I want you to picture a dumpster. A bad one, full of rotting fast food, like a McDonalds-parking-lot-at-3am dumpster. One that no one bothers to lock or protect from animals because even the racoons will stay away from the fermenting, rancid waste.
Got a mental picture? Now place that dumpster aboard a Viking funeral of a ship, ablaze, sailing toward an enormous waterfall with nothing but jagged rocks below.
I was working on writing this gigantic 4,000-word monstrosity of a post where I tried to align specialty services with the old-school Dungeons and Dragons “Lawful/Chaotic vs Good/Evil” axes for character generation, and it was exactly as complicated as it sounds.
As I worked my way through it, I realized that half of what I wrote was about convincing specialists to come down to the ER and see my patients. At large academic centers where we residents train, we are almost always calling other residents for this task – and therein lies the rub. Like us, they are overworked and underpaid a flat salary to do their jobs. When I call the surgery resident for a consult, for example, I am creating work for them.
I would like to blame my prolonged absence again on COVID-19. To be fair, it does dominate about 95% of my work life and probably 50% of my personal life, but honestly, I’ve just gotten lazy.
The last time I published here was March 5, where I started with “it seems like we are inevitably headed for a massive, global pandemic.” For once on this blog, I get to say I WAS RIGHT ABOUT SOMETHING IN RESIDENCY! No attending or dad can correct this.
As of this writing, my area’s daily hospitalization rates look like a Space-X rocket launch. We’re out of ICU beds, regular beds, gurney, cots, sleeping bags, and patience. The worst is somehow yet to come. I am coping with this impending doom by playing with my dog and, finally, writing again.
The journey through second year of residency is an interesting one. As I’ve mentioned before, we are tasked with two major, new responsibilities: performing most procedures and seeing a much greater volume of patients. We’ve all gone through a substantial adjustment period. It’s been hard.
One of these journeys is toward two, or greater, patients per hour. I hit this milestone rather infrequently. In fact, it is about as likely for me to achieve this as I am to win a game of Oregon Trail. It is far more likely that I will die of dysentery, or make it no further than Fort Collins before my oxen quit on me. Continue reading
The title will make sense later. Trust me.
As I’ve mentioned before, I split most of my residency training time between two hospitals: a large tertiary care center that has all the bells and whistles, and an understaffed county hospital that on occasion struggles to perform basic functions of a healthcare facility, such as checking routine vital signs or (spoiler alert) admitting patients.
Hi. I have just completed a stint of night shifts – twelve in the last fourteen days – and I feel like a moldy, rotted potato.
As I write this, I’m trying to “flip back to days” for a regular day shift tomorrow, as the cruel scheduling gods have elected to grant me one day of work during normal people hours (albeit on a Saturday) before switching back to a third week of uninterrupted nights. Continue reading
The new interns started their orientation this week.
I say this mostly because it means I am just a few short days away from no longer being “the intern.” This is fantastic news, mostly because it relieves me of the duty of explaining to non-medical people the vestigial and archaic distinction between an intern and a resident. Just so everyone (grandma) remembers:
I made that diagram. Aren’t you impressed?
I am back in the Cardiac Care Unit this rotation. If you recall my earlier tribulations from my previous CCU block, this means I am once again forced to Constantly Replete Potassium. I have never really forgotten how much I hated the CCU – all other rotations are judged in relative fractions of CCU terribleness – but I had, at least, airbrushed out the violent rage induced by being interrupted every eleven seconds about electrolytes.
(This post is, in fact, not about electrolyte repletion, although there will be frequent references. You may all breathe a sigh of relief.) Continue reading
There is a Bible in medicine for interns. Published in 1978 by an intern doing his first year in internal medicine, The House of God is a cynical and hilarious look at the dehumanizing, cruel, and sad life that is residency. Continue reading
So I know the last time I wrote, it came off a little bit angry and a little bit sad. I said things like “none of this matters,” and “bloated, terminally diseased healthcare system,” and mentioned Wharton’s Jelly again.
I am happy to report… that I took Step 3, the final step in the general medical board exams. And it was stupid. Continue reading