Monday, August 31, 2015

how to stand out as a medical student on rotations #1

1. know everything about your patient (when abx were started, what the new cxr showed).  also look far back in the medical history to see what old meds were tried, chemotherapy regimens (what cycle, etc)

2. jump in politely when the intern/resident can't remember a lab value off the top of their head

3. offer help with administrative stuff if you can (obtaining medical records, etc)

4. learning dumb criteria and eponyms makes you seem really smart even though you have 0 patient management knowledge

5. pretend you're the only doctor for the patient (follow up on everything), bring up changes in physical exam/mental status/etc

6. go to codes with your team

7. take call when you don't have to

8. check up on patients for your residents when they're busy.  it's great having extra eyes and ears

Sunday, August 30, 2015

caring for your loved one in the ICU #1

I wanted to write a series of entries for family members who are in the ICU room of a very sick patient.

1. Your loved may be in the ICU because they got very sick while in the hospital or they were seriously ill enough to need direct transfer to the ICU, known as "the unit."

2. Your loved one may be in the ICU because they have a condition that is easily manageable but they need to be in the ICU because closer, more vigilant monitoring is available there.  There are generally more nurses per patient in the ICU.

3.  Ask questions, no matter what they are.

4. We might not always know when your family member will leave the ICU because conditions can change quickly, or we're waiting for a floor bed in the non-ICU part of the hospital.

5. You will at some point be asked to make medical decisions for your loved one if you're the medical power of attorney.  It will be hard but you will have all of the support available to you that you will need.

6. It's okay for you to hit the "call nurse" button on the phone for something your loved one needs.  You don't have to get frustrated roaming the unit looking for the doctor.

7.  It's okay for you to tell us if something happens like urine suddenly being brown or red, or a lot of choking and gagging.

8. If your loved one is intubated, the doctors have medicine to help their breathing tube be more comfortable for them, like sedation medicines like fentanyl and versed.  It also helps them from pulling out the breathing tube by themselves which is very unsafe.

9. If your loved one seems to become confused, let us know.  We will investigate it.  It's often due to them being very sick or a side effect of a necessary or helpful medicine.  It will help them become less confused if you remind them where they are and if you open the blinds during the day to let light in.

10. Wash your hands very well before and after you touch your loved one and be aware of any infections they are treated for.  Wash your hands upon coming in and out of the ICU.

things to not do intern year

some stuff i've gathered from online and asking questions in the hospital

1. keep giving NS when someone's hyperchloremic or has an NG put in
2. inject vancomycin bolus. it has to be infused with a pump over 1-2 hours
3. give TPN in a random line.  TPN needs a dedicated TPN-only line

Complaining in the hospital, the bad nurses and the good nurses

Hospitals are where a lot of complicated care plans are in place.  Hospitals are a place where many people are emotional, stressed, tired, hungry, hurt and struggling.

Residents seem to complain a lot about minor things, but usually among themselves.  Complaining gets to me more when its done by staff in the hallway or within earshot in the unit.

A while ago I heard a nurse get angry because a patient was in pain and needed help.  "I hate whiny people.  They've been sick for so long they should be used to it.  I hate hand-holding."

That nurse always talks about how they want a break from this and that while no other nurse does.  I haven't seen that nurse offer any help, to the physicians or patients.

The other nurses are so great though, always bringing up things the unit should be thinking about.

I've come across a lot of people who talk about what they'd rather be doing everyday at work, just really unhappy types.  They often complain loudly about things that are minor and have no impact on patient care.  I think they should go pursue those activities they'd want to be doing instead and open up their position to someone who is more compassionate and excited to be there.  

Saturday, August 29, 2015

tired intern tips #2

1.  Circle around the ICU often checking on your patients, don't wait for a call on this or that, even if you're tired.

This is because there could have been an abnormal lab value during the 45 minutes you were taking care of a crashing patient, and then no one calls you for 2 hours on that sky-high troponin.

2. If the nurse is in the room when you walk in, ask her if there's anything she needs help with or anticipates needing help with.  It might keep you from getting called for something that could've been prevented so you might be able to catch a nap.

3. Write down learning points on rounds.  You're going to forget what you were told by the end of the day.  You need to build an arsenal of knowledge daily and keep adding to it.  Take a digital photo of your notes.

4. Take notes during grand rounds.  Don't let it be wasted time.  Get the most out of it.

5.  Anticipate the worse and prepare for it.  You have a cirrhotic patient with banded esophageal varices, platelets of 28, bacteremia, ascites, and they're not tachycardic or in shock..yet.

6. Check baseline creatinine, PFTs, old ekgs and old CXRs on patients.  Know how things have been changing since their hospitalisation

7. When you get any new information, write it down.  You'll constantly be tired, hungry, paged, called, busy and you can't afford to forget anything.

8. Don't take criticism/rude tones too harshly.  I've noticed that people who talk to me a certain way talk that way to everyone.

9.  Thank nursing and ancillary staff for everything, no matter how tired you are.  Say things like "Thanks, I'll keep you in the loop."  Smile, be polite.  They'll appreciate it especially when they see the fatigue in your eyes.

10.  It might not seem like you have any time, but the best time to get coffee is just before conference

Friday, August 28, 2015

downtime & being the dumb intern

finally have a great during the day.  since i started intern year i felt like so many other interns were a lot smarter than me and i still kinda do.  i haven't rotated with any other interns yet, its been just me as the only intern, feeling dumb.  i havent been made to feel dumb on purpose which is good and im hoping it  doesnt happen much more frequently since i was a med student, because i had some awful experiences.

so far i think intern year has been okay because i ask a lot of questions and confirm with people before doing anything.  im lucky to have had teams i can ask questions because i heard some upper levels and attendings wont help you or hate helping you (isnt this a teaching institution?).

gotta run

Tuesday, August 25, 2015

the ICU life

exhausting so far.  really tiring.  i feel like once i get home and shower it's already time to sleep and get ready for the next day.  but at least i get to come home and shower and eat.

hospital sleep is the worst and i do my best to avoid it, as tired as i get.  most call rooms have hard beds and terrible blankets that feel like they're made of sandpaper.

everyone around me is so smart and i want to know as much as them and even more.  i'm dedicating 15-20 minutes to read every night and hoping it sticks because i'm really too tired and short on time for anything else.

i do miss being a med student.  those were the days.  when you felt you were a doctor but you really didn't know anything anyway and you had a great schedule, lol.