Last week I started in MICU. Fortunately, the motto of MICU is "we only take them to our service if we can improve there quality of life". Throughout the day, many consults come in from attendings on the floor for patients that may need extra help. The consult team has to decide, do we take this patient or not? Last week, an 85 year old man with 4th stage laryngeal cancer was turned down because coming to our floor wouldn't benefit him at all....the guy is on his deathbed and palliative care is a much safer option than bringing him to a floor that does all they can to save people. I am sure there are some in the hospital that do not like the fact that MICU is so picky when it comes to taking patients, but when you have limited resources and staff, you can afford to be picky.
Yesterday was the start of week 2 and it was nothing but exciting (from a medical standpoint). Because of my love of emergency I was given the 23 y/o patient who accidentally overdosed on iron pills. It was quite interesting to see her progression throughout the day....the iron was destroying her liver, GI tract, and kidneys....she was slowly dying before us. My superior senior resident was on the phone with all of the major hospitals (Mt. Sinai, NYU, Columbia) trying desperately to transfer her out because what she really needed we couldn't provide....a liver transplant. The problem: the patient was not a citizen of this country and therefore does not qualify for the $500,000 procedure. As the day progressed she looked worse and worse. The critical care fellow had a great idea to rectify the situation....have the patient sign out AMA (against medical advice) and drive to either Mt. Sinai or NYU and go to the emergency department. Sounds weird but it happens all the time and it works because of federal law....once a patient shows up at the ED care has to be given and if that patient happens to be in liver failure and she shows up at the ED of a liver transplant hospital, well then guess what?? Her chances of receiving the necessary care just increased. The problem with this....the patient was just too unstable even for her family to drive her. Unfortuntely for this patient, she just picked the wrong hospital to come to that morning. Eventually, by mid afternoon, NYU agreed to take her and she was quickly whisked away to their medical ICU. But whether or not she gets the liver transplant is anyone's guess...she may just spend her last days in the MICU at NYU instead of Coney Island.
Oh, I also got to show my superior CPR skills yesterday on an elderly patient who coded on our floor. We got her back....but only long enough for her family to come to the hospital and say goodbye....she passed away about an hour later :(
Okay, back to work. Have a great day!
Tuesday, September 28, 2010
Thursday, September 16, 2010
2 more days
My time at Methodist is almost over. Only 2 more days of work in the peds ED and and exam left, where has the time gone?? I was going to blog about my Tuesday morning shift last night, but I was so exhausted that I fell asleep around 6pm :) So, it was not surprising to wake up at 5am today :) I have to go in at 8am, so I have some time to write now. Lets start with sunday's shift, then I'll fill you in on Tuesday's.
Sunday, I was in the peds ED with Micah another 4th year student. And unfortunately, it was very slow. The shift was 4pm-12am (I missed the final episode of True Blood, although Chelsea and Matt were kind enough to let me make it up Monday night :). I have come to the realization that I just don't like peds ED. As you all know, I am not much of a "kid" person, but its more than that. I get so annoyed when parents know nothing about their kids illness: when it started....how high the temperature was (most don't even own a thermometer or know how to use it)...how to dose medication properly...or the worst, waiting until the child looks like death before coming in to see someone and then getting mad at us because their child needs to be admitted and that would cut into their precious time. Seriously??
So, I have a 13 year old girl on Sunday who is having knee pain and swelling. Very bright and intelligent girl, answered all of my questions with complete sentences, not just "I don't know" unlike Mom who seemed to be bothered by the whole experience of being away from home and the television. Anyway, I find out that this young girl was run over by her cousin on a bicycle one week ago. Over the last 7 days she has been limping and the pain and swelling have increased. So, what does her mother do....she brings her into the Emergency Department at 9:30pm on a Sunday. We send the girl for x-rays....the mother complains about everything (putting the gown on (her daughter, not herself), going across the hall, waiting for the radiologist to read the films). We tell the mother there is no sign of fracture....the mother complains (what a waste of time, this ED is horrible and I'm not coming back, how much longer do I have to sit here). We ace wrap the knee and give the girl some crutches to use for the next week AND the mother complains (how is she supposed to go to school with crutches (I seriously almost laughed in the mom's face for this statement). My daughter needs a note to stay home from school, what?? you aren't giving one, fine then one for gym for the next month. What do you mean for only 2 days until I follow up with ortho I am not taking her to no ortho doctor. How am i supposed to get her to the bus stop, I want a voucher for a taxi company for the next month....etc, etc, etc. This went on for almost 20 minutes, until finally the doctor gave the mom all of the paperwork and told her to leave. Interestingly enough, the daughter was fine with the directions and fully understood everything we were saying. I almost felt bad for the girl having to put up with a mom like that.
So, my final adult ED shift was Tuesday morning 12am-8am. I was hoping it was going to be busy and was it ever, the time flew by and I was so happy, although the night had its moments, specifically with the nursing staff. We were so slammed that patients were waiting 6 hours to be seen by a doctor. I was working with a 2nd year resident who did a great job for having so many high acuity patients at one time. Unfortunately, the nurses were not doing a great job at all. I had to do most of the IVs and blood draws on our patients, and was asked by one nurse to do her job because "I am too busy right now" and then she proceeded to sit down and talk to another nurse for 15 minutes. Then, at one point our patient needed pain meds so the resident asked me to go to the nurse and inform her the order was just placed and to give the medication. As I am telling the nurse this, she says "I am going on break, it will have to wait" and she walks away. I was floored. I understand you haven't received a break yet, but neither have I...or my resident....or the attendings for that matter because its so froggin busy. Luckily I found a nurse willing to give the meds for our patient.
The one thing about Emergency Medicine that I love is the team atmosphere. It really takes effort from everyone in that department for a successful night. The clerks...the nurses....the transport team....the xray techs...the residents....the doctors....and even med students. What sucks about Emergency are those nights when this system falls apart.
So, today I have a peds ED shift 8-4pm. Tomorrow is my written final and oral presentation. And my final shift is Sunday from 8-4pm. Soon, it will be Monday and I will be back at Coney Island, my first home, doing medical ICU :)
Sunday, I was in the peds ED with Micah another 4th year student. And unfortunately, it was very slow. The shift was 4pm-12am (I missed the final episode of True Blood, although Chelsea and Matt were kind enough to let me make it up Monday night :). I have come to the realization that I just don't like peds ED. As you all know, I am not much of a "kid" person, but its more than that. I get so annoyed when parents know nothing about their kids illness: when it started....how high the temperature was (most don't even own a thermometer or know how to use it)...how to dose medication properly...or the worst, waiting until the child looks like death before coming in to see someone and then getting mad at us because their child needs to be admitted and that would cut into their precious time. Seriously??
So, I have a 13 year old girl on Sunday who is having knee pain and swelling. Very bright and intelligent girl, answered all of my questions with complete sentences, not just "I don't know" unlike Mom who seemed to be bothered by the whole experience of being away from home and the television. Anyway, I find out that this young girl was run over by her cousin on a bicycle one week ago. Over the last 7 days she has been limping and the pain and swelling have increased. So, what does her mother do....she brings her into the Emergency Department at 9:30pm on a Sunday. We send the girl for x-rays....the mother complains about everything (putting the gown on (her daughter, not herself), going across the hall, waiting for the radiologist to read the films). We tell the mother there is no sign of fracture....the mother complains (what a waste of time, this ED is horrible and I'm not coming back, how much longer do I have to sit here). We ace wrap the knee and give the girl some crutches to use for the next week AND the mother complains (how is she supposed to go to school with crutches (I seriously almost laughed in the mom's face for this statement). My daughter needs a note to stay home from school, what?? you aren't giving one, fine then one for gym for the next month. What do you mean for only 2 days until I follow up with ortho I am not taking her to no ortho doctor. How am i supposed to get her to the bus stop, I want a voucher for a taxi company for the next month....etc, etc, etc. This went on for almost 20 minutes, until finally the doctor gave the mom all of the paperwork and told her to leave. Interestingly enough, the daughter was fine with the directions and fully understood everything we were saying. I almost felt bad for the girl having to put up with a mom like that.
So, my final adult ED shift was Tuesday morning 12am-8am. I was hoping it was going to be busy and was it ever, the time flew by and I was so happy, although the night had its moments, specifically with the nursing staff. We were so slammed that patients were waiting 6 hours to be seen by a doctor. I was working with a 2nd year resident who did a great job for having so many high acuity patients at one time. Unfortunately, the nurses were not doing a great job at all. I had to do most of the IVs and blood draws on our patients, and was asked by one nurse to do her job because "I am too busy right now" and then she proceeded to sit down and talk to another nurse for 15 minutes. Then, at one point our patient needed pain meds so the resident asked me to go to the nurse and inform her the order was just placed and to give the medication. As I am telling the nurse this, she says "I am going on break, it will have to wait" and she walks away. I was floored. I understand you haven't received a break yet, but neither have I...or my resident....or the attendings for that matter because its so froggin busy. Luckily I found a nurse willing to give the meds for our patient.
The one thing about Emergency Medicine that I love is the team atmosphere. It really takes effort from everyone in that department for a successful night. The clerks...the nurses....the transport team....the xray techs...the residents....the doctors....and even med students. What sucks about Emergency are those nights when this system falls apart.
So, today I have a peds ED shift 8-4pm. Tomorrow is my written final and oral presentation. And my final shift is Sunday from 8-4pm. Soon, it will be Monday and I will be back at Coney Island, my first home, doing medical ICU :)
Monday, September 06, 2010
PS Done
With the help of my sister and her amazing english language skills, my personal statement is done!! I uploaded it to my application on Saturday and sent it to all 76 programs. So, everything on my end is complete. I am just waiting on 2 letters of recommendation, one from Maimonides which should be sent out at the end of this month and the other from Methodist, my current rotation. So now I just sit back, relax, and wait. Of course, I am busy preparing myself for interviews, formulating answers to questions that may be asked. I want to come across as very confident with no signs of stress or nervousness as if this interview thing is something I always do in my spare time. Hence, the preparation now.....
So last night I went out in the big city with a friend for drinks and sushi. While walking towards Washington Square we come upon a jumper. Easy to pick out because A) Everyone was looking up B) There were 8 police cars and 2 firetrucks C) There was red tape blocking the area off D) There was a gigantic inflatable device waiting to catch said jumper (almost looked like the ones used in movies for the stunt men). I didn't see the jumper, although everyone on the ground watching this scene were pointing saying "There he is....." "Look, I see him...." "He is going to jump...." And of course, they were pointing in all different directions and areas of the building, so I am not sure exactly where he was. But I would say he was at least 30 stories or higher in this building.
But, then it occurred to me what SHOULD happen next. The police should just push the guy off the building onto the giant bouncy thing. Why you ask?? Well, here is my explanation. First, it is obvious that this jumper has been up there for a while since the police had time to unroll red tape everywhere and blow up a giant inflatable bouncy device directly underneath him. Second, the police should be getting their money's worth for all of the time and energy spent on this one person by at least using the giant bouncy. And lastly, if this person was really serious about committing suicide they would have jumped already, long ago, BEFORE the police got a chance to respond. I don't doubt that this man is depressed or has issues, but he is crying out for help and attention and not at all interested in killing himself. So, push him off the building onto the bouncy. That drop alone (and the almost heart attack like scare that comes from it) in a person who really doesn't want to jump will prevent any future ideas of jumping. He will land safely....think "Holy Shit, I will never do that again" and will be taken to a psych facility for treatment. Of course, there is a small chance he is serious about jumping and in that case, next time he will do it well before the police get an opportunity to use their toys. I would hope though that the time spent in a psych ward for his "push" and the help from psychiatrists would lead to treatment of his disease and prevent any future episodes.
So, tonight I work 8pm-8am. I am hoping that we get more than intoxicated patients on this Labor Day. Have a great day, oh and a big HAPPY BIRTHDAY to my sister. I don't have a present for you this year, but I promise in a few short years to make it up to you ;)
So last night I went out in the big city with a friend for drinks and sushi. While walking towards Washington Square we come upon a jumper. Easy to pick out because A) Everyone was looking up B) There were 8 police cars and 2 firetrucks C) There was red tape blocking the area off D) There was a gigantic inflatable device waiting to catch said jumper (almost looked like the ones used in movies for the stunt men). I didn't see the jumper, although everyone on the ground watching this scene were pointing saying "There he is....." "Look, I see him...." "He is going to jump...." And of course, they were pointing in all different directions and areas of the building, so I am not sure exactly where he was. But I would say he was at least 30 stories or higher in this building.
But, then it occurred to me what SHOULD happen next. The police should just push the guy off the building onto the giant bouncy thing. Why you ask?? Well, here is my explanation. First, it is obvious that this jumper has been up there for a while since the police had time to unroll red tape everywhere and blow up a giant inflatable bouncy device directly underneath him. Second, the police should be getting their money's worth for all of the time and energy spent on this one person by at least using the giant bouncy. And lastly, if this person was really serious about committing suicide they would have jumped already, long ago, BEFORE the police got a chance to respond. I don't doubt that this man is depressed or has issues, but he is crying out for help and attention and not at all interested in killing himself. So, push him off the building onto the bouncy. That drop alone (and the almost heart attack like scare that comes from it) in a person who really doesn't want to jump will prevent any future ideas of jumping. He will land safely....think "Holy Shit, I will never do that again" and will be taken to a psych facility for treatment. Of course, there is a small chance he is serious about jumping and in that case, next time he will do it well before the police get an opportunity to use their toys. I would hope though that the time spent in a psych ward for his "push" and the help from psychiatrists would lead to treatment of his disease and prevent any future episodes.
So, tonight I work 8pm-8am. I am hoping that we get more than intoxicated patients on this Labor Day. Have a great day, oh and a big HAPPY BIRTHDAY to my sister. I don't have a present for you this year, but I promise in a few short years to make it up to you ;)
Wednesday, September 01, 2010
September 1st!!!!!!!!!!!!!!
Yes, I am aware that the title of this blog has alot of exclamation points. Its just my way of saying that today marks the official upload day for residency applications...and I just electronically sent my application!!! YAY!!! Of course, that was after ERAS conveniently subtracted $1525 from my bank account. Wow....applying for a job is very costly.
I have been lucky in that my application process has gone fairly well. I think it has alot to do with my preparation skills. I had most of my application completed in mid August and certified MyEras on August 27th. All of my letter writers are marked in the system, and so far, two letters are in the gate ready to go. My photo is uploaded....my transcript is sent. I also spent 1 week at the end of August researching all of the Emergency Residencies throughout this country and narrowed my list to 76 programs this past weekend (thank you to Microsoft and their wonderful product called the spreadsheet :).
There is only one thing I am missing. My personal statement....the paper albatross that has been swinging around my neck since March. I have tried and tried with numerous attempts and countless drafts to get it just right with no such luck. This is my opportunity to really shine and sell myself and I want it to be absolutely perfect. So, I called in some help in the from of my sister, who is not only a speed-reading demon (hello, I finished the final book of Harry Potter in 2 1/2 hours) but an equally fantastic writer. I am hoping she can help me bang out the last little details leaving me with a concise, polished, and striking statement about myself that will quickly draw the reader in and make them think "Wow, I need to meet this girl". And once that is uploaded, my application will be complete.
And then....I wait....for interview invites to roll in. I hate waiting.
I have been lucky in that my application process has gone fairly well. I think it has alot to do with my preparation skills. I had most of my application completed in mid August and certified MyEras on August 27th. All of my letter writers are marked in the system, and so far, two letters are in the gate ready to go. My photo is uploaded....my transcript is sent. I also spent 1 week at the end of August researching all of the Emergency Residencies throughout this country and narrowed my list to 76 programs this past weekend (thank you to Microsoft and their wonderful product called the spreadsheet :).
There is only one thing I am missing. My personal statement....the paper albatross that has been swinging around my neck since March. I have tried and tried with numerous attempts and countless drafts to get it just right with no such luck. This is my opportunity to really shine and sell myself and I want it to be absolutely perfect. So, I called in some help in the from of my sister, who is not only a speed-reading demon (hello, I finished the final book of Harry Potter in 2 1/2 hours) but an equally fantastic writer. I am hoping she can help me bang out the last little details leaving me with a concise, polished, and striking statement about myself that will quickly draw the reader in and make them think "Wow, I need to meet this girl". And once that is uploaded, my application will be complete.
And then....I wait....for interview invites to roll in. I hate waiting.
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