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Tuesday . July 08 . 2003 . 7:25pm thank you, bell commission On-call nights may be the worst slumber party ever, but I love the aftermath. Thank god for post call days off. Thank you, ACGME. Thank you, Bell Commission. (If you have know idea what I'm talking about, consider yourself lucky.) Although the Bell Commission and similar resident work hour rules operating under similar philosophies have created some truly heinous scheduling templates, like Night Float (yes, I know some people love Night Float), I am so glad to be doing my residency in New York, where the Bell Commission has been doing its thing for the past ten-plus years, and waiting for some of the more egregious offenders around the country to catch up and let your residents go home already, for chrissake. You know who I'm talking about. Yes, well, anyway. * * * My little patient is doing OK, though the plan for him now is to go to the OR later this week for some more procedures and testing. Basically, while he's zonked out in the OR, every doctor that has ever weighed in on his diagnosis or treatment is going to pop in and take a little piece of him for lab analysis, be it five hundred tubes of blood or biopsies of various parts of his anatomy. So we'll see what comes of that. He's hanging in there, though I admitted a patient last night with a chief complaint of vomiting up large-ish amounts of blood. Fun. She was sent up from the ER with IV access, but barely, as she had the smallest possible catheter in the entire hospital sticking out of the back of her hand. If she comes to need a transfusion down the line, this IV just isn't going to deliver the goods, so early this morning, I tried to put an 18-gauge into her antecubes. I failed both times. She was a good sport about it, considering how big the needle was, but man, I felt bad. I think I'm a procedure dunce. Granted, this patient is a hard stick, and even her mom says that she's needed PICCs or central lines placed in the past because of difficulties with access, or even had to go to the NICU for line placement, since they're so accustomed to accessing teeny collapsible veins--but that only made me feel a little better. I'm like mean bad intern, poking kids with needles to no avail. It's better than being mean bad medical student trying and failing at procedures, because that short white coat makes it all the more obvious that you have no idea what you're doing, but still, it feels bad to learn on patients even if you have to. Earlier that day, I had to get an ABG from this tiny little baby, and missed that too. Actually, according to my senior, I was in the artery (we did see a flash) but then it spasmed, as they are wont to do, cutting off the blood supply. I'm not sure if he was just saying that to make me feel better, though. I am determined to get it next time. Man, I miss adult patients and their big, fat, juicy veins. * * * So, according to Kenneth, I'm the number one site to pop up when you do a Yahoo search on "intern year sucks." Cool. Hang in there, Kenneth, only eleven and a half months to go, right? Not that it really sucks that badly. Well, parts of it suck. The hours, mostly. And the deadly inexperience. But my question is this: at what point do you stop feeling like such a dumbass? At what point do you say, "hey, I know stuff" and stop keeping a running list of medical topics you need to review so long that you start indexing and chaptering it? At what point do you stop answering every thing the nurse asks you with, "Hmm, let me ask the senior"? Because I'm definitely not there yet. I really like my job, I just don't know what the hell I'm doing most of the time. I'm sure this is all really inspiring for anyone who's ever had to go to the hospital before. * * * I'm four-fifths of the way through the newest Harry Potter and I'm really enjoying it. So much so that I brought it to work with me to read on the subway, and was even considering reading a couple more chapters last night at 3am when things started to quiet down on the floor. (Luckily, sanity prevailed and I went to sleep.) It's all very dark and exciting and revelatory, like "The Empire Strikes Back." And I am very amused by Harry's little Chinese girlfriend. Cho Chang! Ha! He has an Asian fetish. (Hello again, porn-keyword searchers. There are no nudie ladies on this site, sorry.) Also, I love Hermione. My sister hates her, because she thinks she's a know-it all and a sasspot, but I think she's great. They'd better not try to work out some kind of Ron-Hermione romance in subsequent volumes, though. That would be wrong. Also, who's going to die, already? No, don't e-mail and tell me. Don't! I just can't believe it hasn't happened yet. My guess is Dumbledore. No, Ron. No, Hagrid. It's someone close to Harry, right? Who else could it be? Dobby? I hope they kill off that little fucker sometime, I hate that thing. (But mostly because I saw the movies before I started reading the book, and his voice made me want to hurl myself off of someplace high.) * * * I have an in-service exam to take tomorrow, so I'm going to rest my brain tonight. I'm going to do so badly on this test that it's going to be embarrassing--it's basically something like the Pediatric Boards, but all residents in all three years have to take it annually. There's no real pressure to do well--in fact, it would probably behoove the program for you to do poorly, so they can take credit for our subsequent improvement over the next three years--but still, the prospect of sitting through a three hour exam and having to guess on all of the answers is a little depressing. Maybe I should just put down "A" for everything. Even a broken clock tells the correct time twice a day. So I think 20% is a good grade to aim for. xo Michelle |
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