On the wards .. finally!

It's finally here! I'm finally a wards resident!

We had a junior resident retreat a few weeks ago so that people could share the highs and lows of being promoted to resident. As I've had 6 weeks of elective and 2 weeks of vacation during the first 3 months of this year, my colleagues joked that they were trying to keep me away from the new interns! July sounds like it was pretty crazy in the hospital, so it's nice to have some interns who have been in the system for a few months when it's my first time being the team leader.

At the retreat, I confessed that I had been dreaming of my first day as wards resident and had been crafting my first day speech for months. My fellow residents chuckled at me, but based on my experiences from last year, I feel the resident sets the tone from the very beginning. My speech wasn't as articulate as I had imagined it would be, but I hit my main points:

1. I believe in the duty hours limits. Interns have to leave the hospital after 30 hours if not sooner!
2. We should function as a team. There's no "That's not my patient."
3. Training is about learning -- about diagnosis, disease management, and communication skills. Paperwork is something we have to learn how to do efficiently so we have time for the rest of our learning.

I was unleashed onto the wards a little over a week ago and met with the members of my team recently to see how things have been going. I've been trying so hard to be the kind of resident I would want--pitching in with orders and paperwork, making sure everyone gets food, and ensuring my team members go home and sleep. However, I wasn't sure if I was being the kind of resident they want.

Overall, it seems like things are going well. My attending said she couldn't tell it was my first time doing this, which plastered a big smile on my face. My interns appreciate our efficient rounding, and they feel well supported. However, they're both kind of worried about how much I've been eating and sleeping. And there it is. I'm totally exhausted. When I'm stressed out, my appetite goes down the tubes, so I haven't been eating right. Today is the first time I've spent more than 15 minutes with my husband in 3 days, and that's only because it's my day off. I've been so worried about my patients, students, and interns that I haven't been taking care of myself at all. Instead of helping everyone else in doing their jobs, I have to figure out a better way for me to do *my* job so that I can stay sane.

Despite my total exhaustion, I absolutely love my job.

I want to see a doctor, too!

I have a confession to make. I haven't seen my primary care doctor in almost two years. I'm relatively young and healthy, but I'm a believer in the annual visit. Those visits are not just for Pap smears, colonoscopies, and mammograms. It's just plain healthy to spend 30 minutes talking about your health with a doctor at least once a year. My primary care clinic is in a community health center, and I see a large percentage of young African American men. I usually don't run any tests, but we spend the majority of the time talking about safe sex, wearing seat belts, guns in the home, and developing good eating habits. (You won't believe how often young single guys eat fried chicken! Learn how to make a sandwich, guys!)

Anyway, so I haven't seen my doctor in a while. I actually made two appointments to see him last year. Making an appointment is half the battle since I have to remember to call during office hours and then find a day when both he and I are free. Sadly, I forgot to go to both appointments! I know I'm a bad patient. That's what happens when I schedule them on my one day off a week and then get so excited about sleeping in that I forget.

Instead, I try to monitor my health myself. I know what I'm supposed to be doing, but sometimes people, including doctors, need an authoritative voice to push them in the right direction. For the past two years without my doctor pushing me to take care of myself, I've turned to Oprah. I'm an avid Oprah watcher, and I really enjoy her medical shows. I'm sure I'm not the only American getting my health information from her gurus Drs. Mehmet Oz and Christiane Northrup. I even took Dr. Oz's Real Age Quiz. Despite my lack of exercise, I'm surprisingly one year younger than my real age, but I took the tips the website had to offer to heart. I went to a yoga class on my day off, and I've started flossing again as it was one of those habits that went by the wayside during intern year. I'm still working on the fruits and vegetables. Getting in five servings a day is hard work!

I'm a big fan of Dr. Oz although part of me feels strange about getting my medical information from a cardiac surgeon on television. So, I called my doctor's office today. His first appointment ins October 15th, but my first weekday off after that isn't until November. See you in three months, doc!

Google to the rescue!

Okay, I'll admit it: I use google to find medical information. I know I'm not the only one. Use of Google, Wikipedia, Emedicine, and other web sites is very common in the hospital among med students, residents, and attendings. I've seen you all using it! Usually I use google to confirm information I'm pretty sure I already know, but once in a while, I'm really not sure what's going on and give it a try.

Recently in the emergency room, I was pretty sure my patient had a viral gastroenteritis, but she had a black tongue. I had actually woken up with a black tongue last week, and it went away within a day. I didn't think any of it, but understandably, my patient really wanted to know why her tongue was black. So, I turned to google, and I found a wiki that linked to this:

The active ingredient in Pepto-Bismol contains bismuth. When a small amount of bismuth combines with trace amounts of sulfur in your saliva and gastrointestinal tract, a black-colored substance (bismuth sulfide) is formed. This discoloration is temporary and harmless. It can last several days after you stop taking Pepto-Bismol. Individual bowel habits, your age (the intestinal tract slows down with age), and the amount of the product taken all help to determine how long Pepto-Bismol is in your system.

I went back to the room and asked if she had any Pepto-Bismol recently, and she had! And I had some Pepto last week the night before my tongue turned black. Thanks, Google!

Nightfloat as therapist

As nightfloat, I was usually the last person interns saw at the end of their days and then the first person they saw in the morning. Being a social gal, I would usually ask, "How was your day?" More than once an intern started tearing up. Sometimes they would be angry, sad, frustrated ... the list goes on. Last year, I remember bottling up my emotions all day as I interviewed and assessed patients, tackled mounds of paperwork, and crammed some learning in, but when interns sat down to hand off their patients to me, sometimes it would all come out. That was fine with me as I didn't have anywhere to run to; I was working all night.

An end to the USMLE trilogy

I'm continuing on what seems to be an annual tradition of studying for some ridiculously expensive required standardized exam so that I can be a doctor. This year's test: USMLE Step 3.

Yes, I'm hunkering down in preparation for the last step in the USMLE trilogy. Don't worry, there's still the Internal Medicine boards! Plenty more testing to go in my lifetime! I like doing practice questions because reading prep books can be pretty dry. Step 3 covers a wide range of subjects, including surgery, obstetrics, and pediatrics. It feels like a long time since those third year clerkships, but after some studying, I know that you need some sterile saline, gauze, and ice to pack a severed finger for transport and that lesbians are at lower risk for cervical cancer than heterosexual women. My tip for Step 3 is that the answer is never "Quickly examine the patient in the parking lot." Got to love those ethical conundrums!

PPD negative and cavity-free!

The nice thing about being on nightfloat is that I have daytime hours free. I should be sleeping, but when else am I going to be able to run my errands?

I'm pretty sure intern year had a negative impact on my health. (Those hospital cafeteria chicken wings are pretty hard to resist.) However, it's nice to know that my teeth are still intact and that those N95 masks really do keep the tuberculosis away.

If only I could have gotten an appointment with my primary care physician! There's an 8-week wait for an appointment. Somehow I called my dentist, and I got an appointment within a week. I also called my mechanic and was able to bring my car in the next day. I have high hopes for change in our healthcare system not just because I'm a frustrated doctor; I'm also a frustrated patient.

Hello, PGY-2!

Now that I'm a PGY-2, I'm really looking forward to leading a team of interns and doing more teaching, but July 1st was a bit anticlimactic for me as I'm starting out on elective. In some ways, it seems wise to stay away from the inpatient wards this month. I've gone to visit some friends on the wards, and it seems like controlled chaos. My fellow PGY-2's are a little frustrated that their interns are not as efficient as we were, but we remember well how difficult the first few weeks were for us. Looking back, I was thankful to survive each day somewhat intact.

Although I'm not leading a team, new responsibilities abound everywhere I look now that I'm a resident.

• In the urgent care clinic, I'm now expected to see six patients a session instead of the four I saw just two months ago in the same clinic. I haven't become magically more efficient, but I'm quickly learning lest the nursing staff kill me for keeping them late!


• Next, I will be admitting patients overnight as the junior resident nightfloat. While there is a senior resident around if I have questions (in addition to fellows and attendings by phone), I'm largely expected to admit these patients on my own. I know it is something I am capable of, but I feel a bit like I'm swinging on a trapeze without a safety net.


• After a few weeks of nightfloat, I'll be in the emergency room, again without any interns to "boss" around. Instead, I will be running the "medical traumas" that come into the ER, such as overdoses and strokes. Yes, a patient will be rolling into a trauma room, and I will be yelling out orders!

This year will be an adventure, for sure. I'll keep you updated!