That was the answer from the guy on "my" team when I asked him what his major was. He was a first year college student.
Then those kids started kicking my ass on the basketball court again.
I'm old.
Saturday, April 28, 2007
Wednesday, April 25, 2007
Oh!
And looking at the post below I just realized that I forgot to tell you what prompted the post's title .. "routine".
I meant to tell you that I finally had a routine down in the morning, going up to A700 in the morning after having thrown my jacket into the residents' workroom, picking up the current list of patients on the consult service in the dialysis unit on the way, then paging Jen from one of the phones in the kitchen, putting a halved bagel into the toaster, pouring orange juice into a cup, at which point Jen will return the page, I talk to her, after which the bagel is done and I put some toppings on it, after which I go sit down at a computer and check up on old patients in the computer or, if I'm lazier than that, I'll just check my mail, read the news or start blogging.
I did the latter today, but was rudely interrupted by the first later-to-be-cancelled consult in mid-breakfast as you can read in the post below.
Blog to you later!
I meant to tell you that I finally had a routine down in the morning, going up to A700 in the morning after having thrown my jacket into the residents' workroom, picking up the current list of patients on the consult service in the dialysis unit on the way, then paging Jen from one of the phones in the kitchen, putting a halved bagel into the toaster, pouring orange juice into a cup, at which point Jen will return the page, I talk to her, after which the bagel is done and I put some toppings on it, after which I go sit down at a computer and check up on old patients in the computer or, if I'm lazier than that, I'll just check my mail, read the news or start blogging.
I did the latter today, but was rudely interrupted by the first later-to-be-cancelled consult in mid-breakfast as you can read in the post below.
Blog to you later!
Routine
Yesterday, the service was back up to its usual five consults. Most notable exception was that my patient for the day was in the ER again, a place I still like to go to. Although I'm far from being an expert yet, nephrology is already becoming a bit monotonous. If I imagine focusing on the kidney for a significant number of years, like my attending would approve, it doesn't seem like that could still be interesting then. And I don't feel like one has to be particularly smart to do it. There's a large but still limited number of diseases a kidney can have and it still holds true that hearing hooves usually signifies horses. And figuring out the occasional zebra will certainly be satisfying but rare (and we're here at a good university hospital in a consult service that deals with the cases the primary teams cannot or will not figure out - so pretty selected collective of patients already). I'd still rather be in the ER, obviously things were less repetitive in there.
That said, it's not completely boring here. Physicians mix things up by overdosing people on Lasix last night, for example, poor guy's in the ICU and probably deaf right about now. I guess I shouldn't go into details on that.
And another interesting mix-up happened .. apparently someone was very much post-call and wrote an order for DDAVP (desmopressin, basically vasopressin with an arginine attached) for a patient with a sodium of 120. Apparently they got it confused with another medication starting with "D": Demeclocycline, a vasopressin antagonist, after having been awake for too long. I guess we're all human.
(Disclaimer: These stories are needless to say purely fictional and any resemblance to actual events or persons is, of course, coincidental.)
(I started this post with breakfast in the morning. This is the third time I was interrupted and I'm continuing this draft, it's 7:30pm and I'm back home.)
So, where was I. Ah well, what does it matter anyway.
The reason I was interrupted so often today was that the two residents we had up until yesterday were done with their renal consults. We got one new resident today, but she was, of course, in clinic this morning. That left Jen and myself, Jen having a kidney biopsy scheduled. That's how I ended up with my first consult at 8:45am, when I had spent one and a half hours on it and was close to getting done she paged me again to let me know the primary team had just cancelled the consult. They'd send the patient home this afternoon. 20 minutes later I got another patient, HIV+ with PCP in the MICU. 33 minutes later, at 11:07am (I'm reconstructing this from my pager) Jen called again to inform me she was about to start the biopsy and given that this had taken more than an hour yesterday she would like me to get started on a third patient. I replied "Sure. So you're planning on rounding around 5pm, right?". I was trying to make sense of this guy in the MICU's chart again but failed miserably. He had apparently been turfed from one place to the next a lot, hitting one normal ward, one step-down service and three different ICUs in little more than a week. Naturally, they all had different kinds of flow sheets that overlapped (good luck trying to figure out ins and outs there) and medication orders were a mess.
To paint you a picture: One and the same medication, Bactrim, was showing up on the same day's medication sheet three times. Once as p.o. medication, with a "d/c'd" behind it, as in "discontinued". One more line saying "Bactrim", this time i.v. and with some number of mg/kg but no times of administration behind it. And a third line on that same page starting with "Bactrim", i.v. again, this time saying 250mg and followed by four different times of administration. Two of those time points were circled, two were crossed out, all carried some hieroglyphs around them - presumably initials from nurses but they could mean anything as long as you're not familiar with *all* of the abbreviations that could be used on these medication order sheets. It turns out that the circled times of administration are doses that are not actually given to the patient, while the crossed out ones are. And that's only one of the four different antibiotics this person has been given in the time he was there, not even speaking of the plethora of other medication this 69 y/o HIV, HepC, PCP, HTN, CRI now septic patient has been given over the past week. It took me probably about five minutes of deciphering interns', residents' and especially surgeons handwriting just to find out when the guy was intubated - namely yesterday.
I would have needed a very high threshold for frustration today, which, alas, I didn't have. It was frustrating that it still takes me forever to assemble the simplest pieces of information and I'm still not sure how I can speed it up.
The best way probably is to keep doing consults. Although it probably wouldn't hurt if someone at some point sat down with me and gave me an introduction into things like "a circle around a time point on the MAR record means that this dose was actually not given". Thank you, you've just saved me half an hour of grief and the recorded fluid intake on the flow sheet finally goes together with the fact that this antibiotic is administered in 500ml IVPBs.
You live, you learn.
That said, it's not completely boring here. Physicians mix things up by overdosing people on Lasix last night, for example, poor guy's in the ICU and probably deaf right about now. I guess I shouldn't go into details on that.
And another interesting mix-up happened .. apparently someone was very much post-call and wrote an order for DDAVP (desmopressin, basically vasopressin with an arginine attached) for a patient with a sodium of 120. Apparently they got it confused with another medication starting with "D": Demeclocycline, a vasopressin antagonist, after having been awake for too long. I guess we're all human.
(Disclaimer: These stories are needless to say purely fictional and any resemblance to actual events or persons is, of course, coincidental.)
(I started this post with breakfast in the morning. This is the third time I was interrupted and I'm continuing this draft, it's 7:30pm and I'm back home.)
So, where was I. Ah well, what does it matter anyway.
The reason I was interrupted so often today was that the two residents we had up until yesterday were done with their renal consults. We got one new resident today, but she was, of course, in clinic this morning. That left Jen and myself, Jen having a kidney biopsy scheduled. That's how I ended up with my first consult at 8:45am, when I had spent one and a half hours on it and was close to getting done she paged me again to let me know the primary team had just cancelled the consult. They'd send the patient home this afternoon. 20 minutes later I got another patient, HIV+ with PCP in the MICU. 33 minutes later, at 11:07am (I'm reconstructing this from my pager) Jen called again to inform me she was about to start the biopsy and given that this had taken more than an hour yesterday she would like me to get started on a third patient. I replied "Sure. So you're planning on rounding around 5pm, right?". I was trying to make sense of this guy in the MICU's chart again but failed miserably. He had apparently been turfed from one place to the next a lot, hitting one normal ward, one step-down service and three different ICUs in little more than a week. Naturally, they all had different kinds of flow sheets that overlapped (good luck trying to figure out ins and outs there) and medication orders were a mess.
To paint you a picture: One and the same medication, Bactrim, was showing up on the same day's medication sheet three times. Once as p.o. medication, with a "d/c'd" behind it, as in "discontinued". One more line saying "Bactrim", this time i.v. and with some number of mg/kg but no times of administration behind it. And a third line on that same page starting with "Bactrim", i.v. again, this time saying 250mg and followed by four different times of administration. Two of those time points were circled, two were crossed out, all carried some hieroglyphs around them - presumably initials from nurses but they could mean anything as long as you're not familiar with *all* of the abbreviations that could be used on these medication order sheets. It turns out that the circled times of administration are doses that are not actually given to the patient, while the crossed out ones are. And that's only one of the four different antibiotics this person has been given in the time he was there, not even speaking of the plethora of other medication this 69 y/o HIV, HepC, PCP, HTN, CRI now septic patient has been given over the past week. It took me probably about five minutes of deciphering interns', residents' and especially surgeons handwriting just to find out when the guy was intubated - namely yesterday.
I would have needed a very high threshold for frustration today, which, alas, I didn't have. It was frustrating that it still takes me forever to assemble the simplest pieces of information and I'm still not sure how I can speed it up.
The best way probably is to keep doing consults. Although it probably wouldn't hurt if someone at some point sat down with me and gave me an introduction into things like "a circle around a time point on the MAR record means that this dose was actually not given". Thank you, you've just saved me half an hour of grief and the recorded fluid intake on the flow sheet finally goes together with the fact that this antibiotic is administered in 500ml IVPBs.
You live, you learn.
Monday, April 23, 2007
Day off
Wow .. just one single little consult for the entire service today. And since I checked in after one of the residents this morning, he got it and I didn't even have to do it. Now I know what hem/onc service must feel like ;D
I had time for morning report as well as electrolyte conference today. I'm going to miss the latter next month. The attending - or should I say guru - at the head of the table has an extremely calm and wise aura about him as he infers incredible amounts of information from little more than about a dozen lab values and how they develop over time. Actually, the fellows go through the labs, commenting them, and the attending - who never heard about the case before either - asks questions. Questions like (I'm just making these up for illustration, don't even have a clue whether they make sense) "so, what would give you a urine osmolality this high with a TTKG (trans-tubular potassium gradient) of 5 in the setting of severe dehydration?" Or "what's the mechanism of renal failure in severe hypercalcemia with non-gap acidosis?" Uh, well, uhm .. luckily the fellows react similarly often enough, which makes it even more humbling and awesome when this attending kindly and most of all vividly describes (or leads us on the way of finding ourselves) the pathophysiology behind everything.
Yes, you read right. Physiology. This man does care about mere ions and ion channels and enzymes and pathways yet manages to not only integrate all that knowledge into an astoundingly accurate clinical picture of the patient (without history, physical exam or any other information, just part of their labs over one or two weeks!) but he also describes them as entertainingly and plastically as only Americans can. It's like a German professor in pathophysiology crossed with an American teacher.
He's awesome.
If my kidneys ever get sick, I'd rather have this man take a look at my labs for one minute than 10 other docs conferring for hours.
Oh, and I believe I had already mentioned that the pizza is good.
I had time for morning report as well as electrolyte conference today. I'm going to miss the latter next month. The attending - or should I say guru - at the head of the table has an extremely calm and wise aura about him as he infers incredible amounts of information from little more than about a dozen lab values and how they develop over time. Actually, the fellows go through the labs, commenting them, and the attending - who never heard about the case before either - asks questions. Questions like (I'm just making these up for illustration, don't even have a clue whether they make sense) "so, what would give you a urine osmolality this high with a TTKG (trans-tubular potassium gradient) of 5 in the setting of severe dehydration?" Or "what's the mechanism of renal failure in severe hypercalcemia with non-gap acidosis?" Uh, well, uhm .. luckily the fellows react similarly often enough, which makes it even more humbling and awesome when this attending kindly and most of all vividly describes (or leads us on the way of finding ourselves) the pathophysiology behind everything.
Yes, you read right. Physiology. This man does care about mere ions and ion channels and enzymes and pathways yet manages to not only integrate all that knowledge into an astoundingly accurate clinical picture of the patient (without history, physical exam or any other information, just part of their labs over one or two weeks!) but he also describes them as entertainingly and plastically as only Americans can. It's like a German professor in pathophysiology crossed with an American teacher.
He's awesome.
If my kidneys ever get sick, I'd rather have this man take a look at my labs for one minute than 10 other docs conferring for hours.
Oh, and I believe I had already mentioned that the pizza is good.
Sunday, April 22, 2007
Lake Michigan
Hello reader,
another little picture post.
I didn't find out the weather was so beautiful yesterday until I stepped outside on the way to the library. It was surprisingly warm again and I was wearing way too many clothes. Then again, I thought the library would probably be air-conditioned. Because I actually went to the library, shortly. It was pretty much deserted as it has been the only other time I had been there. Interestingly, their first floor is open 24/7 for your studying needs - and so far hardly anyone is in that huge, endless library even during the day. So I decided I wouldn't be in there either, took my stuff and left, riding my beach cruiser bike east
and further east
still going
east on 55th (can you feel the tension rising?)
crossed the metra tracks (almost there!), look to the sidewalk on the right to get an indication of the temperature yesterday
and boom!
The lake.
With a mild breeze and plenty of sunshine.
I sat down at the tip of the headland up there and got my book out. Took me about 20 seconds to get distracted not by these guys
and not the view
but those three people in the middle, walking away.
The two people on the right are married and from Finland, with him doing an internship with a law firm and her doing research in pharmacoeconomics here. The girl on the left is actually from Germany and also doing an internship in the law firm. They were here to kill time waiting for their tickets to Body Worlds that they had bought at 10am to become valid at 6:15pm. Apparently they sold tickets for the same day at that place that would make people wait more than eight hours to get in. Well, as you probably know any excuse is good enough for me when it comes to not having to study, so I talked to them.
another little picture post.
I didn't find out the weather was so beautiful yesterday until I stepped outside on the way to the library. It was surprisingly warm again and I was wearing way too many clothes. Then again, I thought the library would probably be air-conditioned. Because I actually went to the library, shortly. It was pretty much deserted as it has been the only other time I had been there. Interestingly, their first floor is open 24/7 for your studying needs - and so far hardly anyone is in that huge, endless library even during the day. So I decided I wouldn't be in there either, took my stuff and left, riding my beach cruiser bike east
and further east
still going
east on 55th (can you feel the tension rising?)
crossed the metra tracks (almost there!), look to the sidewalk on the right to get an indication of the temperature yesterday
and boom!
The lake.
With a mild breeze and plenty of sunshine.
I sat down at the tip of the headland up there and got my book out. Took me about 20 seconds to get distracted not by these guys
and not the view
but those three people in the middle, walking away.
The two people on the right are married and from Finland, with him doing an internship with a law firm and her doing research in pharmacoeconomics here. The girl on the left is actually from Germany and also doing an internship in the law firm. They were here to kill time waiting for their tickets to Body Worlds that they had bought at 10am to become valid at 6:15pm. Apparently they sold tickets for the same day at that place that would make people wait more than eight hours to get in. Well, as you probably know any excuse is good enough for me when it comes to not having to study, so I talked to them.
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