Fresh Coffee...

I had the freshest cup of coffee about an hour ago. Not fresh meaning that it was brewed this morning (which it was), but fresh meeting that I roasted the beans myself last night. It's like when speed addicts start making their own methamphetamines in their own kitchen... I roasted some Bolivian beans which were imported by a Bolivian company with offices in Bolivia and Massachusetts. (The beans are certified fair trade and organic). Good stuff. This is the start of a lovely new experiment in life.

The doc's advice: do something near and exciting this weekend.

Alive and Well & "What do I know now that I didn't know a year ago?"

Hey there, I am alive and well. I don't know what I have been up to recently but just haven't really felt motivated to jump on here to give any exciting updates...

I finished up my medicine ward month on June 3rd. It was nice to finish up on the wards, however, it is always bittersweet because when I left, I was giving up the right to continue taking care of three patients whom I greatly enjoyed. That doesn't mean that I have not poked in to say hi to them, and in fact, the one patient who I diagnosed with septic pulmonary emboli will actually be getting me as her primary care physician. It's exciting because she has done remarkably well. And by remarkably well, I mean being hospitalized has given her a chance to get off of heroin and to reconnect with some of her family. I am actually quite excited for her because she is doing so well. The other patient was one of my most favorite to patients so far. She was discharged to a rehab facility, and I have plans to go meet up with her and her husband for tea at some point. The last patient was discharged out of the hospital yesterday, and should have an uneventful course from here.

I have also just recently finished two weeks of geriatric medicine. (No, dad, not so that I can take care of you some day). It was pretty helpful, but, two weeks was not enough. It's kind of like pediatrics in a way. People fall and get hurt. People lose control of their bowels and bladder. Drugs which do well for adults cannot be used as easily in the elderly. It was also interesting going to a rehab facility for two afternoons, and to see the amazing work that is done on that end. My interest in the geriatric/rehab aspect is that I'm sure some day I will not have the luxury of having a geriatrician or rehab Doc to help me manage these patients.

I'm in clinic for the next two weeks. I have mixed feelings about clinic. I enjoy the patients we take care of, but the clinic itself can be a bit of a pain in the ass!

I have a few projects working at this point and was hoping to use this weekend to get caught up on them. I'm working on getting my international health track going at hospital, with the target date too start July 1st, 2007. I'm also trying to organize the immense amount of paperwork and articles and reading materials that I seem to have accumulated over the past year. I was half tempted to just throw the stack away and start all over.

Speaking of starting all over, I cannot believe that a year of residency is almost over!!!!!!!!!! HOLY SHIT! What do I know now that I didn't know a year ago? I'm sure I have learned a lot, but ask me to name one specific detail and my mind goes utterly blank. Utterly blank. Utterly blank! You see, when I try to think about what I have learned in the past year, all that comes to mind is how much I still need to learn. For example, this July 1, I find myself again on the pediatric ward. Last July 1, anytime I had a question, I was able to ask my senior resident and get the answer. This July 1, I am that senior resident. What is really different from a year ago? I guess what is really different days that this year I am more confident. I suspect I do know a hell of a lot more than I did a year ago...

Three Days and Counting...

Three days left. Including call tomorrow. It's kind of the home stretch now. I've hit that point where it does not matter how tired I am because the end is in sight, and no matter how bad call could be tomorrow, come Friday afternoon, I am a free man! I kind of dreaded seeing my attending today. I knew that after the way things ended on Friday, I was not going to have warm fuzzy feelings for her. But again, the end is in sight. And I didn't have warm fuzzy feelings for her. It kind of sucks, because I think she's a good doctor, and I know she wants us to become a doctors, but her constant criticisms have just left me a bit annoyed with the entire month.

Miserable fucking day, Part 2

So, I have this bad habit of logging in to the hospital computer from home to check up on my patients. Before I left this afternoon, my attending was grilling me on why I ordered a CT angiogram on a patient of mine this morning. I defended my actions to her, but could tell that she wasn't too impressed that I had ordered a test which will probably cost the hospital a few thousand dollars. At 7 a.m., when I ordered the test, I knew I would have to defend my actions. This patient, has been complaining of a pain, and we haven't found and the source. The pain is not due to kidney stones, nor due to a kidney infection, so based on the fact that she uses injection drugs, I was worried about disease in the lung. I figured she had a lung infection which hadn't shown up on a normal chest x-ray. So I ordered the CT angiogram, cognizant of the fact that this patient doesn't have insurance.

And guess what, it shows that she has multiple tiny infections in the lung. The best part, is that they called my attending with the results. I wish I could have been there to seen her face when she found out that the test, which she criticized, had proven exactly what I was looking for.

Intern =1, Attending =0

And like that, all of a sudden, my confidence is right back to where it was before this downward spiral began.

A miserable fucking day

It's just been one of those days. Where the work is good, but the overall experience has just fucking sucked. Actually, this all began yesterday. Yesterday, my co-intern said "this could be the day I quit residency." I thought he was being a bit dramatic. Today, I said "this could be the day I quit residency or rather this residency." I know I was being dramatic. But is it funny, how when you're just stressed out, quitting seems like a good option. Let me explain...

At five o'clock last night, I met with my attending doctor. It had already been a trying day. First off, by five o'clock I should have already signed out and been at home. At 5 p.m., my attending gave me about another hour's worth of tasks that she felt needed to be done. So of course, I did them. Even though they could have waited till today. At six o'clock, I signed out to my co-intern (who thankfully hadn't quit). I then spent two hours with a patient and his family trying to figure out why he wasn't getting better. I left at eight. Four hours past when I should have left.

This morning I started at 6 a.m. By 8 a.m., Molly (our medical student), and I were telling a patient that he has esophageal cancer. A few minutes later, I ran into my attending doctor, and that is when the day began to turn sour. She hasn't been happy lately, and made it clear that today wasn't going to be an exception. To make matters worse, she informed me we would meet this afternoon. To make matters even more worse, she wasn't pleased to hear that my senior resident was getting me out early this afternoon. And so, knowing that in the afternoon we would have a confrontation, I spent most of the morning trying to figure out what the fuck her problem is. Our team has been working well over the number of hours we should be working, discharging patients quicker than other teams, and still she constantly has issues for me and my co-intern. Which is why, I had a miserable fucking day thinking about where I'd rather be than where I was.

How did my day end? Instead of leaving at one, I left at three. Surprise. Surprise. Surprise. And, that was after being berated for 20 minutes about things that happened yesterday, and things that hadn't been done today. Being a resident can just fucking suck.

Thank God, only one more week of medicine wards

More thoughts on the liberty

Today is my day off. I've decided to use these days off this month (all four of them) to have some fun in life. So today I was going to go hiking. Unfortunately, it's been passing rain for days now. Rain brings mud, a chance for dirtying up the liberty. So instead of going hiking, I went four-wheeling. My goal was to get mud on the top of the liberty. I was successful. Unfortunately, the liberty now has a wee bit of a scratch. Well, not a scratch really. Actually, after the bump I took I'm pretty happy that it's just a scratch. Some of the moulding is a little bit looser, that was earlier in the day. I'm pretty sure it's something that can be fixed fairly easily. I'm proud of the liberty, she handled like a charm...

anyways, it's probably time to go ahead and get busy on the things I really need to get done on my one day off this week. Grocery shopping laundry, etc. etc. etc.

hope you had a nice weekend!

Cheers,

Brian

New toys...

So, it's pretty amazing what you can do to justify buying a things. Let me explain. The thing I really dislike most about my job, it's all the damn paperwork. So, in my quest to reduce the amount of paperwork that have to do on a regular basis, or at least to make it more fun and interesting, I've decided to buy new toys. For example, tonight instead of using the boring keyboard to put this in I'm using my voice recognition software. How did I justify this purchase? Let me tell you..

Whenever someone leaves the hospital, we do this painful process of documenting their entire stay of the hospital with the premise that someone actually reads the pages long of babble that write. So, since I've been spending in oh at least an hour every night working on these summaries, and while I'm not the slowest type or the world, nor the fastest, I've justified buying some voice recognition software. And basically, you are my guinea pigs. Kidding!

So, tonight I'm working on my discharge summaries by dictating them at home. I'm hoping that, while it may not speed up the process, it will at least distract me from the pain associated with doing these damn discharge summaries. There's more though. Did you also know that they make SD cards, which are also jump drives? What this means, essentially, is that the discharge summaries that I start tonight, I will carry around in my palm pilot tomorrow, and update them periodically throughout the day. And as patients get discharged. I merely take the S D card of my palm pilot, plug it into a computer and boom I can get the patient discharged.

Tomorrow is my day to round. It should be a short day, theoretically. In at 8 a.m., and if all goes well, out the door by 2 p.m. That being said, realistically, I know will probably be 3 or 4 p.m.

Anyways, now it's time to put this new toy to work, and crank out some of those damn discharge summaries.

Cheers, Brian

A Million Thoughts...

Are running through my mind. It's monday night, 9:15 and I'm basically sitting here paralyzed. I want to go to the gym. I want to go grocery shopping. I want to read about my patient's conditions. I need to start writing the discharge summaries for my patients. I want to get caught up on email. I want to get caught up on talking to family. I really want to get caught up on sleep!

I hoped that a cup of coffee would start a nuclear reaction of energy and that somehow, I'd find the energy to do something from the above list. And nada..

Work is busy. Busy, blah blah blah. But it's good. I find I set myself up for this dilemma every day. We're suppose to work 7am to 4pm. "suppose to." Today was 6:30 am. I was hoping to make it out of there by 4pm today (so I could get some of the above errands done). Realistically I knew it would be 6pm. But shit, again there was a patient to be discharge at the last minute. And then I wanted to go check up on 2 patients before I left for then night. I left late.

It's not really a big deal, except that I had expectations to get some stuff done this evening. Which is why it is now 9:30, and I can't even figure out where to start.

Today was a pretty good reality check. Just when things seem to be clicking along great, feeling pretty confident that I've learned a lot so far, wham-O! Very complicated patient. A fantastic patient who I totally adore, who is a bit sick. I admitted her last night. At first it seemed kind of straight forward when the call came from the ED. Pneumonia. Simple stuff. But then when I met the patient and got the story and looked at her preliminary labs, the simplicity quickly faded. My current reference frame for seeing patients is "in 3 years and 2 months (yikes), I may very well be working out in the boonies and what would I do in this situation." Usually that forces me to think things through and things start falling into place. Last night, though, ll I could come up with was: Better get the hematologist to tell me what the hell is going on! And as I headed home last night, I was determined to put on my detective hat look up some of the abnormalities, and figure out what was going on... But I was just too tired to muster the strength to open my "Harrison's Principles of Internal Medicine." I'm not going to read tonight either...

B

March of the Jeep Liberty

Have you seen March of the Penguins? There's this part where the penguins essentially call out for their mates and kids. Last night in the parking lot, when I could not for the life of me remember where I parked, I had to walk around pushing my automatic lock button waiting to hear the Liberty beckon me to her!

Back on med wards.. I think I had forgotten how busy med wards is.. But, that's not necessarily a bad thing. I no longer get that "oh God, now what" feeling when my pager goes off. It doesn't freak me out that I have patients to discharge and at the same time others waiting to be admitted. I think this is going to be a great month to learn and improve my skills.

So the earliest we can sign out on non-call days is 4pm. I think I'm just going to resign myself to planning on leaving at 6pm every night (which actually means It'll be more like 7pm). I had a discussion with a co-intern in my program today. We both have a reputation for being there late. And we discussed how it seems to be that other interns leave at 4pm. Granted, it is quite possible that we're both just slow. Rather, we concluded that enjoying the best part of our job (actually talking with patients and families), means that we're in the hospital later. I'm pretty sure I could have dodged out of there at 6pm (instead of 7:30), but that would have meant not going around to peek in on everybody this evening, and leaving a few loose ends for the on-call intern to deal with.. As we were getting ready to leave, there were 2 senior residents who, likewise, were not on call, and who were leaving damn late. They are in our program. What do I like best about the residents in our program? We care for our patients. This brings me back to the Time article (see previous post). Personally, their fucking slant against residents pisses me off, and quite frankly, they can fuck off. (Although I did sign out for a subscription to fight my cultural ignorance). So, it's almost 10 pm, I had a quick bite after popping in to the gym briefly, and now I'm going to spend at least an hour on the computer working on discharge summaries for patients who are hopefully going to go home tomorrow. (Again, fuck off Time).

I suspect I'll be Marching for the Jeep Liberty again soon.

Cheers,
B

Prilosec (Omeprazole)... Taco Bell... Med Wards... Time Magazine...

So, Saturday was our monthly intern gathering. (Once a month we have an intern retreat, so we get together as a group and socialize). On the way to our hiking destination the 3 of us in the car were chatting. This is the summary of part of the conversation. One of my peers has recently started taking omeprazole as well! Here I am, trying to hide the fact that I'm self-treating some GI upset issues and come to find out that 3 of the 7 of us are all on PPIs, as well as quite a few other residents in our program! Even more shocking, this intern has also had to QUIT COFFEE!! Woah there, lets not get all crazy! Come on, I pop those little pills in the morning so my stomach can tolerate the coffee!

Anyway, Saturday was outstanding. Amazingly, we were all off on Saturday. So we had a lovely hike, followed by dinner, followed by dessert, followed by drinks in this tiny bar with 2 guys playing what I learned was Americana music. Good times. We have a great intern group!

This is my last free weekend til sometime in June, so it's been a nice lazy weekend. I was also out Friday night, which, ended up at Taco Bell at 3am. Wow, haven't been to Taco Bell in prob 2 year?? Suspect it'll be another 2 years as well.

Blah blah blah, blah blah blah.

Oh, so this is cool. When I was having dinner with J&J on Friday, they had this great candle burning, that sounds like a "crackling fire." So, I had to get one of those today as well. Cool stuff.

That's really about it for now. I'm starting med wards on Wednesday. Aside from the 6 days a week, I'm actually kind of looking forward to it this time around... Speaking of medicine, the new issue of TIME has an article about medicine, and I'm not the biggest fan of time, but a part of this story caught my eye, and that part was a slam against residents.. I have only read the first part of the article, so I'm deferring final comments til later...

Alright, should probably get some sleep...

How I spent my morning...

I wish it was laying in bed, reading the paper and listening to NPR while my servant brought me a french press and fresh fruit and a warm scone. Really, that would have been preferable.

When, in reality, this is how it went... I was laying in bed, wondering if the woman who paged me at 11:30 last night was in fact having a heart attack, or was in just indigestion. While eating my oatmeal for brekky, I logged on to work and decided to do some follow-up. I had told her to go to the ER to be seen. Shockingly, there was no record of her being in the ED last night. Well, maybe she went to the private hospital down the street. While I was there at the computer, I decided to follow up on another patient...

So I got a call from a mom at 6:30 last night. She was concerned that her child may have been harmed, intentionally. I was concerned that her child was harmed, intentionally. We talked for probably 10 minutes on why she needed to take her child to the ED to be seen by a pediatrician, and she was in complete agreement. So, shockingly, that child also wasn't seen in the ED last night. ARGH! So, had she gone to the ED last night, at bare minimum, the child would have been evaluated by the pedi res/doc, who could have gotten the story better than I did over the phone, and they would have all the info needed to involve social services, and maybe the police. However, since she didn't show up to the ED, and since I'm a "mandatory reporter" the fact that I have concerns about the welfare of this child means that this morning I had to try to reach this mother, and when I failed at doing that, I had to call social services and pass on what paltry information I did have. 2 hours of phone calls and forms. The mom isn't answering her phone... And all I can think about is if this kid is ok...

Cruising on autopilot & Next Year's Schedule

Kind of going through the motions more than anything these days. Which I think is ok. There really isn't that much going on, and try as I might, I can't bring myself to get extra projects done.. I'm suppose to be doing this 2 week elective in radiology, interventional radiology. 2 days would have been plenty, 2 weeks is just damn painful. I kind of just float around the radiology department popping in here and there to observe. Well, ok, not just the radiology department. I did manage to pop into Costco and then the grocery store yesterday, and then popped home and to the gym. I justified it on the basis that after 39 hours of work responsibility, I was free to go...

So, I had these grandiose plans to come home and read up on some nagging topics (what is the outcome in lichen planus), do some practice questions for my next board exam, read a few journals. Yeah, I took a nice nap, instead...

This is my free weekend, the last one til June. Does it seem ridiculous that I was going to go away this weekend? I was torn between driving somewhere (Philly, Burlington, Montreal, NY), or backpacking. Instead I'm going to chill out this weekend and get caught up on social engagements.

My Schedule (including vacations)

May-medicine wards (6 days a week, don't expect to see much of me)
June-2 weeks geriatrics, 2 weeks ambulatory (2 weeks of jeopardy call)
July-Pedi Ward (as a senior resident-pretty crazy)
August-Pedi Surg (vacation #1 to HG's wedding)
Sept-Pedi ICU
Oct-Adult ICU (hence, long stretch!!!!)
Nov-Going to Ireland the first week
Nov-Elective
Dec-Medicine Wards (prob home new years)
Jan-Pedi development
Feb-Neonatal ICU
March-Indian Health Service (Arizona/New Mexico Border)
April-first week vacation in Denver
April-Adult ED
May-Medicine Wards
June-1 week night float, 3 weeks community medicine

Subject to change at will...

Cheers,
B

Married to my pager...

I've been married to my pager since 9pm last night, and am married to it until at least 8am. Lemme think.. so that's like 37 hours. Let me explain...

So last night and Friday night I was the overnight intern, which means I went to work at 9pm and then the other medicine residents signed out their patients to me. I was covering somewhere around 70 to 80 patients. Those night went well. Even managed to get a bit of sleep Friday during the night.. I finished at 8:30 this am.

But, since 8 am I have been the on-call doc for clinic patients. Pretty chill today as well, but means I need to be available to call people back..


Things I miss about Dublin (yes, there are some things).
-It is raining today. It's the perfect day to spend it indoors (obviously) having friends over for tea and conversation. I don't know why that doesn't really happen here. Maybe it's because aside from J & J, my friends are co-residents. When you're working gobs, it's kind of tough to make spontaneous coffee hanging out things happen. Maybe that's a bullshit excuse. I dunno.

What I do know, is that since I'm on call today, and when I found out it was going to rain all day, I decided that this would be the perfect day to stay home and finish some house chores, including organizing my books so I can hopefully start being a bit more productive in my study habits..

I'm more inclined to sip coffee and think about tea with friends in Dublin.

Speaking of Dublin.. possible trip to Dublin in November.. shhh! I'm keeping it quiet til I know for sure.

Cheers,
B

Springtime...

Nice day today. Amazingly got out of clinic by 5:30 pm. A record! I even cleared out all the charts and mounting paperwork in my box. Form. Refills. The part of my job that I loathe! Paperwork.

The days are getting longer. Green is making a comeback in the outside world...

Work hasn't been too shabby the past few days. I'm bopping around in the radiology department trying to get a bit of a scoop on what really goes on when we sent people down for special tests...

I'm on "night float" this weekend. Maybe I have mentioned this elsewhere... Night Float, so when I show up Friday and Saturday night, I get to be the lucky intern to cover all the house medical patients... Should be fun fun fun. So, will be sleeping all day Saturday.. And then Sunday during the day I am on clinic call, so will be available by phone to the clinic patients.

Can't believe only 2 months left of internship...

Cheers,
B

Lima Taxi

Taxi #1: from the airport. the hotel was suppose to send me a taxi to pick me up. it never showed. got my own taxi. haggled a price to what the hotel said they would charge. taxi driver wants to take me to another hotel. no thanks i say, i have a reservation at this place. he keeps pestering me to change hotels. i suspect he has a connection at the other place. end up at the hotel i booked.

Taxi #2: going into central lima yesterday. young looking kid driving. i get his life story in a matter of minutes. married 8 months and hating married life. he has "a few" other girlfriends on the side. reading between the lines i think he´s trying to find out if i want a hooker. when he points out the hookers on the steet 5 minutes later, i confirm my suspicions.

Taxi #3: leaving central lima yesterday. almost get into a minor fender bender. will, it may have not been all that minor since the taxi i was in would have held up as great as aluminum foil. traxi drier races ahead and yells obscenities at the other taxi driver. this goes on for 5 minutes over the couse of a few stop lights.

Wanna have fun in lima? take a taxi.

Holy Friday... most things are closed. i was crushed to find out that the starbucks where i was going to spend most of the day is closed. damn.

back to the us tonight.

from lima,
B

Hi From Lima!

Wow, lots to mention ..

arriving in lima. sleeping in the airport. flying to puno the next morning. walking around that day in puno, trying like mad to remember basic spanish, taking in all the sights, smells. feeling great to be somewhere new and exciting. walking around getting lost. taking an afternoon tour to the burial area of sillustani. back to trown. finding the local market and walking around at dusk buying local fruits. waking at 6am for desayuna, bread and jam, yoghurt with quinoa (this awesome grain with huge protein content). taking the boat out on lago titicaca (lake titicaca) to Los Islas Flotantes (the Uros Islands). amazed that these FLOATING islands are man-made, last 30 years, and some 2000 people live on the 35 islands. continuing on to the island of taquilli. nice hike in the sun, boat back to puno. spening the evening eating at one of the local food stalls (dinner cost me 60 CENTS) chatting with random stranges, not seeing any other tourists. Taking a 6 hour bus ride to Cuzco the next day, stopping along the way at local markets. Arriving in cuzco, meeting up with susanna. cuzco is much pretier than puno, but far more touristy as well. no blending in here, look non-peruvian and you´re approached constantly. spending the next day walking to 4 inca rouins, including ¨sexy woman¨among others. meeting that night with the tour group for the inca trail. the inca trail. what to say about the inca trail. i´ll summarize the inca trail in a separate blog to do it justice. beautiful. hard. amazing. diverted through aguas caliente due to mud slide, waking at 4 am to head to Machu Picchu. i´ve seen it in pictures, but in person, it´s just amazing. back to cuzco last night. had been fighting some kind of GI upset on and off for days, thought it was related to food, not sure. finally started cipro last night, didn´t eat for 24 hours, and can finally eat today. i am officially giving up beef for life. in lima today. exhausted. have been getting up anywhere from 4am to 6 am the entire trip. wandered around miraflores section on lima a it today. found 2 starbucks!! sick, i know. along the beach, elevated on a cliff, starting to read ¨The spirit catches you and you fall down.¨ last too tired to go into central lima and be a tourist today. just need a bit more down time. . .

Impressions:
1) poverty sucks
2) i like being outside of america, and i can´t explain why, and am not sure i need to
3) when on the inca trail, don´t look at how steep the trail is, just focus on the next step
4) i have a lot more material shit than i need in life
5) manners have gone by the wayside in the US.


i´m too tired to proof this, the web page is in spanish, and i don´t want to delete the thing by trying the spellcheck...

From Lima,
Brian

Leaving...

I am headed for the airport. Yesterday was beautiful! Sunny. Went running outside. Had coffee at Starbucks. And then finally got around to packing last night..

Will try to drop a blog or two from Peru.

Til Then-

Cheers

The Countdown...

Has begun.

All day long, I kept thinking: One week from now. One week from now. On a plane to Peru. I don't think I'm going on vacation so much as I think I am escaping my current situation.

I don't mean to make it sounds all bad, but the past 2 weeks have just fucking sucked. I can't even sugar coat it for myself, let alone for you. Every 4th night for the past 2 months I have been on call. I have not worked less than 90 hours a week the past month.

I don't recall the last time I cooked an actual meal (I live off of oatmeal, yoghurt, cottage cheese, fruit, and a ton of fucking coffee!). I haven't written a proper email in months. Sometimes I can't even remember what I did 2 days ago.

I knew this was going to be the worst part of this year. I knew that 2 months of back-to-back call, let alone pediatrics in the busy season, was going to be tough. What has made this unbelievably tough was the recent death of my closest friend in residency. And that fucking sucks!

One more week...

Keeping a low profile..

Lots of things going on these days, and I'm just doing what I can to keep a wee bit of sanity about me til I leave for Peru in 11 days. This month got wickedly long on Sunday, and I can say that it will be memorable; for the wrong reasons.

Lots to get done tonight.

b

More shit you can't make up...

A few of us were in clinic way too late tonight trying to get caught up on mounds of paperwork, when a fellow resident called a patient. This in the conversation, as I overheard it.

"Hi, Mr. Smith? It's Doctor Bob. You left your blood pressure prescription in the clinic today. I know, but like I said in clinic, there are many ways to lower your blood pressure without medications. You could eat better, get some exercise, stop smoking crack, or take the prescription..."

I shit you not. Verbatim.

It' been a long month so far. Can't wait for peru.
Cheers,
B