7/7/14 02:17 am - First week of residency
I knew residency was going to be hard but I didn't know it was going to be this hard. This past week was abysmal.
I thought I was starting off hard cuz my first shift was a night shift. Never knew that it was gonna be the easiest time I'd have in a whole week. Cuz I was on night, by the time I was on day shift, my co-intern was already on his third day of day shifts so he was light years ahead of me. And it feels like I've been falling behind since.
First week is all about learning the computer system. How to order stuff, what buttons to click on. How to change settings so you're not spending so much time looking for what you're looking for. One of the worse days of my life was Sat. First let me explain my schedule.
This entire month, I only get 2 days off. I don't get weekends off cuz patients need to be taken care of on the weekends too. And I'm doing one night/week. Anyways, so I was talking about Sat.
I got up at 430 to get to the hospital at 545. Then, my senior resident decided that I'll see 8 patients that morning- 5 of which, I knew nothing about. So I started scrambling to learn about them. That means finding out what they're at the hospital for, what problems we're treating, how the treatments have been and how they're doing. And that means, vitals, labs, consult notes, meds. And then, what my plan for them would be for the day. The whole shebang about each and everyone of them. And clearly, there wasn't enough time to do all of that for all of my patients.
So you get to the hospital and you pre-round, meaning you look everyone up on the computers to gather information. Then, you have to go see each one of them, talk and examine them, all before rounding begins. Some patients take forever to see cuz they're miserable and ask you to do this and that. Some patients have family members who want to talk on and on. Doesn't matter. I have to see them, examine, talk to their nurses if possible about what happened overnight and/or give them instructions. Then, before rounding begins, I have to have all my thoughts gathered to present.
So the timeline is this. Wake up 430, get to hospital at 545. Pre-round till 830 or 900, during which I have to have learn everything about my patients and have seen them. This includes walking all over the hospital cuz they're spread out all over. During rounds, we see most of the patients. For each patient, we stand outside their door and I have to present to the team. Have to talk about what happened overnight, what was done, how they're doing this morning, their vitals, labs, imaging, then list out their problems one by one and talk about what we're doing and what I want to do next for each problem. Each team normally have ~15 patients.
Sat was bad cuz I didn't have enough time to learn about my patients. So I did such a terrible job presenting them. I was asked questions and I had no answers cuz I didn't know my patients. And assessment and plans, pfffff, I had none. It was painful listening to myself. So rounds was bad. Rounding usually ends at noon. That day, we decided to discharge 3 patients. And I knew a little bit about how to discharge them but each took such a long time cuz they're complicated and again, it's hard to write a discharge summary of their hospital course when I barely knew them. We had to get each of them out the door in a couple of hours cuz we already had patients waiting to be admitted! So discharging patients, putting in orders for the ones who are staying and calling the consultants for those who needed further work up. We have to call consultants early cuz they need to see the patients we consult them on the same day and so they need time to work on. I was trying to get ahold of a consultant with no avail. I paged one several times but no call back. Finally, I called the attending and he was pissed cuz it was already 330pm. He berated me for calling them so late but not only that but also on my lack of knowledge on the patient I was consulting on cuz I had learned about her only that morning. My senior ended up finishing the call with him. It was bad.
So everything was happening at the same time from noon-3pm. Entering orders for patients who are staying, calling consultants, discharging patients and this whole time, my pager was going off once a min! Nurses page constantly on all of our patients and I was holding the pager that day. When paged, we have to answer within minutes. Usually, I'm picking up the phone the next second after the pager goes off. And then, I have to ask the senior or figure out how to answer the most trivial questions cuz I still don't have the knowledge or the confidence to handle the questions.
Admitted 3 patients that day after discharging 3. Admitting means looking into the computer to see if they've been to the hospital before and if so for what, what happened, what their labs were, everything about them medically. Then find out what they're doing here, review labs/imaging and then we go talk to them and get their whole history through them. Then examine and then add in orders for them to be admitted.
So 3 out, 3 in. It was 9pm when I was finally able to slow down a little to have a sip of water, the first I've had since 430am. I started following up on the consultant notes, putting in orders and started on my notes. So every day, we have to write a note on the patients we see. I saw 8, discharged 3 and admitted 2. So I had 8 progress notes to write, 3 discharge summaries and 2 H&Ps for admissions, which are much lengthier progress notes.
I left the hospital at 11:20pm Sat night. And everything was going to start all over again in about 6 hours.
That day was exceptionally bad cuz we were the admitting team. There're better days when the other teams are admitting so we just have to take care of our own patients. The rest of the other days haven't been as long but they were pretty similar. I have never felt more incompetent in my life.
There just have been no time to learn. It was a vicious cycle of sleep, eat when I can and running like a headless chicken at work. I literally lost 5lbs this past week. And cuz I hadn't had time to learn, I haven't increased my knowledge on what to do in terms of treatments, etc. And I do terrible during rounds.
Everyone has been so nice though. The team is made up of one attending, who has gone through residency, a senior resident and two interns. I'm an intern- a first-year resident. So the senior resident has even more responsibility of course. He has to be on top of his game by knowing everything about ALL of our patients and also, supervise us. He had to pick up a lot of slack from us cuz we just don't know what we're doing. And we always have a gazillion questions on what button to press to give what order.
So outside of that, I got into a car accident on Fri. With a cop. And apparently it was my fault. But thankfully no tickets. But since my car was in the towing place over the weekend and was not commissional, Dan has been taking me to work and back this whole weekend. So in additional to not seeing me and putting up with my mum all day, he had to get up at 530am to get me to work and come back out to get me whenever I get out. He has been going through a lot too. So I come home all pooped and cuz my Mum hasn't seen me all days, she follows me around like a puppy. A yippy puppy cuz she wouldn't stop asking questions or stop talking. A lot of times, I just have to ignore her and work. Oh yeah, I try to organize as best I can at home by looking in on my patients at night so I wouldn't get so flustered the next morning. Some nights, I just pass out.
So Mon, today's my only day off for awhile. I need to read up on stuff and get prepared and be ready for a long 2-week of wards cuz my next day off is on the 20th. I probably won't be contactable for awhile.