My First Month

And it has begun. I officially started residency a month ago, on July 2nd, and it has been awesome.....ly tiring. Hospital-wide orientation began on a Friday... a day so hot I decided to wear a polo and shorts, because if all the other guys wore shirt and tie, the polo wouldn't make me stand out too much. Most of them did. I reveled in my comfort. The day preceded with a bunch of useless lectures, including one on how to avoid lawsuits and all, which was presented in a much better tone than Ted Buckleys. After the day ended for most people, we went on to the surgery department orientation which is when we first received our white coats. Obviously, we threw them on immediately and felt impowered.... a feeling that would quickly dissipate in a few days. After the weekend, we started our first day. Luckily I knew how things worked at the hospital because I was there as a student, but it took me time to realize that nothing happens in a hospital without an order.DAMN ORDERS. It's what I spend most of my time doing when I'm at a computer. Putting in orders for patients. Medications, foleys, nap time, imaging, lab work, and tickling sessions. Even though they know more of how to manage a patient from their experience, nurses really aren't allowed to do much without an order from a doctor. A doctor.A term that still feels unearned. For the most part, I introduce myself to doctors and usually nurses by my first name. I feel unworthy of it. I may have grown 1% more comfortable with being referred to as a doctor, but it's still weird, because when I'm addressed that way, it is because I have to make a decision. I have to give an order. And when I started out a month ago, that was overwhelming. But, going back to the first few days. I stumbled around a bit trying to remember that I have to put in orders for things to happen. Nurses would call me to put in orders. I would get paged cause I put in the wrong order.... "Doctor (there it goes again), the patient is NPO (nil per os, nothing by mouth) so they can't take pills, can you change it to IV?" (What? Are you not accepting my challenge?) "Oh, yeah, sorry. Changing it as we speak! Thanks." Obviously, the best part of doing this whole thing is the ability to operate. http://www.youtube.com/watch?v=2wZlqsw-VyY And as Dr. Turk Turkleton once said, "This morning, I had my hands inside of a guy's chest. I couldn't even see them! I should not be allowed to do stuff like that." As an intern, I'm not doing big crazy cases (though I did get to do a laprascopic appendectomy and cholecystectomy [take out appendix and gallbladder using small incisions and a camera]), but normally doing hernia repairs. It was a great feeling to have the attending tell the scrub nurse (who gives us the tools in the OR) to pass me the knife to make the first incision, and I realize that though I am learning I am going to be doin most of the operation, which I do. Just recently I had to take a cancerous mole (melanoma) from a patient's cheek, and I didn't think I'd be doing that incision, but the attending passed me the knife and said becareful around the eye. AH! Oh, and I did get to amputate a toe. That little piggy ain't going NOWHERE! I do love operating. It may get repetitive, but that's how you learn. This isn't easy stuff. That's why training is 5 years just for general surgery plus a fellowship to specialize... and even then you're not gonna be at your peak. And each human body is different. Each case is different. And then, when you think you have nothing else to do, you can always be at a teaching hospital and train students and other residents. Plus, we're not only doing stuff in the operating room. On my second week, I put in a chest tube to help decompress a patients lung. And guess what, it worked beautifully. http://s1.e-monsite.com/2009/01/19/10/40556091pneumothorax-gif.gif (This is an example, notice how there are no lung markings on the left, it's completely dark... that's a collapsed lung). Also on my second night, I get consulted as I'm covering urology to put in foleys (the small tubes that go into the urethra to help you pee) for patients because older medical residents are uncomfortable. I literally strolled up to one of them and said: "I talked to the urologist and he said there shouldn't be a problem putting in a foley, he's not at risk for bleeding, so you can do it." "No, I'm not comfortable, but he really needs one, he's very distended" "Alright, fine. I'll do it." And on the 3rd day, GP said, LET THERE BE PEE! True factoid. The patient was so distended and had to urinate so bad that he could not lay still. He was calling out for help and writhing around. The moment the foley went in and about a liter of urine poured out, the patient passed out. But I'm not putting in foleys into pensis all day, all night! Sometimes, I'll find myself in the ER or some hospital room cutting into peoples abscess to let the pus drain out. That's what we do as surgeons, we take care of bizniz. We can take care of our patients operatively and nonoperatively. We can prescribe the medications and all that, but when it comes down to it, we can do all these procedures as well. But unfortunately, compared to more senior residents, I won't be operating as much. I'll get to a decent amount, but I'm an intern. I have to learn how to cover the floor, manage the patients, and answer the pager...... The.... Pager.... The source of all my anger. The pager is not so bad. It helps nurses get in contact with us when they need an order. I was terrified my first morning to get my first page. Why? Not because I wouldn't know what order to put in or how to answer a question. I knew that was gonna happen regardless. I was nervous for the page that would be like "Doctor (Stop calling me that!) your patient is coding!" which is code for dying... NOW! The heart rhythm is all out of wack, their breathing might be gone, they may not have a pulse. It calls for CPR, fast medications, and even defibrillating them like you see on TV.... CLEAR! BZZZ! My first page like that.... I was on night float. My pager went off a few times in a row which is common at night. I can literally sit at a phone for an hour just answering pages because as the intern, we are covering all the other surgical patients which I would say is close to a 100. That can get extremely overwhelming and frustrating, especially when you already have a tone of other work to follow up on from the day team, new consults to see, and emergencies to take care of. But anyway.... my pager goes off a few times, but I'm in the middle of seeing a patient so I dont rush to answer it. When I look at my pager I see ithe callback number is from a room. I start to dial back when I panic... the overhead system says "Doctor Vidal (Whose playing this joke on me?!), please call 8 Tower!" WTF IS HAPPENING? They answer my call on the other side. "Is this Doctor Vidal?!" "Yes" "Your patient in room 69 is bleeding out, come here quick!" I start running. I'm not even sure the fastest way to that building because as hospitals grow they tend to build buildings into complicated mazes with hallways that don't line up, and floors that are not in alignment. But I'm running and thinking to myself what the hell am I gonna do. Luckily, my senior calls me at that very moment while I have the phone in my hand to call her. I tell her about the patient. By the time I get there, thankfully she was closer, she had already applied pressure to the wound to help stop the bleeding. There was blood all over the patient, the floor, and somehow the door about 20 feet away. It was an arterial bleed and so it was gushing like... almost kind of like in the movies when they fake chop off someone's arm. In the end, everything turned out ok. But... that's what I was most afraid of when holding the pager. I still am. More so when I'm on Nights because the whole team is not there. My first time taking call like that was working Fourth of July. I know I know things. I did graduate school. But being new and not understanding protocols and how things work is frustrating. It felt like I was boxed in, but in an open box, yet I was afraid to step out of it. That holiday, there was a patient who was very distended because he could not urinate. He needed a foley, but the nurse had asked if I should straight cath him (just stick in the foley for a second, drain the urine and pull it out, rather than leaving it in) or just put in the foley. I couldn't decide. I kept thinking, would my senior get mad if I make the decision without her? Would I make the wrong one? When exactly do you choose one or the other? Why am I getting so nervous about this? Neither decision will kill my patient, and that's my one goal: Don't kill patient. They tend to frown upon that. The nurse had to stop me and tell me to put the foley in. She said, he needs it just do it. It will be okay.I'm grateful for that. She told me she understood because I don't have confidence at all. I'm pretty sure I had so little confidence I probably owed some back to the general pool of confidence. Ze Lago de Confidencia. All the nurses int he station and I had a good laugh about it, and they all agreed that it comes with time and they understand. I think that gave me a little more confidence to realize that if I know a decision won't kill a patient then it's not the worst thing if I handle it myself. The days and nights have gone better. I feel myself becoming more comfortable at the hospital, but I'm still nervous. I play it off cause I'm awesome, but sometimes I just feel like a glorified student. I'm not ready to feel like a doctor. I know that will come with time. That's why I'm training for a long time. But regardless of all that, this is all about the patients. They are the ones who have to get better. They are the ones in a bed sick, suffering, dying. The crap I go through is nothing to what they experience. I haven't undergone major surgery. I don't have tubes and drains and IVs sticking out of every arm and part of my body. I'm not confined to a bed and room that's not mine. I don't have deep-seated fear that maybe I'll never make it back home. I can suck up being tired, being hungry, and being yelled at... I gotta learn my lesson, turn around, and just keep swimming. (FINDING NEMO IN 3D COMING SOON!) And I do love talking with the patients. Most of them are great, and most of them are very appreciative. You can see it in their faces when they are getting better, when they are ready to leave. We once had a patient say, "Alright guys. I really appreciate you coming in to see me, but it's 5 oclcok so you guys should get out of here and go to happy hour!" Awesome. And so yes, I'm working a lot... 80 hours a week. I'm there 6 days a week. The hopsital doesn't shut down, because the patients don't shut down.... well, not all of them. It's always there. My mind is now 20% always there. I am at a baseline of tiredness... I get hungry often but that's cause I love food... I have to sacrifice a good chunk of a social life to do what I have to do, because it is a responsibility that I took upon myself. And so I will.... and recently I think it has been sinking in more. And I have to say I'm more glad now that I had great early 20 years to look back fondly on, but it is hard not to miss not seeing all my friends, especially now that it is summer. Maybe facebook exacerbates that. I don't know what other things I will have to give up. Somethin happened last week that made me thinkin about all this and is it worth it. And I hope so, I enjoy it now and I'm not going to stop. But it's tough. But I'm not the first person to do this. There have been many a surgeons who have gone on to have families (or had families in residency, had other careers, etc), have great friends, travel the world, etc. They just need the support of people who love them, and are patient, and dedicated. Who are understanding.... that hey, maybe I can't see you every week. But I don't think any of this would be possible without having worked so far with great residents cause I'm no superman. We have a lot of laughs. Pulled off a few prank calls to nurses and other interns. Joke around about things. Everyone loves it when my phone goes off and it's Your Love by the Outfield. It's so far been a great experience and I'm having fun.But I have to be honest... I would like to sleep a little more.... see my friends a little more... dance a little more... http://www.youtube.com/watch?v=bhh7qzurMZY