Catching up

So, it seems that almost 8 months have gone by since I last posted. How did that happen? At the start of the year, I was half way through my second year of residency and was tired of being at the bottom of the totem pole. Woe was me. Now, I am three weeks into my third year and still feel like I am at the bottom of the totem pole (surprise!).
My third year is divided into four, three month rotations both at my home institution and at other institutions. This first rotation is Pediatric Neurosurgery at [redacted] hospital in mid-western state. The schedule has taken some adjustment - home call is both a blessing and a curse - so far, mostly curse...
Getting woken up every hour and or having to come into the hospital to see a sick child and or operate for hours at a time and THEN having to come back the next day (provided it was not so late at night that I just had to stay in the hospital) and work another full day the next morning is KILLER. It is NOT normal. Perhaps it is punishment for all those times I complained about taking in-house/overnight call.
Aside from that, I am operating a lot, learning tons and, can you believe it - working out 5 days a week. Needless to say, it doesn't leave much time for anything else. Sorry Mom.
I get up at 3:45 am, work out, get to work, leave anywhere between 6 pm and 9 pm depending on whether or not I am on call and try to be in bed by 7:30 pm. I kid you not.
But it's just three months. Right?
Right.

Things I need to do by the end of Sunday
1. Call my parents
2. Log my OR cases
3. Catch up on my research project
4. Do laundry
5. Replace the hubcap on my right front tire
6. And, as always, read, read, read.


Until the next time.

New Year and such

I'm tired.
Tired of being at the bottom of the totem pole. Of always having to grin and bear it. Of always being in the wrong, always having to apologize, always being the one who does the stuff that nobody else wants to do.

"Hey, the surgical PA is not going to be around for the next 3 weeks to write the H and P's on the pre-op patients or write the chief resident's post-op orders."
"That's ok. We have drc."
"But what about when the surgical PA leaves? You know she's moving jobs, right?"
"Yes. Drc will do it. Speaking of which, can you tell drc she's covering next weekend's call instead of A? She was post call the day we made the schedule for the entire next 6 months, but we just went ahead and made it anyway, we didn't have time to wait."

Just shoot me.

I suppose I talked to M about this stuff way more than I realized. And now, I have no one to complain to, to release all that anger and frustration before it drives me nuts. Which, I guess it is.

That's not entirely true. I have my Mom. And my Dad. And my siblings. And C. And J.

I just want to get smart already. And have more power and authority (You WILL respect my authority!). And that means I have to read. More.

And be more vocal. According to Dr. R.

Argh! Happy New Year, friends.

Merry Christmas

The regular milk conspiracy

Ladies and gentlemen. All across America, in cafes and coffee shops alike, a conspiracy is afoot. It is the conspiracy of regular milk. Take for instance, the coffee shop right at the entrance of the hospital when you walk in through the revolving doors adjacent to the employee parking garage. With its chalkboards inscribed with coffee ground humor, brightly lit signs, displays of muffins, brownies and baked goods galore, you'd think Christmas had come early. You walk up to the ahem, 'barista' (now there's self pomp and delusion of grandeur at its finest) and are immediately bombarded with choice. There's coffee with a hint of cherry, hazelnut roasted beans, breakfast blends, medium dark, decaffeinated coffee (what freak of nature drinks that?!), coffee with shots of espresso in it, basically, there is coffee up the wazoo. But before that, first you must decide on the appropriate receptacle. You may select the short, which in my opinion, should be labelled I'm-the-kind-of-person-who-says-F-U-to-the-system-and-buys-what-I-need-for-ME aka, I'm a pompous prig who thinks the world rotates around my axis, to small (which has no business being associated with this name, given that four shorts could fit into it with space for cream) and all the way to venti....or is it grande (pronounced grawn-day)? I forget. Anyhow, you get the point. After you have painstakingly made your selection, you make your way to the designated waiting area and decide, while your beverage of choice is being 'designed', if you want sweet n' low, Truvia, Splenda, sugar in the 'raw', honey or just plan old fashioned white table sugar. Lest you get bored, there is cinnamon, nutmeg and other spices, that I cannot dissociate from baking (like, am I making a cake here?! Wtf?) that you can add to your already hyper-flavor infused drink. You are handed your highly anticipated cup, which, depending on your selection, may require the addition of some cream-age. Then...you take a look at the dairy that is displayed and you are flabbergasted. You turn to the barrister with a sheepish grin on your face and ask "OK, where are the hidden cameras? Because, this must be a joke. On me. Haha, you got me!" But no. It's true. After the amazing selection of cups, beverages, beverages for those beverages, toppings, snacks and sweeteners, you have only two choices when it comes to dairy. Skim milk and half and half. Could this be? Are you born with the wrong set of taste buds? Is it un-conceived of to yearn for the taste of regular milk in your coffee? Are there only two kinds of people on this earth? Those who like skim milk in their coffee and those who like half and half? How much trouble will it cause this coffee shop to serve an alternative to the two extremes? Say, a carton of 2%? A jug of whole? Maybe, even, if the former involve preparations far too complex, a bottle of 1%?
So I tell you. It must be a conspiracy. There is just no other explanation. Somewhere, around a large mahogany table, there sit executives in black suits. There are flickering candles in the corner, casting their distorted shadows on the walls, balanced on rickety corner tables dripping candle wax on a stone floor. And they are scheming. "We will gather ALL the regular milk from ALL the cows on this planet, yes, we will divert it from ALL the coffee shops and into our giant regular milk powered ray gun. And with this giant regular milk powered ray gun, we will air a special on national TV and hypnotize the ENTIRE nation into BUYING...MORE...COFFEE!!". Then they rub their hands together in fashion most cryptic and laugh menacingly into the ceiling.
So you see, ladies, gentlemen. A conspiracy is afoot. Watch. And be ready.

Plotting and scheming

Will there ever be a day when I don't have any paper work to do? It seems I am constantly battling a never ending pile of forms - both online and in hard copy. No sooner do I fill out a form that my program co-ordinator has been nagging me about, there are ten more that spring up in its place. For instance:
There are health benefit forms to fill out - before Monday at midnight, mind. And, online courses about the new electronic record - to be done by December 1st, please. Then there's the book chapter I keep having to make changes to, because, it turns out, I'm just not the sharpest tool in the shed when it comes to research, apparently.
In other news...
I'm on vacation for (gasp!) 10 whole days. I spent part of this with my sister and (only the best) nephew (in the world) in Florida. My sister and (only the best...ok, you get the point) nephew picked me up from the airport and it was great to see them both. To add that purple icing to the cake, I walked in the door of my sister's apartment and it was all decked out, Happy Birthday style, with balloons and streamers. Then...the best meal on earth, a candle topped cake WITH ice-cream, complete with party hats and a nephew-sister rendition of Happy Birthday deadrocketcow. There are some feelings that just cannot be expressed with words. Needless to say, it was a good day.
Now, I'm back in [mid-west city]. I start work again Monday. The prospect of going back without M, does not make me a happy girl. But...what can I do? I'm just a PGY-2, yes?
Hey, guess what? I bought some weights, and so far, I have done two full body workouts right in the comfort of my very own apartment. I know. You're jealous.
For the rest of this month, I plan to:

1. Read. Every single day. No more procrastination. This "I'll do it tomorrow" attitude just isn't cutting it.
2. Do three full body workouts a week, two HIIT sessions and one aerobic session.
3. Live each day like it's my last
4. Just breathe

Cheers.

(Not so) Happy Birthday deadrocketcow

I turned 28 today, and what a day. My thoughts were dissipated, tormenting my heart. I will always remember this day because of how I felt.

Points to ponder

1. If you are writing up a discharge summary on a patient who is deceased do you write about them in the past tense?

2. Is it OK to tell your patient that you just operated on that you don't know what type of tumor they have, when in fact, you just heard that the frozen pathology (high chance of being inaccurate) was malignant?

4. Are some patients lying about how much pain they're in?

5. My PHQ-9 score is 8. Am I depressed or just a neurosurgery resident?

6. How much caffeine is too much caffeine?

7. Why do I end up staying late at work only on days when I make plans?

8. Why is there such a thing as a VIP patient? Isn't everyone a VIP patient?

I cannot escape it

It's on those lonely early morning drives while the sun is a distant rumor on the horizon, and I have nothing but myself for company that I take a moment and stop to think to myself, out of all those existential life questions such as, what is the meaning of my life, and is Pluto a planet or not and are people inherently bad, deep down, in their souls, where no one is looking - why did I do it?
And I turn the music on. And then I turn it on a little louder, because that question for which I stopped, on this lonely early morning drive, to think to myself, will keep nagging, as questions without easy answers are in the habit of doing, echoing louder and louder in the back of my mind where all those other difficult questions have been banished, to be since buried and forgotten.
But they do not stay buried.
It was her laugh. I heard it once and then a second time on that day, and I was lost. It was a laugh like no other; rich with the promises of all that could be good and beautiful. Of mutual feelings shared. We hesitated, we faltered against our individual alter-egos whispering out our lives to each other. Her Max, my Judy. Our 9th grade christmas plays, family trips to the amusement park, in-laws, grandparents, vows made in the presence of God to last until death.
I came home a different man that day and I have been a different man since. My only refuge from my thoughts is the unconsciousness that comes between the hours of 10 and 4, although it lasts but an instant. It has been said that only God will judge us, but I know better. I am judged daily - in the smiles of my children, in Judy's kiss as I come home from work and in the eyes of that man in the mirror. What is done cannot be undone, and what will be, will be.
This is my thought, on this lonely early morning drive, and I cannot escape it.

Yet another 'Happiness is...' post

Happiness is

-A clean pair of socks on a call day
-A clean apartment on a post-call day
-French vanilla cappuccino en route to see the 5 ER consults I just got in the past 15 minutes
-A fully charged phone
-A co-resident with whom I don't have to watch what I'm saying
-That rare, golden weekend
-A charge nurse (S) to whom you only have to say "S, there's a patient coming up from the ER with a subarachnoid hemorrhage", and before you know it, you have an open ICU bed, a ventricular catheter already set up at the bedside and the crash cart at the ready.
-A chief resident that tells you it's going to be OK
-A day in the OR
-A mother you can call, at a moment's notice, no matter what hour of the night, because things are just not going well
-Dinner on the balcony with J
-A set of bills that have just been paid
-A good night's sleep
-Being pimped by your attending, in front of the entire team, and knowing the answers
-That patient that tells you, when you least expect it, how glad they are to have you as their doctor

Letter

Dear floor nurse,

You and I - we used to get along real well, back when I had a 16 hour limit on the number of consecutive hours I could be in the hospital. We laughed together, we shared the occasional moment. We even discussed work related issues. Life was good. But now? Not so much. Let's face it. Our relationship is not what it used to be. I'd like to be the noble person here and say it's not you, it's me....but come on, let's not fool ourselves. It's really just you.
Look. I'm not saying you're a bad person. It's not that at all. It's just...you're not a good person and frankly, you're not that bright. We ALL can't be the sharpest tool in the shed, eh?
You know I have 60 odd patients on my service; you know I have to cover the ICU, the step down unit, the floor, all consults AND the ER, right? So why do you call right when I am in the middle of placing an EVD, sterile, and unable to answer the phone without someone placing it to my ear, and immediately launch into a long spiel about the most non-urgent matter, without even giving any identifying patient information, until I realize that the person of whom you speak is not even my patient?
I realize your three patients must consume a tremendous amount of your time. I know you are overwhelmed because your scheduled two hour breaks are not enough down time during your third 12hr shift of the week, but....do you do this deliberately? To antagonize me? To make my blood pressure rise when your third consecutive phone call comes in and I am praying there is not a ruptured aneurysm on the other end of the line? Do you like to torment me?
And what about that sweet moment, when I finally have half an hour to myself and I can lay down and drift to sleep, and you call me with a NORMAL lab result? What can I do besides mutter "Thank you for letting me know" and hang up? God only knows. Another thing - when I am at the chart, looking through a patient's vitals...is there a sign above my head that says "You must now update me on every single patient issue from their bowel habits to the breed of their son's dog"? Do you realize that once I hear your concerns I HAVE to address them? Do you know that this causes my adrenal gland to pour out cortisol? Do you know that I am stabbing you in the eye, in my head?
I am trying to make this relationship work. I really am. Right now, though, I think the prognosis is poor. We might have to have a talk soon.

Sincerely,

Your resident physician.

Pause, reflect.

Each step of this dreaded USMLE process hangs heavier and heavier over my soul, like that one essential piece of carry on luggage on a 2 bag limit airline. I have postponed step 3, and have paid dearly with my wallet - I choked out an extra $200 and promised it was the only time. Therefore, on May 21st and 22nd, come hell or high water, I Must Take This Test. But have I not proven my medical acumen? Must I take yet another exam to show to the world, that I can indeed practice medicine? And pay for it? Mon dieu! Self pity aside, I did just have 4 straight days off (miracles never cease) which I spent deep in USMLE World, agonizing over 26 year old women with PID and 74 year old men with diabetes, hypertension, high cholesterol and 80 pack year smoking histories. Nice. I feel I have made progress. Tomorrow, it is back to the world of General Surgery - my very last month - where I will express my joy at Nissen fundoplication this, whipple that, all the while wishing Neurosurgery - starting in June, yay - would come yesterday. There are things; an entire operating day with the infamous Dr. S, lunch with my family medicine intern friend, free french vanilla cappuchinos in the resident lounge and the intangible fulfillment that making a difference in a patient's life can bring; these are the things that make everything worth it.

I'm just that awesome

I stride down halls with my [long] white coat flapping in the wind because I am badass. I answer trauma activations with "I got this" because I am that cool. I run codes in resuscitation room 1 with my eyes closed, a blindfold on, and one hand tied behind my back. I resect basilar tip aneurysms bedside. When Martin and Spetzler were looking at an MRI trying to grade an AVM, they called me. I know all the CPT codes, for all the procedures, all the time. Off the top of my head. I passed the Neurosurgery boards before I went to medical school. This 7 years of training? Just a formality - I have accepted the position of chair at Big Top Notch Academic Center of excellence, to commence the day after my graduation. When the chair at my program is away on vacation, who steps in? This girl. When there is an emergency in the OR, an unexpected turn of events, who do they consult? You got it, this girl. Why? I'm just that awesome.

Mens sana incorpore sano

Since it's almost the New Year, I've decided to get all mainstream and whip up some resolutions. All the cool people do this, right? Right.
Six months of internship has been good, bad, exciting, aggravating and fulfilling all at once. I go from being completely out of my depth to striding into patient's rooms, cool as a cucumber and ready to kick some General Surgery butt. Overall, the stress levels on a scale from 1 to 10, with 1 being "I could do this with one hand and my eyes closed", and 10 being "Somebody stab me now. In the eyeballs, and make it quick", range from 3 to 8. Basically, I need to figure out a way to relieve stress, get down with some R and R and generally, not turn into that bitter, angry and jaded surgical resident I used to hate when I was a medical student.
There are setbacks to this:
The administrative/paper work/scut crap I have to do in order to get things done, that is, Care For My Patients, is just atrocious. Does there seriously have to be a form for everything? Do they seriously have to be placed at opposite ends of the hospital? And whose job is it to stock those things anyway?! Grr! But, I digress.
And...well, I can't think of anything else right now...but I tell you, there are setbacks!
I went from working out 6 days a week and eating like a champ on my Neurology rotation to not working out for the entire month I was on Vascular Surgery and shoving down chocolate chip muffins and regular sodas like they were umm...candy. (They were, basically). This month, I am on Plastic Surgery and have been somewhat better - a grand total of 4 trips to the gym during a three week period and some concern about how many grams of sugar enter my insides.
But, like I said, New Year, new resoulutions, yes? Yes. Listen:
I decided to hop onto the Weight Watcher's bandwagon. It can't hurt to have killer abs, glutes you can debride a sacral pressure ulcer with AND be a Neurosurgeon, can it? I agree.
In order to reward myself, I plan on using my last week of vacation sometime in May or June and jetting off to an exotic land of white sand, gorgeous beaches and unending Pina Coladas. May it be so.

In other news, I start work in the Neuro Intensive Care Unit on New Years day, which is AWESOME! Enough with this General Surgery ish.

Happy Birthday deadrocketcow

Two-Seven: I'm a big girl now.

1 month done, 83 to go

I survived one month of general surgery trauma and have now moved onto my Neurology rotation, which is going to be three months of pure bliss. Only having to be at the hospital at 7am, and leaving at 4pm, with two days off a week does wonders for the soul. On top of that, I might actually have the time to learn something. Top 5 goals for the month of August (in no particular order):

1. Actually use the gym membership I purchased...at least 3 times a week
2. Get this car buying process over with
3. Furniture, anyone?
4. Register, study for, and take Step 3 (the evil never stops)
5. Make it through 6 chapters of Blumenfeld

If I can do those things, I will be a happy somebody*

*Read Baking Cakes in Kigali for the origin of that quaint expression

Please accept my apologies

If I don't return your call until next week. If you send me an email and I never reply. Instead, I text you three days later. I'm busy, I'm tired and I am stressed - I don't hate you. Yet.
In other words, it's not you, it's residency. On June 21st, I took the bus to my new hospital/home for the next 7 years and started Basic Life Support training. This is a course that incoming interns need to complete before they can be set loose on all the unsuspecting patients in the hospital. How to do CPR, what to do if a person collapses in front of you...good stuff you'd like your doctor to know, right? Health care workers (that's me!) need to get re-certified in this every two years. The course I had during medical school was three years ago - and long forgotten - and so it began. On the 22nd, I had Advanced Cardiac Life Support training, which is, well...advanced. I had to pass a test and practical the next day, so I was memorizing and punching my head that night. Then I had orientation, and more orientation and even more orientation. Fast forward a week and it was Friday, July 1st, the first day that three other interns (Emergency medicine guy, other Neurosurgery intern/guy and General surgery guy) and I had to take care of our 40 or so patients on the general surgery trauma service (I am doing a general surgery rotation this month). Basically, the day was probably, the worst day of my life.
The pressure from my seniors to get things done, the desire not to look like a complete idiot, the necessity of having to keep your cool, be diplomatic and not tell that nurse who keeps paging you about patient X's bowel movements to just leave you alone...added to the stress of not knowing where things are/how to do them/what the protocol is and getting lost in the maze of buildings is almost unbearable.
I worked literally, non-stop on Friday from 3:20am (I got up at 2:15am) to about 8:30pm at night. I did not eat, I did not drink and for the last four hours I continued my work with a full, pressed bladder. Very exciting. I never thought I would ever think to myself - I really, really NEED some coffee right now...but I did. On day 1.
I am told things will get better.
On another note, one of the general surgery seniors on my team ought to do stand up. This is what he told me:
Senior: "Hey deadrocketcow, what do you call a talking, breathing, neurosurgery patient?"
Me: "Umm, I don't know..?"
Senior: "Pre-op"
Me: "______"
The joke being, since Neurosurgery is fraught with complications and is generally, a high risk specialty, the only talking, breathing patient you would see on the Neurosurgery service hasn't had their surgery yet.
Today is my one day off (I get one a week) and I feel so much better because of it. I have slept 8 hours instead of 5. I have had a good breakfast instead of no breakfast and I am even being brave - I might work out! I guess this is my life for the next seven years. God help me.

Deadrocketcow, MD

I graduated from medical school today, and I can say officially, that I am a doctor. It was a day like any other, but one that I most probably will never forget. My mom, brother, sister, aunt, uncle, cousin and N came and made it even more special. Next stop: residency.

Step 2, you are getting in the way of my relaxation

I have postponed taking Step 2 twice, I think, because my brain was broken. It's currently on the mend, which is good, because I am going to take Step 2 next Friday. Or else.
Four years of undergrad and 3.5 years of medical school culminated in my applying for a residency in Neurosurgery and my matching. I will be leaving New York to go to [Mid-western state] in about a month. Now that that horrid business is over, and I am over my disappointment in not getting my first choice (almost over it, almost...), I am starting to get excited about finally pursuing the career I have dreamed about since time immemorial. I am looking forward to meeting my new co-intern, resident and attending family and exploring the hospital. Before that, I have to learn how to drive, find a place to live and move all my belongings.
For now, it's back to First Aid for the USMLE Step 2 CK and USMLE World.

I matched

Interesting quote

[T]rue gender equality is actually perceived as inequality. A group that is made up of 50% women is perceived as being mostly women. A situation that is perfectly equal between men and women is perceived as being biased in favor of women.

And if you don’t believe me, you’ve never been a married woman who kept her family name. I have had students hold that up as proof of my “sexism.” My own brother told me that he could never marry a woman who kept her name because “everyone would know who ruled that relationship.” Perfect equality – my husband keeps his name and I keep mine – is held as a statement of superiority on my part.


[Lucy, When Worlds Collide: Fandom and Male Privilege.]