Around we go

The Wiccan calender is all about new beginnings. Yeah, Samhain is the "new year" for most of us, but really the whole frickin' thing is about renewal and fresh starts. Now I have another New Year celebration - July 1st. Thus begins my second year of residency. Happy New Year. 

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I’m now 3 weeks into second year and I can report a couple of things: I like not being new at my job, surgery is fun, complicated pregnancies are complicated.

I’m on the benign gyn rotation during the week but second year involves lots of weekend call so I’m also spending time on L&D. I had an absolutely insane shift the first time I worked a solid 24 hours (we don’t do 24 hour shifts as interns, a hold over from some old duty hour restrictions that got lifted but our program kept them. I’m eternally grateful). The second 24 I worked was THIS weekend and it was a bit different, I worked my regular day shift job and then showed up on L&D to take report from the day team and work a second shift on L&D until morning. I managed to sneak in about a 40 minute power nap prior to my shift and the night was a steady stream of busy but not the insanity of over a dozen deliveries, half done by me, that last weekend brought us.

I have admitted a couple of people with some interesting problems to our Maternal Fetal Medicine unit on my weekends on L&D. It is interesting how much of a Black Box Warning pregnancy is for every other kind of medicine. If someone happens to have something else going on - Lung infection? Cellulitis? Broken bone? Odds are good that we will either be called to consult or be asked to admit a person to our service even though we have no idea how to manage the medical issue that brings her in! We had someone who was miscarrying recently and still the medicine docs would not recommend surgery for an unrelated and REALLY IMPORTANT problem she was having. Instead they opted for “conservative management” which involved NOT fixing the problem that they wanted to fix surgically before they realized she was pregnant. The consult note from my gyn-team colleague had very explicit ALL CAPS instructions about recommending “DO WHATEVER THE HELL YOU WOULD DO IF YOU DIDN’T KNOW SHE WAS PREGNANT!!)”

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Two small raccoons, one lying, still, on the side of the road. The other approaching carefully, tentatively forward from the tall grass. Nose to nose. Heartbreak in a flash of my headlights at 5am

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Laparoscopic surgery is a different kind of frustration. There are issues of dexterity and muscle memory with all surgery but this year I’m getting more exposure to laparoscopic surgery. It’s making me wish I’d played a LOT more video games in my youth! It is so frustrating to be looking at my tools on a screen, trying to grasp and maneuver, find the right angle.Trying to make the tools do what I need them to do, while remembering they are on a fulcrum, that levers move backwards (If I want the grasper to go up, I move my hand down). And on a 2 dimensional screen. And that is real tissue you are grasping, so don’t pull too hard, watch where the instruments are going, and please for the love of everything holy, do not require us to open because you perforated the bowel or tore open a blood vessel. Also, I’m trying to remember crucial details like the names of the different types of graspers and when you use them, a Maryland is different from a Prestige which is different from a Hunter Bowel (really, you have to know what to ask for. Often the scrub knows what I need before I ask for it, but sometimes s/he is wrong and I need to adjust my field of view. AND I need to remember the steps of the surgery - DON’T FORGET TO INJECT THE DILUTE VASOPRESSIN!!!!! WHY DO I ALWAYS FORGET THAT STEP?!?!?! Sigh, anyway, it’s July again and I love my job but I am going to be a LOT better at it in six months!

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I just had an amazing half day in clinic. As I think I mentioned, as a 2nd year a lot of your responsibilities increase. We have a lot more people on our clinic schedule and they can be more complex than return OB prenatal visits. This time, I had 8 patients on my schedule - and they all came!! That in and of itself is a little unusual for me. I usually have at least 1 no show to give me a little breathing room. Today I had 3 Spanish speaking patients, 3 return patients, a consult for PCOS, a woman needing a new contraception plan (one of the Spanish speakers), a woman with gestational diabetes who wanted a trial of labor after cesarean and didn’t have her sugars with her and didn’t know how she was supposed to be testing her sugars (also a Spanish speaker) and what turned out to be a VERY complicated IUD removal. I didn’t get a single note done before the end of seeing patients, but I got all the prescriptions done as I went, I had all the salient details either in the notes or in my head or written down someplace so I could write my notes afterward. My last patient had a 4pm appointment and I walked into her room at 4:22. That is running spectacularly on time in a resident clinic! Then I stayed after work and finished my charts before heading home. I’m getting good at this!

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I’m on vacation as of this afternoon.. I haven’t started packing yet. I need to be at work in 40 minutes and I’m still in bed. I will be driving to DC at some point today. I should probably get up!