Friday, October 12, 2007

The saga continues

I'm pretty tired. My last call night was just non-stop, I admitted four patients, all of whom required about two hours each just to read through their charts. One was a four year old boy who had just gotten a heart transplant, and was transferring out of the PICU (where he had been for three months previously). One was a girl with a super-rare genetic disorder who was admitted to the PICU in heart failure, and transferred to us when she was stabilized. Four of the six patients I talked about in my last post are still here.

I have mixed feelings about this rotation. In general, I do not like it, but I can't put my finger on why. I'm not a big fan of being awake for 30 hours straight, but have been on other rotations without too much trouble. I think the biggest thing is that these patients have very complicated, chronic conditions that are generally beyond my level of understanding. Rounds in the morning are also painful, being hours long, but I have to pay close attention because one out of four nights I'll be watching over all the patients, and on the weekends I'll be rounding on some of the other interns' patients. That all being said, I have to admit that in the long run I think this rotation is going to be very good for me in many ways. First, patients with issues like heart transplants are very intimidating to me, and this rotation has been helpful to make me realize that the basics of medicine still apply to them. Second, I am forced to follow more patients than I ever have before more closely than I ever have before, and I have to keep a lot of information in my head about each one. Third, it makes me have to put into practice all the things I know in theory--like what to do if someone spikes a fever, or has decreased urine output. At this point I put things into practice very badly, so it is a good thing that I have a senior resident take call with me to sign all my orders and step in when I am clueless. Also, I never fully realized how many stupid little details have to be managed and ordered.

I'm starting to feel like I have a better grasp on things, particularly since I am now only following five patients instead of nine. I felt better after I asked the interns what they thought of this rotation compared to others, and they told me that they had similar frustrations to mine.

I'll be on call tomorrow--then I'll be halfway through my calls! And once this rotation is over, I'll have ER for a month (shift work!) then two months totally off (except for interviewing)!


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