This post was idea I got from Year3clerckship blog. It was such a good Idea I decided to make a post. I'll try to post what I learn along the way.
Tips and tricks I have learned so far:
Presentations:
1. Pick a common topic that you can easily look up (ie more information = less researching time).
2. Use "UptoDate" make it makes Px so much easier ~ less researching time. It has everything you want to know, stats, pathophys, management, risk factors ~ everything.
3. Compare your research and check the facts with the textbook the residents are using
4. Double & triple check for grammar and spelling~ you lose credibility if you can't spell!!
5. Make enough handouts for everyone so they don't have to squint and read the screen.
Tuesday, July 31, 2007
What's in your call bag?
I'm not sure how many of you have had call yet, but I would like to know what's in your call bag? What do you bring? your favorite blankie & pillow, snacks?
Heres my call bag:
1. Snacks + supplemented snacks ( Oreos, Jalapeno chips, sandwhich) I buy from Cafeteria
2. Lots of fluids: bottle tea, water, sport's drinks. ~ its really dry in Odessa, I drink a lot more fluids here in Odessa than in Ft. Worth.
3. Shower supplies: shampoo, soap, tooth brush, tooth paste, towel ect Most impt: shower shoes
4. Extra change of clothes if I have to go to noon lecture (even after post call :( )
5. Don't forget MP3 & books
4. Don't forget Earplugs ~ there are so many alarms going off and doors slamming around the call rooms.
I don't bring my own pillow and blanket (others prefer to ) b/c I don't want to contaminate my stuff with hospital germs. I don't sleep on hospital pillows either.
Which rotations don't have call? anyone know?
Things you will need for the Odessa apt:
1. extra outlet plug
2. Quarters for laundry
3. Definitely your own bed sheets and pillows
4. Your favorite mug.
Heres my call bag:
1. Snacks + supplemented snacks ( Oreos, Jalapeno chips, sandwhich) I buy from Cafeteria
2. Lots of fluids: bottle tea, water, sport's drinks. ~ its really dry in Odessa, I drink a lot more fluids here in Odessa than in Ft. Worth.
3. Shower supplies: shampoo, soap, tooth brush, tooth paste, towel ect Most impt: shower shoes
4. Extra change of clothes if I have to go to noon lecture (even after post call :( )
5. Don't forget MP3 & books
4. Don't forget Earplugs ~ there are so many alarms going off and doors slamming around the call rooms.
I don't bring my own pillow and blanket (others prefer to ) b/c I don't want to contaminate my stuff with hospital germs. I don't sleep on hospital pillows either.
Which rotations don't have call? anyone know?
Things you will need for the Odessa apt:
1. extra outlet plug
2. Quarters for laundry
3. Definitely your own bed sheets and pillows
4. Your favorite mug.
Monday, July 23, 2007
The Cat Fight Rrrarr!!!
So shelf exams are coming up soon for us 6weeker rotations, and that means I'm going to make these posts a little shorter temporarily. I have been doing calls now q2 days and its the same old same old.
Now lets get to the juicy part. So I have been on call twice with a 3rd yr resident (Dr. R) and an intern Dr. O. Both are females. Dr. R is late twenties I want to say 29-30 without kids. and Dr. O is 36 with 4 kids...yea I don't know how she does it!!! Dr. R is really impatient and tough on the intern Dr. O, it was her first call day, and my first call day. She's always harping at her " why haven't you done this or checked that pt" "I'm sorry but you're just going to have to work faster..." Dr. O had a appointment after call, and that weekend we were up to elbows with patients that were not enough beds for them in L&D and the other parts of the floor. So the next day we were also busy with rounding. Dr. O was left to write all the orders on 20 pts and I tried to help her round. She was begging Dr R to help her so she can get done in time to be at her appointment. Dr. R just said sorry, you just have to work faster next time. I stayed around to help her write orders, but I'm still so slow myself. Luckily another resident saw us after call and said he would finish up for us and we finally went home. Dr. R also talks down to the intern like she a little kid. I too saw how she was being extremely impatient with her. In my head, to myself I said" Give her a break its her first call day, and its only been 2weeks since she started."
Most of the time me and the intern Dr. O are usually left to ourselves while Dr. R runs to finish her notes in her pt charts that have piled up from clinic. So both of us are clueless. It gets worse, one time Dr. R and Dr. O laying out an ugly nasty argument in the call room in front of me, it got bad I had to walk out of the room. The second time on call with Dr. O I told her that I'll be on call with her I also said it was with Dr. R. She told me she wanted to cry when she saw Dr.R's name on the call list, and that she would pay $1000 not to have to work with her. Well second call night went a little smoother now that I made a scut sheet of pts so that I could help Dr. O with checking pts q 2hrs and be sure to write what orders for which pts. We had so many pregnant ladies that weekend in labor several had other medical complications.
Well after several more arguments between Dr. O and R. Dr. O finally got fed up and talked to the residency coordinator. Not only that later on that night 3am, or attending sat us down and talked to us about team work. I literally fell asleep in front of my attending. My eye lids got so heavy and she talks so fast ...that the words started to meld together and her voice became very melodic that I just closed my eyes. She says"now your not falling asleep on me are you?" I mean really how do you get out of that one? I completely fell asleep. So maybe I was asleep, can you blame me I was up since 5am that morning working until 3am the next day without break except for food. Basically some higher power of residency gods sat Dr. R down and had a chat. The next call night, Dr. O told me that Dr. R was so so nice to her and the night went on smoothly.
At first I wasn't sure if Dr. O's idea to stand firm and complain about her senior was a prudent idea. I was afraid there might be backlash, and things might be even harder on Dr. O, but to my surprise everything worked out and Dr. O is a much happier intern now. I was telling Dr. O that there will always be difficult people that you encounter and that because she is your senior, I was telling her to endure a little longer. I told her to do her best so Dr. R cannot find reasons to pick and gripe at her. She explained to me you know even as a intern, and you as a med student have rights. She was telling me it was wrong of Dr. R to talk down to Dr. O infront of me (med student) and the nurses, she should have talked privately. Basically saying that b/c Dr. R showed no respect for Dr. O, I would also lose respect for Dr. O too. Dr. O said, I'm a resident and not a 4th year student, she needs to respect me as a colleague and a person.
Dr. O is too good of a person, just an overall mentor I would never lose respect for her. Dr O constantly teaches, and gives advice on all aspects of medicine, wards, and how-to-do-stuff : write good notes, be a good student. I am instead disappointed that as a 3rd year Res, Dr. R would not understand how hard it is to be an intern that she too at one point in her life was at the same position as Dr. O and how she could not just give her a break or be a little more patient.
Hooray, I'm glad the Dr. O stood her ground. I'm just very passive, and I don't like to stir trouble. However after seeing Dr. O , an intern, stand up for her self respect. I'm much impressed and hope if this ever happens to me that I can rise to the occasion.
Thanks everyone for reading and commenting. I hope Bgetter and you're buddy CV will start blogs. I want to know how everyone is doing.
Now lets get to the juicy part. So I have been on call twice with a 3rd yr resident (Dr. R) and an intern Dr. O. Both are females. Dr. R is late twenties I want to say 29-30 without kids. and Dr. O is 36 with 4 kids...yea I don't know how she does it!!! Dr. R is really impatient and tough on the intern Dr. O, it was her first call day, and my first call day. She's always harping at her " why haven't you done this or checked that pt" "I'm sorry but you're just going to have to work faster..." Dr. O had a appointment after call, and that weekend we were up to elbows with patients that were not enough beds for them in L&D and the other parts of the floor. So the next day we were also busy with rounding. Dr. O was left to write all the orders on 20 pts and I tried to help her round. She was begging Dr R to help her so she can get done in time to be at her appointment. Dr. R just said sorry, you just have to work faster next time. I stayed around to help her write orders, but I'm still so slow myself. Luckily another resident saw us after call and said he would finish up for us and we finally went home. Dr. R also talks down to the intern like she a little kid. I too saw how she was being extremely impatient with her. In my head, to myself I said" Give her a break its her first call day, and its only been 2weeks since she started."
Most of the time me and the intern Dr. O are usually left to ourselves while Dr. R runs to finish her notes in her pt charts that have piled up from clinic. So both of us are clueless. It gets worse, one time Dr. R and Dr. O laying out an ugly nasty argument in the call room in front of me, it got bad I had to walk out of the room. The second time on call with Dr. O I told her that I'll be on call with her I also said it was with Dr. R. She told me she wanted to cry when she saw Dr.R's name on the call list, and that she would pay $1000 not to have to work with her. Well second call night went a little smoother now that I made a scut sheet of pts so that I could help Dr. O with checking pts q 2hrs and be sure to write what orders for which pts. We had so many pregnant ladies that weekend in labor several had other medical complications.
Well after several more arguments between Dr. O and R. Dr. O finally got fed up and talked to the residency coordinator. Not only that later on that night 3am, or attending sat us down and talked to us about team work. I literally fell asleep in front of my attending. My eye lids got so heavy and she talks so fast ...that the words started to meld together and her voice became very melodic that I just closed my eyes. She says"now your not falling asleep on me are you?" I mean really how do you get out of that one? I completely fell asleep. So maybe I was asleep, can you blame me I was up since 5am that morning working until 3am the next day without break except for food. Basically some higher power of residency gods sat Dr. R down and had a chat. The next call night, Dr. O told me that Dr. R was so so nice to her and the night went on smoothly.
At first I wasn't sure if Dr. O's idea to stand firm and complain about her senior was a prudent idea. I was afraid there might be backlash, and things might be even harder on Dr. O, but to my surprise everything worked out and Dr. O is a much happier intern now. I was telling Dr. O that there will always be difficult people that you encounter and that because she is your senior, I was telling her to endure a little longer. I told her to do her best so Dr. R cannot find reasons to pick and gripe at her. She explained to me you know even as a intern, and you as a med student have rights. She was telling me it was wrong of Dr. R to talk down to Dr. O infront of me (med student) and the nurses, she should have talked privately. Basically saying that b/c Dr. R showed no respect for Dr. O, I would also lose respect for Dr. O too. Dr. O said, I'm a resident and not a 4th year student, she needs to respect me as a colleague and a person.
Dr. O is too good of a person, just an overall mentor I would never lose respect for her. Dr O constantly teaches, and gives advice on all aspects of medicine, wards, and how-to-do-stuff : write good notes, be a good student. I am instead disappointed that as a 3rd year Res, Dr. R would not understand how hard it is to be an intern that she too at one point in her life was at the same position as Dr. O and how she could not just give her a break or be a little more patient.
Hooray, I'm glad the Dr. O stood her ground. I'm just very passive, and I don't like to stir trouble. However after seeing Dr. O , an intern, stand up for her self respect. I'm much impressed and hope if this ever happens to me that I can rise to the occasion.
Thanks everyone for reading and commenting. I hope Bgetter and you're buddy CV will start blogs. I want to know how everyone is doing.
Thursday, July 19, 2007
The morning report and call
So Monday I had call again, but the only thing I remember was watching one SVD (spontaneous Vag Delivery), then checked on some pts ever so often. After that all I can remember is that I accidentaly overslept (4hrs) I was to report back q2hr to L&D (labor and delivery), luckily the senior resident of night didn't say anything. Since I forget most things that happen during the day I decided to start writing a short list of things that happen during the day that I find funny or interesting and keep it in my pocket. So here it goes....
Wednesday morning, after rounding at 6am and morning report followed at 7am with chief resident of OB (4th yr Resident & TCOM alum), 3 attendings (including the clerckship director), 1st year intern, 2 FM residents rotating through their OB/gyn rotation. Well normally nothing really happends during morning report that is worth me mentioning but Wednesday was different. Dr. CD (clerckship director) was there. He is a man in his maybe late 50s, and is attune to details. Well morning report started off with students presenting their cases. Normally the entire session never lasts more than 30 mins, but Wed Dr. CD was there. So every sentence, or perhaps mid sentence he would correct/clarify/ correct pronuciation/ correct use of adjectives/ and the general order of items in the presentation. This happens multiple times each pt presentation that a student would present. Questions would entail, For example "What does pelvic rest mean mean? "What is a normal Hbg and Hct in a pregnant lady?", so if you had this X Hbg and this HCT this is microcytic anemia, "What other anemias are microcytic"? "What do we want to look for after post/op ? ie infection- what are the signs of infection? This went on and on... from student to student. Questions would range from generally medical vocabulary and random off wall topics.
FYI "pelvic rest" means nothing in the vagina (after surgery usually to prevent post op infections), usually intercourse, douching ect. After a student replied to Dr. CD, resident mutters under her breath " but you can have sex in other places" ...Haha implying oral sex. She's too hilarious. Basically that morning was non stop pimping. The entire time the chief resident (4th yr TCOM alum) has her back to Dr. CK and she is mouthing answers to us. However much she tried to help we all strained to read her lips and were constantly giving the huh,what, maybe, I don't know looks. Well pimping was okay, but this was dragging on to like 45 mins, and everyone wanted to eat breakfast. All the residents were tired of standing and are rolling their eyes ...Haha.
I must say, the chief resident mouthing answers to us, is one of the nicest residents, and she has enormous patience in teaching med students. She has saved my butt several times. Later on I went to Tumor board meeting, where we discuss several cases of various cancers and current mangment strategies. This was a really cool lunch topic, we were fed catered food and a pathologist, radiologist and heme/onc person would talk about their respective part in each case.
Later that night I started night call # 3. It was another rough night without sleep. This time I got to see my first C-section on a recovering former IV drug user, 20yo, first pregnancy, HIV -ve, Hep C neg & 250lb. I scrubbed in, and unbeknowst to the minute details of sterile technique, I got lots of angry looks and harsh remarks from the nurses.
Ok C-section is bloody too. Both forms of delivery look bad to me- just as painful, and just as bloody. C-section reminded me of anatomy lab were we cut through fat and fascia and muscle all while the patient is groaning in pain even with anesthesia. Later the groaning stopped but its not relieving to hear it as you cut. My job was to as you guessed it, hold the retractors. Man its a tough job, I mean on a big lady you really have to use all your strength. It was a 30 min surgery but man is it tiring with your feet going numb and your arms are getting sore. The senior resident did most of the cutting with looked like cauterizer and he looked like he was burining the tips of my attendings gloves and she would wince and retract her hand. Her glove was slightly blackened at the fingertips Ouch!!!So as the C-section was going on, the senior resident had to scrub out b/c someone was in active labor ready to deliver vaginally. I continued holding retractors for my attending during the C-section. We continued to admit people for vaginal bleeding and other pregnancy related stuff.
The next thing the nurse says in her call room were we all sit around (me & residents) is
"Doctors standby!!, an emergency enroute to the hospital." I so wanted to burst into tears and giggle, I really thought that was only said on TV. As you can see I am completely immature most of the time. So we go check it out, and its this 19yo possible ectopic pregnancy with abdominal pelivic pain. We do the entire transvaginal sonogram and order B-HCG, and discover after interview she is 11 wks pregnant but did not know it. The senior res does the speculum exam and pulls out a dark red mass maybe the size of a small lemon of guess what.... placental tissue...it had all the blood vessesls. It was placed what looked like a urine specimen cup and shipped to pathology.
Things I learn.
1. Its okay to be ambarrased and unable to answer some of the pimping questions, it is expected of me because I am learning....this is what a wise 1st year intern told me. She was was really encourging helps us out frequently.
2. I always ask is really necessary (Nurses) to treat med students without respect. I mean really is this how you would treat other coworkers. Let me tell you there are always nice nurses, and mean ones. They don't try to learn our names, b/c one nurse claimed there are too many of us (6 students), so she prefers just to call us by "med student". I have mostly run into mean ones during call. I just try to remember how these moments feel and make it my personal mission to never talk down to people like they have.
3. Being a student is hard, you have to adapt to constantly changing environments, and people multiple times during the day: nurses, attendings, residents, and other students whether they are mean, rude, demanding and even the nice ones. At the end of the day, I hold in alot of frustration but I am still going strong !!!
Wednesday morning, after rounding at 6am and morning report followed at 7am with chief resident of OB (4th yr Resident & TCOM alum), 3 attendings (including the clerckship director), 1st year intern, 2 FM residents rotating through their OB/gyn rotation. Well normally nothing really happends during morning report that is worth me mentioning but Wednesday was different. Dr. CD (clerckship director) was there. He is a man in his maybe late 50s, and is attune to details. Well morning report started off with students presenting their cases. Normally the entire session never lasts more than 30 mins, but Wed Dr. CD was there. So every sentence, or perhaps mid sentence he would correct/clarify/ correct pronuciation/ correct use of adjectives/ and the general order of items in the presentation. This happens multiple times each pt presentation that a student would present. Questions would entail, For example "What does pelvic rest mean mean? "What is a normal Hbg and Hct in a pregnant lady?", so if you had this X Hbg and this HCT this is microcytic anemia, "What other anemias are microcytic"? "What do we want to look for after post/op ? ie infection- what are the signs of infection? This went on and on... from student to student. Questions would range from generally medical vocabulary and random off wall topics.
FYI "pelvic rest" means nothing in the vagina (after surgery usually to prevent post op infections), usually intercourse, douching ect. After a student replied to Dr. CD, resident mutters under her breath " but you can have sex in other places" ...Haha implying oral sex. She's too hilarious. Basically that morning was non stop pimping. The entire time the chief resident (4th yr TCOM alum) has her back to Dr. CK and she is mouthing answers to us. However much she tried to help we all strained to read her lips and were constantly giving the huh,what, maybe, I don't know looks. Well pimping was okay, but this was dragging on to like 45 mins, and everyone wanted to eat breakfast. All the residents were tired of standing and are rolling their eyes ...Haha.
I must say, the chief resident mouthing answers to us, is one of the nicest residents, and she has enormous patience in teaching med students. She has saved my butt several times. Later on I went to Tumor board meeting, where we discuss several cases of various cancers and current mangment strategies. This was a really cool lunch topic, we were fed catered food and a pathologist, radiologist and heme/onc person would talk about their respective part in each case.
Later that night I started night call # 3. It was another rough night without sleep. This time I got to see my first C-section on a recovering former IV drug user, 20yo, first pregnancy, HIV -ve, Hep C neg & 250lb. I scrubbed in, and unbeknowst to the minute details of sterile technique, I got lots of angry looks and harsh remarks from the nurses.
Ok C-section is bloody too. Both forms of delivery look bad to me- just as painful, and just as bloody. C-section reminded me of anatomy lab were we cut through fat and fascia and muscle all while the patient is groaning in pain even with anesthesia. Later the groaning stopped but its not relieving to hear it as you cut. My job was to as you guessed it, hold the retractors. Man its a tough job, I mean on a big lady you really have to use all your strength. It was a 30 min surgery but man is it tiring with your feet going numb and your arms are getting sore. The senior resident did most of the cutting with looked like cauterizer and he looked like he was burining the tips of my attendings gloves and she would wince and retract her hand. Her glove was slightly blackened at the fingertips Ouch!!!So as the C-section was going on, the senior resident had to scrub out b/c someone was in active labor ready to deliver vaginally. I continued holding retractors for my attending during the C-section. We continued to admit people for vaginal bleeding and other pregnancy related stuff.
The next thing the nurse says in her call room were we all sit around (me & residents) is
"Doctors standby!!, an emergency enroute to the hospital." I so wanted to burst into tears and giggle, I really thought that was only said on TV. As you can see I am completely immature most of the time. So we go check it out, and its this 19yo possible ectopic pregnancy with abdominal pelivic pain. We do the entire transvaginal sonogram and order B-HCG, and discover after interview she is 11 wks pregnant but did not know it. The senior res does the speculum exam and pulls out a dark red mass maybe the size of a small lemon of guess what.... placental tissue...it had all the blood vessesls. It was placed what looked like a urine specimen cup and shipped to pathology.
Things I learn.
1. Its okay to be ambarrased and unable to answer some of the pimping questions, it is expected of me because I am learning....this is what a wise 1st year intern told me. She was was really encourging helps us out frequently.
2. I always ask is really necessary (Nurses) to treat med students without respect. I mean really is this how you would treat other coworkers. Let me tell you there are always nice nurses, and mean ones. They don't try to learn our names, b/c one nurse claimed there are too many of us (6 students), so she prefers just to call us by "med student". I have mostly run into mean ones during call. I just try to remember how these moments feel and make it my personal mission to never talk down to people like they have.
3. Being a student is hard, you have to adapt to constantly changing environments, and people multiple times during the day: nurses, attendings, residents, and other students whether they are mean, rude, demanding and even the nice ones. At the end of the day, I hold in alot of frustration but I am still going strong !!!
Saturday, July 14, 2007
Call begins today!!
Currently 10:55 am. SAT
10:55amSat: Call began 8:00am today and ends 8:00am Sunday. I hope its going to be a slow night. I currently lounging in my room and surfing the net. Well after a slow afternoon (no one in labor). Later in the evening the crowd of pregnant ladies started to stroll in. My Intern and senior resident visited 2 cases in the ER one for VB (vaginal bleeding) and another for a urinary tract infection. The first case was a threatened abortion. Remember from class that alot of women miscarry early in pregnancy.
After that, at night I assisted in my first SVD (spontaneous vaginal delivery) with a senior resident. First the mother comes in aching in pain from contractions she kinda looks like she's groaning. She immediately asks for the epidural. Then we stick what looks like a big plastic toothpick and rupture her amniotic sac. So in awe of what I saw with that tooth pick thing. My mouth dropped open and in awe, my intern says outside umm try not to make faces like that in front of the pt. I mean usually I can keep it toghether, but man birthing is just another world of its own. Then a couple hours later of labor we start to gown. Man everything happens so fast. I am hurrily trying to put on my face mask, gown, and gloves. I am such a klutz I switched the L& R gloves on my hands so they felt really tight, like when you wear the L shoe on your R foot. I completely had no sterile technique. I should have been wearing booties but no one told me about them. Then my mask fell off one of my ears and I put it back on...Oops. The mask didn't hit the floor, but in the world of Surgery and OB/gyn that's a NO NO. So my attending is this 70ish yo guy who is just hilarious, starts to help me suit up. After suiting up he literally pushes me into the frontlines.
OH my, was I in the shock and horror of my life. I have never known a woman's vagina can dilate to like 10cm. Pt's mother who looked incredibly young, and pts husband were there to enourage the pt to push. After being given the epidural, the MOM was so out of it, she gets really angry and tells her husband are you watching?, are you looking down there at the baby? LOOK down there!!! Haha this went on for about 30mins. So after lots of screaming, moaning from the mom and pushing we see some hairy ball peak out of the vagina. I didn't really get to touch the baby. My resident did the grab the head and with a towel and start to pull the baby out. I held down the perineum to facilitate the baby's head coming out. I must say, it was a total freak show to me.
Babies are not born cute. They are born blue and purple much like a smurf. After the baby was out, o my I was not ready for the blood and rest of the amniotic fluid to gush all over my WHITE NEW ADDIAS running shoes (remember no one told me about the booties). I tried taking a step back, but I was too late, blood splattered and some gooey stuff were on my shoes ...YUCK. Then after delivery 8lb 5oz purple baby, we were waiting for the placenta to come out. So what you do is clamp down the umbilical cord to prevent more blood gushing out and you start to yank on it. While yanking on the placenta, your PT the MOM will groan...and say that hurts. Eww if it doesn't start to come out, the resident will then start to put her hand up into the vagina and start pulling it out. All of this goes in a big plastic bag between pts legs. Also as you push the baby you are actually doing a Valsava and mom will start pooing. All that said and done that big purple baby tore that mom's perineum up = 1st degree laceration. So her perineum had to be sutured up. All that said and done... Delivery #2 came along this time I was too slow, so I didn't walk into the delivery suite and I just waited outside. After what I saw, I don't want to have children via SVD~~ C-section for me please!
So the night goes on....without rest and sleep the delivery was around ~10pm, so 12am, 2am, 3am, 4am I'm still in LD checking other pregnant ladies, ladies being transferred from other hospitals for other RUQ pain.~ suspected appendicitis~final DX : cholecystitis. So back up at 5:45am being rounding on Ob pts on the hospital floor (those who recently gave birth and recovering). 8am comes round being presenting to the new call team on Sunday. 9am leave the hospital. 10am shower and crash in my bed.
# of hours worked 8amSAT-9amSUN 25hrs
#of hours of sleep: 3 on call
#times I wanted to topple over b/c of lack of sleep : countless
Baby delivery is cool and gross at the same time. Part of what makes it so cool is that its one of the most bloodiest things I have seen. Ob/Gyn ~doctors are some of the most sleep lacking people, I really don't know how they can be so perky the next morning. Ob is cool b/c Mom's are generally healthy, happy people.
10:55amSat: Call began 8:00am today and ends 8:00am Sunday. I hope its going to be a slow night. I currently lounging in my room and surfing the net. Well after a slow afternoon (no one in labor). Later in the evening the crowd of pregnant ladies started to stroll in. My Intern and senior resident visited 2 cases in the ER one for VB (vaginal bleeding) and another for a urinary tract infection. The first case was a threatened abortion. Remember from class that alot of women miscarry early in pregnancy.
After that, at night I assisted in my first SVD (spontaneous vaginal delivery) with a senior resident. First the mother comes in aching in pain from contractions she kinda looks like she's groaning. She immediately asks for the epidural. Then we stick what looks like a big plastic toothpick and rupture her amniotic sac. So in awe of what I saw with that tooth pick thing. My mouth dropped open and in awe, my intern says outside umm try not to make faces like that in front of the pt. I mean usually I can keep it toghether, but man birthing is just another world of its own. Then a couple hours later of labor we start to gown. Man everything happens so fast. I am hurrily trying to put on my face mask, gown, and gloves. I am such a klutz I switched the L& R gloves on my hands so they felt really tight, like when you wear the L shoe on your R foot. I completely had no sterile technique. I should have been wearing booties but no one told me about them. Then my mask fell off one of my ears and I put it back on...Oops. The mask didn't hit the floor, but in the world of Surgery and OB/gyn that's a NO NO. So my attending is this 70ish yo guy who is just hilarious, starts to help me suit up. After suiting up he literally pushes me into the frontlines.
OH my, was I in the shock and horror of my life. I have never known a woman's vagina can dilate to like 10cm. Pt's mother who looked incredibly young, and pts husband were there to enourage the pt to push. After being given the epidural, the MOM was so out of it, she gets really angry and tells her husband are you watching?, are you looking down there at the baby? LOOK down there!!! Haha this went on for about 30mins. So after lots of screaming, moaning from the mom and pushing we see some hairy ball peak out of the vagina. I didn't really get to touch the baby. My resident did the grab the head and with a towel and start to pull the baby out. I held down the perineum to facilitate the baby's head coming out. I must say, it was a total freak show to me.
Babies are not born cute. They are born blue and purple much like a smurf. After the baby was out, o my I was not ready for the blood and rest of the amniotic fluid to gush all over my WHITE NEW ADDIAS running shoes (remember no one told me about the booties). I tried taking a step back, but I was too late, blood splattered and some gooey stuff were on my shoes ...YUCK. Then after delivery 8lb 5oz purple baby, we were waiting for the placenta to come out. So what you do is clamp down the umbilical cord to prevent more blood gushing out and you start to yank on it. While yanking on the placenta, your PT the MOM will groan...and say that hurts. Eww if it doesn't start to come out, the resident will then start to put her hand up into the vagina and start pulling it out. All of this goes in a big plastic bag between pts legs. Also as you push the baby you are actually doing a Valsava and mom will start pooing. All that said and done that big purple baby tore that mom's perineum up = 1st degree laceration. So her perineum had to be sutured up. All that said and done... Delivery #2 came along this time I was too slow, so I didn't walk into the delivery suite and I just waited outside. After what I saw, I don't want to have children via SVD~~ C-section for me please!
So the night goes on....without rest and sleep the delivery was around ~10pm, so 12am, 2am, 3am, 4am I'm still in LD checking other pregnant ladies, ladies being transferred from other hospitals for other RUQ pain.~ suspected appendicitis~final DX : cholecystitis. So back up at 5:45am being rounding on Ob pts on the hospital floor (those who recently gave birth and recovering). 8am comes round being presenting to the new call team on Sunday. 9am leave the hospital. 10am shower and crash in my bed.
# of hours worked 8amSAT-9amSUN 25hrs
#of hours of sleep: 3 on call
#times I wanted to topple over b/c of lack of sleep : countless
Baby delivery is cool and gross at the same time. Part of what makes it so cool is that its one of the most bloodiest things I have seen. Ob/Gyn ~doctors are some of the most sleep lacking people, I really don't know how they can be so perky the next morning. Ob is cool b/c Mom's are generally healthy, happy people.
Thursday, July 12, 2007
Still no internet !!@@##$
Well things are going smoother now that I have got the hang of things. I already gave my presentation. You're right Alex, doing it first was a good idea. I am now just really behind in all my readings.
I am kinda liking my OB rotation. Its kinda fun to see happy pregnant people. They have the weirdest cravings, and ask funny questions: like "Dr. Is it alright that I eat ice?, because I like to eat a lot of ice." I'm getting the hang of writing OB soap notes they're kinda different from FM, IM notes. I'm gradually getting better at presentations too. I'm just doggone tired. Man I wake up at 5am and start rounds at 6am then my day ends at 6pm. Man thats 12 hrs a day x 5 days a week. Its been so hard adjusting from the student lifestyle of daily napping and sleeping in until 8 or 9 am.
Today is also my birthday!!! Happy Birthday to me!!! I got a call from my mom during clinic and she left me a cute message. Things I have learned recently.
1. Less is more. For example someone was told by the Ob/dept head to talk less, to write less detail soap notes. This person should just get to the point when talking & writing.
2. Keep a peripheral brain- Keep notes in my pocket to refer to...diabetes, prenatal labs ordered, examples of notes.
3. Score points with attendings by researching & learning the diseases of your patients as much as possible.
4. People see fakeness quickly, the gunner student was quickly shot down by the dept head refer to #1.
Until next time...Let me know what you guys want me to write about.
Well things are going smoother now that I have got the hang of things. I already gave my presentation. You're right Alex, doing it first was a good idea. I am now just really behind in all my readings.
I am kinda liking my OB rotation. Its kinda fun to see happy pregnant people. They have the weirdest cravings, and ask funny questions: like "Dr. Is it alright that I eat ice?, because I like to eat a lot of ice." I'm getting the hang of writing OB soap notes they're kinda different from FM, IM notes. I'm gradually getting better at presentations too. I'm just doggone tired. Man I wake up at 5am and start rounds at 6am then my day ends at 6pm. Man thats 12 hrs a day x 5 days a week. Its been so hard adjusting from the student lifestyle of daily napping and sleeping in until 8 or 9 am.
Today is also my birthday!!! Happy Birthday to me!!! I got a call from my mom during clinic and she left me a cute message. Things I have learned recently.
1. Less is more. For example someone was told by the Ob/dept head to talk less, to write less detail soap notes. This person should just get to the point when talking & writing.
2. Keep a peripheral brain- Keep notes in my pocket to refer to...diabetes, prenatal labs ordered, examples of notes.
3. Score points with attendings by researching & learning the diseases of your patients as much as possible.
4. People see fakeness quickly, the gunner student was quickly shot down by the dept head refer to #1.
Until next time...Let me know what you guys want me to write about.
Monday, July 9, 2007
2 entries in 1: NOT having Internet sucks
Day 2: Meeting People
So I was told to report to “7 –Central” by 6:30 am to learn how to scrub in for surgery. This means I wake up at 5:30 am. Well It took me forever to learn that “7-Central” was actually the nurses station where all the residents congregate in the morning. So after waiting for a long time I whipped out my case files and began reading. As I was reading someone stands over my shoulder and begins reading over meà this completely annoys me and not to mention they had a really stinky BO. I could not really say “ hey you stinky, please step away from me”, since several people were nearby. The scrub tech never showed up so I went to do “rounds” with the Ob team. Rounds end at 7:30am where I had extra time 1.5hr to read today’s assigned chapters before lecture. Luckily we meet a PGY1 (intern) newly graduated from my school and she was super nice to us she was doing her Ob-Gyn residency. I was quite surprised at how nice everyone has been to me. I expect far worse : to be yelled at, severely embarrassed, and ignored. So I spent the morning in clinic with my intern and I watched her get pimped in front of the attending. She is quite bright however, whenever she was put on spot she blanks out. She was explaining the same information the attending asked her to me, and the next minute the attending asks her the same information she just explained she blanked out.
I introduced myself to everyone I met, doctors, nurses, residents ect. The more I put my name out there the more people are willing to seek me out to allow me to follow them or show me something interesting. The morning clinics were uneventful however, in one of the attending doctor’s office (she’s an ob/gyn) there was a quote on her wall stating “Women don’t have hot flashes, they have power surges” …Haha I though was pretty funny. Later that afternoon I followed a 3rd year resident from El- Salvador around on high risk pregnancy cases. She is tall and slender and very bubbly. Well what does high risk mean? High risk means any pregnant lady who has other comorbities like hypertension, diabetes, drug abuse, HIV ect. So I introduced myself to the 3rd year resident, and as I was waiting for her she’s says “ I think someone is paging you, are you going to answer your pager.” I had no idea my pager just went off, I mean I didn’t even hear it ~ it was like a chirp. Man that was embarrassing. That afternoon I saw a lot of diabetic pregnant ladies. These ladies are on the heavy side. If I had not seen them in the high risk clinic, I would have no idea that they were pregnant, I mean some look like they were just overweight.
Later the resident asks me where I from as to make conversation, I mention some cities, and she says “O’ that’s where my boyfriend is from” I was like what does he do? Well my resident speaks English with a Spanish accent and she says her bf got into a neuro-radiology fellowship in what sounded like Harbor …was actually Harvard.” Me “ O, Wow , amazing” I was surprised she was not married yet, because it seems like everyone else is. Aww I’m glad there is hope out there for us single girls (you know who you are—readers). What single girl would turn down a neuro-radiologist boyfriend who goes to Harbor…!!!
Friday, July 6, 2007
I reported to 7am morning rounds at the hospital with the ob team. I was amazed at 7am all of the residents GynO girls and other residents (family med) look so well put together in the morning. They were in full on make up and smartly dressed. I did the makeup thing and looked my best on the first day of rotation. By the end of the first day in sweltering Texas heat my makeup completely melted away I looked and felt tired. On the second day, I resolved not to wear makeup making my morning routine much more simple. I wake up at 5:30am, leave the apt by 6:30 and meet team by 7:00am. Not to mention I extremely sleepy and tired in the morning. I am just surprised that as tired as the residents are they manage to look very good that early in the morning. I know for a fact that the residents must be exhausted. I spend another day in high risk clinic/ women’s ob/gyn clinic. We also had didactic lectures during lunch.
One person was late to lecture today and tattled on his resident. Big mistake, this person was done with Gyn surgery before 11am and was told by an intern to go home since there is nothing left to do. Let me count the mistakes:
1. He went home when there was a lecture at 11am by our cleckship director
2. He was late to lecture
3. He listened to a first year Intern and actually went home
5. He told the cleckship director the actual name of the Intern who told him to go home …big mistake
Things this person should have done:
1. After surgery he should have stayed on campus until 5pm (it’s a 8am-5pm job)
2. Do not listen to a 1st year Intern who just started the same time you did
3. Do not name names….have the balls to admit your mistake and apologize.
Lessons I learned today: As a med student…
1. Do not tattle tale on your resident.
2. When the faculty, senior residents, junior residents, and attendings have a meeting, à We sat in a U-shaped arrangement of tables where everyone can see eachother and their feet. If you’re a medstudent hoping for a excellent evaluation à please do NOT take off your shoes where everyone can see your bare feet, = some one actually did this.
3. Do Not actually walk around the conference room without shoes off with the attendings and faculty around.
4. Do not rest your feet on another chair like you are lounging on your lazy-boy at home during the conference
I got to tell you all these things actually happened.
So I was told to report to “7 –Central” by 6:30 am to learn how to scrub in for surgery. This means I wake up at 5:30 am. Well It took me forever to learn that “7-Central” was actually the nurses station where all the residents congregate in the morning. So after waiting for a long time I whipped out my case files and began reading. As I was reading someone stands over my shoulder and begins reading over meà this completely annoys me and not to mention they had a really stinky BO. I could not really say “ hey you stinky, please step away from me”, since several people were nearby. The scrub tech never showed up so I went to do “rounds” with the Ob team. Rounds end at 7:30am where I had extra time 1.5hr to read today’s assigned chapters before lecture. Luckily we meet a PGY1 (intern) newly graduated from my school and she was super nice to us she was doing her Ob-Gyn residency. I was quite surprised at how nice everyone has been to me. I expect far worse : to be yelled at, severely embarrassed, and ignored. So I spent the morning in clinic with my intern and I watched her get pimped in front of the attending. She is quite bright however, whenever she was put on spot she blanks out. She was explaining the same information the attending asked her to me, and the next minute the attending asks her the same information she just explained she blanked out.
I introduced myself to everyone I met, doctors, nurses, residents ect. The more I put my name out there the more people are willing to seek me out to allow me to follow them or show me something interesting. The morning clinics were uneventful however, in one of the attending doctor’s office (she’s an ob/gyn) there was a quote on her wall stating “Women don’t have hot flashes, they have power surges” …Haha I though was pretty funny. Later that afternoon I followed a 3rd year resident from El- Salvador around on high risk pregnancy cases. She is tall and slender and very bubbly. Well what does high risk mean? High risk means any pregnant lady who has other comorbities like hypertension, diabetes, drug abuse, HIV ect. So I introduced myself to the 3rd year resident, and as I was waiting for her she’s says “ I think someone is paging you, are you going to answer your pager.” I had no idea my pager just went off, I mean I didn’t even hear it ~ it was like a chirp. Man that was embarrassing. That afternoon I saw a lot of diabetic pregnant ladies. These ladies are on the heavy side. If I had not seen them in the high risk clinic, I would have no idea that they were pregnant, I mean some look like they were just overweight.
Later the resident asks me where I from as to make conversation, I mention some cities, and she says “O’ that’s where my boyfriend is from” I was like what does he do? Well my resident speaks English with a Spanish accent and she says her bf got into a neuro-radiology fellowship in what sounded like Harbor …was actually Harvard.” Me “ O, Wow , amazing” I was surprised she was not married yet, because it seems like everyone else is. Aww I’m glad there is hope out there for us single girls (you know who you are—readers). What single girl would turn down a neuro-radiologist boyfriend who goes to Harbor…!!!
Friday, July 6, 2007
I reported to 7am morning rounds at the hospital with the ob team. I was amazed at 7am all of the residents GynO girls and other residents (family med) look so well put together in the morning. They were in full on make up and smartly dressed. I did the makeup thing and looked my best on the first day of rotation. By the end of the first day in sweltering Texas heat my makeup completely melted away I looked and felt tired. On the second day, I resolved not to wear makeup making my morning routine much more simple. I wake up at 5:30am, leave the apt by 6:30 and meet team by 7:00am. Not to mention I extremely sleepy and tired in the morning. I am just surprised that as tired as the residents are they manage to look very good that early in the morning. I know for a fact that the residents must be exhausted. I spend another day in high risk clinic/ women’s ob/gyn clinic. We also had didactic lectures during lunch.
One person was late to lecture today and tattled on his resident. Big mistake, this person was done with Gyn surgery before 11am and was told by an intern to go home since there is nothing left to do. Let me count the mistakes:
1. He went home when there was a lecture at 11am by our cleckship director
2. He was late to lecture
3. He listened to a first year Intern and actually went home
5. He told the cleckship director the actual name of the Intern who told him to go home …big mistake
Things this person should have done:
1. After surgery he should have stayed on campus until 5pm (it’s a 8am-5pm job)
2. Do not listen to a 1st year Intern who just started the same time you did
3. Do not name names….have the balls to admit your mistake and apologize.
Lessons I learned today: As a med student…
1. Do not tattle tale on your resident.
2. When the faculty, senior residents, junior residents, and attendings have a meeting, à We sat in a U-shaped arrangement of tables where everyone can see eachother and their feet. If you’re a medstudent hoping for a excellent evaluation à please do NOT take off your shoes where everyone can see your bare feet, = some one actually did this.
3. Do Not actually walk around the conference room without shoes off with the attendings and faculty around.
4. Do not rest your feet on another chair like you are lounging on your lazy-boy at home during the conference
I got to tell you all these things actually happened.
Wednesday, July 4, 2007
Day 1: Orientation
Orientation began with me parking in faculty & staff parking like it said in my packet of papers. I had 5 minutes to to get from the parking lot to the 3rd floor where I was to meet the clerckship director. Its not good when the parking cop stops me and says I can't park in this lot because I don't have a permit. My god this is was like a scene straight out of a movie. My first day at work, I'm about to be late, and I'm pleading with the traffic cop to let me slide this one time. I think he agreed to let me go this one time. I parked my car and I'm frantically putting on my white coat and then he comes over says " you know since you don't have a permit, you should really park your car on the street." I continue to plead that I'm about to be late, its my first day for crying out loud and the lot is completely empty, just let me park here for a few hours until I get my permit. So finally he stops pestering me, and I run like a mad, crazy person.
Whew, I get there in time and the director isn't there yet. Okay so they throw us a packet of papers to sign and stuff to fill out. We did our drug screens, went through IT to set up computer accounts, picked up our pagers, and get our parking permits. The admin assistant told us campus security was coming by to give a talk. I sat in a conference room in a chair near the door
and who but of all people comes but the parking lot, cop who I was begging to let me go. I told him I placed a permit on my dashboard. He gave a talk, and when he left he gave me a wink. I was like what was that. Okay after a day of computer modules on HIPPA ( saying that you not tell all the suff you here from a patient to everyone) we met our clerckship director ( he was tied up in meetings in the morning).
Tips I learned from observing others.
1. Never arrive late - and make the director fuming mad (part of crew was late & missing)
2. Never wear stilletos - or any stylish shoes ( you don't want a feet full of blisters)
3. Never wear plunging necklines on the first day.
Okay I'm tired I should hit the books.
Whew, I get there in time and the director isn't there yet. Okay so they throw us a packet of papers to sign and stuff to fill out. We did our drug screens, went through IT to set up computer accounts, picked up our pagers, and get our parking permits. The admin assistant told us campus security was coming by to give a talk. I sat in a conference room in a chair near the door
and who but of all people comes but the parking lot, cop who I was begging to let me go. I told him I placed a permit on my dashboard. He gave a talk, and when he left he gave me a wink. I was like what was that. Okay after a day of computer modules on HIPPA ( saying that you not tell all the suff you here from a patient to everyone) we met our clerckship director ( he was tied up in meetings in the morning).
Tips I learned from observing others.
1. Never arrive late - and make the director fuming mad (part of crew was late & missing)
2. Never wear stilletos - or any stylish shoes ( you don't want a feet full of blisters)
3. Never wear plunging necklines on the first day.
Okay I'm tired I should hit the books.
5-hour Drive Through Nothingness
The day before rotations began, I began my 5 hour journey to West Texas armed with a stack of CDs, dumplings I made in the morning, and a bottle of No-Doz (caffeine pills). Driving through West Texas is one of the most boring drives I have ever made. I lost count of the number of oil rigs after counting five. The acres and acres of corn and crops and an occasional rustic, red barn reminded me of a William Faulkner short story.
Driving was even more fun through a humungus rain storm. I remember I was little when ever my parents got their car washed at a gas station a big brush would roll over the car and you couldn't see anything. Well that was like the rainstorm I drove through, I could not see a thing and my car was moving.
After one pit stop at some shady gas station to gas up my car and a restroom break at dairy queen, and a windshield splattered in smushed bugs I arrived in Odessa. I knew I was approaching civilization again when I saw from a far a huge Super Walmart sign.
I arrived to my apartment got the keys and immediately checked out my apartment for the next six weeks. Okay it was not a good sign when you barefooted naked little girl asking what my name was, followed by their barefoot mother in a wife beater following behind her.
Okay the apartment is a furnished with twin beds in a 2 bedroom 2 bathroom apartment. The apartment isn't too bad. The keys successful away rotation living situation:
1. Arrive to the living premises before your roomates.
2. Scope out the rooms, bathrooms, closets, beds, furniture and claim the best bedroom before your roomates arrive ie (spread your stuff all across the room like a big mess ie leaving no room for a potential roomate). One bedroom will always be better than the other. I chose the room in the back of the apt, quiet, dark and secluded. The other bedroom was right at the front door, it looked hot, and small.
3. Next scavenge the apartment for things you need (extra toilet paper, more towels, table fan, desk, chairs, soap) and put them all in your newly claimed room. Don't forget to scour the room your roommates will be living in.
My roomates finally arrive hours later and I offered one to room with me. She didn't seem to eager to room with me, maybe its my neat, organized nature that turned her off. Perhaps it was a pile of dirty sheets, carpeting, and other trash, on the other twin bed in my room I didn't claim turned her off. Whatever it was I didn't care my plan is working. Now my 3rd roommate arrive we allowed her to choose which room to use between me and the 2nd roommate. After scoping out my room she decided to room with the 2nd roomate. To my suprise I now have my own room at the back of the apt with my own bathroom.
Ok so I met the rest of the Odessa crew and we cruised around looking for whats around and food. We spent the rest of the night chatting away. I got home tired, and fried from moving in the sun. I showered and jumped into my bed with absolutely no back support at about 1:30 am.
Driving was even more fun through a humungus rain storm. I remember I was little when ever my parents got their car washed at a gas station a big brush would roll over the car and you couldn't see anything. Well that was like the rainstorm I drove through, I could not see a thing and my car was moving.
After one pit stop at some shady gas station to gas up my car and a restroom break at dairy queen, and a windshield splattered in smushed bugs I arrived in Odessa. I knew I was approaching civilization again when I saw from a far a huge Super Walmart sign.
I arrived to my apartment got the keys and immediately checked out my apartment for the next six weeks. Okay it was not a good sign when you barefooted naked little girl asking what my name was, followed by their barefoot mother in a wife beater following behind her.
Okay the apartment is a furnished with twin beds in a 2 bedroom 2 bathroom apartment. The apartment isn't too bad. The keys successful away rotation living situation:
1. Arrive to the living premises before your roomates.
2. Scope out the rooms, bathrooms, closets, beds, furniture and claim the best bedroom before your roomates arrive ie (spread your stuff all across the room like a big mess ie leaving no room for a potential roomate). One bedroom will always be better than the other. I chose the room in the back of the apt, quiet, dark and secluded. The other bedroom was right at the front door, it looked hot, and small.
3. Next scavenge the apartment for things you need (extra toilet paper, more towels, table fan, desk, chairs, soap) and put them all in your newly claimed room. Don't forget to scour the room your roommates will be living in.
My roomates finally arrive hours later and I offered one to room with me. She didn't seem to eager to room with me, maybe its my neat, organized nature that turned her off. Perhaps it was a pile of dirty sheets, carpeting, and other trash, on the other twin bed in my room I didn't claim turned her off. Whatever it was I didn't care my plan is working. Now my 3rd roommate arrive we allowed her to choose which room to use between me and the 2nd roommate. After scoping out my room she decided to room with the 2nd roomate. To my suprise I now have my own room at the back of the apt with my own bathroom.
Ok so I met the rest of the Odessa crew and we cruised around looking for whats around and food. We spent the rest of the night chatting away. I got home tired, and fried from moving in the sun. I showered and jumped into my bed with absolutely no back support at about 1:30 am.
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