Discover Top Posts Tagged with #pgy-2

hey y’all it’s been a minute, hope everybody is doing okay.

Currently finishing up month 2 of being a PGY-2 (!!!)

I started the year off basically with a week of nights at our busy university hospital with brand new interns. Being an upper level is mostly terrifying so far but also exciting.

Also, if you are able to, adopt an adult dog (or two). Highly recommend, my life is way better now. My husband and I adopted our two sweet girls in January and haven’t looked back. So much more motivating to exercise myself when we take them on a walk or a hike! Also dog doors are great, 10/10 would recommend.

#medblr #PGY-2 #internal medicine #residency

Little Things I Love About Anesthesia (Residency)

- Syringes and needles. So many syringes and needles.

- When all of the labels are neatly lined up and facing the same direction. Or just generally when everything is neatly lined up and facing the same direction.

- Getting that perfectly crisp loss of resistance on epidural placement.

- When patients say, "Wow, getting that IV [or other awake procedure] didn't hurt at all!" (Thank you, intradermal/subcutaneous 1% lidocaine.)

- Smooth wakeups, especially after propofol TIVA with adjunctive dexmedetomidine, lidocaine, or remifentanil/sufentanil infusions. The best usually involve some variation of the arms-crossed-behind-the-head position.

- Insta-bonding with patients over commonalities or shared opinions. There's no better way to set a patient (and yourself) at ease.

- Insta-bonding with other staff over commonalities or shared opinions. I recently discovered that one of our 64-year-old orthopedic surgeons and I have freakishly identical tastes in music (both rock and classical). Not sure if that says more about him or about me.

- Feeling like an airway ninja. So far, this has most commonly occurred after (1) awake fiberoptic intubation, (2) feeling tracheal rings with the bougie, or (3) just plain getting that coveted Cormack-Lehane grade 1 view.

- Visualizing local anesthetic spread on ultrasound in exactly the place you intended.

- An effective regional anesthetic. There are few things more satisfying than a (mostly) awake patient remaining completely comfortable while a surgeon is literally drilling, sawing, and hammering away at their bones.

- Planning for cases and preparing the OR. It feels like a sacrosanct ritual, a meticulous preparation for any contingency that might arise.

- Being a go-to guy for all matters relating to cardiopulmonary physiology, pharmacology, and difficult access.

- Learning all of the tiny details that can make or break a smooth (and safe) anesthetic plan. They're a pain and a half to learn, but the process is endlessly rewarding.

- Being, for all intents and purposes, the medical equivalent of a potions master.

#anesthesia #residency #anesthesiology #medicine #PGY-2 #CA-1 #things I like #my job is great #seriously people

Oh my heart...

Today I was booking it across the ward to try to make it to my journal club presentation on time and a little boy was standing outside his sister’s room. He looked up at me with the biggest, most imploring eyes I have ever seen, so I stopped in my tracks and crouched down to get on his level.

He immediately grabbed my elbow, then traced my forearm to hold my hand in both of his.

“I asked for a truck,” he said very seriously, with that incredibly earnest look on his face. “I’m still waiting.”

He was so cute I just about melted. Another little girl, one of his sisters, popped out right behind him with the same puppy dog eyes.

“Where are all the toys?”

In that moment, I felt like there would be no greater achievement than somehow finding these kids something to play with.

Sometimes I get so caught up in myself and what I have to do that I don’t stop to consider what the people around me might need. I’m so absorbed in my to-do list that I fail to notice when my friends and family might be having a hard time. When I saw this little boy and his wibbly little pouty face, I think it was a bit of a wake-up call; this little boy had something he really wanted, and in order for me to help him, I had to stop and listen.

This definitely applies to my relationships with other people, but also to the way I treat myself. I feel a little guilty slipping away to eat when we have a patient list a mile long and a hundred thousand things to attend to, but I do need to stop and listen to what my body needs. Sometimes I find myself doing things a certain way because my senior residents or my staff are telling me I have to, but I think there’s a better way; I need to stop and listen to my gut, and make sure I at least voice my thoughts. And most importantly, I need to stop and listen when the red flags are rising--when I am dragging myself out of bed already waiting for the moment I can lie back down, or when I am going through all the motions of regular life but feeling numb and empty.

Stop and listen; it will always be worth it.

Some days I feel like medical school and residency have ruined me. I’m not the same person I was six years ago. Some of that is for the better, but a lot is for the worse. I’m not sure if it’s some intrinsic defect inside of me or a side effect of our high intensity training, but I have a hard time concentrating and doing one thing at a time. Even at leisure. A few weeks ago I had my second year meeting with my program director. It was a casual meeting that we all have, just touching base us to go over our reviews, talk about how second year is going, assess our mental health, and to talk about any potential areas for program improvement that we see. The one thing I can’t really shake about this meeting is, when asked about what my hobbies were, I was just... crickets.

I’m not really sure when this happened. I had a lot of hobbies growing up. I played baseball and soccer. I ran cross-country and track. I sketched a ton. I read like a fiend. I played video games regularly. I wrote short stories. I loved movies and had a couple of television shows that I watched regularly. The list goes on and on. But now... I basically work and sleep. The time I have outside of those two tasks, which definitely varies depending on whether I’m on the wards or on a consult service, I just spend kind of existing. I don’t actually DO anything except for waste time on the internet. I’ve tried multiple times to get back into some of my old hobbies, but I find these things no longer hold my attention. I try to watch television. I try to watch movies. I get bored and start distracting myself with other tasks while “watching. And again we come back to the hard time I have with concentration unless 50-million things are happening simultaneously.

#residency #pgy-2 #internal medicine #I need a hobby or three for serious

My 80 year old patient: I haven't taken the meth since my bout of pneumonia in January. Me: Meth? Patient: Yeah, the doctors told me to stay off of it. Me: Uh-huh. Patients Wife: He means methotrexate. Patient: She knows what I mean!!!

Me:

#meth #Medblr #medicine #methotrexate #patient #internal medicine #PGY-2 #doctor #docblr #tales from the clinic #pneumonia #prescriptions #things patients say

Call Night Inception

Around 3:45 AM, I was awakened by a page about an emergent exploratory laparotomy coming up from the ED. I hauled myself out of my call room cot, trundled down to the OR, and started hastily setting up the room. Within seconds, the patient crashed through the OR doors in extremis, left lower extremity mangled, multiple blood products already transfusing, barely responsive, purpuric abdomen exposed and grossly distended. Heart pounding and palms slightly damp, I geared up for rapid-sequence induction and intubation.

...Only to be suddenly jerked from sleep at around 3:45 AM by a page that an emergent case was heading into the OR.

#anesthesia #anesthesiology #CA-1 #PGY-2 #residency #definitely just incepted myself #might as well set my alarm ringtone to Edith Piaf

Brief observations from behind the drape, vol. 1

Patient interactions are so pleasant and endearing in this specialty. I feel like I can connect more with most of my patients in a few minutes and learn more about them (as humans) than I could at any point during my year of internal medicine. (And people honestly say the most peculiarly uninhibited things when they’re zonked on midazolam or emerging from a propofol TIVA.)

Production pressures are real. Virtually no time is budgeted for us to turn over a room, evaluate and consent our patients, place IVs, and roll back. Perioperatively, efficiency is the name of the game. And if delays occur, it’s always anesthesia’s fault. (Though I’ve gradually learned to be okay with this.)

I’m lucky to be (or have become) a morning person. My alarm sounds at 4:30 AM, whereafter I roll into the hospital in sweats before changing into scrubs and moseying over to my OR—where I can listen to string quartets while meticulously preparing for the day’s cases to my liking. Those hours are some of my favorites: an introvert’s paradise.

No other specialty has such a steep learning curve. After ~1 month of frantic one-on-one tutoring, we’re expected to have developed sufficient breadth and depth of knowledge/technical skill to conduct a simple anesthetic for a reasonably healthy patient with minimal supervision. It’s a trip.

No regrets so far. None whatsoever. As far as I’m concerned, anesthesiology is a consummately high-tech, high-touch, high-intensity specialty with just the right quality and quantity of patient interaction. 5/5 stars: would recommend highly to others.