Tuesday, December 05, 2006

Bitter

I had the weekend off—didn’t really do anything fun or productive, although I did manage to write up a couple H&Ps—we have to turn in four which wouldn’t be a problem except that we need to write up an extra discussion about the differential diagnosis. It’s not really hard, but it does suck up time.

Yesterday I was on call, it was busier than Friday which was nice—also, I got to leave at nine instead of ten since I had helped admit two patients by then. The first patient was a 13 month old boy with a five day history of forceful cough, posttussive emesis (throwing up due to coughing so hard), diarrhea, and low grade fever. His pediatrician had taken a chest xray, but they didn’t bring it—all we had was a sheet of paper from the radiologist that said “bilateral pneumonia”. We started him on IV fluids and an antibiotic (even though this is most likely viral). His lungs sounded good to me, but he got an albuterol treatment as well. Overnight though, he did start having lower oxygen saturations, so his pediatrician started him on steroids.

The other patient was a 5.5 month old girl with a two day history of diarrhea (16 watery stools/day), vomiting, and fever. She was admitted to the hospital because her bicarbonate was 11 (normal about 24) at her pediatrician’s office, signifying dehydration. Most likely viral gastroenteritis, probably rotavirus. She got IV fluids and an electrolyte recheck this morning which showed bicarbonate <5. So, we started replacing volume lost in stool in addition to maintenance fluids. I had to call the community hospital lab to get the results of her stool culture (she had gone to the ER on Saturday)—all that had been ordered though was a gram stain and culture—no viral tests were done, so of course all the results were negative.

I talked to my intern from the first couple days last night and it turns out the kid that we admitted to the other team (that she is actually on now) ended up having Kawasaki disease—we had initially been suspicious of it, but thought it unlikely after exam since the kid only met a couple of the criteria for it—lymphadenopathy and a rash, and since the rash started the day after taking amoxicillin we thought it was probably a side effect of the medication. Apparently though, over the last few days he developed the other classic signs: fever >5 days, bilateral conjunctivitis, and palmar desquamation. I kind of wish he had been admitted to my team as that would have been very interesting to see.

I got my surgery grades today—I did fine, but I am fuming right now. My first month of surgery I was on a team with two other students, an intern, two senior residents, and four attendings. I ended up getting evaluations from (drumroll) the intern and one of the attendings (the one I had virtually no contact with). The evaluation forms essentially give several categories in which the evaluator ranks the student 1-9, and then there is a space for comments. The attending gave me all sevens and wrote no comments, and he did the exact same thing for the other two students. Given the fact that neither of the two attendings I had more contact with bothered to fill out an eval, I’ve got to give the one attending credit for filling one out, cursory, mechanical, and essentially meaningless as it may have been. What really ticks me off is that neither of the senior residents, the two people who were in the best position to accurately rate my performance, filled one out either. The other two students weren’t evaluated by them either, so it’s not just me. Incredibly frustrating—I’m supposed to pick an advisor out of the faculty over the next month—I have medicine doctors I can go to, but since none of the surgeons I have worked with are apparently even aware that students exist I’m not quite sure how that’s going to work out. Guess who I won’t be requesting letters of recommendation from? /end of bitter mini-rant—at least no evals are better than bad evals.

This afternoon we had to go to an hour-long ethics discussion—quite possibly the most worthless hour of the week, and that’s counting the hour I spent on the weekend going back and forth between the basement and my room to see if my clothes were dry because I really wanted to go to bed but had to have clothes for the next morning. I can’t really explain what was discussed because really nothing was. Fortunately we only have one more session and we’ll be discussing an actual case so I might be able to at least feign interest. On the plus side, our interns told us we didn’t have to go back to the floor, so we got to go home at 2:30.

1 Comments:

Anonymous Alice said...

It's very frustrating to want to establish contact with the attendings, and feel like they're oblivious to your existence. For what it's worth, though, I would strongly recommend trying to have a surgery adviser, whether it's someone you met later on in the rotation, or even someone who isn't actively teaching. (Our department has an older surgeon who doesn't practice anymore, just teaches the students, and tells amazing stories of Vietnam War surgery.) If you have an adviser from another field, they won't be able to give really meaningful advice when you want to apply to surgery residencies: how many do you need to apply to, how many interviews do you need, which programs should you be looking at, what are the important characteristics about the program to check out. . . I know, because my adviser is ob/gyn, and she just kept saying, Boy, I don't know how the surgery people see that, you should ask a surgeon - that I quit asking her anything. I don't know how big your department is, or how approachable the chairman is; for my school, the surgery chairman is pretty well-known and influential, so it was important for me to get his support and a letter from him. He was willing to give me lots of advice; since it consisted mainly of, You should stay at my program, I didn't totally appreciate him either; but that's a separate problem. :)

6:09 AM  

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