My Study Buddy

I’m studying.  Again.

You see, I have another sporadically scheduled treatment planning exam this Tuesday.  I had one last Tuesday (which got cancelled… And has yet to be rescheduled… UGH).  It seems that I have a “get me to do something” sign taped to my face.  This week’s topic is Rectal Cancer.  Last week’s was Small Cell Lung Cancer.  We can’t get much further apart.

I spent my morning picking up a few things at the grocery store and cleaning (ah, I do love a clean house (just don’t look in the guest/to-be-baby room or our room)).  I have mac and cheese in the slow cooker and the oven preheating to make some veggie crisps (looked like a good idea on the internet).  Patrick is playing Wii with his little brother with Big Brothers Big Sisters (great organization, by the way).

I decided to hole up finally and get some studying done.

I can’t study on my own anymore.  I have these two study buddies.  One goes everywhere with me, thanks to a little thing I call the placenta.  The other is the feline that can only travel as far as the confines of the apartment (hypothetically).

Jeter has a strange obsession with sticking nearby.  Today, he passed out on my textbooks.  Including the one I wanted to read. 10325749_10153286555099316_5885870976480320603_n

Silly cat.

Plus, the placenta attached study buddy is having a small dance party in my uterus.

Clearly these folks are not the best study partners.  They did not get the memo.

So, I’m updating my phone and my laptop and writing a blog post.  With a textbook open in front of me.  If it is open, it at least half counts, right?

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Top Ten Books That Kept Me Up Past My Bed Time

It has been a bit since I’ve done a Top Ten Tuesday with the folks over at the Broke and the Bookish. This week’s topic is about book clubs. I would love to be in a book club (no, journal club does not count). But, alas that is not in the cards any time soon (unless you count my plans to drag the Creature with me to the kids programs at our new library once he makes an appearance).5f1e1-toptentuesday

So, I’m going with the freebie from last week. And my freebie item of choice is the top ten books that kept me up past my bed time. And I did not included textbooks that were involved with studying (plus, I don’t often study past my bedtime anyway).

  1. Hannah’s Dream by Diane Hammond. I didn’t know a book about an elephant could make me feel the way this one did.
  2. Gone Girl by Gillian Flynn. Yes, I stayed up late reading the end and then had crazy dreams.
  3. Ten Thousand Saints by Eleanor Henderson. I just cared way too much about these characters.
  4. Looking For Alaska by John Green. Once I hit a certain soul crushing point, I had to keep going just to know what happened.
  5. The Fault in our Stars by John Green. I read this whole book over the course of a call shift and post call day. I got angry when pages interrupted my reading and it took a lot of will power by the time I finally thought I could settle for the night not just to stay up and read (because I was probably going to be woken up anyway).
  6. The Hunger Games trilogy by Suzanne Collins. I’m pretty sure I stayed up way to late reading each of these books while I was away on an elective.
  7. The Case For Christ by Lee Strobel. This really surprised me in a number of ways. I quite liked it and again as a result stayed up to keep reading on more than one night.
  8. The Book Thief by Markus Zusak. Sometimes you just have to know what will happen, even when you already know it is probably not going to be good.
  9. The Silver Star by Jeannette Walls. She draws you in and the next thing you know, you are almost done and might as well finish it the same night.
  10. Twilight and the other books in that series by Stephanie Meyer. Don’t judge. I would allow myself to read one after every exam in Med2 before things got crazy again for a period of time. Between the excitement of reading for fun and the fact that they are pretty engaging books, I wanted to read the whole thing at once.

What books have kept you up late?

Things that keep me up past my bedtime

In order of likelihood to do so…

  • My pager.
  • World Junior Hockey/Olympic Hockey
  • NHL playoffs when the Habs are playing.
  • Travel.
  • Visiting friends or family.
  • An exceedingly good book.
  • Homework.
  • Patrick.
  • Something highly intriguing on TV (including other “less important” hockey).
  • My mind on overdrive (especially dangerous when combined with pregnant uterus sitting on bladder).

My priorities are odd.  Its too bad we spent a week visiting friends and family that wrapped up with last night and tonight being hockey and tomorrow night being on call.  And usually sleep is so important to me (and my work is piling up).

Some someecards that describe this weird relationship the M household may or may not have with hockey.  Don’t judge us too much.

Whoo!  Go Canada!!

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?

Playoffs versus Sleep

Few things can make me stay up past my bed time.

Let me list a few:

  1. Call.
  2. Caring for a very sick relative or friend.
  3. Seeing a very special relative or friend for the first time in a while.
  4. A playoff hockey game.

It is the playoffs.  And my team… The Montreal Canadiens are still in it.  As a result, every Montreal game means that it is hockey night in the M household (during the regular season, I generally only stay up for whole games on the weekends).  That means I have to stay up late every other night for the last almost week.  It also means that I eat more junk food (not good given I can’t run).

Image from the Montreal Gazette.

Yes, I have to.  It is not an option.

Tonight, we cleaned the house.  I did an assignment for my Molecular Genetics rotation and worked a wee bit on my manuscript (almost done the submission for research day).  We are now watching the hockey game and it is around that time I would normally be hitting the hay.

I’ll be sleepy in the morning (and I have to leave extra early because my half crutch/half walk thing I have going on means it takes me about triple the time to get to the bus stop).

And yet, I don’t want this to end.  I will deal with the sleep deprivation of a good long playoff run (I would like to thank residency for training me for this kind of thing).  Preferably Stanley Cup kind of long.

I am a hockey fan.  What can I say?

 

In the Middle of the Night

Last night’s home call, as I alluded to last night, was sub-optimally home.

I had an admission coming from another hospital scheduled to arrive at 9, then 10.  I called the nursing floor around 11:45 after forcing myself (foolishly) to stay awake until I had to go back in to find out that the flight was, in fact, delayed and that they had found this out a half hour ago and didn’t think to tell me.

I decided to go to bed.  Try to get some sleep.

I just dozed off and the pager went off.  A question from the junior covering the floors on my admission from earlier in the evening. Easy enough.

Back to sleep.

Slept for an hour and the pager goes off again.

After the mild freak out that comes with begin awoken from a dead sleep, I call the number back, ever so slowly processing that the number I was calling was not the nursing unit, but the emergency department.

Cue low level frustration.

A stroke to be admitted.  Fair enough.

I grumble, drag myself out of bed, put clothes on and stagger out the door.  By the time I park and navigate my way to the hospital from the parking garage, I am awake  again.  I am really  awake by the time I cut through the waiting room of the emergency department and have someone get mad at me for clearly being a doctor and just strolling in at 1:30 in the morning.  In my head I argued back.  But really, I just ignored them and kept walking.

I saw this consult.  I wasn’t sold on it needing admission, so I held them overnight for tests.  They could have just waited until morning to be seen by neurology.  It would be the exact same outcome.  That made me a bit cranky.  But, it was still a perfectly reasonable call.  Just one that had I known the symptoms were resolving, I might have asked if they could hang on to the person and I would see them later, when I was in to see the admission (whenever that was going to be).

I finished my consult at around 3:30 in the morning.  I called the floor.  Still no word on my admission.

Cue internal rage.

I didn’t want to go all the way home, so I went to pick up a call room key and decided camping out in the hospital would be better.  And safer.

I started singing this song to myself and it made me feel better.

As life works, as soon as I signed out the call room key, my pager went off.  My person had finally appeared.

I got home at 5:45 this morning.

As much as I whine, I feel badly for the poor people who were up all night because of travel, sickness and me making them do crazy things like finger to nose testing at all hours in the morning. Plus, it is my job.

I found this comic from doccartoon.blogspot.com (check out her page) that kind of parallels what it is like getting called in at all hours in the morning.

Last Call… Neuro (not EtOH) Edition

Tonight is my last night of Neurology call.

I am a happy girl.

I am going to be a sleepy girl.

I was already in to admit a stroke.  I know I have a direct admission coming at some point later tonight.  And odds are something else will go down in the next 10 hours.

Exciting parts of tonight were plentiful thus far, though.

I correctly identified a giant brainstem stroke based on exam findings and confirmed it with finding the lesion on the MRI.

Not all strokes are obvious like this. Image from neurology.org.

In correctly identifying the giant brainstem stroke, I managed to actually elicit a few findings on neurologic exam I don’t often get to see like  clonus, unilateral hyperreflexia (complete with 4+reflexes) and an up going babinski reflex (translation: signs of upper motor neuron lesions aka something higher level than peripheral nerves).

Image from meded.ucsd.edu.

Patrick kept supper for me in the microwave.  I got to garnish it with the deliciousness that is Siracha sauce that has become my favourite grocery purchase this week.

*Kind of Spoiler Alert*: Sheldon and Amy on The Big Bang Theory tonight.  So awkward (to the point that they make me feel better about my own level of awkward).  So cute (in a way that I don’t find nauseating).

This was not the episode I am talking about, but I do love these dance moves. Image from fanpop.com.

As much as it sucks that I know I am guaranteed to have to go back in sometime in the next couple hours, I also know that this call is much better than in-house call.  Also, I will likely be in hospital doing this next admission that I will get to be post-call tomorrow and possibly get paid for a full night of work.    The issue is that I will probably also be too sleepy to enjoy most of the day because of my post-call-ish-ness.  I can always hope otherwise, though.  I am getting better at being post-call.  If there is such a thing.

I feel like I could do better than this… Some days. Image from doccartoon.blogspot.com.

Plus, I am looking forward to tomorrow night when I finally get to redeem my Christmas present from Patrick by going to a dinner theatre that is a parody called “The Big Twang Theory.”

Good things.  Good things.

I will need this reminder a bit later tonight when I am sleepier and crankier.

Mama said there’d be calls like this…

Just a warning: I whine in this post.  A lot.

Today was just one of those call days where I was being pulled in 10 different directions at once.

This, after being stuck over two hours (until almost 11)  after my call shift was done Saturday morning when I should have been done at 8:30 because of a 7am consult that took longer than it should have.

I guess it was one of those call weekends.  And such seems to be my luck whenever I have Friday/Sunday call.  Although, theoretically I like the Friday/Sunday better or at least as much as Saturday.

My “home call” adventure had me stuck in the hospital from 8:30 until 6:30.  I didn’t eat, didn’t pee and didn’t even get to finish my morning coffee.  Yuck.

The day’s adventures included being physically threatened by a patient, helping to gather someone off the floor and being barraged repeatedly by a demanding family, plus the usual rounding, emerg consulting and phone answering.

But, at least the home call came to fruition when I got to leave at that point and Patrick got me McDonald’s and flowers as a consolation prize.  And now I am home.  And I am glad that I am not on in-house call where I would be stuck at the hospital and likely even busier than I was today.

I have mixed feelings about this.

Part of me just wants to stay home.   That is the reasonable part of me that is grateful that home call is awesome. But, then I know that means I have to work all week like normal people and that I will be tired tomorrow after the weekend and that isn’t so awesome.

Another part of me wants to get called in, so that I can be in hospital after midnight and potentially be one of those people who capitalize on post-call days.  But then, I will be tired and sleep most of the post-call day (which is what they were for, but I still always dream of being productive or useful on those days).

Either way, I am still glad that it is home call because that means it is theoretically a less busy call with potential sleep in my own bed.  I prefer that over up all night, in-hospital stuff any day.  I just want to whine a little because my weekend was yucky because I was too post call sleepy to enjoy a Saturday off, worked all day today and will be back at it tomorrow sleepy again from a busy weekend.

I also need to remember that busy days aren’t that unusual.  They just seem more nasty when you are on your own and when it is the weekend.

Such is life, though.  And that is how you learn.

I am just glad my time management and medical knowledge is a bit better this year than it was last year or I still wouldn’t be done.

I chose this career.  I need to take the good with the bad, just like everyone else.  It is just sometimes, I look at the bad and wonder why I just don’t quit and pick up a nice regular hours day job (Patrick reminded me that I can’t do that because we would never be able to pay back all my loans or make rent if I quit now).

I’m just glad there is generally more good than bad.

I also wish I could clone myself.  That would simplify things.

 

Prolonged Week (the home call version of post call)

I was on call this weekend.

The hospital ate me.

Nothing serious, nothing that kept me up all night.  Saturday was reasonable.  A few outside calls, the usual rounding.  I got out for a walk, baked cookies and we watched the Habs win on TV between all of it.   But, a steady Sunday with all kinds of hiccups and issues that made me want to facepalm repeatedly (like losing a scheduled admission patient for 4 hours only to find out they weren’t able to come in until around 8pm… Please note… We are not a hotel!)

Luckily it was home call, so after working all week, then most of the  weekend, I got to get up and start another week again.

Oh, and my brother in law arrives  for a visit tomorrow.

Thank goodness I have an awesome husband who helps around the house.

And I wouldn’t trade my full weekend home call for in-house call for anything.

Too bad I can’t call in exhausted and in need of a good housekeeper.

I had such a good run of call.

It is either feast or famine.

On a semi-related note, today is Medical Monday.  To check out much more eloquently written (though possibly at times equally sleepy) posts from medically related folks, check out the link here.


Some random tidbits

I don’t know what to write about it… So, boys and girls, it is time for random tidbits from my week for your reading pleasure.

Patrick got me these lovely purple-pink carnations for my birthday.  He then looked up carnations online and discovered that they are toxic to cats if they eat them and can even apparently cause a skin condition if they touch them.  Now said beautiful carnations are kept in the spare room with the door closed.  They are nice.  I wish I could enjoy them more.

I worked at 4am yesterday and the doctor I was working with asked me if I wanted a stimulant.  I looked at him confused and stared blankly.  He took that as a yes and returned with a coffee.  Suddenly it all made sense to me.

Today, at Costco, I was looking for a new pair of pants for exercise.  I saw some fantastic looking ones and found “my size.”  I then unfolded them and realized they looked like they would fit my arm.  I stood there puzzled for a few seconds, then realized they were girls’ pants.  Oh, fail.

I was tired of hitting skip on my iPod while exercising, so I finally caved and made a gym playlist.   I realized my workout playlist is as eclectic as my everyday playlist.  It contains everything from Katy Perry to The Wedding and Journey to Hey Rosetta.  I am so excited about it!

I have an overwhelming urge to put “PGY1” after I sign my name… No matter where or for what.  Problem is that it will change to “PGY2” soon and I really don’t need that bit in most of life.

I talk in my sleep.  Patrick likes to listen and then report to me what I have said.  Thankfully, I generally make no sense.

Patrick and I had a bet that we came up with a few months ago.  They are building a hotel just across the street from our apartment and we were having a debate about when it would be finished.  Patrick believed that at the rate they were going, it would be opening by the end of summer.  I thought it would be longer, sometime after mid-September.  If I won, he had to be in charge of making or choosing supper for a week.  If he won, we would go to dinner and a movie of his choice.  Then, I saw a “coming soon” sign.  Turns out, it isn’t opening until Spring 2014.  I guess we were both kind of wrong.  Although, I kind of want to point out I was more right.

I went to McDonalds a few weeks ago and asked if they could make me a decaf iced coffee.  The girl said they don’t officially have it (I can’t understand why… It is ice and coffee.), but that she would make me one.  I guess the issue is that they don’t have cold decaf.  But, she added extra ice before and after she poured the coffee and it worked and didn’t taste half bad for decaf and watered down.  I have tried twice since and both times I got a blunt, “no.”  I totally understand why they say no.  But, I also don’t understand why it can’t be an option.

We bought mass cat food and cat litter today at Costco.  The lady at the checkout asked us how many cats we have. I am sure she expected us to say two or three.  When we said one, she looked surprised.  The advantage is that we only have to buy mass food and litter every 3 or 4 months.  Patrick said afterwards that we should have lied and said something like five just to see her reaction.

I finally caught up on Grey’s Anatomy yesterday.  Besides crying my face off (which has been less frequent this season), I played the game of let’s guess who is going to get killed off this season.  My guess was wrong.

That is all for now.

What is random about your week this week?