The very first patient I had seen in this hospital - the one Jen sent me to see the morning of my very first day here - has just been presented to the residents in morning report. The 50.000 IU of vitamin D per day for months. The attending overseeing the presentation shook his head in the end and said this is something you will hardly ever see.
Except if you're a student fresh from Germany starting on renal consults.
Friday, May 18, 2007
Wednesday, May 16, 2007
Over time.
I had a very good one and a half days.
They'd probably not be very good by everyone's standards as I've been in the hospital for 26 of the past 33 hours.
So here's how that happened. Yesterday started at 7:30 with critical care rounds again, I was pretty tired after around four hours of sleep - it had gotten rather hot and humid in Chicago that night and I needed to wait for Monday's episode of Heroes to download and be watched, obviously. But it went on to be a pretty normal day on the heart failure team. I was still enjoying having a load of time to go to all the conferences, with ample time to check on the three patients on our service. Jess was in clinic, but that didn't matter too much. It only meant that we'd be rounding a tiny bit later than we were used to, started maybe at around 3pm. A patient from the critical care unit was in surgery at that time and on our way to a lecture by a German liver surgeon we met his family. News from the OR had thus far been good, except for the fact that he was oozing blood just about everywhere, since he was on argatroban being heparin-intolerant which is non-reversible. So Brainy answered their questions and told them that they'd just have to wait for the bleeding to stop and that things would be fine. Even at that point in time, she was a little too definite with that last statement for my tastes when talking about a very sick patient from the unit undergoing open heart surgery.
Brainy and I went to the lecture, we were sitting rather isolatedly amidst all the surgeons. As it seemed, Brainy really didn't have any barriers when it comes to hierarchy and the likes. It was awesome. From the way we talked, joked around and exchanged candy in there she might as well have been a medstudent or I may have been an attending or we could basically just have been friends. I mean I really appreciate it and I'd love to see it the same way when or if it ever will be the other way around, with me not on the bottom end of the hierarchy I mean. Unfortunately, Brainy was paged during the lecture that the patient had died on the table, so she left and brought the bad news to the family.
Now, CS had told us two days before that she had changed to the cardiology inpatient service and was going to be on call yesterday. There were no U of C medstudents with her that night so she had invited any two of us to join her and admit cardiology patients that may come in. She was also planning on continuing the little EKG tutorial she had once started with us at six and had asked us to decide upon the two of us that would be on call with her yesterday. I figured, we might as well do that together during the tutorial since I expected all of us to be there. Unfortunately, I learned through a page during the lecture by the German guy that EKGs were cancelled. During the day, some of us had talked about who wanted to go on call and it seemed that not all were interested to do it and people from the second wave of the German invasion were kind enough to say that they'd probably have more opportunities to get a taste of on call inpatient admissions. Nevertheless, when I paged CS after the lecture at 6pm, I fully expected the jury still to be out on who'd be doing it.
"Philip, yes. Come down to the ER, Nema's already here and I have a patient for you."
So that was that then, it seemed.
Apparently though, my questionably bad luck with on call nights has turned since our service got slammed last night. CS was actively and actually sweating with the number of patients pouring in and that was the main reason why I was actually in the hospital until almost midnight - so six hours later. CS would not let me see more than one patient, but she wanted to hear my entire presentation on her and go through assessment and plan before she'd let me present to the attending the next morning. That was not an easy thing to get done while new patients required a cardiology bed left and right and CS was wheathering the storm. Still, she took a remarkable amount of time to listen to our presentations and give us hints and corrections for when we'd present to the attending the next day. So apparently the deal was that I should just see one patient and then go home - which is what I did. From what I heard from CS, their attending was going to arrive around 9 the next day and I was to present the patient I saw during their rounds which would be around then.
So I went home and slept. Critical care rounds this morning had unfortunately been pushed up to 7am, so I guess I wasn't really all that fresh again when I came to the hospital this morning. This time though, I arrived before Brainy (so far they had always been rounding for at least five minutes before I came stumbling through the door). So I paged my new fellow on the general cardiology consult team (because I was actually switching teams today, from heart failure to general cardiology). I had never seen her or heard of her in the hospital - I guess she must have been away, maybe on vacation before. I should ask her about that. When Brainy came, we rounded for just half an hour until we went up to cardiology case report conference at 7:30. The cases were pretty interesting. At 8:30, the conference was done. Walking out of the conference room, Brainy saw the intern that was going to be on cards consults with me and introduced us. While we were still walking down the halls, I got a page from CS at 8:36 reading "Phil, rounds in 5th fl WR now. Thx, CS".
Uhm, ok. So I went to the workroom where last night's team was assembled - CS, the two interns, Nema and myself. CS asked me whether I had checked up on my patient and was displeased to hear that I hadn't - I thought I still had time. One of the interns had grabbed the morning vitals and labs on the patient though and kindly brought me up to speed before the attending came. When he did, we went to a little windowless conference room (apparently nicknamed the "Bat Cave" by some as I had learned the night before), sat down and got introduced. The attending asked for our names and pager numbers. At first, I said he wasn't going to need my pager since I wasn't going to be on his service. Turns out I was wrong, though, since he would also be the attending for the general cardiology consult service.
Speaking of which, I hadn't heard back yet from the fellow of that service that I had paged at 7am. But hey, I tried to touch base .. what more could I do. So after that short introduction, the on call team started rounding with the attending and I just followed along, since I didn't have anything else to do anyway. While they were seeing the first patient, which was not mine, I paged my new fellow again and this time she did respond. I talked to her on the phone while the team was rounding, it was around 9:20. The new fellow, let's call her Missy, said she was just on her way in and that I didn't have to come in this early. I told her that I had just come for CCU rounds and the conference. She said "oh, OK" and then asked me to just hang out until she'd get there. I told her what I was doing, that I was rounding with the on-call team from last night because I had a patient to present. At that point she got confused and asked who I was again. I reiterated and explained the whole thing, emphasizing the fact that me staying at night was an exceptional thing but already then I feared she would expect me to know much more about what I was doing than I actually did. We saw another patient first, then Nema's and only then did we come up to mine, it was around 10:30 then. Now here's where the main part about the goodness started - I think the presentation went very well. It didn't seem like I had forgotten anything major and sometimes must even have sounded like I knew what I was saying. Having just come off the heart failure team, I was even able to back up some of what I said in the discussion of the plan for the patient with actual trial data. Of course the attending knew much more about the subject and taught us some new stuff but I still think it went exceptionally well. Unfortunately, now I seemed to have two people to convince not to expect too much from me since I seemed to have made rather favorable first impressions on both the fellow and the attending. They're going to be so much more disappointed when they find out the truth about me after initially having this distorted picture of me being highly competent. I would have been much more comfortable if they took me for the rookie I am.
Unfortunately, when I met my current team, fellow and intern a little bit later, Missy handed me an EKG strip to interpret. Despite the fact that I strongly emphasized how little I knew (which as feared, Missy didn't believe) I interpreted the strip correctly as being sinus with incomplete left bundle branch block that turned into overdrive-suppression by a ventricular automaticity focus that paced the heart only slightly above the sinus rate. At that point, Missy completely stopped listening to me when I pleaded that I didn't know what I was doing. So now I was screwed.
She gave me one of the new patients she got today to see and while I was presenting this patient to the attending, I got a glimpse of what was to come when they finally realize the extent of my knowledge. Missy asked me what I thought of the use of "Cardizem" in this case. I truthfully replied that I didn't even know what that drug was. At that moment, I caught a short glimpse of astonished jaw-dropping on Missy's side. I asked her whether that was a brand name and she apologized with a hint of relief that it was diltiazem. After that, I could answer her question somewhat satisfyingly but I'm not sure I want to see what happens when they find out how vague my understanding of things like the anatomy of coronary arteries or cardiology in general actually is.
Still, today was a good day and I can now comfortably watch the new episodes of 24, House and Gilmore Girls, since I don't have to be back in that place until 9am.
Yay!
Blog to you later.
They'd probably not be very good by everyone's standards as I've been in the hospital for 26 of the past 33 hours.
So here's how that happened. Yesterday started at 7:30 with critical care rounds again, I was pretty tired after around four hours of sleep - it had gotten rather hot and humid in Chicago that night and I needed to wait for Monday's episode of Heroes to download and be watched, obviously. But it went on to be a pretty normal day on the heart failure team. I was still enjoying having a load of time to go to all the conferences, with ample time to check on the three patients on our service. Jess was in clinic, but that didn't matter too much. It only meant that we'd be rounding a tiny bit later than we were used to, started maybe at around 3pm. A patient from the critical care unit was in surgery at that time and on our way to a lecture by a German liver surgeon we met his family. News from the OR had thus far been good, except for the fact that he was oozing blood just about everywhere, since he was on argatroban being heparin-intolerant which is non-reversible. So Brainy answered their questions and told them that they'd just have to wait for the bleeding to stop and that things would be fine. Even at that point in time, she was a little too definite with that last statement for my tastes when talking about a very sick patient from the unit undergoing open heart surgery.
Brainy and I went to the lecture, we were sitting rather isolatedly amidst all the surgeons. As it seemed, Brainy really didn't have any barriers when it comes to hierarchy and the likes. It was awesome. From the way we talked, joked around and exchanged candy in there she might as well have been a medstudent or I may have been an attending or we could basically just have been friends. I mean I really appreciate it and I'd love to see it the same way when or if it ever will be the other way around, with me not on the bottom end of the hierarchy I mean. Unfortunately, Brainy was paged during the lecture that the patient had died on the table, so she left and brought the bad news to the family.
Now, CS had told us two days before that she had changed to the cardiology inpatient service and was going to be on call yesterday. There were no U of C medstudents with her that night so she had invited any two of us to join her and admit cardiology patients that may come in. She was also planning on continuing the little EKG tutorial she had once started with us at six and had asked us to decide upon the two of us that would be on call with her yesterday. I figured, we might as well do that together during the tutorial since I expected all of us to be there. Unfortunately, I learned through a page during the lecture by the German guy that EKGs were cancelled. During the day, some of us had talked about who wanted to go on call and it seemed that not all were interested to do it and people from the second wave of the German invasion were kind enough to say that they'd probably have more opportunities to get a taste of on call inpatient admissions. Nevertheless, when I paged CS after the lecture at 6pm, I fully expected the jury still to be out on who'd be doing it.
"Philip, yes. Come down to the ER, Nema's already here and I have a patient for you."
So that was that then, it seemed.
Apparently though, my questionably bad luck with on call nights has turned since our service got slammed last night. CS was actively and actually sweating with the number of patients pouring in and that was the main reason why I was actually in the hospital until almost midnight - so six hours later. CS would not let me see more than one patient, but she wanted to hear my entire presentation on her and go through assessment and plan before she'd let me present to the attending the next morning. That was not an easy thing to get done while new patients required a cardiology bed left and right and CS was wheathering the storm. Still, she took a remarkable amount of time to listen to our presentations and give us hints and corrections for when we'd present to the attending the next day. So apparently the deal was that I should just see one patient and then go home - which is what I did. From what I heard from CS, their attending was going to arrive around 9 the next day and I was to present the patient I saw during their rounds which would be around then.
So I went home and slept. Critical care rounds this morning had unfortunately been pushed up to 7am, so I guess I wasn't really all that fresh again when I came to the hospital this morning. This time though, I arrived before Brainy (so far they had always been rounding for at least five minutes before I came stumbling through the door). So I paged my new fellow on the general cardiology consult team (because I was actually switching teams today, from heart failure to general cardiology). I had never seen her or heard of her in the hospital - I guess she must have been away, maybe on vacation before. I should ask her about that. When Brainy came, we rounded for just half an hour until we went up to cardiology case report conference at 7:30. The cases were pretty interesting. At 8:30, the conference was done. Walking out of the conference room, Brainy saw the intern that was going to be on cards consults with me and introduced us. While we were still walking down the halls, I got a page from CS at 8:36 reading "Phil, rounds in 5th fl WR now. Thx, CS".
Uhm, ok. So I went to the workroom where last night's team was assembled - CS, the two interns, Nema and myself. CS asked me whether I had checked up on my patient and was displeased to hear that I hadn't - I thought I still had time. One of the interns had grabbed the morning vitals and labs on the patient though and kindly brought me up to speed before the attending came. When he did, we went to a little windowless conference room (apparently nicknamed the "Bat Cave" by some as I had learned the night before), sat down and got introduced. The attending asked for our names and pager numbers. At first, I said he wasn't going to need my pager since I wasn't going to be on his service. Turns out I was wrong, though, since he would also be the attending for the general cardiology consult service.
Speaking of which, I hadn't heard back yet from the fellow of that service that I had paged at 7am. But hey, I tried to touch base .. what more could I do. So after that short introduction, the on call team started rounding with the attending and I just followed along, since I didn't have anything else to do anyway. While they were seeing the first patient, which was not mine, I paged my new fellow again and this time she did respond. I talked to her on the phone while the team was rounding, it was around 9:20. The new fellow, let's call her Missy, said she was just on her way in and that I didn't have to come in this early. I told her that I had just come for CCU rounds and the conference. She said "oh, OK" and then asked me to just hang out until she'd get there. I told her what I was doing, that I was rounding with the on-call team from last night because I had a patient to present. At that point she got confused and asked who I was again. I reiterated and explained the whole thing, emphasizing the fact that me staying at night was an exceptional thing but already then I feared she would expect me to know much more about what I was doing than I actually did. We saw another patient first, then Nema's and only then did we come up to mine, it was around 10:30 then. Now here's where the main part about the goodness started - I think the presentation went very well. It didn't seem like I had forgotten anything major and sometimes must even have sounded like I knew what I was saying. Having just come off the heart failure team, I was even able to back up some of what I said in the discussion of the plan for the patient with actual trial data. Of course the attending knew much more about the subject and taught us some new stuff but I still think it went exceptionally well. Unfortunately, now I seemed to have two people to convince not to expect too much from me since I seemed to have made rather favorable first impressions on both the fellow and the attending. They're going to be so much more disappointed when they find out the truth about me after initially having this distorted picture of me being highly competent. I would have been much more comfortable if they took me for the rookie I am.
Unfortunately, when I met my current team, fellow and intern a little bit later, Missy handed me an EKG strip to interpret. Despite the fact that I strongly emphasized how little I knew (which as feared, Missy didn't believe) I interpreted the strip correctly as being sinus with incomplete left bundle branch block that turned into overdrive-suppression by a ventricular automaticity focus that paced the heart only slightly above the sinus rate. At that point, Missy completely stopped listening to me when I pleaded that I didn't know what I was doing. So now I was screwed.
She gave me one of the new patients she got today to see and while I was presenting this patient to the attending, I got a glimpse of what was to come when they finally realize the extent of my knowledge. Missy asked me what I thought of the use of "Cardizem" in this case. I truthfully replied that I didn't even know what that drug was. At that moment, I caught a short glimpse of astonished jaw-dropping on Missy's side. I asked her whether that was a brand name and she apologized with a hint of relief that it was diltiazem. After that, I could answer her question somewhat satisfyingly but I'm not sure I want to see what happens when they find out how vague my understanding of things like the anatomy of coronary arteries or cardiology in general actually is.
Still, today was a good day and I can now comfortably watch the new episodes of 24, House and Gilmore Girls, since I don't have to be back in that place until 9am.
Yay!
Blog to you later.
Tuesday, May 15, 2007
Americans.
Morning report today focused on long-term care of patients with chronic conditions like diabetes or hypertension and the difficulties we are faced with in that area. So the first case was on a 64-year-old african american female who was - of course - overweight. We were told the story of how she started out on one medication in 2003 and when her blood pressures never responded in subsequent clinic visits, how her regimen was gradually extended to four different blood pressure medications.
At this point in the slide show, the next slide posed the question "what else can you think of to optimize treatment of this patient's hypertension?" to the audience. I was convinced that I knew what this slide was going to show. To my surprise, what they were looking for here were the questions "is the patient taking her medications?" - all right, good one. "Can the patient afford her medications?" - uhm, I see. "Does the patient have access to her medications?" - as in - can she get her obese self to the pharmacy and back? I guess that's a valid question too. But that was it.
Whatever happened to "Did anyone ever talk to this patient about less McDonalds and more exercise?" Is educating people about sodium intake and physical exercise and the likes of that so out of fashion that it doesn't even come up in a discussion of the management of primary hypertension?
At this point in the slide show, the next slide posed the question "what else can you think of to optimize treatment of this patient's hypertension?" to the audience. I was convinced that I knew what this slide was going to show. To my surprise, what they were looking for here were the questions "is the patient taking her medications?" - all right, good one. "Can the patient afford her medications?" - uhm, I see. "Does the patient have access to her medications?" - as in - can she get her obese self to the pharmacy and back? I guess that's a valid question too. But that was it.
Whatever happened to "Did anyone ever talk to this patient about less McDonalds and more exercise?" Is educating people about sodium intake and physical exercise and the likes of that so out of fashion that it doesn't even come up in a discussion of the management of primary hypertension?
Monday, May 14, 2007
Sociology
Hey reader,
today was another good day.
It started off with me coming to critical care unit rounds at 7:30am that my attending had invited me to last week. When I met them, they informed me though that there'd be a conference on pulmonary hypertension upstairs. Oh and there would be bagels a resident said. Sold!
The conference was interesting. I met Jess there. She told me she'd be doing a lot of right heart caths today so I stopped by there after the conference. There, she just asked me to check up on our old patients - the whole service! Now that would be much more of a shocker if the service had consisted of more than three patients. Muahahah!
This way I had leisure to check out morning report at 10, which was a somewhat-interesting discussion on how the U of C hospitals should extend community clinic services. Between around 11:15 and noon I actually did look up the labs on the patients and checked in on them. I was back in A700 in time for the lunch conference :D .
For the first time (in the history of the residency program as I later learned), there was actually a drug rep there who sponsored the lunch and handed out journal articles and leaflets. I conveniently (but honestly) missed the piece of paper on the wall stating that this lunch was restricted to interns and sub-interns. I guess that's why the rep did not hand out the articles to me. I'm clearly identifiable by my horrible short coat. A second-wave medstudent from Germany whom we had warned was wearing his regular long coat, so he was "welcome" to the lunch I guess.
Well, whatever. I got food.
After I sat down, somehow a conversation with the person next to me began. Turned out that he, as well, wasn't really entitled to his long, white coat. He turned out to be a sociology major, there to observe. His thesis had something to do with social networks in the medical profession and specifically how people are perceived by others, like some people that are deemed knowledgeable by their peers yet not arrogant, but pleasant to work with. Like my current attending. He had been following a lot of medical teams around over almost a year by now and only had time to come to the lunch meeting for the first time today. He, of course, was very interested in what I had to say about my impressions here and I very much enjoyed exchanging them with someone who was in very similar shoes. We both had been thrown into these "teams" that were alien in many ways for either of us. The noon conference on an interesting case of lupus complicated by myocarditis interrupted us, but on the whole we spent about 2 hours talking. And I did have the time to do that. That was so nice.
And with Brainy (who will be a prime subject for his research) and the mentoring program we're trying to build in Germany and differences between US and German systems we did not run out of discussion topics, so we said we'd meet for lunch again some time.
So around 2:30pm I strolled back to the cath lab, where Jess was doing the same thing I had left her with: right heart caths, just got done doing the seventh. While she was almost done, she asked me to page Brainy to find out when she would want to round. Turned out she was right through the doors of the cath lab in the cardiac critical care unit (nice infrastructure!) basically waiting to round with us. I actually brought her into the cath lab, because the first patient we'd be rounding on had just had pieces of his replacement heart removed by Jess.
So we saved ourselves that trip. Mentioning that second patient only evoked tirades from the female rest of the team about what a sexist womanizing jerk he was. Seeking to provoke, as I usually do, I threw in that I liked him. My attending then explained to me that the advantage of her being smaller than me was that she was perfectly positioned for a right hook to my jaw. She demonstrated the movement and I saw her point. Dude, can you imagine a German attending kidding around with a mere medstudent like that?
They ended up deciding that we didn't need to see that patient that day.
That left only one patient to see, which we did. He had been sent to the floor from the ICU today and was ostensibly doing just peachy.
The three of us subsequently chatted pleasantly for a while until Brainy sent us home around 4.
Brilliant!
today was another good day.
It started off with me coming to critical care unit rounds at 7:30am that my attending had invited me to last week. When I met them, they informed me though that there'd be a conference on pulmonary hypertension upstairs. Oh and there would be bagels a resident said. Sold!
The conference was interesting. I met Jess there. She told me she'd be doing a lot of right heart caths today so I stopped by there after the conference. There, she just asked me to check up on our old patients - the whole service! Now that would be much more of a shocker if the service had consisted of more than three patients. Muahahah!
This way I had leisure to check out morning report at 10, which was a somewhat-interesting discussion on how the U of C hospitals should extend community clinic services. Between around 11:15 and noon I actually did look up the labs on the patients and checked in on them. I was back in A700 in time for the lunch conference :D .
For the first time (in the history of the residency program as I later learned), there was actually a drug rep there who sponsored the lunch and handed out journal articles and leaflets. I conveniently (but honestly) missed the piece of paper on the wall stating that this lunch was restricted to interns and sub-interns. I guess that's why the rep did not hand out the articles to me. I'm clearly identifiable by my horrible short coat. A second-wave medstudent from Germany whom we had warned was wearing his regular long coat, so he was "welcome" to the lunch I guess.
Well, whatever. I got food.
After I sat down, somehow a conversation with the person next to me began. Turned out that he, as well, wasn't really entitled to his long, white coat. He turned out to be a sociology major, there to observe. His thesis had something to do with social networks in the medical profession and specifically how people are perceived by others, like some people that are deemed knowledgeable by their peers yet not arrogant, but pleasant to work with. Like my current attending. He had been following a lot of medical teams around over almost a year by now and only had time to come to the lunch meeting for the first time today. He, of course, was very interested in what I had to say about my impressions here and I very much enjoyed exchanging them with someone who was in very similar shoes. We both had been thrown into these "teams" that were alien in many ways for either of us. The noon conference on an interesting case of lupus complicated by myocarditis interrupted us, but on the whole we spent about 2 hours talking. And I did have the time to do that. That was so nice.
And with Brainy (who will be a prime subject for his research) and the mentoring program we're trying to build in Germany and differences between US and German systems we did not run out of discussion topics, so we said we'd meet for lunch again some time.
So around 2:30pm I strolled back to the cath lab, where Jess was doing the same thing I had left her with: right heart caths, just got done doing the seventh. While she was almost done, she asked me to page Brainy to find out when she would want to round. Turned out she was right through the doors of the cath lab in the cardiac critical care unit (nice infrastructure!) basically waiting to round with us. I actually brought her into the cath lab, because the first patient we'd be rounding on had just had pieces of his replacement heart removed by Jess.
So we saved ourselves that trip. Mentioning that second patient only evoked tirades from the female rest of the team about what a sexist womanizing jerk he was. Seeking to provoke, as I usually do, I threw in that I liked him. My attending then explained to me that the advantage of her being smaller than me was that she was perfectly positioned for a right hook to my jaw. She demonstrated the movement and I saw her point. Dude, can you imagine a German attending kidding around with a mere medstudent like that?
They ended up deciding that we didn't need to see that patient that day.
That left only one patient to see, which we did. He had been sent to the floor from the ICU today and was ostensibly doing just peachy.
The three of us subsequently chatted pleasantly for a while until Brainy sent us home around 4.
Brilliant!
Sunday, May 13, 2007
Catching up
Hello readers,
I grew a bit tired of blogging, which is strange since I have basically way fewer patients to see and therefore more time during the day.
On Wednesday, yet again, my attending changed. And if I was impressed with the last one, this new one is even more incredible. She has never admitted to her actual age, keeps making up numbers jokingly. So I'll have to guess her at around 35. She's born in Chicago, daughter of a sociology major and a physician somewhere in Switzerland, I think. She studied European history in college, which is where her comments about Hegel she shot at me during rounds must have come from.
When I first saw her, in the ER, she was in the middle of listening to the presentation of a patient by the ER resident. She was scribbling down things on a pad, looking up the patient's labs and sending text pages on the computer while intermittently grabbing the phone when her pages were answered. In between, the attending shot short questions towards the resident when she had forgotten to mention something. She would talk fast, but friendly. It seemed like she could remind you that the thing between left atrium and ventricle was the mitral valve and still make you believe that it wasn't a big thing to forget and that it could happen to anyone. In the middle of all of this, one of her ever-moving hands reached out towards me, she smiled and introduced herself to me with her nickname and last name. I had time to shake that hand and say my own first name (I have given up using my last name permanently over here) before the fraction of her focus I was allotted at that time was taken away again. I didn't mind, on the contrary, I was pleased with her productivity. Rounds would be good.
And I thought Jen was the embodiment of the ability to multitask - this new attending was like Jen with a quad core processor.
A resident I know from renal consults, who is now on the ICU team that the new attending also rounds with, found a nice way to describe what her impact on her surroundings is. While the new attending - let's call her Brainy (heheh) - was busy working up a patient with the rest of the team and the ICU staff, the resident and I stood to the side and he muttered to me
"dude .. she's like a tornado."
True. But now in this picture that I've drawn so far, you'd probably imagine Brainy to be excited or appear stressed-out. And here's the strange thing, that couldn't be further from the truth. She's more laid back than almost any attending (except for the first one I had over here, no one can match that guy when it comes to taking life easy). She'll never speak in anything but a calm tone albeit fast and direct. Every other phrase coming out of her mouth will be ironic or funny in some other way but to the point. At the same time, she will never try to make you feel inferior (you just inherently do) despite the fact that the collective jaws of the heart failure team will drop every so often when she just never seems to run out of answers to just about any question there is.
For example - a patient post heart transplant turned up with undulating fevers that no one in the hospital could find a reason for in the past weeks. Outside the patient's room, while flying through the pages of the chart, Brainy asked for the patient's tacrolimus level (an immunosuppressant for the transplant). It was rather high. Brainy frowned a bit, skipped ahead to the medications list and then asked the nurse practitioner to hold his tacrolimus dose for three days. She also said that they shouldn't even bother drawing blood for another level tonight, it would be high again. Naturally, the team sported blank expressions and one of us managed to blurt out the question how she came to these conclusions. She pointed at the medication list, specifically a rather new order of voriconazole and looked at us with wide, but friendly eyes. This didn't help us much so she quickly explained that voriconazole will inhibit cytochrome P450 3A4/5, which is responsible for tacrolimus metabolism. Uh-huh. Well - you can still write this off to being her tools of the trade. She's in heart failure and involved with a lot of transplants. Big deal. But it got better.
After asking this same patient questions that we could halfway relate to about contact to kettle, cats and rabbits the patient said he hadn't had any contact to those kinds of animals. Oh, just his niece had brought a turtle. Instantly, Brainy asked the nurse practitioner to add cultures for salmonella. Turtles have salmonella? Of course they do. Did any of the rest of the team know that? Nope. After Brainy imparted some more wisdom on the patient (including how to clean your ears without a q-tip) we left that patient's room and Jess confronted Brainy with "how do you know all this?". Brainy just downplayed it as not being a big deal as she would always do.
But this woman is not limited to theoretical knowledge. We rounded on another patient who had broken his leg while carrying another person's heart in his chest (which is where we came in). He was going to be operated on by ortho as soon as the swelling in his leg would go down and his platelets (that were down for some unknown reason) were back up. Now, cooling the leg would have been helpful with the swelling, right? So Brainy asked the primary team's resident that took care of the patient why there was no ice on the patient's broken leg. The resident replied that he had written for it, but the nurses couldn't do it because the ice packs they had were too small for the leg, they'd always fall off. Brainy abruptly went to the nearest garbage container, took out the trash bag and gave it to me to hold, grabbed a fresh garbage bag that they keep inside these containers, went to the ice machine in the nourishment room, filled it and that was that. While doing all this, however, she would NOT give anyone a hard time about it. She would not even say anything about people having lost common sense and practical skills somewhere around their medical training. I challenge anyone to not even making a single remark in that direction in this situation.
The next day, that same patient was to receive one of those little plastic machines that you blow into for breathing exercise. You know, with the three little balls you have to blow up. The resident said he agreed that he should have received that thing and started practicing the sooner the better but the nurses just hadn't gotten around to giving him one yet despite him writing the order. He was a rather tall resident, so he had to duck when Brainy opened a closet high up on the wall right in front of the patient's door. It contains a number of frequently-used items in patient care, such as urine cups, syringes, foley bags - and the little plastic breathing exercisers. She took one and handed it to the resident. She also advised the patient to drink a lot of cherry juice and stay away from watermelons during the summer. By now, I have totally forgotten why but I'm sure it makes total sense just like all the other pieces of knowledge this attending has been spraying out.
Can you tell I'm a fan?
Now don't get me wrong, I believe I couldn't stand her personally if she kept up the pace she brings to work every day. But since I only see her at work and we have a minuscule patient load I get to profit immensely from her - since she enjoys teaching.
Problem is that CS, Jess and Brainy all keep stacking journal articles on me "to read" - the number of these being only directly proportional to the amount of bad conscience I come to work with, since the number of articles I'll read will remain constant right around zero.
In other news, after interviewing the director and an associate director of the residency program in internal medicine the chicagoans got together
and worked on the mentoring system we're supposed to institute at our medschool back in Munich. It's slowly taking shape and at least I for one believe that it's going to be an extremely cool program.
And on Friday all of the chicagoans came to Looptopia - a brand new festival premiering this year in Chicago celebrating the loop.
There were artists on the streets and numerous events all over the buildings around the loop. It wasn't that much of a success for us though, since we didn't have much of a plan of what events to go to and we ended up waiting in line most of the time and giving up and walking out somewhere halfway through.
Allright, that should do for now and keep you busy. I'm off to do happier things like finally finishing that book on EKGs or something.
Blog to you later.
I grew a bit tired of blogging, which is strange since I have basically way fewer patients to see and therefore more time during the day.
On Wednesday, yet again, my attending changed. And if I was impressed with the last one, this new one is even more incredible. She has never admitted to her actual age, keeps making up numbers jokingly. So I'll have to guess her at around 35. She's born in Chicago, daughter of a sociology major and a physician somewhere in Switzerland, I think. She studied European history in college, which is where her comments about Hegel she shot at me during rounds must have come from.
When I first saw her, in the ER, she was in the middle of listening to the presentation of a patient by the ER resident. She was scribbling down things on a pad, looking up the patient's labs and sending text pages on the computer while intermittently grabbing the phone when her pages were answered. In between, the attending shot short questions towards the resident when she had forgotten to mention something. She would talk fast, but friendly. It seemed like she could remind you that the thing between left atrium and ventricle was the mitral valve and still make you believe that it wasn't a big thing to forget and that it could happen to anyone. In the middle of all of this, one of her ever-moving hands reached out towards me, she smiled and introduced herself to me with her nickname and last name. I had time to shake that hand and say my own first name (I have given up using my last name permanently over here) before the fraction of her focus I was allotted at that time was taken away again. I didn't mind, on the contrary, I was pleased with her productivity. Rounds would be good.
And I thought Jen was the embodiment of the ability to multitask - this new attending was like Jen with a quad core processor.
A resident I know from renal consults, who is now on the ICU team that the new attending also rounds with, found a nice way to describe what her impact on her surroundings is. While the new attending - let's call her Brainy (heheh) - was busy working up a patient with the rest of the team and the ICU staff, the resident and I stood to the side and he muttered to me
"dude .. she's like a tornado."
True. But now in this picture that I've drawn so far, you'd probably imagine Brainy to be excited or appear stressed-out. And here's the strange thing, that couldn't be further from the truth. She's more laid back than almost any attending (except for the first one I had over here, no one can match that guy when it comes to taking life easy). She'll never speak in anything but a calm tone albeit fast and direct. Every other phrase coming out of her mouth will be ironic or funny in some other way but to the point. At the same time, she will never try to make you feel inferior (you just inherently do) despite the fact that the collective jaws of the heart failure team will drop every so often when she just never seems to run out of answers to just about any question there is.
For example - a patient post heart transplant turned up with undulating fevers that no one in the hospital could find a reason for in the past weeks. Outside the patient's room, while flying through the pages of the chart, Brainy asked for the patient's tacrolimus level (an immunosuppressant for the transplant). It was rather high. Brainy frowned a bit, skipped ahead to the medications list and then asked the nurse practitioner to hold his tacrolimus dose for three days. She also said that they shouldn't even bother drawing blood for another level tonight, it would be high again. Naturally, the team sported blank expressions and one of us managed to blurt out the question how she came to these conclusions. She pointed at the medication list, specifically a rather new order of voriconazole and looked at us with wide, but friendly eyes. This didn't help us much so she quickly explained that voriconazole will inhibit cytochrome P450 3A4/5, which is responsible for tacrolimus metabolism. Uh-huh. Well - you can still write this off to being her tools of the trade. She's in heart failure and involved with a lot of transplants. Big deal. But it got better.
After asking this same patient questions that we could halfway relate to about contact to kettle, cats and rabbits the patient said he hadn't had any contact to those kinds of animals. Oh, just his niece had brought a turtle. Instantly, Brainy asked the nurse practitioner to add cultures for salmonella. Turtles have salmonella? Of course they do. Did any of the rest of the team know that? Nope. After Brainy imparted some more wisdom on the patient (including how to clean your ears without a q-tip) we left that patient's room and Jess confronted Brainy with "how do you know all this?". Brainy just downplayed it as not being a big deal as she would always do.
But this woman is not limited to theoretical knowledge. We rounded on another patient who had broken his leg while carrying another person's heart in his chest (which is where we came in). He was going to be operated on by ortho as soon as the swelling in his leg would go down and his platelets (that were down for some unknown reason) were back up. Now, cooling the leg would have been helpful with the swelling, right? So Brainy asked the primary team's resident that took care of the patient why there was no ice on the patient's broken leg. The resident replied that he had written for it, but the nurses couldn't do it because the ice packs they had were too small for the leg, they'd always fall off. Brainy abruptly went to the nearest garbage container, took out the trash bag and gave it to me to hold, grabbed a fresh garbage bag that they keep inside these containers, went to the ice machine in the nourishment room, filled it and that was that. While doing all this, however, she would NOT give anyone a hard time about it. She would not even say anything about people having lost common sense and practical skills somewhere around their medical training. I challenge anyone to not even making a single remark in that direction in this situation.
The next day, that same patient was to receive one of those little plastic machines that you blow into for breathing exercise. You know, with the three little balls you have to blow up. The resident said he agreed that he should have received that thing and started practicing the sooner the better but the nurses just hadn't gotten around to giving him one yet despite him writing the order. He was a rather tall resident, so he had to duck when Brainy opened a closet high up on the wall right in front of the patient's door. It contains a number of frequently-used items in patient care, such as urine cups, syringes, foley bags - and the little plastic breathing exercisers. She took one and handed it to the resident. She also advised the patient to drink a lot of cherry juice and stay away from watermelons during the summer. By now, I have totally forgotten why but I'm sure it makes total sense just like all the other pieces of knowledge this attending has been spraying out.
Can you tell I'm a fan?
Now don't get me wrong, I believe I couldn't stand her personally if she kept up the pace she brings to work every day. But since I only see her at work and we have a minuscule patient load I get to profit immensely from her - since she enjoys teaching.
Problem is that CS, Jess and Brainy all keep stacking journal articles on me "to read" - the number of these being only directly proportional to the amount of bad conscience I come to work with, since the number of articles I'll read will remain constant right around zero.
In other news, after interviewing the director and an associate director of the residency program in internal medicine the chicagoans got together
and worked on the mentoring system we're supposed to institute at our medschool back in Munich. It's slowly taking shape and at least I for one believe that it's going to be an extremely cool program.And on Friday all of the chicagoans came to Looptopia - a brand new festival premiering this year in Chicago celebrating the loop.
There were artists on the streets and numerous events all over the buildings around the loop. It wasn't that much of a success for us though, since we didn't have much of a plan of what events to go to and we ended up waiting in line most of the time and giving up and walking out somewhere halfway through.Allright, that should do for now and keep you busy. I'm off to do happier things like finally finishing that book on EKGs or something.
Blog to you later.
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