Buzz buzz buzz, I'm a busy bee!

Hello everyone!

I have been very busy lately, and didn’t write for a while (18 days actually), but my friend Christine told me I needed to update my blog more often. LOL! Okay then!

A lot has been happening lately. I am going to start my last week of my sub-I at the hospital I am in. I’ve decided to drop my dread of the process and enjoy the fact that I am still a student and am allowed to make mistakes and can learn. This is the time for me to learn how to be an intern.

So… I am working hard. I really like this program and actually planning to rank them as my #1 spot. I hope I’ll get it, because I really like the place, the residents and the doctors! They have a great variety of patients and get to do a lot of procedures. When I told my dad that the only problem I see with this place is that it is a very small program and that I feel like they need an extra person, he told me that I’ll have the same hard work and increased number of patients everywhere. I will work like a slave next year, and that will be the case everywhere.

In any case, I’ve been driving back and forth to the hospital. It’s about an hour and twenty minute drive from my house, and I found that if I get into bed by 9-9:30 by the time my alarm clock rings at 4:15am, I am not overly tired. Originally I was planning to stay at the local discounted motel the program had offered, but one of my fellow medical students showed me her bed bug bites and I decided that I will stay there only if it snows or if I am really tired. I stayed there once so far… let’s just say that I’d prefer to sleep in my own bed, but I didn’t have bugs in my motel bed....

During the past three weeks I have had several interviews—I actually drove up to Connecticut, the one weekend it snowed really bad (ugg!). It’s amazing. Every single time I drive to a place that might have snow in it, it does! I mean, my friend interviewed at the same place a week or so before and she had no problems. The snow Gods must hate me! I was very happy dad convinced me to change my tires. We changed it before my drive to Massachusetts, and ever since then I have been enormously thankful! On that snow Monday morning in Connecticut there was a good bit of snow and slush on the ground. My car held well, but all of the signs were covered with snow, so I really had no idea where I was going. I gave some good guesses and surprisingly made it to the hospital without getting lost at all! Wow! By the time my interview ended, the snow have melted and my drive south was so easy.

My second interview was at a beautiful well known children’s hospital in NY. The program is big, but I really enjoyed the place. It’s the complete opposite of the place that I am intending to put as my number one choice, but I can’t deny that this is an excellent program and I would be delighted join it. Oh, on the way back on the train I sat next to some other interviewees (they looked like interviewees, so I asked them if they were, and struck a conversation with them). One of them studies in the American program in Israel— we all exchange emails and I am intending to keep in touch with them. Nice folks!

Anyways… so that’s been my life—either driving to the hospital or driving for interviews…

I should probably tell you about my hospital experience. Our signouts (transfer of patients from night team to day team) starts at 7am normally, although we had a day when we started at 6:30. We have a long list of all the patients with all their medications and medical conditions etc, and then we discuss each and every one of them. The intern from the night team presents the patients in the following way:

Patient So and so is an (age) day/month/year old male/female with (put admission reason or diagnosis here) and past medical history of (put whatever past medical history here). Hospital day number (number here). Has been afebrile (or febrile) with a t-max of (put highest fever here). Is on X amount of liters of oxygen nc (or other delivery of oxygen). Patient is on (put medications here) Overnight patient did well (or not… and then explain what happened). Labs received and lab pending is next… etc. etc.

Anyways, we do this with all patients. I then pick three patients to follow. If this is a week day, I will have at least one patient whom I've followed the day before, and has not been discharged yet. I then ask the residents to photocopy my patient signout sheets so I’ll have all of the information handy and then.

Then we either have morning report (where the residents present cases from overnight or interesting cases from several days before) or we go on rounds with the neurologist. The neurologist is a bit intimidating, but I am glad to learn from him… he teaches a lot during his rounds, and I normally go home or read during the day stuff we have discussed. I forgot a lot of my neurology and am intending to learn more of it before I start next year. Hmmm. Dad made a comment once that he has this image in his head of medical students acting like poisoned rats under intimidating doctors. LOL! I refuse to be a poisoned rat!!! (which means I have to stop writing and go study, right?)

After rounds with him, I go and see my patients. Check them, talk with them and their parents, if it’s the first time I meet them, review the history I received from the night team to make sure it is all accurate. I then review labs and studies to try and catch all that is pending. Then I start writing my notes. By the time I finish my second note it is usually time to round with the attending. Each attending rounds differently—the neurologist does bedside rounding, which basically means that we discuss everything on the go and next to/with the patients. The 3 general pediatricians I have encountered enjoy table rounds—which means our discussion of assessment and plan is done at a separate room where we actually sit and discuss our patients.

After rounds, I complete any remaining notes, work on discharge papers and summaries if appropriate, continue some more labs chasing, try and get my patients to different studies, order medications (I actually don’t get to do that in this hospital as a student, but I remind the residents what we decided to order on my patients). If I have questions about my patients I use this time to ask them and to read about things I don’t understand. We then go grab lunch and go to noon lecture.

After noon lecture we do resident rounds, in which we just review what still needs to get done. We then return to the floor, and I check on my patients again and then chase more pending labs. If anything changes I let the residents know and then we discuss what we should do to change plans. Here is an example: I checked a young baby with RSV+ bronchioliltis and he just did not look good… he was saturating in the low 90’s (oxygen saturation) and had wheezing, subcostal retractions and head bobbing. I described this to the resident and asked if we could put in another albuterol treatment and then reevaluate the patient. So we did that, and we also increased the frequency of the albuterol treatments for him.

Well, by 4pm we have to updates all of our signsout sheets again. We have many consulting doctors that come in and out all day long, so if my patient needed a doctor consultation, I usually tag along with them to see their assessment of the patients, to hear their plan and ask them questions. By the evening we get ready to do signouts with the night team and let them know of any changes etc. Similar to our morning signout :o)
Oh yeah, if there are any admissions during the day I usually go down with a resident to do it.

Anyways, it doesn’t sound like all that much on paper, but in real life it is, and I am also learning how to be organized, and what is important and what is not…. so it is actually is a lot of work.

I asked the residents so many questions about living there, about life as an intern, about any suggestions they have, and so far these are my favorite answers:
-“The first few months of internship suck. It is so hard. I hated it. I was always tired. You’ll probably hate it too. But… it gets better!”
-“The best advice I ever got was: ‘Own your patients. Feel like they are your own, no matter what. If they are important to you as your family is you will not forget to check on this lab or that, because you will truly care about what happens to them.’”
-“Reut here is my advice—get a clipboard! It keeps me organized and it will keep you organized, I’m sure of it!”
-“How do I handle stress? I work out. I ran every day. Yes. Every single day.”

There are many more things they told me, and I just love this group of people I have met… they are so nice and down to earth.

Funny/interesting/wonderful/not-so-wonderful things that happened to me during the past 3 weeks:
-One of my patients had MRSA (Methicillin-resistant Staphylococcus aureus) and decided when I was listening to his lungs to stick his finger in my nose. EWWWWW! I washed my nose good, he didn’t have an abscess on his finger, but I still feared of being colonized with this bacteria.
-One of my kids was really sick and was transferred to PICU
-a tiny baby came in with some unknown ailment. I was the one to review some of the lab work with mom and get some very happy tears when I told her that her child did not have cystic fibrosis. We still didn’t know at that point what the baby had, but she was so relieved it wasn’t CF.
-I got to see a child with an epidural abscess and learned all about it. I also gave a small presentation on it during our rounds with the neurologist. The triad we need to remember is: fever, localized pain, and neurological deficits. I don’t think I’ll ever forget it now.

There is so much more…

So putting it all together—I know so little, and need to learn so much (Go read!!!) It is so nice to have this time to learn… I am very excited to be starting residency, and now after doing this for 3 weeks, I am not as intimidated by the prospect. What else… oh yeah… sleep is good.

I forgot to mention one more thing—this hospital has night float system, which means that they have a night team and a day team. This is not true for some of the hospital I interviewed at… in the other hospitals the way they do it is by call… every 3rd or 4th night you stay the night and care for all the patients over night time and admit all new patients. Then you stay through morning rounds and leave anywhere from 12-2pm. Hmmm. I like the idea of night float better. Also, if you take me and my personal preference out of the equation, you’ll see that having a doctor that slept all day long and is now fresh for the night is much better than a doc that has been awake for more than 24 hours… plus, you’ll have your day doctor and night doctor. Much more consistent, don’t you think?

Well, enough about that.
You wound never guess what I did two weeks ago… my friend Matt asked me for a ride to the railroad station which is like a 5 minute drive. I offered to drive him to the train station that is 40 minute away, but would have cut 3 hours out of his ride, and then decided to try and see dad who had just returned to NYC from Arizona. And so I did!!!! I took the train to Penn with Matt and then walked to the hotel. Dad and I went to our French restaurant and had a good lunch (it wasn’t as good as our last visit, but it was still good). We then returned to the hotel, dad reviewed my rheumatology translations and suggested a few changes, and then I took the train back here. It was such a short visit, but it was also the first one I didn’t feel sad leaving… I guess it was because it was unplanned and I knew it was short and just pure extra time with dad. I loved it, and will try and do it again!

Next on the agenda cats update—
I’ll start with Vega. Vega has been acting funny for the past few days. She kind of nibbled at her food ate two bites total (!) in the past 3 days and is very ‘lovey’ (which is unusual for her). I took her to the vet this morning, and he said she looked normal on gross examination, but had a low grade fever. He did some blood work on her and will call me with the result on Monday. I hope she has nothing major, and that she starts eating soon. As per vet’s advice, I bought some turkey for her and new cat food. She ate a bit of the turkey and then vomited a big hair ball and all the turkey with it… I am worried about her, but crossing my fingers that she’ll get better soon. My gut feeling tells me to let her rest and eat whatever she can and see if she gets better within a week. If she doesn’t I will then return to the doctor.

KC is fine. He is eating double, as Vega isn’t eating her food. I should have prevented him from eating her food, because he can catch whatever she has, but I didn’t realize what was going on in the first few days, and I am sure if he’ll get infected it is too late now. I will stop him from eating her leftovers from this point on though.

Lily got adopted!!!!!!!!! I came to the shelter two weeks ago and was happy to see that Lily wasn’t there :o) She was adopted by a family that wanted a kitty friend for their cat. Yay! I was told that the family is very nice. I sincerely hope she has found a good home and that she will be spoiled like she deserves to be.

… I didn’t get a chance to go volunteering last weekend, or today, but I will try and go tomorrow… all depends on when I actually wake up, LOL!

Well, I guess one thing I haven’t talked about yet is how much I miss mom. It didn’t hit me all of the sudden, as it was always there, but now that I have a quiet driving time every morning and every night I have time to sit and think a lot. I think about what mom said to me. I think about what we did. I think about what mom would have said to me about stuff that’s going on at work. The other day I met a person that spelled her name Dayana. I just about fell out of my chair, because I thought mom was the first one to come up with that spelling… so on my ride home I thought about how mom would have loved that story.

I also found that whenever I go to bed, between the time I shut my light and the time I actually fall asleep (which, granted, can be just minutes these days, as I am extremely tired) I think of mom’s funeral. And of how horrible it is I can’t have a normal conversation with her.

The sad thing for me this month was that I didn’t get to have mom visit me in any of my dreams. It wasn’t until I said it out loud—“Hey E-ma, you need to come visit me” that she came. I was SO happy to have three straight nights of dreams with her in it. Maybe I just need to ask her to come and she would.

I just feel so sad not to have her here.

Well, that’s about all. I meant to add pictures, but I need to install the CD for the camera on the new computer… I didn’t do it properly the first time around, and got to fix it. In the meanwhile, here is a picture from Connecticut well after the snow had melted (off my phone camera).



















Night everyone!

Reut