Monday, October 30, 2006's November?

Time has been playing tricks this year - I can't believe my fourth year is only 3 months old, but at the same time I'm not entirely convinced it's almost November.

note: I have been catsitting and spent the weekend knitting, napping and petting the cats. As I type this, everything that was in my car is now in their living room. The cord that connects my camera to my computer is in that pile. I hope. Pictures when I find it. Or by another one.

My trip to NYS&W was my first time in Rhinebeck and I'm fairly sure that it won't be my last. As many have already said, the fairgrounds were swamped and the weather was great. The long drive down was good (but long) and both nights I slept better than I had in weeks. I did, er, whine a bit, but I'm going to plead exhaustion and wheel-
love and then promise to be much more agreeable next time.

I left with a new Forrester spindle (my second) and various types of fibers (some bought for the color, some for the feel (how could I leave the shetland bumps there? I couldn't keep my hands off of them!) and some simply because I've never spun that type and want to start building my experiences). Some amazing sock yarn and various lace yarns screamed my name, and I found a bin of books that were all half price.

All in all I don't regret any of my purchase. I do regret not being able to sit and spin with people, and not being able to say more than a passing "hi!" to people I would love to have spent at least a few minutes with. That being said, the conversations I had were wonderful and catching up with those I did see was worth the trip.

(Another highlight was that I got to see one of my wheels. Robin has been living in Boston and I have missed her - missed her more than I thought I would. I love that wheel. (Love.) Norma's mitten also loved the wheel - but that's another story.) I had less than 24 hours with her before I dropped her off with Gil (her maker) so he could replace some of the screws with bolts and give her a tune up. Handing her off - even to the person who used his hands to put it together - was hard.) I bought Robin from someone at the Maine Fiber Frolic and I know that I will never again find a wheel at such a great price. Gil knew the wheel as soon as he saw it, remembering that it had intially been a single tredle that he modified to become a double tredle; it's one of the first set he made, and I love that he knows it's ins and outs. It had been klunking and he has since fixed that AND given the wood another oiling. Now I just have to figure out how I'm going to get there to pick it up...

Physically stepping out of the medical world and giving my brain a chance to stop whirring with facts (of varying relavence) does funny things to took several hours for me to fall back into myself, and stop the constant awareness that comes with being questioned at every move. Thus far my rotations have demanded a lot from me, and I've gotten critisicm at every turn, with every question I answer and the feeling of being judged isn't something that goes away easily or quickly. I continue to be the medical student that doesn't "fit" the "rules" and over and over again I hear about how I need to change, how I won't be able to continue to take care of patients the way I have been and that I am not nearly as efficent as I should be.

In September I spent the month at a rural health site; the Appalachian Trail ran through the town and I saw hikers with various injuries (who were thisclose to being done with their hikes and just needed to get through the last 200 miles), and Outward Bounders who had not showered in nearly three weeks. The site I was at happens to the only clinic in the area and they were busy, busy, busy. This site gave me insight into the difference between a teaching hospital or residency program (essentially a teaching clinic/hospital/etc) and just a regular doctor's office. The doctors who have students more often than not know how to ask questions, and guage what I know.

I've struggled with how to describe how hard that month was for me, and how I re-thought every aspect of my future almost every night as I cried and cried and wondered what exactly I'd gotten myself into. That feeling continued into last month, during my sub-I; the first two weeks were horrible. Not only did I have to prove myself to the patients I met, the residents I worked with and the ever-changing attending physicans, but I had to learn a new computer system, a new hospital layout and new schedule. The expectations seemed to change with every person I worked with and it quickly became apparent that my mindreading skills just aren't what they used to be.

I've said it before, but I don't thrive on competition - instead I back off and do all I can to get out of the situation, letting those around me fight it out. Continually questioning me and challenging what I know doesn't lead me to learn more - even if I know the correct answers, chances are good I won't be able to elaborate on the topic in those situations.

The above is just an aspect of medical education, but combined with attacks on my "style" and "compassion" it leaves me unsure of what I'm doing in this field. Over and over again, by more than one doctor, I've been told that I "spend too much time" with the patients, include too much information in my progress notes, and at one point I was told that I give the patients too much information.

(***to expound: I know that in the face of managed medical care and low insurance rembursements doctors see as many patients as they can to make ends meet; but if I only have three patients to see in a four hour time period, why wouldn't I spend a full 15-20 minutes with them? Every single patient that I "spent too much time with" told me that they finally felt as though they had answers to all of their questions. Many told me that they hope I never change, and those statments kept me going during the moments when I was ripped into by docs who felt I was simply wasting time.

regarding too much information in my written notes: I can plan for that if I know who will read them (and only write in abbreviations or short, short sentences), otherwise I've found that it's much easier for me to include too much information than not enough. (I was never told that my notes were too long last year...)

re: the patient having too much information - I believe that patients should know what they are diagnosed with, and what their tests show. A patient who has had a stress test and echocardiogram deserves to know that it showed they'd had a heart attack. When the future might include a cardiac catheterization and the pt is getting pressure from cardiologists and the general doc to schedule the procedure, I think evidence that they had damage to the heart muscle is important. The other docs argued that it wasn't important in the scheme of things or that they already knew the results. (they didn't know and thanked me profusely after finding out)

End expounding.***)

I suppose the best way to put it is that I am tired, and having to be in these sorts of situations (throw in living in dorm rooms and moving every four weeks) is wearing me down. I have thought more about where I want to do my residency, and what is important to me for my future. I will get through this - it will pass - but right now it's hard to keep that in mind.

Tomorrow I start a surgery rotation with a breast specialist and I am looking forward to picking it up where I left off after my radiology rotation. My clinical skills exam is at the end of this month and with Thanksgiving thrown in there chances are good time is going to start speeding up. With only 30 weeks and 5 days left til graduation, I can’t say I’m sorry to see it start to move quickly.

Thursday, October 26, 2006


went to Rhinebeck and had fabulous time STOP came back to piles of work to do and am working with people who have no appreciation for wool STOP my alarm goes off at 5:30am and I'm (still) not a morning person STOP am recovering from Tuesday, or my last 30 hour shift on call and am extremely overtired STOP will ramble again with complete sentences and more coherent thoughts soon STOP

(I would give anything for time to spin and a cup'o'tea. Sigh.)

Monday, October 09, 2006

tips for being on call....

it's now 1:30am and I'm two thirds of the way through my thirty hour "day(night)day" on call.

I know that if I try and climb into bed it will only invite my pager to chirp and disrupt my dreams (leading me to ponder which is worse: being punchy and tired or being woken from a sound sleep and 100% disoriented) and so I'll tempt fate by trying to post.

It's been several months since I last played the on'call'game, and I thought it was time for me to make a few notes for the next time (a few days from now) because I seem to forget just what being on call is all about...

- Change into scrubs as soon as possible. It doesn't matter how comfortable my dress pants are, nothing beats feeling like I'm wearing pj's around the hospital.

- the chocolate milk in the doctor's lounge is better when mixed with skim milk, and the combo of the two is easier to chug when being called to a floor.

- nice handwriting is worth the extra seconds it takes. Spending many minutes on the other end, trying to figure out what something says is the #1 reason why mine is now legible.

- do not try to knit when on call. Even if you are working on a sweater that you are hoping to wear to a very large fiber event in two weeks. Do. Not. Knit. On. Call.

- the cafeteria closes at 6:30. Sharp. Even if nothing looks good, having a ________ (cookie, apple, orange, cookie, english muffin, or cookie) for later is worth swinging by.

- for heavens sake...if you disregard the above and knit, do not try to fix the "little" mistake. Because then it will become a big mistake.

- we want patients in the hospital to do three things: sleep, eat, and poop. We seem obsessed with how often they are doing these things, and ask them on a daily basis when the last time they did each was. What are the only three things the patients will be unable to do? sleep, eat, and poop.

- don't try to fix the big mistake either. Just don't knit.

- the DunkinDonuts across the street is open all 24 hours of the day and night.

- instead of sneaking off to said DunkinDonuts, take orders from those you are working with. Not only will they know where you are, they'll be nice for a good 10-15 minutes after you get back.

- if you do try to sleep, leave your sneakers on. Either of two things will happen: 1. you'll be ready to jump out of bed when the pager goes off, and it saves time with tying laces (and leaves more time to figure out where you left your glasses...) or 2. Because you are more prepared, it won't go off. You'll wake up wondering why you are asleep with your shoes on.

There is, as always, much more to say. I've had some fairly intersting conversations with doctors about my future in medicine, and had to stand up for myself more than once. This rotation, an "acting internship" or "sub-internship" is putting me in the role of a first year resident - sort of like playing a doctor on tv. It's been quite an experience to see how hospital based medicine differs from outpatient services, and, again, I find myself having to read the minds of whomever I am with.

(doctor A wants me to list all of the meds, doctor B thinks that is a waste of time but wants me to number the problems sequentially and keep them in order while doctor C thinks all of the above is a waste of time and I should shorten everything I can (which includes not writing basic abbreviations because the reader will know what I mean. And I take too much time to write neatly.) I think they mean well. I hope they mean well. I'm learning how to nod and smile.)