It's been a busy few months - house-buying flurry (I have the greatest house ever!), quickly followed by honeymoon (romantical, and also a good vacation), and trying to get back into the swing of work after two weeks off, while covering for a colleague who's having a somewhat protracted family emergency. Part of me is a little frustrated that I can't really get the most out of the rotation I'm supposed to be doing this block, but on the other hand we do what we have to do to make it work for each other.

I'll think about posting more often. (No promises.)

I went to the dentist this morning to get some cavities filled in. (Still not sure how I made it all the way through high school without any cavities, and am working a few per year since then... Nonetheless.) Aside from waiting for 20 minutes to go back to the room and 25 minutes until I got the Q-tip of local anesthetic - for a 9am appointment! - everything was smooth. The dentist remembered me from a few Saturdays back, the anesthesia worked well, and my neck didn't get too stiff during the fillings.

It occurred to me during the whole experience that I was keeping my eyes closed for most of it. Partly it's because the lights are bright (and shining right into your face) and I don't like to see sharp things coming towards me. But I opened my eyes for a little while and realized there's another reason. The dentist has the mask on, so when you're laying back and open your eyes, all you see is the dentist's eyes. Staring right at you. Nevermind that he's focused on your mouth most of the time. But every now and then he talks to you and makes eye contact. Except it's much more intense and intimate than typical eye contact, because the eyes are the only feature you see. And it makes me a little uncomfortable.

I was trying to figure out why I've been so irritable in the last few days, and then I realized that it's probably because today was the TWELFTH day IN A ROW that I've worked! And most of those were 10-11 hour days. Dah!!! I did weekend coverage last weekend, which is supposed to be about 4 hours per day, come in, write bad notes, go enjoy your life. Except that I was in the hospital for 6.5 hours on Saturday and 8 on Sunday... I haven't seen much of my husband in two freaking weeks!

One of the current PGY-4s told me that the third year of residency at our fine program is all about time management. We juggle a partial inpatient load (up to 6), as well as 10h of clinic per week. I am definitely going to have to work on this, since most of my clinic patients no-showed and I was still there from 8am to 6-6:30pm most days this week. ::grumble, grumble::

Tomorrow is my last day as a PGY-2, and Thursday is my first day as a PGY-3. And then Saturday I get married. Squee!

Call was not so bad. (Not like the last one, with the same intern [who works very hard!], when neither of us slept at all.) I got to lay down for a few hours, then woke up and realized I'd missed some pages, took care of it, and lay back down. The awake time was not so hectic, either.

And most importantly, never again!!!

(And also quite nice, intern welcome party this afternoon, with free booze. Mmm, post-call booze!)

Ever.

Two more overnight calls ever. Unfortunately, one of them is tomorrow and I was also on call Tuesday. And on Night Float last week. And moonlighting this coming Sunday (2 days after being on call). Blech. But the end is nigh!

Last night of Night Float ever... Just twelve more hours and then I don't ever have to work third shift again without getting extra cash for it!

Our ED's computer system has a space for patient's chief complaint, which is usually something simple like fever, belly pain, depressed, etc.

Tonight we have "HA s/p GSW to head".

I guess the Grand Rounds went fine. Other people have told me I did well. I went last, and things were already running a bit late. I hadn't practiced much. I was hyper-aware of every time I stumbled over or mispronounced a word, or repeated myself. I tried to inject humor, which worked most of the time. My face turned bright red (I blamed the lights and my sweater, but I know it was from anxiety) and afterward I was short of breath and feeling like I could probably use some albuterol.

But it's over, I can put it on my CV, and I don't have to do that again for a very long time.

About 6 months ago I agreed to be part of the Resident Grand Rounds. I would give a 15-20 minute presentation about a paper I wrote (so you'd think I'd be familiar with the topic). Then I revised a PowerPoint presentation I'd created back in med school to talk about the same paper (at a much earlier stage, granted). A few one-on-one meetings with the departmental chair to craft this presentation. And now I'm supposed to give the talk today and I'm nervous! I feel totally unprepared to get up and speak about this in front of a bunch of really smart people. It's much easier when you're submitting a journal article more or less anonymously...

(And also - the department chair won't even be there for the presentation today because he'll be out of town. This further ingrains the lesson that smart mentors are not reliable.)

Chef is improving, and is even back to work on "light duty". (On the other hand, I think only one person has taken advantage of his lifting restriction and asked him to fetch a gallon of milk. A little sad.) He's still sore and building back stamina, and frustrated about that, but definitely happy to be allowed to go to work. His follow-up appointment is in a few days with the surgeon-wife of one of our attendings, which is awesome of her to see him.

As for me, I've got a period of three weeks in a row with a few days off per week. Memorial Day was a holiday, next week I'm taking Mon-Tues as vacation (but not going anywhere, because one of us might get sick again!), and there have been some restful call nights allowing me to actually do things the next day. Shocking! It definitely interferes with some of my clinic schedule, but with a month left I think I'm ready to be done with PGY-2...

In case y'all were interested, Chef is improving rapidly, and plans to return to work today on light duty. Lifting gallons of milk...

So I correctly diagnosed appendicitis a few days ago. Unfortunately, it was Chef's appendix. Rather, ex-appendix - it was removed while we were on "vacation" in the hippie town in the mountains. (He sure knows how to show a girl a good time, eh?)

The patient experience in this particular hospital was awful. We spent about an hour in the ED waiting room (even though he had rebound tenderness, which I made him tell everyone who interviewed him, and he mentioned on his own that I'm a resident). We got back to an actual room and were seen pretty quickly by the ED doc, who promised pain meds and a scan. Chef dozed for a while, so I didn't push the point on the pain meds, but after the pain woke him an hour after the doc saw us, I went to the nurses station to inquire. Two different nurses came in quick succession (like they weren't sure who was assigned to him), got him some morphine, then moved us to another area of the ED and gave him oral contrast to drink over the next 2h. (With several more doses of morphine, of course.) Meanwhile the ED nurse teased and picked at Chef (I know she meant it kindly) until he explained to her that he was terrified, and then she backed off a bit. The CT went pretty quickly, and while they said we probably wouldn't hear back about the results for an hour, the ED doc came in 30min later saying that Chef's appendix was pretty big and he had called the surgeons. Then it was another 30-45min before the surgery PA saw him, then a little longer before God (I mean, the surgeon) poked him and pronounced that he needed an appendectomy. (Duh!) The surgeon had the personality of a turnip. An arrogant turnip. At this point it was another few hours until they wheeled him to the OR around 3am. I got a few things from the hotel then came back to the waiting room. On my way back they called and said the operation was over and uncomplicated, and that someone would come see me in the waiting room in 15-20min. 30-45min later I asked at the desk and was given a room number and told he'd be taken upstairs in 15-20min. I found the room, and Chef was wheeled in probably 45min later. (They're not really good at estimating at this hospital.)
We both got a few fitful hours of sleep that night in between a fire drill and hourly vitals and q2h morphine. Then we sat around all day long waiting for the surgeon to come round and talk to us. I didn't want to miss him,, but I finally left to check out of the hotel (so I wouldn't have to waste any more money on it). The Percocet made Chef itchy, but the nurses couldn't get a hold of the surgeon to change the order so they switched back to morphine IV. Chef had some post-nasal drip producing painful coughing fits, but when we asked about getting Claritin, the LPN basically told me that if I got our home supply out of the car she would look the other way. IV fluids abruptly got hung mid-morning, because maybe the order was overlooked? Chef got a full diet right away (well, breakfast was Cream of Wheat, which is pretty much soft diet). There were no SCDs. Nobody actually checked the wound under the bandaids. Chef pretty much was left to himself, with occasional opiates, Toradol, and Maalox. We went on a few walks, and he showered, ate, farted, and peed. My friend who's a Family resident out there visited for moral support, but couldn't really do anything about the conditions.
The surgeon finally showed up at 6pm (!!!!), having been in the OR all day, poked Chef's belly and listened to the surgeon's spot. He was surprised that Chef was already eating a regular diet, but shrugged when he realized Chef was tolerating it. When we asked about the Claritin, he told us to just use our own - "take whatever you want". He did switch the opiate order from Percocet to Vicodin (which was tolerated better when used for dental stuff). However, he did not look under the bandaids, either. He said he'd keep us until the next day because Chef's white count was still high (though lower than the 18 in the ED) and he'd developed a left shift (post-op - who'd've thunk?). He wanted another night of IV antibiotics and would recheck labs in the morning, but would probably discharge Chef the next afternoon.
We slept a little better that night, though still not well with q4 vitals. This morning we attempted the hospital breakfast (I'd been going out to get Subway and Asian noodles so Chef could actually have something edible). When we hadn't seen a phlebotomist by 9am, I asked about it. The RN called and got the surgery PA to order "now" labs. (!! - the thing they wanted to see before discharge hadn't even been ordered?) The PA came by around noon (actually close to as promised) and said we were clear for discharge as soon as the paperwork got finished. My magical all-knowing program coordinator got me a hook-up for a follow-up appointment in our town (rather than driving 4h for a post-op check), and the hospital's only competent employee (I mean, social worker) made the appointment and faxed the records. Chef's IV didn't get taken out until 1pm, and then we spent 30min at the hospital pharmacy to get his Vicodin filled (they weren't that busy, and there were 4-5 people working there). And for the last straw, on our way out the guys who were doing construction on the roads waved me ok to drive, then waved toward the left at me, which I took as "turn here". The guy stopped us and said "didn't you see me waving? Don't drive on the fresh asphalt!" (with an implied "idiot!" in his tone).

All in all, a shitty experience followed by a 4h drive home. Chef's now asleep on our own bed (it's been a long few days), and I need to wake him up for a light dinner soon.

According to the program director, "I knew you were smart, but I didn't realize until I looked at your scores you were damn smart".

(I don't indulge my ego often, so nyah on you if you don't like it!)

I get to stay here to do my Child fellowship!!!

Rassafrassin' #(@*$@#(&*^(@#*%)(!!!

I found out Friday that the fellowship decision has been post-poned until next week. It's already been 2 months almost since I interviewed, how can it take this freaking long to decide which one person they're not going to accept?

(I vote it should be the individual who left that individual's therapy session [as the doctor] to answer the page about "we have information about the fellowship decision". There were two others of us doing therapy at that time who stayed in our sessions...)

Yesterday I was at work until 8pm, being my first real day back from vacation. (I spent Monday in the boonies, without real access to the hospital and my notes.) I'm still catching up on reschedule requests and trying to figure out my schedule for next year.

Tomorrow I will do CBT at 7:30am, because I am covering the walk-in clinic and ED starting at 8:30 (the therapy appointment is usually at 8) and I missed last week. I am too damn nice.

Then Friday I (hopefully) find something out about my future, and then go on call.

See picture. (I was very excited about this, but since I've taken the picture, I've continued to play.)