The Day Shift.....

So after two weeks I think I have the day shift pretty much down, which definitely does not mean I am good at it. Day shift is VERY different than what I thought it would be, it's like more of hospitalist/internist medicine. As in you deal with a lot of internal medicine problems on all the trauma patients that have been admitted and are either recovering from or waiting to go to surgery. So my days look something like this...

6am - 6:15/30ish - sign out in the west wing ICU- night team gives you the run down on any problems your patients may have had over night and the scoop on any new admits on your assigned "wall" of the TRACU or upstairs (peds, ob and med surg)

6:15/30ish - 9am - sit in TRACU on a computer looking up all the morning labs, diagnostic imaging, reviewing other services consults or progress notes, seeing your patients (ie: physical exam) and writing notes on your patients. ( now this may seem like a long time, especially for me because I am only allowed to see at a max 5 patients, but trust me when the patient has a few chronic conditions on top of fractures, mental status changes, alcohol withdrawl symptoms, and electrolyte imbalances.. the time goes by waaay quicker than you think.) What is amazing to me is that in 2.5hrs these PA's can get most of their notes done on an average of 10 patients! They are AMAZING!!

9am - 12 (or sometimes 1,2 or even 3) Grand Rounds - yep, the big bad scary ground rounds of legend. Which actually turn out to not be so bad for the most part. But just like anything else it depends on the attending your rounding with. Some are slower than others, some teach as they go, some sit down with you after rounds and go over your notes with you. Presenting during rounds is still pretty rough for me, though after you've rounded with the attending once and know how they want you to present it's much easier and a little less intimidating. If I had one piece of advice it would be to WRITE down your lab values and do not be afraid of saying I DON'T KNOW. I don't know is always better than trying to bluff your way through something! I've watched it go very badly for people who try to do this and it is ALWAYS better to honestly answer any question, you will never ever be able to predict everything the attending will ask you so I try and write down as much of what I think is pertinent.

LUNCH - the PA's will usually make you go eat lunch even if rounds run over and clinic is waiting for you, on Friday's (even though that's usually your day off) there is a lecture from a couple residents that is interesting to attend if your there.

After rounds the rest of your scheudle depends on what day it is

T,W,Th - 1-5pm = Trauma clinic - it's fast paced, hectic and takes a while to get used to. ( I wasn't a fan) but one of the cool parts about doing nights first is that sometimes you get to see some of the patients you took care of when they were first admited.

S,Sn,M,F - finish up all the order changes to the patients you saw in the morning, write discharge summaries for patients that will be going home that evening or the next day. Depending on which PA your working with the rest of the day is spent learning either from quizing or lecture or it's your time and you can study, enter typhon, watch TV, take a nap, or blog :)

the night shift...

The Trauma night shift has been quite the roller coaster ride for me. Extremely mixed emotions, some very low, lows and happy highs.

The highs:

Lot's of learning: managing ventilator patients, Hyponatremia protocols, calculating a FeNa, indications for exploratory laparotomies, ECMO, Normal pressure hydrocephalus, CIWA protocols, evaluating a trauma, and the list goes on and on...

Procedures to do: Inserting a foley catheter into a ruptured bladder with vaginal fistula, Retrograde urethragram, Femoral stick ABG, lots of sutures and stapling. helping with chest tubes, Arterial line and exploratory laparotomy.

Seeing really cool injuries - Giant scalp laceration I could stick my entire hand down, stab wound to the neck, unfortunate C-spine fractures with spinal cord involvement ( jury's out on future paralysis) fractured pelvis, subdural and subarachnoid hematoma's, X-ray of roofing nails from a nail gun to the chest and heart!!! (I didn't actually see this patient but the x-ray was pretty impressive by itself)

Super awesome preceptors, who are smart and fun and happy to teach.

the Low's:

Mostly consist of my own inner dialog berating myself for not knowing the answers to questions, (especially the one's I actually DO know but somehow fail me when under pressure).

and the worst

The Attending who's displeasure with me was palpable. First he ignores me, then asks my preceptor why I'm doing the ROS cause I "apparently don't know what's important". Then he tries to make me look like a fool because when I asked the patient "any surgeries" and they said "no" I foolishly reported a negative hx of surgeries, so he calls me out on it cause he knows the patient had some kind of abd surgery cause of a scar (which he found doing the PE, which only the Residents and Attending's do on a level I trauma) Yep that night was an all time low and I cried on the way home from the hospital in the morning. (luckily he's now on days and I have new Attendings who are AWESOME!!)

Overall trauma is shaping up to be every bit of the amazing rotation I thought it would be. I would love to work in trauma... someday but I think I'll need a few years under my belt before I feel confident enough to be there (I'm guessing less "impostor syndrome" anxiety for me).

TRAUMA!!!

Tomorrow I begin one of the most anticipated rotations scheduled! I am so excited I can barely contain myself!! As I understand it I'll show up at 6am get my scrubs, a tour and introduction to my new home for the next 6 weeks. I will then be sent home to sleep, so I can be ready for my 12 hour shift starting at 6pm ending at 6am. Yep that's right - Night shift straight out the gate! I'll be working at least 72hrs a week with Fridays off. I'm not sure how often I'll be blogging during this rotation as I'm told it's exhausting. So just keep your fingers crossed that gun shot wounds, stabbings, random accidents and MVA's have a slight increase over the next 6weeks.... but you people stay safe!

Back in the saddle...

so technically it's a chair not a saddle but here I am again, sitting in a classroom listening to lectures. This week is a recap back at school, when we here a few lectures, network with people from class, learn about contract negotiation and writing a CV, discuss plans for our graduation party, awards, and take a boards practice test. Some good stuff to review yet.... I'm sooooo done with sitting in a classroom!!! After being out there and doing, it's tough to come back and sit passively receiving information. At least I get to see my favorite people again, that's the biggest plus of PPS (Professional Practice Seminar) week.

Ok class is starting now, so back to the learn'n

Breast-Specific Gamma Imaging vs. Mammography

I cannot upload my poster because the formating is not recognized. So I'll just tell you that BSGI is more sensitive and specific (ie: better at finding breast cancer) than mammography, especially in women with dense breast tissue. It is similar in cost to mammography and thousands less than MRI. oh and lastly it doesn't require crushing breasts into pancakes.... yeay! here are some images off the web so you can see the difference in images produced.

Almost complete

Capstone paper is nearly done, the bulk of the work is finished. After meeting with the writing consultant all that's left is just the finishing touches. Last is the poster, which I plan on being done with tomorrow. I am also thinking about actually submitting my paper to a journal for publication after a few professors comments. But honestly I really don't feel like what I produced is truly journal material. The biggest issue is I think a lot more work to spruce it up to make it journal worthy would be required and that's a big "NOT gonna happen" from me. But at least I chose a topic I didn't end up loathing and I learned a ton doing it. ( I'll post the poster when I'm done if anyone wants to get a synopsis of what my paper was on)

Tonight I did a shift at Essential Health clinic, the free clinic our university works with. Two professors and two first year students were there with me. It was a little rough to get back into the swing of writing SOAP notes and presenting after having a 6 week break from it. But in no time at all I was back on my game. High/Low lights of the night included an interesting case with a pregnant woman (they always present more of a challenge) and a Digital Rectal Exam (I've done probably 10 of these and I think I'm kinda done with the butt, really I don't ever want to do another one ever again).

So now I have around 2 weeks of blissful vacation before I start trauma! I plan on studying my ACLS and Trauma algorithms and cleaning up the house. But the evenings belong to Ryan and I, so nice to have so much down time to spend with him these last few weeks. It's like I got my life back. And ooohh how I missed my life with him!!!

Oh other important milestones.... I just got my ticket to KENYA!!! That's right 59 days and counting until I'm on a jet plane to Africa!!!

Paper of ..... procrastination!

ugh I HATE this paper! I find myself procrastinating at every opportunity. The topic is interesting and I enjoy reading the articles but writing this is torture! I just want to get through it so I can have a few weeks of leisure time, but I can't seem to make myself sit down and power through it!