(for now….two more weeks in December and then I’m done with nights for good!)

Hospital basement at 2am

It’s been about 4 months into my internship so far and I still feel like I have no idea what I’m doing, but I’m so grateful for all the people at work who teach me how to be a better doctor each and everyday.  Lately, work at the hospital has been a little hectic with the swine flu wreaking havoc on patients in the emergency department.  There are more people coming through the doors, which means more sick people, and ultimately, a little more work for all the residents.  I think as a result, everyone has been just a little more worn down (moreso than usual anyway).

Well, our wonderful program director, Dr. Tom, who has always been such an advocate for the residency, sensed our need for a break and sponsored this AMAZING dinner and night out at Barbrix Wine Bar.  The tab was on him, and we TOTALLY took advantage of it!  Its been so long since everyone has gotten together for dinner, and everyone had such a GRREEEAAATTT (pronounced like Tony the Tiger) time.  Thanks to everyone who showed up, and thanks again to Dr. Tom for always supporting us.  Cheers!

I’m not going to lie, working nights sucks.  You’re up when everyone else is asleep, you’re taking care of patients you don’t even really know, and your entire circadian rhythm is thrown off.  I don’t even really know when and what I should eat anymore!  I mean, cereal at 2am in the morning?  Or is 2am time for dinner?  I guess that only applies to the situation when you actually have time to eat, which most nights, is very hard to do.  When you’re getting pages every 1-2 minutes from 5 different nurses with unstable patients, mixed in with the 10 million pages from nurses who want stool softeners at 2am in the morning (totally not necessary by the way), it’s really hard to do anything else but work when you’re covering everyone’s patients at night.  Lucky for me, the computer system was down the other night, meaning my pager was silent for 3-4 hours.  Being the sort of mischievous person I am, my fellow residents (Gabe and Rob) and I, took it upon ourselves to not only clean out the residents lounge refrigerator and computers, but we also put together this awesome collection of facebook (and stick figures) of internal medicine residents.  If you haven’t been down in the lounge, make sure you check it out.

Yes, those cabinets on top used to be completely bare.  Now they’re just glowing with warmth!

And here’s the close-up

Central Line Kit

Whether you’re doing internal medicine for a year or 3 years, you’re bound to come across really sick patients.  Usually, I can tell within the first 10 seconds what’s wrong with the patient when someone tells me, “hey, there’s a 95-year-old guy in the emergency department.” Alarm bells start going off in my head and the first thought that comes to mind is that this is going to be a train-wreck.

My initial diagnosis (as always in these situations): Old Age

People who are old are just bound to have tons of medical problems; bad hearts, bad lungs, bad kidneys, you name it and they don’t typically have just one, they have all 3. They come to the hospital requiring tons of help, usually with aggressive fluid resuscitation and medicines called pressors to help keep their blood pressure up and their brains perfused (afterall, no brain = no life).

As an intern, these cases are a little overwhelming.  These patients are really sick and need lots of attention, but sometimes it’s left on you (the fresh out of med school doctor) to figure out how to treat these patients.  Sure, there’s a protocol, there’s help, and there’s backup if you need it, but it still feels like your calling the shots…and it definitely gets your adrenaline pumping because you actually feel like someone’s life is truly hanging in the balance–like life and death is going to be based on the decisions you make in the next several minutes.

Of course, instead of thinking about all this and taking the time to analyze each problem and how to fix it, these situations require doing everything all at the same time…giving fluids, antibiotics, oxygen, pressors and whatever else may be needed because if you take your time to take each step and see how the patient does, you may be moving too slowly.  Since I’m an intern, I definitely work slower, so I get only one task, and that’s usually to put in a central line (the special line you need so that you can give pressors).  It involves putting a big needle in someone’s groin, neck, or underneath their clavicle and threading wires and other catheters into the vein so that the patient has good intravenous access.

I talk about this because for some reason or another, this week has been “old age” week.  Lots of sick patient’s, lots of central lines. It’s not THAT complicated a procedure really.  I’ve had training, I’ve watched tons of them done, but this week was the first time I had ever put one in myself.  Wait, did I say one?  I meant two! That’s right! And I nailed them…both!  Sure, I had to poke someone’s leg about 7 times (inadvertently hitting the femoral artery…one of the largest arteries in the body….several times), but i put in a central line in the femoral vein and the subclavian vein (right under your collar bone)!  I’m sure it sucked to be a patient in these situations because I was learning at their expense, but at the same time, they needed a line in and I was the only one that was sort of, kind of available to do it.  The hardest part of it all is breathing/maintaining your core body temperature when you’re in a sterile gown, gloves, mask, cap, and sticking a big needle into one of the biggest veins in the body, then threading a wire into that vein so you can get this big catheter in.  Your mask fogs up, you sweat, you start to itch (but you can’t scratch cause your hands are sterile), and if it’s your first time, it takes an eternity cause your hands just aren’t used to the procedure. (Not to mention I’ve been staying 2-3 hours later than I was supposed to so that I can put these lines in).

Anyway, the truth is it felt so rewarding to put in those central lines this week.  I’m a prelim medicine intern, which means I’m only here for the year, and I was hoping to skirt by doing ZERO procedures.  After being here for a while though, I realized I just wouldn’t feel like a real doctor unless I knew how to perform procedures.  So after successfully completing two lumbar punctures last month, and now two central line placements, I can’t wait for the next one to come.  It’ll probably still be scary, but it’s just so rewarding when you do it right.

Looks kinda like this when it’s all done:

Central Line in the Subclavian Vein

Didn’t cause a pneumothorax (meaning I didn’t poke a hole in the lung while blindly looking for the vein) and didn’t kill the patient, OR poke myself with the big needle.

Ever wonder how Halloween all started?  I did some digging, and courtesy of history.com….

Halloween’s origins date back to the ancient Celtic festival of Samhain (pronounced sow-in).

The Celts, who lived 2,000 years ago in the area that is now Ireland, the United Kingdom, and northern France, celebrated their new year on November 1. This day marked the end of summer and the harvest and the beginning of the dark, cold winter, a time of year that was often associated with human death. Celts believed that on the night before the new year, the boundary between the worlds of the living and the dead became blurred. On the night of October 31, they celebrated Samhain, when it was believed that the ghosts of the dead returned to earth. In addition to causing trouble and damaging crops, Celts thought that the presence of the otherworldly spirits made it easier for the Druids, or Celtic priests, to make predictions about the future. For a people entirely dependent on the volatile natural world, these prophecies were an important source of comfort and direction during the long, dark winter.

To commemorate the event, Druids built huge sacred bonfires, where the people gathered to burn crops and animals as sacrifices to the Celtic deities.

During the celebration, the Celts wore costumes, typically consisting of animal heads and skins, and attempted to tell each other’s fortunes. When the celebration was over, they re-lit their hearth fires, which they had extinguished earlier that evening, from the sacred bonfire to help protect them during the coming winter.

By A.D. 43, Romans had conquered the majority of Celtic territory. In the course of the four hundred years that they ruled the Celtic lands, two festivals of Roman origin were combined with the traditional Celtic celebration of Samhain.

Here’s just a couple of pictures from Halloween:

Storm troopers and ghost busters

Baby bumble bee

An interesting array of costumes

Some Twilight and Disney Magic

Baby dinosaurs

Neighborhood pumpkins!

Still downloading pics…stay tuned!

Theme:  Where the Wild Things Are

Left: A kid quivering under his blanket, Right: A wild thing in the wild

Thanks to Christine for coloring outside the lines when she was younger and putting on her pumpkin carving hat today to help me turn these pumpkins into masterful works of art!  Halloween pictures coming soon!