Great Day

After a thirteen hour day and minimal food intake, how could a day be great? Let me tell you.

Team Dynamics
I've mentioned previously how lucky I am to be working with such a great team. Here's why.
1.) I'm in good with the interns: They don't scut us out too much. They teach a lot. They actually like and respect us. I can talk shit to them. Makes for a funner, lighter work day.
2.) Senior residents: See above, minus the shit talking. I'm in particularly good with the chief resident. He's verbalized this and the fact that I'm standing out of the group. This is doubly great since he and the other senior grade me.
3.) Attendings: Have had lots of interaction with the chief of surgery, med student director, and resident director. Med student director took greater notice of me after a presentation last week and have been getting along particularly well since. I'lll be scrubbing in with the chief resident, chief of surgery, and resident director on a particularly big surgery (Whipple) this Friday. Nice opportunity since the attendings obviously also grade us.

Though it may sound like it, this is all happening without cutting down my fellow med students. I'm insanely lucky to be working with such a good group of M3s - I wouldn't consciously step on them just for my own benefit. ...there are kids in my class who would. I have their back and vice versa with work and helping each other out.

White Coat Benefits
I don't openly put it out there that I'm a med student. In fact, I despise people who go out of their way to make this fact known. Who the hell do you think you are that you need to advertise yourself? A jackass is the correct answer. When meeting people, it only comes up if someone else mentions it or if they ask what type of school I'm in. On being asked what I do, I say I'm still in school - if they keep asking, I tell them.

That said, I don't mind the perks that come with other people finding out what I'm going into.

1.) Last winter, I forgot I had my white coat on under my winter coat. Part of it must have been flashing beyond my overcoat. After ordering a Polish sausage, the guy says "this one's on us" - after paying for my Polish. Didn't really know what happened, since I just paid for my dog. When I get home to eat, I find an extra Polish and fries. Nice.

2.) At 445AM this morning, I was rolling down a local road (95th St). I guess I got to going about 45 in a 30. You know how this story ends. I'm still gonna tell it. I get pulled over by two suburban cops. (The suburb is next to a not so great part of the city.) He must've noticed the white coat in my back seat. The abbreviated convo goes as follows:

cop: You a doctor?
me: Nah, just a med student.
cop: So you'll be saving my life someday?
me: Hopefully not.
cop: I'll be back.
...a few minutes pass...
cop: *Hands me a warning* Thanks. Have a good one.
me: Thank *you?*

I neither want nor expect special treatment because of what I'm going into. That doesn't mean I don't appreciate it :)

The Game Changer
I got my board scores back this morning. If you'll recall, this number has a big say in what specialty you go into and where you can go. I passed, which I was honestly expecting. The question concerning me was how well I did.

I did better than both my "realistic" and "hopeful" goals. (!!!) So yeah, I'm pretty psyched. The score is above average for most specialties, including EM and surgery :) It's only below average for some of the most competitive specialties (plastics, derm, ENT, radiology) which I'm okay with. It's actually on par with ortho, which is one of the most competitive specialties. My surprise comes from testing amid a pool of ~16000 of the brighter kids in the country. And still doing decently above average. Hence the excitement :)

In short, my score keeps the door open to quite a few specialty options - which is all I was hoping for. Self-flattery aside and long story short - I'm pretty excited about my board score!

Overall: good day!

Call. Oy.

My on-call night Thursday was particularly rough. For those wondering what it means to be on call, it means that you're covering your service (i.e. surgery) after regular hours into the next day until the full team gets back. Basically your work day extends through the night and into the next day. For me that meant in at 5AM Thursday and leaving at 11AM Friday...technically. Technically because there's supposedly a thirty hour workday rule. Much like there's an 80 hour work week rule. Both rules are more guidelines than anything. I actually left on time Friday. But my work weeks are at least 89 hours.

It's not *as* bad most nights, when I can get an hour or two of sleep. Thursday night was crazy busy though. Meaning me and the intern got no sleep. At times during morning rounds, I was pretty much a walking zombie. Before rounds, the intern fell asleep at the computer 3-4 times. Surprisingly though, I was good for the vast majority of the "day." The sleepiness only hit when things slowed down for a bit. The worst part was the hunger actually. My dinner was at 630P Thursday. I didn't eat a meal again until noon Friday. Fortunately, I'd learned to stuff my white coat with some granola bars. I went through about 8 bars that night/morning.

Before midnight it seemed like the pager was going off every 5 minutes. Some of the stuff was just nurses. Half of them were consults though. A consult is the worst type of page. Especially when only 2.5 people (chief resident, intern, med student) are covering four surgical services: thoracic, pediatric, general, and vascular surgery. A consult takes awhile because you have to do a quick read on the chart, look at vitals/labs/imaging, do a quick h&p with the patient, and then present to your senior(s). The whole process can take 30-45 minutes. And when consults start piling up, on top of regular nurse pages, postop checks, floor work, and whatnot - it gets a little overwhelming. There was a time when six consults had piled up between me and the intern. You just hope that no one gets missed or left behind. The best type of mistake is one where no one dies. In all seriousness. As interns or med students, we will mess up at some point. I'm constantly reminded by upper levels that it's all good as long as no one dies.

Quick side note about consults in the ER. Patients usually aren't too happy. By the time surgery gets a consult for an ER patient, they've already been there for 6+ hours. Abdominal pain, once ruled nonemergent, gets triaged lower on the ER's queue. Once they finally get seen by the ER, labs and imaging can take a while to get going. After all that, surgery finally gets consulted. No one likes talking to three members of the surgical team three separate times. On top of that, no one likes hearing they need surgery. It makes for interesting trips down to the ER.

As bad as things may sound, things aren't all that bad. The team's reduced to minimal numbers meaning there's a lot more for each of us to do. Spun in a good way, that means that I learn a lot more and get to do a lot more stuff when on call, vs during the day. While on call, we're also on page for the trauma service. Last Thursday there were about 15 trauma pages through the night. About 10 of those were gun shots/stabbings. Welcome to summer on Chicago's south side. On slower nights, I usually make my way down to the ER for trauma pages...since I'm interested in both trauma surgery and emergency medicine. And luckily, I'll actually get to rotate through trauma surgery for a week. It's supposed to be pretty cool and they supposedly let you do a lot of stuff...especially when on call. I already got to do a decent amount of stuff on my rotation through pediatric and thoracic surgery last week, so I'm pretty psyched.

Back to the sleep deprivation. It's real and thus has real effects. While pulling numbers on patients, basic things like reading efficiently become more difficult somehow. As long as I'm actively involved in something the next morning though, it's pretty easy to stay awake and perform similar to precall levels. It's even pretty easy to turn off the drowsiness and act wide awake while talking to patients. It's when things slow down the next morning that nodding off becomes an issue. On that note, driving is particularly problematic. Sitting is already a bad idea. Doing something boring, semi-passive, and monotonous is even worse. There were a few times when I almost fell asleep. And I did doze off a bit at a traffic light. Being on the phone definitely helps. But next time I have that rough a night, I'll probably take a nap in an on call room before heading home.

All that said, being on call is an interesting experience. Personalities change, things get crazy, and there's not a lot of sleep to be had. Since I'm on call tomorrow night, I think I'll get to bed early. It's a new strategy...getting plenty of sleep before going on call. Results TBA.

Last week's highlights:
-5 day old newborn with his stomach, intestines, and spleen herniating through the diaphragm into the left side of his chest and preventing development of that lung
-taking out someone's esophagus, part of which was done robotically...an eight hour surgery

Surgery!

Quick intro to those unaware, med school is basically a two part process. First two years are mostly books, culminating in boards. First year is normal stuff, second year is abnormal. The last two years are the clinical years, when we're out in hospitals and clinics. UIC's third year has six rotations: medicine, surgery, family, peds, ob/gyn, psych.

As a newly minted M3 (feels weird to finally say that), we started our first for real clinical stuff last week. On top of that, a subset of us started out on surgery - a particularly intense rotation. Non-call work days range from 12-14 hours, 6 days a week. "Luckily" we're guaranteed 24 hours free of clinical duty. Nights when we're on call see that work day extend to around 30 hours (~29-33), and we're on call an average of every fourth night. By my math, that puts the work week at a minimum of 89 hours. Yikes. (Although as I'm finally finishing this post, I have a 3 day weekend...yay!)

Strangely enough, it doesn't seem that bad. I'm at an outstanding site in terms of med students, nurses, interns, residents, and attendings. Everyone's pretty friendly, helpful, and happy to be there. Most importantly: there is good teaching, the scut work is minimal, and our team lets us go at a reasonable time (doesn't make us come in unnecessarily early/stay ridiculously late). Even better, our team dynamic is actually really good - everyone from the chief resident down to the med students get along and work together really well.

The previous paragraph is key to making the next two months enjoyable, especially given the hours we'll be putting in. I say this because surgery rotations have a reputation of being the exact opposite of the site I'm at. I won't go into detail, but I've heard horror stories about some of the other hospitals - lots of yelling, crying, berating, scut work, and and even longer hours. It makes me feel legitimately blessed to be at such a good hospital, especially for such a potentially hostile rotation.

In the interests of minimizing medical jargon, I'll cut to some of the cooler moments so far.
-holding someone's gall bladder
-holding someone's appendix
-grabbing someone's thyroid and trachea...actually just being able to poke around someone's neck
-being arm deep in someone's abdomen...so much cooler than anatomy lab

Overall, the rotation's pretty cool and I'm reminded of why the field used to/still does appeal to me. Minimal paperwork, minimal rounding on patients, not too much thinking, and a lot of procedures (obviously). The biggest downside is the number of hours. And for me, that's a pretty significant downer. But we'll see. I still have my other rotations to get through, some of which are significantly different in their style of medicine. As of right now though, surgery is making it's way back onto my short list of specialties I'm interested in. Even better though, I'll be taking a one week elective in trauma surgery. It should be a nice mix of my two interests of emergency medicine and surgery. We'll see what happens.