Burn

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.

American Academy of Emergency Medicine

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!

Anticipatory Stress

I have a problem with anticipation, whether it’s good anticipation or bad anticipation. It goes hand in hand with my mild-obsession with my calendar (and partial Type A personality). I check and update my calendar a lot. These next two months are going to be busy, not necessarily bad busy, but just busy. I have my yearly in-service, national Emergency Medicine board, my junior case presentation, Step 3 (last of 3 national boards!), and I am running my first half-marathon, all while rotating through the Burn ICU (hello 80 hour weeks!). In the midst of all of this, I am going to Las Vegas for AAEM . Just typing everything is sort of stressing me out. Though I often tell my friends who are stressing out that they should take one day at a time, it’s much harder to follow my own advice, especially now that I’ve started to study for these silly tests that I keep having to take. I don’t know how I used to study so much (10-12 hrs a day for 30 days straight for Step 1)! Now, it’s hard even to motivate myself to study after working all day. However, despite it all, as ironic as it may seem, I think I do much better when I’m busy and stressed. Due to my time limitation, I am much more productive and I procrastinate a lot less, or so I tell myself. With that being said, I may have to go old-school and make a study schedule. I have a lot of practice questions to get through and not so much time. I don’t know how this schedule got to be so hectic, but for now, I just need to keep reminding myself to take deep breaths. Just have to get through the next two months. Sigh.