How Did That Happen?: Surviving Call

I am way overdue for a How Did That Happen? post yet again.stethoscopes1

This week’s How Did That Happen? is all about surviving call. I did buddy call last weekend with our new first year resident (did I mention I love teaching?) and I have been briefing our other junior resident about what to do in certain situations and stuff like that. It had me thinking back to my first full weekend call as an R1 and my first gen surg call (shudder) and all that good stuff.

  • Like anything else, show up and do your job. Seriously. I have met some mighty lazy people who just want to slack off or get others to do the work. Other people notice. It makes you look bad. It puts patients at risk. And if the other staff get wind of it, they can make your life pretty much miserable.
  • Answer your pages. This goes along with doing your job. I mean answer your pages when you get them. Don’t make people wait if you can help it. Nurses notice if you’re being a jerk and not answering. They will also take pity on you when your pager stops receiving pages in the middle of the day and you failed to answer them the first two times they called (true story, my pager decided to konk out this weekend for about 4 hours… The fact that I am usually answer saved me from a ton of trouble).
  • Trust your nurses and allied health professionals. They are my superheroes. A good nurse can tell when things are going south and give you tips and suggestions when you are new and unsure.
  • If you are rounding on inpatients you don’t know, take the time to skim their chart and figure them and their current issues out, especially if they look unwell.   It can save a world of touble.
  • Before you leave after rounding, ask the floor staff if there is anything else you can do. Sometimes it creates work, but most of the time, it saves calls and it is the polite thing to do.
  • Get handover. I’m serious. It is a huge safety issue. Even if people aren’t seeking you out to give it, check with the regular team if you can. If someone is unwell, find out what the regular team would want you to do in the likely scenarios. Ask for that plan. If they don’t know suggest something. Going in knowing what to do about certain expected issues can make life easier.
  • Give handover. This is the safe and polite thing to do. Find the person coming on the next day and tell them either in writing or in person what happened to their patient, especially if it something that changes the plan.
  • Know who you are on call with. If you are a resident, you will always have at least a staff person on with you. Often, a senior resident too. Know their name and number in case it is asked of you or you need to get in touch with them.
  • Keep notes. Notes about the patients you need to give handover on, notes about things like outside calls. All that good stuff.
  • Ask for help. There are situations that you just can’t handle on your own. Or you aren’t sure of yourself. Do the best you can, but ask for help. Try to know what your plan might be, but admitting you don’t know or trying to figure something out is good learning and much safer.
  • If someone offers to lend a hand, take it. Sometimes, I had more senior residents tell me to text them if something weird came up that I just wanted to run by them. I was immensely grateful to just bounce a plan past someone without having to always run to the staff, especially when it was something simple that I was just new at.  
  • Sleep/eat when you can.  I feel like I say this often. But, I have been burned many times by staying up to wait for that last call or waiting to eat at a certain time. Just do it.
  • Some nights just suck. You can’t do anything about it. Just count down until it is over.
  • Bad stuff will happen on your watch. Someone will die (both expectedly and unexpectedly). Someone will get worse. Something crazy will happen (like a piece of suture hanging out of a drain that nobody can explain). Someone will hate you (because you told them they needed something they didn’t want). Someone may come at you with a weapon (people get creative sometimes).   Someone (including yourself) will make you look stupid (for instance, no matter how many times you tell a certain nurse not to do chest compressions because the person has a pulse and you need to manage their airway because they aren’t breathing, if the code team arrives and that nurse is still doing chest compressions despite your repeated attempts to tell her to stop while you are trying to ventilate because she just wouldn’t listen, they will still think you are the fool because you were “in charge” and it wasn’t even your patient, you just happened to be down the hall and arrived on the scene a minute before to help) know that. Learn from it.
  • Sometimes, you just have to go curl up in a ball and cry because the badness is just too much. Other times, you have to beat the pulp out of a pillow. And at times, you will need to leave a room to laugh your face off.
  • That paniced feeling of not having a clue what you are doing subsides. I don’t know when it goes away. I’m not there yet. It still comes in waves.
  • Have good references on hand. Don’t be afraid to look stuff up.
  • Prioritize your time. There are times where you are pulled in a million directions. Know what needs to get done. The sickest people are your priority. Computers and phones make good friends to help with reviewing results and doing quick orders.
  • Document stuff. Because, as above, bad stuff will happen on your watch. So does good stuff. The medical record is important, both for patient care and legal purposes. Plus, the day team will appreciate knowing what all went down.
  • If you are sick when you start call, odds are you will be sicker when it is over. One night, the nurses on a certain unit found it both sad and humorous that over the course of the night, my voice disappeared and my cough/breathing progressively got worse than half the patients I was managing. The whole illness being worse at night is amplified if you don’t sleep.
  • If you do home call, don’t forget things like your stethoscope. Nothing is worse than carrying your tired body back to the hospital at 3am only to realize you have to use one of the crummy “fisher-price” stethoscopes because yours is in your other bag.
  • If something can wait until morning for the regular team to take care of it, then let it wait. They might have a plan you weren’t aware of.
  • If you feel annoyed at that 2am call for Tylenol or a sleeping pill, just be glad it isn’t a new onset fever in a chemo patient or wound dehiscence.
  • Hospitals often have mice or rats. They come out when normal people are sleeping. Brace yourself.
  • There is a rule when it comes to call… If you have big plans the next day, stuff to get done, etc. it will be busy.  That being said, always bring something to do if you have down time.  But, know it will likely be interrupted.
  • Phone chargers and tooth brushes make the stay in hospital much better. So does take-out!

What are some of your surviving call tips?

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How Did That Happen?: How to schedule in order to optimize both life and learning

I am spending this weekend on call.   And the first weekend that it has seemed really summery here. My timing is impeccable.Thank goodness for home call.

This week’s How Did That Happen? is about scheduling. I call it “how to schedule to optimize both life and learning.”stethoscopes1

I had this conversation with one of the other residents in the program last week about how to schedule vacation and calls and life to try to optimize learning and good quality time to do those things that we want to do. It is tricky to say the least. Sometimes it just doesn’t work.  t have something on the go every weekend in July, so scheduling call and church set-up duty and things this month coming were logistical disasters.

As usual, I don’t have it all figured out. And I am pretty sure there is no magical formula.

  • Not every rotation gives you the luxury of picking call or even requesting days to not be on call if you don’t have formal vacation booked. Sometimes, you just have to work on a certain day. Make the best of it.
  • If you get scheduled for call or a shift when you have something planned or something comes up, try to trade with someone. This may not work because others may have plans or may just be jerks. I have encountered both.
  • If you don’t have something on the go and someone asks to switch shifts with you and you have no good reason not to, switch with them. What goes around comes around.
  • Keep a calendar with important dates on it. Refer to said calendar in advance. The more notice you can give people of shifts you can’t take or time you want to request off, the better.
  • If you get guaranteed post-call days, make use of them. The afternoons are prime times to go to appointments, run errands or even travel (ensure sufficient rest if you are the one driving). Some of my best post-call days were used to go on café dates with the husband, travel home or get important shopping done.
  • Use call to your advantage. If you are lucky like me, your contract might stipulate that if you work on a statutory holiday, you get a day off in lieu. That means it is another day that doesn’t count against vacation time to use at another time (in my case within a couple months of the actual holiday). This is great for constructing a long weekend or getting an extra day to study or work on research.
  • Choose your vacation wisely. We are allowed to break up our vacation any way we want, so long as we don’t miss more than ¼ of any rotation. I have seen people take it all in the first couple months and then had nothing left or not used it and were stuck trying to take days excessively at the end of the year.
  • Being allowed to break up your vacation is advantageous in that you can take a day or two and tag them on to weekends you know you are off to make long weekends instead of just having one week.
  • Conferences are your friends. We get funding and time to go to certain conferences while some other departments might allow a cetain amount of tiem to go to whatever conference. They can be in really nice places and taking extra vacation around these can lead to you getting to enjoy a place you might not have otherwise had the time or money to visit while getting some learning in.
  • Keep in mind that things like exams and presentations are often scheduled in advance. Try not to be on call the night before and if possible schedule them at times where rotations and your life aren’t too hectic.
  • If you are married, both call schedules and vacation schedules should probably be run by the spouse.  Sometimes, it feels like we are a logistical nightmare, but every once in a while we have a scheduling “win” and get some extra time together.
  • You can’t do everything.  Sometimes you just have to say no to things.
  • You need to do something fun.  Try scheduling in mandatory fun time.  Or, if that isn’t an issue, schedule mandatory homework time.  Or both.
  • If you pick your call, try to do the same day every time, so it is easy to remember.
  • If you pick your call, try not to be on call before special teaching events or things you will end up missing if you are post-call.
  • Use your time wisely. Seems simple. But its not.
  • Know that despite all of your planning, something will go wrong. Your exam will get rescheduled three times, your relatives will die, you will get sick.
  • In the end, you will work about the same amount and be off about the same amount, so it is not the end of the world when something doesn’t work out. You win some and you lose some.

How Did That Happen?: How to survive rotations you hate

This week’s installment of How Did That Happen? is all about surviving rotations you hate.stethoscopes1

I know, there are people out there in the world who love all of medicine and enjoyed every single rotation they did. I am not one of those people. I tolerated every rotation. I did well on them. But, I did not see myself living in that department much longer than already required.

  • First of all, refer to the post on trying to be a good resident.  Trying to be a good resident or med student is always a good launching point for surviving any rotation.
  • Feign interest. I’m not talking being over the top. Just show up and act semi-interested and participate while not complaining.
  • Don’t lie or suck-up. Nothing is more annoying than that kid who always has their nose in the staff’s butt, no matter what rotation you are on. They always want to do this forever and love everything. If you like something, then say so. If you don’t, stop faking it. People can see through it or pick up on it over time. It makes you look bad. And annoying to the people you work with .
  • Be positive. Some days this is harder than others. But, don’t sulk around and be miserable. Find the bright sides in the rotation… Where this will help you in the future, how you are helping others… Those sorts of things. And cling to them. Especially when people ask what you think and your first thought is to say it sucks.
  • Look on the bright side. This is kind of like being positive, but moreso in your own head.   Think of how things could be worse or how much you have already completed or other milestones that get you through (like vacations, weekends, post-call days, academic half days).
  • Do your job. If you are on a rotation and you have a job to do, do it. Simple.
  • Figure out what you like and stick with it.If you can’t leave the rotation, join them. What aspects make you want to gouge your eyes out less? When I was on Radiology, I rewarded myself with Nuc Med stuff once a week. On Gen Surg, I would volunteer to do clinics because it was better than going to the OR.
  • Go the extra mile in ways you can handle.If you are a procedures person, offer to do the procedures you come across (even if they are few and far between). You are more theoretical? Volunteer to do the journal club or presentations. Even if you are bored or unhappy, taking steps to do things that show your interest in some area is better than nothing.
  • Don’t be afraid to try new things. Sometimes, the stuff I think I will hate the most is the stuff that turns out to be okay. I generally say I don’t love procedures. I do, however love debriding wounds and pulling drains. I wouldn’t have known if I didn’t try.
  • Set goals.My program often doles out giant lists of objectives for every rotation. It is good to know what you need to do or even what you want to do, so that you can focus on getting it done (and getting the bad pieces over with). Plus, it can direct studying and such, so you hopefully don’t have to do it again.
  • Have a good support network. Have good people around so that when you have a rough day or are working with ridiculous people, you can vent and bounce ideas off of them. There are some rotations where my rant days outweighed the good days, but that is life.
  • Do other stuff. Some rotations eat your life. Sure, you might work a million hours and study most of the rest, but take time to go to the gym or eat out with friends. It keeps a person sane, especially during the rough stuff.
  • Remember other people survived this too. There has to be some way out if everyone does it.

What are your surviving bad rotation tips?

My head hurts (welcome to pathology)

My head hurts.

Translation: Welcome to your Pathology rotation.

Yes boys and girls, despite me swearing after my med 4 pathology elective that I would not do pathology again, here I am back at it for the last 4 weeks of PGY2.

Pathology is neat.  I like knowing what things look like and seeing stuff that causes disease.  I really enjoyed my rotation in med school.

I do not like microscopes or formalin.

Neither does my head.

I had hoped that because I am on different migraine prophylaxis, off combined OCPs and in better shape this would not be as much of an issue.  It isn’t as much of an issue.  Day two and no migraines, which is shaping up to be better than the first time around where I had a migraine on day one or two and every couple days thereafter.  But, I have had daily headaches.  And those are still not cool.

I need to drink more water.  And maybe getting back to the gym will help.

Perhaps this is just a blip and it will get better.

I have already learned a bunch and I can sense I will enjoy this pathology rotation even more than my med school rotation by virtue of how much I have already learned and how many teaching sessions and interdisciplinary rounds are going on.  Plus, my learning is targeted toward oncology, not entirely randomness. I am okay with spending my evening reading about gastric cancer pathology reporting and staring in microscopes half the day when it means that I will better understand the disease in the end.

I will have a good rotation.  Even if my head is trying to disagree.

 

Lost

I lost my med student today.

I don’t lose things.

Apprently, I can lose people.

Somewhere between the consults at the three hospitals in the city, he went missing.  I paged and there was no answer.

In the process of trying to find said med student, I could have seen the consult myself.

When we finally did reunite, it turns out he wandered between the two other hospitals looking for the outpatient chart I had on my person to try to make things more efficient.

I have no idea how I didn’t somehow run into him on my way back and forth.  But somehow we just missed each other.

And, it isn’t intuitive that one of the hospitals (the one I was paging from) isn’t “in house” and thus will ring busy if you don’t dial 9 first from the other hospitals to return the page.

At least I ate and figured out the consult while trying to find the med student.  He didn’t eat.  And the afternoon was insane, so by the time we headed out, he was about to eat one of his own limbs (in my defense, I insisted he get food while I finished that consult and before the scope we were going to, but he was worried about getting lost/missing something).

Needless to say, I had an apologetic shadow for the rest of the day.  And understandably so… I would have done the same thing if I were him.

I just plain felt bad (although I also saw humor in the situation).

I don’t think I was ever lost for that long, although I was lost before.  I do remember working with another med student when I was a med 4 who was always going missing.  And not accidental missing, sketchy missing.  We started using their name as a verb meaning that people were missing intentionally… We called it pulling a “Ricky.”

I am glad that I am no longer someone that has to follow or find someone all the time.  Just most of it.   It is still a bit more freeing.

Medicine is terrifying in that you are always being evaluated and judged.  ALWAYS.  So, when stuff happens and you miss something or look like you aren’t there, it is really frightening.

The thing is… It happens to everyone to some degree. 

Also, it is nice to not eat his face with rage because of a simple confusion and normal lost-ness.  A courtesy I wish was bestowed on me from time to time.  Do unto others, as they say.

Plus, it is funny that I can say I kind of lost a person.

The last lesson in this is that a single city SHOULD have one hospital building with one in-house calling system.  Just saying.

And… Switch.

It is switch it up day again.

I still hate changeover days.  I don’t like the unknown of going to a new rotation.  I dislike finding new offices, sorting out times to go to new clinics and all that stuff.  The unknown kind of sucks.

I was really sad to leave Peds Onc.  Minus my episode of semi-depression after the first week and a half, it has been a fabulous rotation.  Kids and Oncology… Not much else more to love!  At least to me as an Oncology resident who not-so-secretly sometimes wonders if Peds is the place for her.

Seriously, it was a great rotation.  I learned how to do cool things like lumbar punctures (poking needles in spines… and administering chemo) and bone marrow biopsies.  And I don’t even like procedures, but those are similar to taking blood and I do get strange kicks out of taking blood.  I learned a ton about kids cancer and chemo drugs and such.  But the bigger piece is that I got to know some super awesome families and play with some fabulous kids.  I actually followed some kids almost weekly in clinic, and a few of them I followed from diagnosis as an inpatient.  In the world of a resident where you are forever darting in and out of services, that kind of consistency is pretty exciting.

Now, I am off to Family Medicine.

My Dad that I should get a by and not have to do it given the med school I went to.  Not so much.  But it is true, I have already done over 12 weeks of Family Med and another 4 of general community Internal Medicine (which in some contexts is still a lot of primary care).  That makes me feel prepared for the rotation, at least.

Family as a med student was one of my best and one of my more liked rotations, but part of that was the doc I worked with was a person I got along with famously.  It helps.

My orientation was good.  The clinic is nice.  I am fascinated by the electronic medical record.  It will be my first time using one in a non-hospital setting.  I am intrigued because I am very pro-EMR (seriously, I wrote a whole health systems paper on them during undergrad).

I start with my first patients tomorrow in clinic.  Whoo.  I find the hardest part is figuring out what people want and what things I need to review and what things I need supervision for.  It seems everyone is different, so it is always a process.

The thing I am most angsty about is that the service also covers their own obstetrics.  Although this isn’t the main thing I am supposed to be doing, I may have to go to a few deliveries (so not my thing), although I will be thrilled to do some prenatal visits (my favourite thing after seniors and babies).

Such is the adventure of new rotation.  You take the good with the bad and figure the rest out as it goes.

This is rotation number 12 of residency.  Our physics exam is at the end of the month, then we are done that for the “year.”  I will no longer be a PGY 1 in just two months (eep).  It is crazy how this stuff flies by.

Procedure

Image from hoMed.

“Hello, my name is Trisha.  I am the junior resident.  No, this is not my home service.  Please, let me now stick a needle in your abdomen.  Of course I know what I’m doing.”

Such is life off-service.

I am now back in the world of livers again, which means I am back to doing paracentesis (aka draining extra fluid off of people’s bellies).  It is an immediately satisfying procedure in that you see instant results.  It is dismaying because people often reaccumulate the fluid quickly and you have to do it again in a few days to months.

I am not a procedure person.  I never have been.

Don’t get me wrong, I do them.  And I am decent at them (although also a bit slow and shaky).  But, I don’t derive the same sort of joy other people do in performing procedures.

Most of the people I went to med school with liked their given field for the procedures.  You get to do blah to people.  And they get a big kick out of that.

This is what happened to us on procedure day… Casts, IVs and blood draws all around. Plus some pig guts and dummies to boot. Image from medschool.lsuhsc.edu.

I remember med school procedure days.  I thought they were neat.  I love the feeling of fresh casting material and it was fun to be better at taking blood and doing IVs than average (thank you undergrad), but I was never as pumped as some of my peers.  They could practice hand ties and sew pig guts until the cows came home.

Maybe part of it was that I have always struggled with fine motor skills.  And I hate not being the best at something (and I will never be the best at most surgical-type interventions).

Another part of my procedure issue is that I just plain find it bizarre how we learn in medicine by practicing on real people.  Its not like we can learn on fake people.  And we do sometimes get to do stuff with dummies or each other first.  Some things just need to be done on real sick people.  But, nothing is more awkward than telling someone, “yes, you are indeed the first person I have done this to.”  I don’t know many other professions where you actually torment live people (under adequate supervision) for the sake of both learning and their theoretical betterment.

I am a person who learns by reading and understanding, so the whole “see one, do one, teach one,” thing is irritating when I have yet to read about one.    I generally like all procedures better once I have a few under my belt.  Because then I don’t feel like a bumbling fool (or at least less of one).  Competence is a requirement for me to like something, me thinks.

When I was in Nuc Med, I loved injecting radionuclides.  I loved taking blood.  But, it was that along with the other stuff.  The other stuff made the bits of hand-eye coordination cool.  I worked in Specimen Collection for a summer and it was quite possibly the worst job ever.  In fact, I use it to this day as a standard to compare all other terrible jobs… Gen surg is the only thing that came close.  I liked taking blood.  I did not like doing it 8 hours a day, 5 days a week.

My Nuc Med buddies teased me because I have a ridiculous tremor when I do take blood and such.  It scares people at first, but I really am quite competent (and the tremor diminished with increased practice and caffeine tolerance).  They made me promise when I got into med school to not do surgery ever.  Because my tremor would terrorize everyone.  Have no fear folks, that isn’t the only reason I won’t do surgery.

I picked my field for the variety.  And because once I am out, I have the option to not do a whole heaping lot of time-intensive technical procedures.

I like giving immunizations.  I am cool with the odd blood draw (just not an 8 hour day consisting of 100+ draws).  I will do your pap or use a scope to peer at your larynx or sew something up once in a blue moon.

I, however, can’t do that all day.  Or every day.  I love my sit-down chats with people.  I love clinical medicine and tolerate procedural medicine.  I enjoy paperwork and computer work, but most of all people work.

As cool as it is to impale people with large needles and suck fluid out to make them feel better, I like making differences in other ways (like prescribing drugs or radiation or talking).

My kind of instruments! Image from benitaepstein.com.

It is a personal preference.  I know it is an important part of medicine.  And some aspects of Rad Onc are super procedural as well.  It is all about what you make of your practice (and what sites you focus on and how much time you spend on certain sites).

Will I do procedural stuff?

Heck yes.  Everyone does.  And some of the sites I think are cool may require me to do procedures.  And I am fine with that, if I like the procedures and I get the variety that comes with the career I chose.

I will also enjoy the procedural stuff more when it is better within my comfort zone and training niche. Knowing what one is doing and its relevance to the care of your own patients is huge in enjoying it.  At least it is for me.

It is good to know what you like or not like.  But, sometimes I wish I could get the same kicks out of sewing or impailing that other do.  Instead, I grin and bear it and take joy in the fact that it helps that person and that once I grow up, I will be able to somewhat tailor my practice (or defer to the off-service junior resident… Muahahahaha…. Okay, not so much).

Things I Wish I Had Known Starting Residency

It is the first Monday of the month… You know what that means!?!  It is Medical Monday.  Use the handy-dandy button below to check out other medicine related blogs of all sorts involved in the blog hop!

Today, I decided to do a top ten sort of post.

I have had a chance recently to think about some of the things I wish I had known before starting residency.  But, when thinking about that, I realized that most of this stuff was actually stuff I had been warned about or stuff that I learned the hard way in med school too (I made a list of things I wish I knew starting med school last year). Clearly, I am a bad listener, at least on the advice front.

  1. Carry snacks and change for coffee in your pockets.  There are many, many times when you may have a delicious lunch waiting in your locker, but you just can’t get to it.  And you will get hungry.  And pre-syncopal.  Have food on-hand.  And be ready to buy coffee or snacks when you pass places that offer that opportunity.  Today was a no lunch until 2pm day and I really wished I had a snack with me… I had a single Cert.  Suboptimal.
  2. Have a pen and paper with you always.  You will get paged to see someone.  You will forget that person’s name or location should you not write it down.  Writing it down will also ensure you do get that info.
  3. Sleep when you can, eat when you can, pee when you can.  You would think it is obvious.  But, there are a million times where I could have laid down for a nap and wasted time reading blogs and wound up staying up the rest of the night with a sick patient.  Or when I had time to grab food or run to the washroom, but I waited because I would have more time in “a while,” but “a while” was a long while.
  4. On the way to a code, the first thing you should do is check your own pulse.  A tidbit from The House of God.  It is true.  You panic sometimes in the crazy situations.  Taking your pulse for that second on the way down the hall makes you focus on something aside from you nerves.  Especially those first few times.
  5. Don’t be afraid to call for help.  This is something I really struggle with.  I like to figure things out on my own.  But, when people’s lives are at risk and when you get stumped, it is better to ask for help sooner rather than later.  Lots of people know plenty about plenty of things… RTs are fabulous with helping with ventilation, nurses are a wealth of knowledge and radiologists can help you figure out all kinds of weird films.  Not to mention there is always a senior or a staff person available when things get hairy.
  6. With the power to write your own prescriptions and orders comes power… And fear… And signficantly more phone calls.  To minimize calls, it is useful to write legibly, add details where needed and discuss complicated orders and regimens with the people involved.
  7. Make time for yourself, your spouse and your friends.  It feels like you have time for nobody except work, but time with these people, even if brief can make you feel a world of better.
  8. The salary stinks.  Compared to the hours worked, you still make no money.  At least you can pay rent.  But, until you get the same pay for a 60 hour per week rotation for a 90 hour per week rotation, you realize it.  That and the fact that it still is tight for money.
  9. People don’t get residency.  They don’t get med school fully and residency is, in a sense even more bizarre because you are neither student nor staff physician.  Just get used to it.
  10. As dumb as you feel, everyone else felt approximately just as stunned (or they were cocky and potentially dangerous).  The stupid feeling is what protects you from doing far more stupid things.  Part of growing in knowledge is learning what you don’t know.
  11. It does get better.  I keep hearing this.  I do believe it… I think.

What residency wisdom do you have or did you wish you had?

“She’s tough, she went to med school in _____”

The other day, I was seeing a patient who was floridly delirious who began screaming and telling me off.

As much as it took me aback, this isn’t exactly something unusual.

In fact, in the hospital, lots of people become confused and some become aggressive like this.  I continued to calmly speak to him and redirected him.  He calmed down.  At least for a little while.

Unknown to me, the other resident and the clerk were walking by the room when this was happening.  This is apparently the conversation that followed.

Resident: Wow, that guy is pretty agitated.  Maybe we should go see if he’s okay.  He is Trisha’s, though, right?

Med student: Yes.  But still.  It sounds kind of wild.

Resident: Wait a minute…  Trisha is in there.

Med student: I hear her voice.  Should we go in and help her out?  It sounds kind of bad in there.

Resident: Nah, she went to med school in N____, she’s tough.

Med student: I suppose.  All the fishermen and drunks and rural stuff.  Are you sure?

Resident: Yeah.  See, its fine.

Both laugh at me when I come out and recount the story.

Ninja doctor. That would help with some difficult situations. Image from surbrook.devermore.net.

The thing that struck me funny about this conversation was the whole “she went to med school in N____, she’s tough,” line.

It is kind of true.  There are stereotypes sometimes for a reason.

Maybe.

I worked in a lot more rural settings and thus saw a lot more people on my own.  We were a smaller school, so in turn, we get a lot more one-on-one teaching and more of our own patients.

A lot of people drink there.  I don’t know it is proportionally higher, but it is an issue.  And once you have to debate through a few emerg consults with drunken patients, you learn.

Plus, at my school, we were actually coached through sessions with fake delirious patients as a part of our teaching.  And we spend a lot of time on medicine clinical teaching units during clerkship.  So, I guess I am tough.

Whether it actually makes me tougher than other people from other schools, I don’t know.

But it is good to know my colleagues at least think I can survive.

It is funny, though, because generally, we have been known for communication skills or some of the nice fuzzy stuff.  At least that is what I have been told.  Not for our secret ninja skills.

Image from lostsarawakdoc.blogspot.com.

I don’t ooze toughness.  One of the same guys teased me the other day that I seep sunshine and rainbows out of my butt.  Also true.  But, I can hold my own in a difficult situation.  Maybe partially because of the sunshine and rainbows, but also because I can switch on an intense seriousness.

I guess I am tough in the able to handle getting crap from people in a clinical setting kind of way.  I would just never really think of it as based on the geography of my med school.

The whole thing cracks me up a little.

Eep… ECGs

Image via healthtap.com.

ECGs terrify me.

Not the getting them part, although the the prospect of exposing my bosom to a stranger is not overwhelmingly thrilling.

I hate reading them.

Although things are getting better.

I learned to take ECGs when I was in Nuc Med, as we need to do both 3 lead and 12 lead ECGs for some of the tests.  That was fine.  I just knew what looked super abnormal to correct lead arrangements.

In first year medicine, we did a cardiology block that was rather intense.  Again, basics of ECGs were covered, but beyond that, not so much.

Then, I kind of forgot about ECGs until clerkship…

Where I went to med school, Friday mornings on Internal Medicine consisted of a kind of torture that begets old school stereotypical medicine… ECG rounds.  Yes, the cardiologists somewhat ironically always provided Tim Hortons coffee, muffins and donuts, so free food was a win.  But, that was countered by the humiliation that came with ECG rounds.

Image from ems12lead.com.

Basically, the residents covering the CCU would hoard ECGs from the week that seemed “interesting” (some of them, depending on who the people choosing the ECG, were moreso cruel).    Then, on Friday morning, they would be displayed one by one on a projector and the clinical clerks would be picked one by one to interpret the ECG and answer questions.  Sometimes the junior residents would get picked too, especially if things were difficult.

This is somewhat relevant to the adventures in ECG rounds… I wish I had referred to the diagram. I would probably be folding jeans at the Gap. But much more well rested. Image from doctorcartoon.blogspot.com.

It was horrific as a med student.  Because you would know it was coming all week.

Some people were nice about it.  They taught around your mistakes and gave some awesome tips.  Others picked and picked.

I think that colored my perspective of ECGs.

But I did learn, yet I doubted what I did learn.

By the time I started Cardiology this time around, I feel as if I could identify obvious ST elevation MIs and a few arrhythmias.

Image from leadsbank.co.uk.

I feel like the last week of call, minus the endurance sleep deprivation test has taught me a bunch about the management of cardiac patients by osmosis and by fire.

But, when I walked into teaching rounds this morning and a cardiologist was sitting there was an ECG up on the screen, I nearly pooped myself.

I know, that sounds dramatic.  But I had horrific memories of the torture of ECG rounds.

So, we, the three off-service residents and two med students, sat down across from this cardiologist and the ECG.  Nobody else looked as uneasy as I felt.  He chatted and got us to introduce ourselves (in my mind, clearly to belittle us by name).

He asked who would like to take the first one.

I had an out of body experience in which I volunteered.

I think it was a defense mechanism. I remembered that people who went first usually go the easier ECGs and sometimes were treated a bit better.  It was worth a shot.

I totally knew what was going on in the ECG… First degree AV block.

Image from gem.fi.

No face eating.

But, it was early.

And yet everyone had a turn.  And sometimes it took a while to get through an ECG and sometimes people made mistakes, but the cardiologist was helpful and pleasant.

We all started helping each other after we all had a turn.

It was quite possibly the most useful session on ECGs ever.  And not the first one where the instructor was nice, but one of the few I have been in (and those aren’t the ones I have generally remembered).

ECGs are such a bizarre thing to get the hang of (this from someone who did Nuclear Medicine sometimes called “Unclear” Medicine).  Little electrical tracings can say so much and make such a difference in management.

Maybe they aren’t quite as scary as I originally thought.