Posting has been a little light due to a recent transplant marathon: one transplant after another, starting in the afternoon, and concluding the next morning. The best summary would be to say, that after doing so many of one procedure in a row, I knew the steps in my sleep – which was good, because that was what it was close to by the end. . . I still wasn’t able to satisfy the attending, who seemed to want to know why, twelve hours after he’d first told me I needed to improve a point of technique, it still hadn’t been corrected. (Saying, Sorry, right now I’m lucky to be standing up straight, and doing something at least functional with the instruments, can’t think straight enough to change habits right now, did not seem like a good idea.) (I sent the poor medical student to bed some time after midnight; he also seemed to find that irrational, but neither of us had enough energy to discuss it in detail.)
I got my fill of “continuity of care:” admit one patient, scribble some pre-admission orders (stat labs and induction immunosuppression) for the next one, run down and do the back-table on one kidney, go meet and examine the second patient, do the first case, write pre-admission orders for the third, back-table the second kidney, go check that the first one is still making urine, look at his chest x-ray, and continue. . . Then, the day after, even though the attending and I rounded before leaving the hospital, so I technically had handed over coverage of my patients to an on-call intern, neither I nor the nurses felt like leaving the intern in charge. If I didn’t wake up every hour to call and check on someone, they were paging me, or else had stumped the intern and he was calling to ask me. . . Eventually I gave up on sleeping and tried to get some chores done instead. I hate that feeling of waking up, and not being able to remember which nurse I had intended to talk to this time, or whether the fluid bolus I’m thinking about is something that has already happened, or that I still need to order. I keep intending to take a paper with me and write notes, but around the time that the difference between am and pm disappears, the coordination required to get a paper and pen in the same place also drops off. The significance of low urine output, however, sticks around.
It’s taken me 16 months of residency to find out what surgery as a profession is really like. I need to figure out who in the hospital has coffee available at midnight before trying that one again. Otherwise, give it another day or two, and I’m up for it.
October 17, 2008 at 5:25 pm
(Old Grumpy Man Voice)Thats the way ALL residencies used to be…Even Psychiatrists were doin Lobotomies at 4am…”Leaving the Hospital” we LIVED in the hospital, I mean REALLY lived, even paid room and board..and Coffee?? You were lucky if there were some old used grounds to run through the Percolator…Ha Ha just kidding, but curious…Are you still an Organ Donor? My only transplant experience was from the sleepy side of the Ether Curtain, but it was enough to inspire me to make a special trip to DMV to change that…
October 18, 2008 at 2:28 am
Sounds like much of the time was spent before and after the actual surgeries; electronic medical record (EMR), anyone?….
October 18, 2008 at 9:00 am
Robert,
suspect you’re not an M.D. if they used EMRs she’d still be at the hospital.
October 19, 2008 at 10:50 am
Frank,
suspect you’re not an M.D. If they used EMR she’d probably be home for dinner by 7pm.
October 19, 2008 at 8:16 pm
Robert, sorry for taking so long to reply, I was at the hospital working on an EMR.
October 20, 2008 at 12:45 am
VUMC-EMR; welcome to modern medicine.
October 20, 2008 at 10:31 am
Oh Yeah!?!?!? Well at least I didn’t kill anyone with Vioxx!
October 20, 2008 at 5:34 pm
Robert,
You’re from TENESSEE an y’all got the gall to accuse me of bein a Luddite? At least in GEORGIA We’all wear Shoes.
Frank.
October 20, 2008 at 8:23 pm
One of us seems to have a loose screw in our head, Frank 😀
October 21, 2008 at 8:45 am
Its you Robert, I downloaded your medical record from the EMR. You don’t have access to MY medical record, unless you jimmy open the trunk to my car, and even then, thats a dummy record I use to fool nosy reporters. Paper Charts do have some advantages, I WIN!! 🙂
October 21, 2008 at 9:01 am
be my guest n’ knock yourself out LOL
October 22, 2008 at 4:04 pm
Frank I’ve said it before and I’ll say it again, grab the wheel, you’re swerving :).