Auntie Q

I'm going to be an aunt.

This means my little brother is going to be a father.

That is so weird.

Clean or full..

DH has been incredibly supportive during this first month of my residency.  He makes me dinner when I forget to eat, makes sure I have tea to drink in the mornings, and sets out car keys for me every night.  He forgives my ridiculous work hours, tucks me in bed at ridiculously early times, and makes sure all the bills get paid.  I have no idea how people survive residency without someone like him in their corner.

Still he is sometimes left speechless by my ridiculousness.

A couple of nights ago I had just made it home at the end of my third eighteen hour day.  I knew I had to be up again at four the next morning.  I was exhausted and starving because I hadn't eaten yet that day.  I also smelled like the hospital.  I was faced with choosing food or showering.

Which is how DH came to find me in the shower.

Eating angel food cake.

Which, judging by his reaction, is not something normal people do.

Tone paging

There are two kinds of paging at my hospital: tone paging and text paging.  Text paging gives you a few minutes to finish what you are doing before you attend to whatever emergency is trying to get your attention on your hip.  Tone paging gives you approximately 27 seconds to get to the closest phone and call back before the person on the other end of the line hangs up.  Tone paging is supposed to only be used for very important calls, and we can get called onto the carpet for not answering tone pages immediately.

The moment I had been dreading since I started residency happened yesterday while I was on call.

I had drank three huge glasses of sweet tea in a valiant attempt to stay awake without drinking Coke.

And I was tone paged.

While in the restroom.

To let me know that my patient had managed to pee.

Calvin Klein

He was well over 80 years old.   He was five foot two.  Tweed pants, suspenders, button down shirt and tie.  Gold tipped cane. Blue eyes.  And a huge hernia right below his belly button.

We had discussed the risks and benefits of the operation - nerve injury, bleeding, failure.  I had answered easily twenty questions about the procedure.  He looked  me straight in the eye.

"Doctor, I have just one more question.  My wife wants to know..."

"Yes?"

"Can I go back to underwear modeling after the operation?"

Working 9 to 5

I am tired.

So very tired.

I got off work a couple of days ago and thought to  myself, 'Self, today was amazing!  It was such a short day!  You are so lucky to be going home while the sun is still up!'

Then I realized I had been at the hospital for 15 hours.

I apparently now consider a 15 hour day a short day.

This is an unexpected turn of events.

Pup, we're not in Kansas anymore

I am most definitely in the South again.

One might ask how I am so sure.

The local news I was watching a couple weeks ago is one sure sign that I have left the North far behind. Mixed in between news of robberies, murder, and kidnappings at the local mall was an interview with a man who called 911 because he saw Bigfoot in his backyard.

"He was just over there, and I saw him, and I got a big stick, and I shook it at him, and I said 'Get.  Get.'  And he get, went back down the path again."

This would never have made the news up North.  First off, if someone in the North saw Bigfoot they would never admit it to their friends and relatives, let alone to police and news crews.  Secondly, they are a stoic breed up there.  I've seen a farmer come in missing half of his arm and his only complaint was that it smarted a bit.  Bigfoot wouldn't be a blip in that guy's day.

The follow-up story was about a pie eating contest.

I most definitely missed living down here.

Seriously?

Mr. Re-pete:  I came in because I'm having an allergic reaction.  I have hives all over, I'm itchy, and I can't breathe good.

Me:  Do you know what you're allergic to?

Mr. Re-pete:  Yeah, it's something in a Taco Bell Burrito Supreme. I know because I had the same reaction the last two times I ate one.  I came in here and they gave me a shot, then they gave me a pen to use the next time I had a reaction.

Me: An epi pen?  For the reaction? 

Mr. Re-pete:  Yeah, that's it. I used it already.

Me:  Okay.  When was the last time you had a burrito supreme before today?

Mr. Re-pete:  Yesterday, and the day before that.

Me: You ate a burrito supreme every day the past three days AND had a severe allergic reaction that required shots of epinephrine all three days?

Mr. Re-pete:  Yeah.  I want to make sure that's what it is, so I keep going back and ordering the same thing to double check.

Stephan Pastis, I heart you

 I love my life in general.  Some days though, I feel a little more like Rat.

Mr. Pastis, you make my mornings better.  Thank you.

* Pearls Before Swine is copyrighted by Stephan Pastis, 2010.  It remains my favorite comic strip ever.

Working 9 to 5

There are restrictions on work hours in residency that have been in place for about five years.  We are allowed to work eighty hours a week with no more than thirty hours in a row. There are other restrictions, but those are the biggies. Going over the legal hours can get your program in quite a bit of trouble; they can even have their accreditation revoked.

Old timers grumble they worked far longer hours than that when they went through residency.  They are absolutely right.  They did work longer hours.  

However, the patient population has stayed the same or increased since then.  The surgeries and treatments have become far more complex.  Back in the day, we only had aspirin to treat a heart attack.  Now we have an entire protocol of medications and interventions and guidelines that require we have a door to catheterization time of less than 90 minutes.  In essence, the amount of work a resident does now has easily doubled and probably tripled since the 1950s while the amount of time we have available to get that work done in has shrank.

This puts current residents in a tricky position.  We have to get the work done.  It is difficult to darn near impossible to get the work done in 80 hours sometimes.  There are times when we might be quite a bit closer to 100 hours than to 80.  We are told that we have to be honest on the hour logs.  Then in the next breath we are told that we have to make sure we are under 80 hours on the log.  We don't want to get our program in trouble.  We don't want to break the rules. We are stuck in a situation where there is no clear solution that ends well for us.

So what is a resident to do?

Lying about hours is unethical.  Residents know it is wrong.  It reflects poorly on our profession and our integrity.  We don't feel good about it.  We don't want to do it, but no aegis is being offered.  Something must change in the culture of medicine, particularly in the culture of surgery.  We are under an obligation to our patients to provide them the safest care within our capabilities.  Operating with slowed reflexes and blunted decision making is unconscionable.  Getting a program suspended by refusing to lie about  hours is unacceptable to superiors.  The blame will immediately fall on the shoulders of the resident who was honest about their hours - not on the superiors who are responsible for getting the resident out on time and the culture that caused the resident to be stuck in the hospital long past the deadlines.  The resident takes the fall.  

Take for instance this cautionary tale told to me.  The person in the story has asked me not to identify him/her.  He or she is currently trying to find a program willing to accept damaged goods.

This resident in a surgical program in the west got tired of lying about his or her hours. He or she decided to truthfully record every hour he/she was working.  He/she turned in the Medicare time card to his/her superiors at the end of the month.  He/she was immediately called in and accused of lying about the hours.  The superiors insisted that he/she could not possibly be working that many hours since the other residents were reporting right at 80 hours.  He/she told the superiors that the other residents were lying, just like he/she had been before. He/she also explained to the superiors that they could look at the charts and records to verify that he/she was in the hospital writing orders, admitting patients, operating, and writing notes during the times he/she had reported. The superiors got blustery.  They got upset and told him/her that he/she was a danger to the program not being on probation.

Then they fired him/her for falsifying records.

So I ask you all - what's a resident to do?

I'll show you all right....

I started residency this week.  I'm on the minimally invasive service for the next month which means I will be doing a lot of camera driving.

Camera driving for an attending is my personal version of Dante's fifth circle of hell. Wrath and sullenness abound.   This is how it goes:

"All I want is for you to hold the camera straight and look where I'm operating."

Sounds easy enough.  Look at the tiny scissors and grabbers on the flat screen.


"Camera, move in."

Moving in.


"Why did you move the camera?  Don't move."  He grabs my hand and puts the camera back in the exact same spot it was.

You just told me to move in, but that's fine, I'll stay here.


"I can't see.  You're too far out. Look left.  That's too far left.  Dang* it."

"Look at where I'm going to be operating.  No, not where I am now, where I want to go. Look left."

 "Make sure you stay in line with my instruments.  Don't look at my instruments. Don't stay in a direct line with the instruments.  Son of a gun*.  I said to look at my instruments."

At this point, I am completely confused.  I'm supposed to look at the instruments, but not directly at them, read his mind to know where to look next, and know exactly how close or far away he wants the camera to be without asking.  Easy task since they teach basic ESP in medical school now - it's a combination class with tarot card reading.


 "Gosh darn it*.  Keep the tools in the bottom third of the screen.  Bottom third.  I want the tools in the center of the screen.  Have you ever held an camera before?  Are you even looking at the screen? Camera, move in.  Not so far.  No, farther."

Gee, this is fun.  Please, pretty please, continue to yell.  I like that.  You have a nice voice when it's screaming at me.  And thanks for noticing that I have to stand on tiptoe on one foot to reach around you, hold the camera, and look at the screen since you are standing in front of me.  It's super easy to see the screen when your head is in front of it.  I spent four years in medical school just to give you the privilege of cursing at me for hours on end.  What I really want to do is take this camera and give you a nice view of your colon.....sir.


*Curse words have been toned down and reduced in number to ensure we remain family friendly.