Crazy next 6 weeks

This is the start of my crazy 6 weeks where I'll be either out of town or on call for weekends.  We'll see how much havoc it will wreck.  The first 2 weekends will be weekend calls, hopefully they won't be too bad.  After that, I'm going back to LA for the first in 6 years for one of my college roommate's wedding.  I have already missed 2 of their weddings. Then I'll be flying home then flying back for the next 2 weekends.  Finally, going to NYC to see Kirstin before I get a breather.

Whew! I can only imagine how my life during the week will be crazy.  But can't wait.

Freaky Friday the 13th

This was my first weird day during residency so far. It was like everything gone wrong with every on of my cases.  The first was supposedly simply J tube for feeding but the patient first had a doomsday feeling and then went into PEA arrest where heart stopped beating but still sending electrical activity. This happened when we busy starting IVs and intubating.  We almost didn't believed it happening but we reacted quickly. Of course, case was cancelled.

Then we got another add on, which was a disaster as the surgeons didn't know exactly what they are going to do until they open him.  Of course, we have to prepared for the worse. Since we were somewhat ready, it wasn't as bad as expected. Just busy throughout the entire time to make sure he was very stable.

Whew! what a day. busy, long, tired, so happy when I got relieved to go home.  My feet hurt and I just wanted to sleep.

Hospitalist ... Again

This month totally reminds me why I chose anesthesia again.  It was definitely a torture for me with chronic patients with never ending problems that don't get better.  Also non compliant patients and patients that couldn't find answers to their problems and expected Cleveland Clinic to wave its magic wand.  Patient load ranges from 12-14 daily with multiple discharges on most days.  It's never ending busy work and totally an intern rotation.  Literally for me I was counting down the days from the first day I started, with working 6 days a week.  So not like the first time around.  Oh, well.

ENT Rotation

Today is the last day of ENT rotation, one of the intern rotation.  The rotation is not bad, it's split with airway clinic and inpatient consults.

The 2 weeks in clinic is busy in the sense that it's a long day.  Starts around 6:15a for morning rounds then clinic usually from 8a-4p then evening rounds after the ENT residents are done with their ORs. Days end sometime between 6-7p.  We don't do anything for rounds, just stand there and sometimes help with sutures removal or copy previous notes.  As for clinic, we do nasal fiberoptic scope for the larynx, so very similar to our fiberoptic intubation.  It was a good practice for our nasal fiberoptic intubation.

Then the next 2 weeks were on consult which we would just hang around from 7a-5p to help out with consults.  Most days we would get abou 2-3 consults and someday we were ignored cuz the resident in charge did want to give us any.  It was good time to get reading done.  I think I've gotten about 2/3 of Morgan & Mikhail done, but the question is more of how much will I retain for the ITE coming up.

Christmas 2011

I got a suprising long weekend for the holiday than originally planned, but didn't find out early enough so that I could've bought tix to go home. Oh well.  So I ended up having Fri to Tuesday off.  I spent Friday grocery shopping for the Christmas dinner and boy were the lines there long and slow.  It seemed like everyone was there with a big basket full of food.  I didn't have that much so I stood in self check out line but the ladies checking out were really slow, it's almost like they didn't know how to use the machine. They kept having the help sign flashing and I think it took them 20min to finish from what I saw but they've  already finished 3/4 then.  Ridiculous.

On Saturday, Christmas Eve, I made the dinner. Menu was Slow cooker turkey, Mexican corn, green bean casserole and mashed potatoes.  Other people brought drinks and desserts.  It was good.  I would have to tweaked the green bean casserole for the next time and make less of mashed potatoes.  The Mexican corn was a keeper and that's the only new recipe for my experiment.  Nonetheless, my first Christmas dinner!


Spent the rest of Saturday chatting and watching TV with the girlfriend that stayed over.  All good times.

Sunday was Christmas and we had breakfast, eggnog waffle, then went to Parkside's service.  Made me realized how much I actually missed going to church.  It felt soothing to be there. There came home and had left over for lunch.

We did make plans to go to Crocker Park on Monday for lunch and shopping but come Monday, just didn't feel like it. I just felt like vegging out so I did for Monday and Tuesday.  It was a lot of time spent on my couch just chilling out and watching TV, saw a few Christmas movies.

Christmas Movies List:
Polar Express
Miracle of 34th Street
Home Alone series

Ca 1 year update

This is just a quick update of life in residency since July, starting my Ca 1 year.  This is the year where I'll start spending my time in the ORs.  It's been good so far, some routine cases and some crazier ones.  Calls have been good, busy during daytimes but question whether surgical teams really know the definition of emergency.  I've had a couple true emergency but most of the cases during weekend calls were not really emergency.  Definitely learned a little about other subspecialty areas that will get more in depth next year.

No complaints overall, enjoying my time being busy at times.  Only wish I could figure out reading daily after being exhausted from work and also squeezing time for exercising and doctors' appts.

Thanksgiving 2011

This year was very low-key. I spent it with a family that I met not too long ago and the wife, Melissa, is also my endocrinologist.  I didn't have to work the day of and had very light day before and after. We just had dinner and just chatted about random things.   Also got to play with their 2 little girls, absolutely adorable. They are definitely a family that I don't mind hanging out with again.  Dinner was actually yummy. They had their food delivered from a grocery store and all they did was heated up.  The cranberry sauce, mashed potato, turkey and stuffing were good.  Corn souffle was a maybe but the green bean was a no.  But it was still enjoyable cuz of the company.

The one thing I was happy was that I finally get to make another apple pie, except this time, I changed it to crumbled and used a combination of granny smith and fuji apples. It was yummy. Friends at dinner enjoyed it too. It wasn't too sweet but it definitely needed another apple in the mix.

First month as Ca-1

First month of GenA, straight out of orientation with 3 months of gap away from anesthesia.

Wow, What a month!!  The first week was like a deer in the headlight for me.  I gotta figure out what it going on and where is what since everything is pretty new. Boy, was I nervous for being on my own.  There's almost no hand holding, it's pretty much sink or swim.  I'm glad I have the personality of just letting everything flow and see where all things go and arrange it as it fits then.  Otherwise, I would be super duper stressed.  The first week, cases weren't that extreme but then they scheduled me a couple of times to the ambulatory center where it's a different system.  It's like starting to adjust and gotta re-adjust again.

Throughout the month, I got some days that are difficult in the sense that the cases and patients were more complicated.  They had me do craniotomy scheduled, whipple and stroke (on-call).  It's been a fast learning curve.  I was just happy that on those days, my staff were nice and more than willing to teach and lend a hand.

Got 4 calls for the month.  It's not bad at all cuz our calls right now fall under the new intern rule where it can't be more 16hrs of work day.  I'm also generally a white cloud and the bad calls would usually consist of being busy early on then when it's bedtime, it's quiet. So generally I get almost a good night sleep with hours. But we all know that we usually are still in the light sleep where we have an ear out for our pager going off.

ResCU

Just finished the month of ResCU.  It's a special unit where people who needed a little longer time to get off the vent completely.  Patients usually either had lung transplant or some underlying lung disease.  Some of them has been in the hospital for months.  There's one on our list that has been here since Oct.  The most painful part of it all is writing discharge summary for them when they leave either to LTAC or rehab.  Because of the length of time that they stay in the hospital and that sometimes you would spend the month taking care of them, you get attached, especially the younger ones cuz you know that they have a better chance to leave the hospital walking.

Overall, it's a good rotation to learn about the ventilator since patients are usually long term with not much of acute issues going on.  Everyday is pretty much the same with minor adjustment for work.

Feeling of Cleveland ... 1st year

This has definitely been my most miserable year.  The job/work has been ok, most of the time I actually enjoy my work.  The part of my life that's been a downer is the living in Cleveland part.

This all started with the fact I moved to Cleveland for residency and that was not my top choice, so in my mind, I didn't fully accept the decision probably until October that I'm here for 4 years. I was in denial in May and June when I first moved out here, but I still went out trying to have fun and meet other interns.  I didn't really find anyone that I clicked with or people that I would like to hang out away from the hospital. By October, the winter has arrived already with the gloomy gray skies.  What I was not expecting was the lack of sun for the entire winter and that the entire winter goes from mid October to April. I knew that I've SAD but I didn't know that I would be in the worst depression that I've every experienced.  I changed my vitamin to get more vit D, but it irritated my stomach, so I had to change it again.  My mood didn't change much.

The fact that I was working over the holidays didn't help, so I went to visit Kirstin.  That help a little but it only made me realize that I really don't belong here in Cleveland.  Other residents say that Cleveland would grow on you, but I really don't think it ever will.  At this, I met Angel and really got to know her as she's going through hard times, so that kind of gave me a different focus, but it didn't last long for my attention span.  I soon got mildly annoyed with her problem, but she was someone that I clicked with.  She was applying for CRNA school and got accepted to one in Florida, which she will be going in Dec if all goes well.  So I'm already trying to distance myself, not getting too attach so I won't be too disappointed when she leaves.

Then I got sucked into the SICU, which was even more depressing with the work load, call schedules and just the ICU madness.  I'm feeling down is not really work related, it's more due to the fact that I don't have anyone in Cleveland that checks up on when I don't show up to church or small groups in a while or someone for me to fall back on to just talk or rant.  I visited Kirstin again this time, and I could tell the difference, I was much more quieter with her, not my usual loud crazy self.  I then realize that this can't keep going.

Now, I'm at the point where I'm very close to asking someone from work to write me a Rx for wellbutrin for short term to just fight this off.  I also got to talking to Eddy and David, so hopefully I'll be able to find a relief through them.  I just feel frustrated with the low moods that I'm feeling, most of the time, I just want to sleep more, and eat more of my comfort food.

I really want to beat this. Please God, help me.

SICU ... hmm

It's been a long 2 months ... 14 calls total with some crazy things interspersed.

SICU environment is one where there's a steep learning curve on everything, ventilation, acute management, putting out fires overnight.  I enjoyed the learning environment, all the staff and fellows are more than willing to teach.  There are a few stories I've got on the seniors that I was on call with.

I'm sure there's always a senior where everything has problems with.  And this one is driving everything nuts.  He has a military background and very much into hierarchy.  It's interesting how he fits in with other anesthesiologists as the people in the field is more laid back, less uptight about the whole medicine hierarchy.  Also I'm not really sure how much clinical knowledge he's got.  He's gotten into some trouble over some things that he's done, like starting insulin drip less than 24hrs after a pancreas transplant.  The nurses did not like him as well so that makes life for me at night a little more difficult.  The nurses will try their best to get around him and find me for things but because I'm an intern, there are some things that I still have to get an ok from him.  Also at times, he would like to teach at 2-3am and I'm like, I'm exhausted and nothing he teach will stay with me. So don't waste anyone's time and just move on.  Boy, am I glad that this is done.  I feel bad for the other intern who was on call with him a couple of times.  He really walked over her, more so than me.  I just don't let anyone walk over me, especially major things.  I also got yelled at by one of the staff when one of his patient went into Afib and find that her electrolytes needed replacement all day, which was not done. 

The second month was not much better.  The first month was actually fun cuz we would prank page each other, talk about other things outside of hospital, in general, we just get along better.  The second month, people were just not as friendly and I find it harder to talk to them about random things.  On top of that there's also another senior who was not fun to work with.  She a little more hands off and disappears throughout the night.  Also during daytime, she would sign out a bit of things to do to the night time. 

I definitely know that when I become a senior, what not to do.

At the end, I just felt like I have been holed up in the ICU dungeon and have absolutely no idea what else is happening with anyone else.  I'm glad that I'm done with ICU until my 3rd year.  Also realized that I'm not a critical care person as I was getting really tired of the medicine that has become more like the floor.  So that's definitely one fellowship I have ruled out.

orientation to ORs

Spent the last 2 months getting to know the OR and getting a taste of how the rest of 3 yrs here in Cleveland is going to be like.  I actually really enjoyed it, may be because everything was new to me.  I had to refresh and re-learn everything that I have already learned during 4th year.

The environment is adrenaline based for a short period of time and then it would quiet down until other burst of excitement that needed to temper down.  Everything is very much about being prepared ahead of time and to anticipate of any problems that might arise.  This totally feeds my neurotic need for control. Haha.  I'm finding that this was a very good choice for me and my personality.  It's funny how we end up in a field that matches our personality to the T.

The only thing that put a damper in my 2 months is that I won't be in the ORs until July, so hopefully by then, I won't forget everything.  :)  But I'm definitely looking forward to the GenA months where I have a little more freedom to learn how to sink and swim.

Me vs My profession

As I was walking in from the garage to the hospital's locker room to change, I started thinking about being perceived as a physician from appearance and thinking myself as one. I'm still struggling with that even now after several months of residency and years of med school prep.

The biggest problem for me is that I don't feel like I'm a physician and that I'm too young for this kind of job, but in reality, most people my age has already been working for several years. My thing is that I actually don't want my first impression with people to be a physician, so I tend to dress fairly casual most of the time, not grungy. I only tell people what I do when I'm asked specifically. It's a ingrained in me since high school that I don't tell people exactly what I do right away because my own extended family has gotten jealous before and would try to put me down.  This is just what I do to protect myself but in a way I think that's just silly as well.  I am confident in what I do but it's just I don't want to come off as intimidating to new people that I meet.  Truthfully, my being a female physician does seem to intimidate a lot of people that I have come across.  I'm sure it doesn't help that I'm usually pretty quiet with new people too.

Someone once asked me if I would do this again.  Maybe, especially with this environment with the healthcare system.  Now more and more the careers of NP, PA ad CRNA seem to be good options as well. But I don't think I'm willing to give up my right to power and in control of my career. So truthfully, to choose this career again would need to give me a huge incentive.  Sometimes I just find it not worth the years, effort and debt I put in to, but most of the times, it's a fairly satisfying career.  We shall see where God leads me with the career.

Oreintation pt 1

Started my official 1st month of anesthesia training, which is looking more like shadowing senior residents having them show us how OR is set up, the basic day to day functions and just get some basic experiences with procedures.

I had a really good senior for the first half of the month, getting me started.  He was really helpful, telling all the little bits of info that he wished someone had told before.  Then had another one that basically let me know try various techniques and procedures and having me try to be in a room by myself. With them, I had seen some crazy airway cases and icu transfers even the staff were saying that it was not a room for orienting intern. Oh well. It was fun.

Next week, we will be starting with 1 to 1 with staff and they may just leave us alone only with a little more supervision and then our own with with senior staffing 2 rooms.  Can't wait and see how well that will go.

ITE as PGY 1

Wow.  In-Training Exam. Felt really dumb as I walked out the room.  Oh, well, I'm glad that this is the first one and I can just keep on improving year after year.  There are some questions that I knew the answers to cuz somebody just by chance told me about it.  But realized there are so much reading to be done.

Alrighty, Jia Yo!!!

Afterwards, our program had a post ITE celebration at Bier Markt.  It was nice to see other people from other classes and to see some of the staff as well.  But there just wasn't a lot people.  And we still kind of hang out with the same people that we know.  Maybe eventually I'll get adventurous and get to know other people.

CORS

This was our notorious rotation where we all pretty much dread it.  The word on the street is that it's draining, do what we are told, don't think, and pretty much be ready to be yelled at.  Oh, it's a 12 + hr day 5 days a week for 4 weeks.  Thankfully, I only have it for 3 weeks before my 1st real vacay since residency.

I've got Drs Hull/Gurland service, which is a good thing in that there are usually not that many patients on the list but it's a service where every detail has to be approved by the staff and the staff has know about it. Needless to say, it was stressful for the first week, since I haven't been on a surgery rotation since as a 3rd year student and I have no idea what to expect.  On top of that, I've got a fellow who is probably one of the laziest one I've had.

The classic moment is when my fellow asked me to go down to radiology to look at CT abdomen to confirm a leak with the radiologist but I'm not surgery intern and I have no idea what to look for.  So of course, got yelled at when I reported what I was told by the radiologist. This happened 2 more times.  This should totally be something that the fellow should do because they know what other questions to ask and how to look at the scans.  It's not something a nonsurgical intern should do.  Later I found out that he should have been the one to do. Oh well, live and learn.

We were told that we do not go into the ORs with the fellow or staff; we just manage the floors.  So of course, my fellow asked the first day if I wanted to go into the OR.  Heck, no.

One last thing that really irked me was my fellow asking me do help with discharge summary.  PAs used to do it but they are so overwhelmed that the fellows are now doing them.  My lovely fellow asked me do it but our instructions specifically said that we are not do them since they have to include surgical info since we don't participate in those.  I almost got into an argument with my fellow over this.  I don't know how many times I have to stand up to him because of the inappropriate things he had asked me to do. Ugh.

Other than my fellow, my staff warmed up to me and really trusted me with her patients about the 2nd week. She would specifically page me before she rounds and asked me to do pain management at my discretion with some of her patients.  She also sent me short emails letting me know that she thinks I'm doing well.  She wrote a good eval to my program chair at the end.  I just felt that I haven't done anything different for any other patients or staff.  I guess I'm glad that my attitude paid off.

Overall, this was an exhausting 3 weeks. I'm glad this is over and that it was during winter, it didn't matter that it was dark coming in or leaving the hospital.

ALD (Pulm)

Started this rotation off with Dr. Akindipe and each of us with 3-4 patients to get to know. Fortunately, I already knew the fellow, Mike, so it wasn't too awkward. There is a PA Kathy and NP Melanie. I realize for the past 6 months so far, I have learned to work with NP/PA to help with the workload.

Anyways, the week was nice, round started around 11am and would be cone by 2pm. After that we just update what we need to then we can sign out the NP/PA as long as one of us is around to help with admission/transfers. Even then, that's only until 4:30pm. Not too bad. Mike was hilarious and very entertaining. He pretty much has a comment for every patient, depending who was seeing the patient and what topics we were chatting about.

2nd week, we had Dr. Minai and it was the week before Christmas, which I worked. Schedule was very similar to the previous week as well. Done fairly early, considering that I didn't come in until 8a on most days. But we did change fellow. For the next 2 weeks, it was Fadi. He was good too. He's a little high strung in the sense that he gets easily stressed out.

The 3rd week was when Fadi really stressed out. We were short one resident, and Dr. Chapman was staff. He known to round forever, the never ending rounds. And our list of patients were long too. I think they said that it's the longest they have seen. Our own floors were filled and we had 8 pts spilled over to other 2 units. We starts rounds around noon but still did not finish until around 7pm. I left around 6pm most nights when I finished with my patients. Thankfully, I did not have patients that are at the end of the list. It was exhausting. By the end Fadi have had it and was stressed out. Then I finally got a holiday weekend off. My New Years weekend fun.

Last week was with Dr. Lane and with a brand new fellow, his first time on the service. The fellow was nice but he was learning so there were a little scrambling at times.  But all in all, it was a good week

Christmas Weekend

I was working the weekend. I was being nice so the 2 guys with family on the service can get the weekend. This way I can get my 3-4 days New Year's weekend for sure.

I guess I lucked out, since the staff on for the weekend is a quick rounder so it won't be too bad. Also CCF gives us a free meal as well for the holiday. It wasn't so bad. The entire weekend I was done by 1pm so I get the rest of day to myself. It was only 4-5 hrs a day and by the time I was finish, I would still be fairly early in calling home.

I do feel sad, depressive, since I was the only one around for the holiday. Definitely lonely. I do believe it was the first time that I have felt the loneliness to this extent. It made me really miss my family. The very first holiday that I did not go home. BooHoo.

I just spent the weekend with me and myself and my lonely pitiful Christmas tree. I did watch the classic Christmas movies too. My favorite is still the Miracle on 34th St (original and remake).

Infectious Disease

Finished one of our crazy rotation. ID in any hospital is busy, so being busy at CCF is no surprise at all.

The service is great despite being long days. The staff are really nice and tried to teach as much as they could. Also there's at least one lecture everyday then the residents have their required lectures depending on individual department. Sometimes I felt like I was just running between patients and lectures all day.

Then we have to come in one day during the weekend. Those days are usually lighter depending on the number of consults and the fellow. I have been getting out by 4pm and usually with 3 consults or so. We also had to see our own patients from the week as well.

Everyday, we had to see our old patients from previous day then pick 2-3 new consults. Sometimes we would double our list in one day. When we get too busy or had one too many complicated patients, our staff would help out too. At times I would have to see 6-8 pts before lecture and new consults rolling in around 9am.

There are some interesting patients being that it is the Cleveland Clinic. One that I had was a patient with a mass growing the brain but negative cultures. The biggest question was what is it. That was never answered but the extensive work up needed required thinking and see what the next set of work up would be required. He may one in which we would never know the answers to.

Other than the occasional strange cases, most of the consults were post surgical infection. I have learned much of the antibiotics, what they are, when to use it and how to manage them. Also learned about the prior tests that should be done before consults. I think this is definitely a good intern rotation especially for the IM residents.

Overall, this has been a good rotation. Totally recommending it.

Thanksgiving

of course, I'm on ID and the first day, was told that Thanksgiving is a regular work day, not a holiday or weekend. Bummer, didn't think I was going to be able to go to Eskestrands for the holiday but could make it to the church one though.

That week was also my first official week on ID with just me, senior res and staff and the load of patients just keep increasing and days are long with us meeting our educational requirement. Days go from 7:30a to 6p.

For Thanksgiving, thankfully, it was quiet and the fellow let us go around 1pm whenever we finished with out share of consults. I did manage to get to Eskestrands' luncheon and met some of their friends from their church. It was nice since it's a truly homecooked thanksgiving meal and good people and company. It at least made me feel like it a family gathering.

After the lunch, I basically got home and showered then went straight to the church dinner with Nepalese and Burmese refugees. It was multicultural and was very nice to see other people who were not able to go home for the holiday gathering together because we have God and church in common.

By the end of the night, I was stuffed, got some left over from church that lasted me for another 2 meals. I'm very thankful that God has provided me with friends that willing to take me in and a church that provided me a home away from home.

I did miss my "mistress", Kirstin's, family, I have spent previoius Thanksgiving with them, they are very much like my own family except Americans and do the traditional Thanksgiving meal. I haven't been to my own family's Thanksgiving get together in years. This year, there's not one potluck but just a few of of family members having dinner with my grandmother. It's always one holiday where I don't try really hard to get myself back home. Christmas is the one that I tried harder. Oh well, but I had fun, not too bad this year being alone.