and, it seems that I have grown quite interested with the mechanisms/etiologies, and treatment of CHF’ers. So much so that I decided to do a research program instead of a MEDPREP program next summer, I’m looking at researchers that focus on CHF. My interest in CHF has also made me look at Cardiology as a possible speciality interest following close behind Critical Care Med but, I still have lots of time to make that all important decision-however, I was able to join the American Association of Black Cardiologists as a Student member and I’ve met quite a few interesting physicians over the internet that have been quite helpful. Pleas continue to keep the posts coming-they are a true source of inspiration to me and others as I’m sure you know. Take care and God Bless!!!
Hi Folks,
I am beginning to feel like a veteran of the trenches already. My chiefs called a meeting of the service to annouce that they were raising the bar even higher. Fortunately, this little chat was not for my specific benefit. My fellow intern on the service has had more than his share of difficult adjustment with this service. I believe that it is his language and I have tried to give him the benefit of the doubt. Yesterday, my chief and the fellow came up for evening rounds smoking and breathing fire. Apparantly, early that morning,an operative permit was not on a chart before the patient was taken to surgery. I had distinctly remembered that my fellow intern took the report and placed it on the chart. I quickly leafed through all of the charts and found the permit misfiled on another patient’s chart. By the afternoon, the attending physician had chewed the chiefs out and they were looking for “butt” that afternoon. As much cleaning up and dumping that I have received from my intern partner, I spoke up in his defense. I saw him correctly file the report the day before. I was not going to let them chew him out for something that he had done right. I just made a mental note to check all pre-ops before they leave the floor when I am doing morning pre-rounds even if the nurses have signed off on them. If I have to do a final chart, check before the patient leaves the floor in the AM, I will add that to my duties but no patient is going down to the OR on my watch without a signed permit.
It was pretty tight emotionally last evening and I know that my fellow intern is trying to quit this program. He is really stretched and I know that I have been " pissed off" at his slowness and difficulty with little things like following up on labwork. After yesterday, I am going to make a concerted effort to unload him as much as possible. Perhaps, starting with vascular surgery was too much. If he had started with a slower service, he might be more comfortable and able to do a better job. It has been very hard for me but it is twice as hard if you don’t understand the language and the nurses on the floor don’t understand you.
Well, back to the books. I am studying on my day off as usual. I am going to the pool and whirl pool to get some needed exercise and relaxation. Again, I will try to do even better next week. I am setting the bar even higher for myself. I need to work on my presentation skills in rounds. My fourth-year medical student is acing me so I have enlisted her help. She is a gem.
Keep at it Nat, god knows you are keeping tons of us going with your journal.
Natalie,
I’m curious, what is your perception of work hours? Do you honestly feel you are able to give your patients 100% when you’ve been awake for so long? Are you no different than your first hour at the hospital? Or is there a dropoff, but not enough to really affect the patients?
| Quote (MD/PhD slave @ July 15 2002 10:35 am) |
| Natalie, I'm curious, what is your perception of work hours? Do you honestly feel you are able to give your patients 100% when you've been awake for so long? Are you no different than your first hour at the hospital? Or is there a dropoff, but not enough to really affect the patients? |
Hi there,
I absolutely give my patients 100% no matter what the hour. I am not doing physical labor every second of the day. When there is down-time, I nap or put my feet up. Yes, there are days where I am tired but I seem to be able to carry on until I get a break. I work very well on short breaks. I have never had a zombie feeling since I have been here and I have had some 36-hour straight through shifts without sleep but some naps. I am fortunate in that I don't need tons of sleep to function. I call it my natural adaption to surgery. As soon as I hit the OR, my adrenalin and concentration take over and I have no concept of the passage of time. I just get into the whole choreography of the procedure that I am doing.You either adjust to what you need to do to get the work done or you don't make it. You also get more efficient as each day passes.
Hey folks,
This morning I had to pronounce my first patient. He was a very young man who was on the hospice service. The death packet procedure here at UVA is very detailed. There are a couple of agencies that must be notifed. The easiest part of the procedure was approaching the next-of-kin for an autopsy. I always present this as an opportunity to learn something that might help another family member.
The hour was early in the morning before I had a chance to get started on pre-rounds. I was covering thoracic, cardiac and vascular services so I had more than a few patients to get seen before work rounds would begin. If I had known that the dying patient’s family was doing “death watch”, I would have visited the room during the night. It is always comforting to the patient’s family for a physician to look in on their loved one even if there is nothing more than comfort measures being done. I always want to make sure that the patient is not suffering. Sometimes an adjustment needs to be made in pain medication.
I ended up examining the patient after death had taken place. I had to fill out and sign the death certificate which will go to the state bureau of records. It was an eerie feeling but it wasn’t as difficult as I thought it would be. The disheartening thing was that the resident who really was supposed to make the pronouncement kind of dumped this situation on me like it was a chore. Providing death care is not a chore as death is as much a part of this profession as any thing else. Only a physician may prounouce a person dead. It is a mark of my profession to provide this service when called upon.
The day has been very slow but I got my first chance to get into the OR. The procedure was repair of an abdominal aortic aneurysm and it was so cool. My attending physician is a female vascular surgeon who really loves to teach. It is a blast being in the OR with her. She has become one of my mentors but many of the more senior residents do not like to operate with her. They say that she does not give them enough autonomy.
I also saw a couple of patients in the clinic too. It was an interesting experience to see and dictate the patients. I am getting better at dictation every day. I still get tongue-tied but I know where the “pause” button is located. There was a third year medical student with me who thought I was just doing such a great job. Wait until next year when he finds out that I am probably learning just as much as he is. 
This is an awesome thread! Thanks for the posts Natalie.
Nat,
Since Im interested in CCM(Critical Care Medicine), I was just wondering how well your service works with the intensivists. I know at the hospital I wwork at, there are times (not very frequently though) when the surgeons and intensivists “bump heads” on whether a patient is stable enough for surgery. Just looking for some input when you have a free nanosecond Take care and God Bless!
| Quote (OHIO DO 2 B @ July 18 2002 11:20 am) |
| Nat, Since Im interested in CCM(Critical Care Medicine), I was just wondering how well your service works with the intensivists. I know at the hospital I wwork at, there are times (not very frequently though) when the surgeons and intensivists "bump heads" on whether a patient is stable enough for surgery. Just looking for some input when you have a free nanosecond Take care and God Bless! |
Hi there,
In terms of "bumping heads" there is no question of who is in charge when it comes to doing surgery. The surgeon is always in charge and ultimately responsible for the patient when it comes to the OR. No good intensivist is going to question the judgement of a surgeon when it comes to opening a patient. If you don't operate, your duties end at the door of the OR.
Yesterday, we had a very difficult dissecting thoracic aneurysm. The room ended up filled with the attending, the vascular fellow, the thoracic fellow, the cardiac surgery fellow and a couple of chief residents all sewing to get this guy thorough the case. In the end, he did very well. The attending in this case was our department chairman. When it was over, the department chair said he didn't realize that so many hands were in the case. Last evening the guy was doing pretty well in our TCV (Thoracic, Cardio-Vascular) ICU.
Our ICUs, that is the STICU (Surgical-Trauma), Burn ICU and TCV are run by surgeons only. In the case of a Pediatric Surgery patient, the Pediatric surgeon is ultimately responsible for the patient. The Pediatric intensivist will always defer to the judgement of the pediatric surgeon in terms of the timing or operative needs of a pediatric surgery patient. Occasionally, an anesthesia resident will rotate though our units but no non-surgical intesivists will be in charge. There is never a question of who determines when the patient gets "bright lights and cold steel". The surgeon is totally in charge here. If the patient has not left ventricle, I can put in a LVAD and give him a kick. No drug can do what the LVAD can do. (Totally unload the left ventricle). I can cut out a slice of of enlarged left ventricular wall to make the heart pump more efficiently, no drug can do this.
The wonderful thing about surgery is that we can do things in the operating room that just are not possible in an intensive care unit. That is the reason that I love Trauma Surgical Intensive Care and will probably pursue that fellowship after completing my General Surgery residency. In the end, if I can't fix you, you are not going to be fixable.
Thanks for the response Nat-now, question #2…Since I’m really interested in CHF/CCM/Cardiology, I’ve been a little preliminary research on post-grad programs and one that I’m really looking into is at Henry Ford Hospital in Detroit. Their Cardiology/CHF subspeciality is listed under the Cardiac Transplantation Service. In my very limited understanding of CHF, I figure that the reason for this is that most CHF patients have EF<30-35% and some type of ventricular hypertrophy(in the case of my partner, left ventricular hypertrophy which is family trait on her mom’s side). This can tend to lead to a Cardiologist to suggest a heart transplant when all other traditional interventions fail. Any input you can offer on this topic will be greatly appreciated!!!
Speaking of the “bright lights and cold steel”, I was working in the ED this past weekend when I guy presented with abdominal pain radiating to his mid-back x 36 hours. After preliminary exam, he was sent to the OR within an hour for repair of a dissecting AAA. We have him now on our Intermediate Care Unit/Coronary Intervention Unit and he’s doing very well.
Take care and thanks as usual graciously sharing your residency experiences with us!
| Quote (OHIO DO 2 B @ July 19 2002 11:04 am) |
| Thanks for the response Nat-now, question #2...Since I'm really interested in CHF/CCM/Cardiology, I've been a little preliminary research on post-grad programs and one that I'm really looking into is at Henry Ford Hospital in Detroit. Their Cardiology/CHF subspeciality is listed under the Cardiac Transplantation Service. In my very limited understanding of CHF, I figure that the reason for this is that most CHF patients have EF<30-35% and some type of ventricular hypertrophy(in the case of my partner, left ventricular hypertrophy which is family trait on her mom's side). This can tend to lead to a Cardiologist to suggest a heart transplant when all other traditional interventions fail. Any input you can offer on this topic will be greatly appreciated!!! Speaking of the "bright lights and cold steel", I was working in the ED this past weekend when I guy presented with abdominal pain radiating to his mid-back x 36 hours. After preliminary exam, he was sent to the OR within an hour for repair of a dissecting AAA. We have him now on our Intermediate Care Unit/Coronary Intervention Unit and he's doing very well. Take care and thanks as usual graciously sharing your residency experiences with us! |
Hey Kimberly,
Your CHF question is a great one for Betsy since her bread and butter is the treatment of CHF. The transplant issue and getting through the post op period is in my neighborhood. See how both medicine and surgery are quite reliant upon each other for support. Following a transplant, a patient would have biopsies on a regular basis for adjustment of immunosuppresson but would otherwise be managed by a good internist or cardiologist. Many cardiologists will specialize in treating post-transplant patients.
Speaking of AAA's, I got into the OR for one today. It was a gentleman with an EF of .15 and lung function that was barely in the aerobic range since he had so much CO2 on board. We managed to get him through the surgery and the anesthesia but I am bracing myself for tomorrow when he may start to crash for my benefit. The question is, what do you do with a 78-year old gentleman with a 6.5 cm abdominal aneurysm with poor heart and lung function? What will kill this gentleman if you operate? What will kill this gentleman if you don't operate? The philosophical questions behind performing this huge piece of surgery on such a frail elderly gentleman abound. If he manages to survive the surgery( and this is not a given just because he came out of the OR alive), what is his quality of life. Right now he is lying in the TCV/PO ICU sucking on a ventilator. What happens if we are not able to wean him from mechanical ventilation? What happens if he doesn't wake up from the anesthesia? At least he can die now without wondering when his belly is going to explode and kill him. If he never wakes up, we won't know.
Surgery is like riding a bicycle. Once you climb back on and get your balance, it comes back pretty fast. I did OK today but I need to study some surgical anatomy this weekend. Off to bed for me.
Natalie