In the Life of a Fickle Intern

March 18, 2014

Hospital Life

Filed under: Daily Lowdown — dailymedicine @ 11:23

A little more than two weeks in and I have already seen more sick patients than probably all of my residency years! Ok, maybe I’m exaggerating some, but the patients here are sick. They come to the ED only when they’re on the brink of death, literally. The people here are very resilient! Because patients wait so long, the pathology that they come in with are really interesting. I’ve seen patients with cerebral malaria, metastatic tuberculous, and the list goes on. Moreover, they don’t complain; they don’t yell; and they are all very pleasant…if they’re awake enough to be pleasant.

The ED experience is similar in many ways to the ED at home, but it’s very different in basic function. They have less resources and their practice is different due to this. When I say less resources, I mean, VERY little resources. Patients’ families are sometimes given a prescription for a medication to take the pharmacy to buy to bring back to the ED for the patient.  And this is a tertiary referral teaching hospital for the country! I wonder what it’s like in the rural parts of the country.

It took a few days for me to determine what my role here was since I don’t speak very much swahili, but now, I think I have established my role as an observer/consultant. Now that the residents know me a little more, they are pulling me into the rooms when they have questions about the patients to get a second opinion. They’re asking a lot of questions which is great. Even though I can’t communicate to the patients, all the doctors and nurses speak in English to each other so I can actively participate. They’re also pulling me into rooms just to see an interesting case.

Patients who come to the ED in Tanzania must pay for all the services provided. This definitely plays a part in the delay of getting medical treatment, but it is kind of nice only to see sick patients. There are very few alcoholics or drug seekers here. It’s a great change of pace. The ED has a total of 9 rooms, but 4 of those rooms can fit up to 5 beds. It definitely can get a little crowded at times. There are only 4 cardiac monitors in the whole department and only two ventilators so they have to be careful who they intubate. They don’t intubate anyone who has a low chance of surviving – HIV patients, TB patients, Hepatitis patients. That would include at least half of my patients in Baltimore!

One of the Peace Corps personnel took us on a tour of the rest of the hospital today. The “ward” consists of a single large room filled with beds that are about 2-3 feet apart. There were 27 beds in one room that was slightly bigger than my living room! There is no separation, no privacy, no anything. There were patients laying on mattresses on the ground. This was a bit overwhelming, but a nice reality check. Americans are so spoiled and the majority of the people don’t realize it. The next time a patient in the ED ask me why they don’t have a TV in their room for their cold and cough, I’m going to show them pictures of the wards in Tanzania! Maybe not, but I would be tempted. 

I am learning so much here, medically and culturally. It is making me realize how little i know of the world outside of work. I just need to remind myself to always keep things in perspective. This has been such a great opportunity and I am so glad to be here. I am already planning my next visit back to Tanzania, but at that time, maybe I’ll just come vacation and climb Kilimanjaro and do more safaris!

March 11, 2014

Selous Game Reserve

Filed under: Daily Lowdown — dailymedicine @ 01:25

My friend and I ventured on our first safari this last weekend. Hands down, it was one of the coolest and most amazing things that I’ve ever done in my life! The animals were everywhere! We saw hippos, lions, monkeys, giraffes, zebras, buffalos, and the list goes on, and all from dangerously close distances. Because we are expected to work Monday through Friday, we only had two days to spare. Luckily, the camp we stayedat squeezed in as many safaris as possible in that time. It was such an incredible experience and I would recommend it to everyone and anyone.ImageImage

March 3, 2014

Adventures Abroad Begin

Filed under: Daily Lowdown — dailymedicine @ 20:26

Hello from Dar Es Salaam! With internet! I am in Tanzania this month for an elective international medicine month. The months leading up to March were really busy, balancing life and work and life all over again. This trip abroad was exactly what I needed to maintain some sanity from my undeniable senioritis. Now that I have a little more free time, I can blog!

Nineteen hours and some odd minutes later, my friend (and classmate) and I land in Dar Es Salaam. The initial heat hit us like an oven. Coming from the East Coast where there is almost a foot of snow on the ground, this was a bit of a shock. The drive to the apartment was…dark. Apart from the main roads, there are very few street lights. There were people just walking and hanging out on the streets in the dark all along the way. I have no idea what to expect from this trip. This is my first time to Africa. My initial impression is that it feels like any other developing country…a little crowded, a little dusty, a little congested with a lot of culture and hospitality.

Today was supposed to be our orientation day, but our tour guide, an attending from our home hospital who has been working here for a few months, got stuck in another country due to a flight cancellation. Because we were banking on having someone show us around, we were left moneyless (Tanzanian schilling), foodless, and internet less with no resources and no maps. With only granola bars to hold us over, we got antsy pretty fast. Luckily, an old copy of Tanzania Lonely Planet was in the apartment. After some perusing, we ventured out of the hospital campus (where our apartment is conveniently located) to find an exchange bureau which lead to a grocery store and ultimately a vodafone kiosk where we got a sim card for internet. Though that sounds simple enough, it took us the good part of the afternoon navigating the city without useable money, a map, or even Swahili. All in a day’s worth! And it totally played out in our favor because now we are once connected via cyberspace to everything we are used to, aka Google Maps and Tripadvisor.

As always, I am a bit jetlagged. At 3’o clock AM, I am ready to get the day started. If only other people were awake!

September 3, 2013

September

Filed under: Daily Lowdown — dailymedicine @ 14:10

How in the world is it already September? Where has all the time gone? I honestly feel like I just started residency yesterday and now, in less than 9 months, they’re going to make me leave and work on my own. I’m mildly freaked out. Older residents have told me that I will get to a point this year when it’ll all click and I’ll be ready, but I can tell you  now that I’m no where at that point yet. I like being sheltered! I am the youngest after all (…only half kidding.)

This last month was a mini-vacation. I did an elective in risk management which was really interesting, but it was also really light. Despite it being an easy few weeks, I’ve had this whole “What in the heck am I going to do next year” looming over me. All my life, things were decided for me whether it was based on situation, cost, admission, etc. I’ve moved every four years since I was 18 years old for some sort of school. Now, all of a sudden, I have EVERY option open to me – I can work anywhere! So overwhelming! It’s a blank canvas.

Right now I’m a little torn between staying for a fellowship (extra training) versus just working. This wouldn’t be much of a question elsewhere, but my program is very academic heavy so a lot of people are doing fellowships, and without anything being said, there is an unspoken pressure to stay in academics. It’s the pressure of the masses. I need to figure out my priorities and go from there.

What would you do….

June 26, 2013

Big Girl

Filed under: Daily Lowdown — dailymedicine @ 14:03

I started my first day of my last year of residency this past Monday. In addition to the normal jitters of beginning a new year, I just so happened to have the hardest rotation of my residency first: Trauma ICU. As a third year resident (brand, freaking new third year), I am assuming the role of a “fellow” on one of the the trauma intensive care units. The other people on the team are real critical care fellows (which means that they are in training beyond residency). The reason this rotation is really scary for all of us is because when we’re on call (30 hours in house call) every third night, you are left alone with all the patients at night. Of course you always have backup because there are so many doctors in the hospital, but for the most part, it’s you and yourself. And these are sick, trauma patients – breathing machines, multiple meds, etc. Kind of a big deal!

Though I have been anticipating this rotation since we got our 2013-2014 schedule, this week has gone really smoothly so far. I had my first call last night and I’m happy to say that we all survived (myself included!) I had a really sick patient who kept me busy for a few hours but I think I did ok. Started some meds, shocked his heart, minor details. I did text page my attending to keep her updated, but she did not have to come into the hospital to help me at all. I definitely had a bit of an adrenaline high this morning when I walked out of the hospital having survived my first call (though I had no problem falling asleep as soon as my head hit the pillow.)

Though I still have many hours ahead of me, I am really pumped that this month has started off with a pretty positive kick. I will be completely and utterly tired, but I’m excited about it. Wish me luck!

May 31, 2013

May

Filed under: Daily Lowdown — dailymedicine @ 19:25

I cannot believe that it’s already the end of May (or that I haven’t posted in months). I tend to blog when things are either really good or really bad. When things are stable, there isn’t much to say. Work is going really well; life is steady. I have no complaints. The only thing that is pending is the inevitable decision that I have to make soon (within months) about what I’m going with the rest of my life.

Up until now, the only big decisions I’ve had to make about my career was that I was going to do medicine and then later on, what type of medicine. The minute details of where I was going to go really depended on all of these other factors: cost, location, acceptance, etc. Now, at the tail end of my training, all of a sudden, I can choose to practice ANYWHERE in ANY SETTING and people are going to pay me to do so. The recruitment has definitely started. I get emails almost daily with opportunities all over the US. It’s weird.

I’m debating whether or not I want to stay in the academic world or leave and just work for a few years in the community. My program is very academic so there is an unspoken pressure to stay in the academic world. I don’t have to make the final decision until the fall, but I think about it all the time. What would you do?

As for now, I’m going to continue enjoying life as it is. 🙂

 

 

March 20, 2013

Content

Filed under: Personal Ramble — dailymedicine @ 21:57

It’s been a really long time since I’ve felt this content with what’s going on in my life. I’ve been happy; I’ve been sad; I’ve been stressed, and during all of these time, I’ve had this overshadowing feeling of tiredness and heaviness, mostly due to my seemingly endless to-do lists and deadlines. Residency can be kind of a bitch at times, and more often than not this last year in particular, I’ve had my waves of feeling really burnt out. Though it was stressful, this last month and a half has left me feeling very accomplished, which in my mind goes hand in hand with feeling content. I survived yet another ICU month while studying and taking two national board exams (one of which took a huge chunk out of my paycheck in addition to TWO full days of my life), giving my first lecture, getting my first case accepted to a national academic journal, running my first half marathon while maintaining somewhat of a social life. I’m totally impressed with myself for just surviving with all of my hair intact!

Now that all of that is done and over with, I am pretty much on cruise control until the end of the academic year (June). I’m back in an Emergency Department of some sort just working and learning, as it should be. Gosh, it’s such a good feeling. Apart from a few minor things (taxes?), my calendar is completely clear of big, blocked out, red deadlines. This is a really great feeling to have as I approach the end of my 2nd year of residency and the start of my LAST year of training. Though that is stressful in itself, it’s kind of exciting.

To celebrate, I am starting a brand new, non-medical, fun book (thanks for the recommendation, Megan!) while planning my upcoming vacation. To be fair, I’m a pretty positive person and I can find something good out of most situations and overall, I’ve really enjoyed residency, but I am truly content right now, which is very rare. I am loving this feeling. I’m going to enjoy it as long as it last.

March 9, 2013

Wealth Inequality in Motion.

Filed under: Uncategorized — dailymedicine @ 10:13

Kind of crazy. Thanks for sharing.

February 28, 2013

Burn

Filed under: Daily Lowdown — dailymedicine @ 20:13

I have a whole new appreciation for skin after this month in the Burn ICU. For me, I’ve always considered the eyes to be the most personal organ of a patient, but now, I’m not so sure.

After four weeks of burn care, I’ve come to realize how much the skin can identify a person! We take it for granted because it’s just there, protecting, shielding, keeping us well and alive! In the Burn ICU, people come in after severe deep burns, and in order for them to even have a chance of surviving and healing, the dead skin is removed and that wound is grafted (with fake skin followed by their own skin). Burn healing is a very, very long process, as I am learning. There are patients who have been there for months! But more importantly, without the skin, everything about your body kind of falls apart. All of a sudden, without the skin’s protection (your skin is your largest organ!), your whole hemodynamic stability is jeopardized in one way or another, whether it’s by infection or dehydration or electrolyte abnormalities. It’s kind of amazing to be able to see the progression of patient care  from burn resuscitation to burn excision to skin grafting and seeing all the complications that occur in between. Though this month has been crazy busy, I have learned so much and I have gotten to do a lot (escharatomy!). Despite it all, I am literally counting down the hours until I am done. My body STILL hates being up for 30 hours every third day. You would think it would get used to it by now, but apparently not. One more call tomorrow.

(And to be fair, despite the cool context of this ICU, the rotation itself is pretty painful – long hours, lots of disorganization, lots of drama!)

Don’t take your skin for granted! Take care of it! Wear sunblock and don’t smoke while you’re intoxicated with an oxygen tank…things I learn. 🙂

Nonetheless, considering how busy life has been since 2013 has started, it’s been good to me so far, much better than 2012 at this time (break in #1, you ask?) Slowly crossing through my abnormally long and important to-do list, one thing at a time.

February 18, 2013

American Academy of Emergency Medicine

Filed under: Daily Lowdown — dailymedicine @ 21:43

I recently went to Las Vegas for the annual AAEM conference. As one of the many perks of my residency program, my classmates and I get to go to an academic conference together annually. AAEM was founded in the 1960s when Emergency Medicine became it’s own field. In the past, ERs were staffed by anyone who wanted to work there, whether you were trained in surgery or neurology or psychiatry. Because of that, there was no universal standard of care for patients coming through the ED. From what I understand, AAEM was established to ensure that EM was recognized as its own entity with its own board certification and hence, my current residency. So much politics.

Nonetheless, the conference was great! The majority of the lectures were on uptodate/current research/new treatment of common ED complaints. With the rising health care cost and the changing healthcare laws in addition to the current overuse of the ED, there were also a lot of discussions on how all of these changes would affect my job in the future. Not surprisingly, AAEM is still very male dominated and very political. As the nerd that I am, I deliberately chose to go to the more clinical lectures over the political ones, though one of these days, I may have to learn how the whole health system actually works. For now, as an underpaid, overworked resident, I will take every opportunity to learn as much medicine as possible.

Best of all, for five days straight, I got to hang out and catch up with my long-lost classmates. As second year residents, we get scattered to five different hospitals all over the area so our schedules rarely overlap. Such is life as a resident. Either way, it was really fun!

Now, to pay the price of getting to skip 5 days of work, I am on a q3d schedule, meaning that for the next two and a half weeks, I am on call (in hospital, 30 hrs) every third day in the Burn ICU with no more days off. It was worth it…or so I keep telling myself. My goal is simple: don’t let anyone die.  It’s much harder than it sounds!

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