Sunday, April 23, 2017

Starting March: Orthopedics and Scared Witless

February has whooshed by so quickly, and with it, my month of OMT and Family medicine, as well as boards. February was enjoyable, painful, and hard all at the same time. We found out at the end of January that our residency program was not going to be accepting new residents for next year, and all the sudden my cozy plans of meeting and marrying the NASA scientist, settling in and buying a condo at the end of the year, and flying home to see Grandmother in July went out the window. My future was all the sudden much more uncertain than I had expected it to be. After the tumultuous year of auditions, applications, and interviews, I was thrilled in March 2016 when I matched into a 4 year residency program. I thought I was set for the next 4 years. No more applications or interviews. No more uncertainty of where I was going or where I belonged. I had my residents and advisors and program directors. What was happening to my life?

All of this occurred just a few weeks before my boards. The end of January and the beginning of February became a chaotic and stressful time, trying to ignore the fact that I might not have a residency or future anymore, imagining myself in an empty clinic with no residents or attendings, and yet trying to study and focus on boards at the same time. It was scary, stressful, and saddening. I didn't know from day to day where I was going, what I was doing, or who I was anymore. I was expecting to become one of a new type of physician, and instead found myself one of the last of the breed. I was expecting to be settled, and instead found my foundation to be threatened.

It is now a new month, and I am on Orthopedics. I have a plan going forward, something that will take a bit of work but might just allow me to secure a future. I am scared witless that I will fail, but I am determined to have some success, determined to find myself some kind of future. I am fortunate that I have the backing of my program and GME, but all the work will have to come from me. More on this in later posts.

In knitting news, I have a couple of finished objects. I had quite a bit of scrap yarn let from a few pairs of socks I made at the end of the year, and I combined them to create these fusion socks.

In addition, I finally finished my TGV-Europe Shawl! I started this last summer, casting on the plane from New York to London. I knit on the project while riding the TGV from Paris to Barcelona in May 2016, and had planned to cast off on the way home. I initially had intended this to be a one-skein project, as the designer intended, and I used a gorgeous skein of red yarn from Stash in Corvallis, Hazel Knits fingering. However, in London, my mom and I had gone to a LYS and bought gorgeous 50g skein of creamy merino and a soft skein of midnight blue light fingering yarn that coordinated with my red shawl perfectly, and I decided that I would add both skeins to the project and make a red-white-and-blue shawl that would show both my love for the US and the wonderful time we had in Europe by incorporating the UK yarns.

Saturday, January 7, 2017

November: ICU Month and Felfs

November is more than half over, and yet I move as if in a dream. Between the election, the arrival of cold weather, and the long, hard, crazy hours in the ICU, it seems as if a century has passed and yet at the same time flew by in a blur and a blink.

ICU month. How to describe the craziness and yet long monotonous days in the windowless little room where I type my notes? Fear, elation, and sleep deprivation.This month has been filled with long days and nights, learning about the most critical patients and worrying about tenths of decimals that show whether a patient has heart failure, kidney failure, or a heart attack. Patients come and go: some get better, some get worse and are transferred to tertiary facilities, and some end their lives in front of our eyes.

I've learned this month to keep walking, keep monitoring, keep talking to the nurses to make sure everything is going as I ordered. I've learned to run at the first sound trouble and to gird my loins at the sound of the overhead speaker. I've learned to think fast and act confident, to speak to patients in a caring and firm manner, and that the nicest patient have breaking points and the crankiest patients have their soft spots. It's been a contentious and challenging month, and it is with great relief and a little bit of sadness that I move on to the next month: OB.

I've done some knitting despite everything, as the fall weather and gorgeous browns, yellows, reds, and orange leaves outside my window enticed me to wrap myself in the season's best hues. I've purchased yarn for mittens and hats, and am waiting for the right time to cast one. In addition, I was in need of some supportive knitting company one day, dropped by the yarn store, and happened upon a felf making class. What are felfs? Little clever slippers designed by Cat Bordi, taught  in simple steps by the ever-clever Bonnie of the Artful Yarn. They are addicting indeed. I've finished one, and am in the process of making another. I suspect I might even make some for ornaments as well. I'd never felted before, and this was another new process for me. It was so much fun to step outside my comfort zone and learn something new, and refreshing to be amongst knitters again, in a light and laughter-filled room with windows that looked out to tree-lined streets, away from the dark, dim hospital hallways full of death and suffering. I haven't quite finished the slippers, but Bonnie's instructions make the assembly process seem like it *shouldn't* be too much trouble. We'll see!

Hope you all are well,

Sunday, October 16, 2016

ER Month and Internalizing, some knitting

This is a long post about the challenges of ER month. Knitting content is near the bottom! ~Z

October is ER rotation month, and brings with it many challenges. I am by nature not the most quick-thinking of people, and coupled with ten hour shifts with no guaranteed mealtimes makes for some interesting experiences. There have been many a day when I've looked up at the clock and realized I hadn't eaten anything in 10-12 hours except a few chocolate almonds and a handful of pumpkin seeds. Makes for a great weight loss plan, but I shudder at what I might have missed in patient care, except that my attendings are sharp and thoughtful and eagle-eyed when it comes to making sure I don't miss anything.

That being said, the second challenge of ER month is the guilt, doubt, and internalizing. ER is such a fast paced place that we are always juggling several patients, hurriedly writing down all the details as soon as possible because no one knows when the next emergent case of septic shock, stroke, or cardiac arrest might come through the door. Patients often feel like it is taking a long time for providers to see them, but that is because there are so few providers for so many patients, and the less urgent cases sometimes get pushed aside to deal with real emergencies. I feel guilty sometimes that my patients are left to wait in a thin gown while I try to write orders and document history and check on lab results for another patient at the same time before I get a chance to go check up on them. I feel guilty sometimes that I don't know as much as I should, and that I take much longer than any of the other residents (okay, so they are 3rd year residents, and I'm a first year, but still, I am the weakest link this month.), and that sometimes I forget to put in orders until after I've seen the next patient. I feel guilty that I'm not doing as much for my patients as I could, such as the lady this morning I did OMT on, but only had time to decrease her pain from 8/10 to 3/10, whereas if I was more efficient I could have decreased her pain to 0/10 and let her go on her vacation completely pain free. I have doubts about whether or not I am doing the right thing, whether or not I am harming my patients with my inept attempts to be a physician. And then there is the internalizing. I saw a patient today who was a low to mid level health care provider, and had a substance abuse problem and a mood disorder. She walked into our community hospital ER, and wanted to get some help to become sober. I was so surprised and happy that she found the strength to seek help, except for the fact that our ER did not have the resources to provide inpatient detox counseling. We called the social worker, got her the phone numbers and resources that we could, but I highly doubt that she will actually follow up. I counseled her the best that I could, but there was very little that I could do in terms of medications and or physical care. And at the end of the shift, I could still remember the defeated and doubtful look on her face as she walked out of the ED with her designated driver. I felt so bad for her life situation, as it would be too easy to imagine myself in her circumstance, life in wreck and ruins, embarrassed to seek help and fearing discovery and recognition by coworkers and other providers. Internalizing patient problems is something that I've learned to manage for the most part, leaving everything at the office or hospital, but sometimes fear and doubt still creep into my private home life, as I lie awake thinking if there was something else I should have done, that I could have done, to help that patient seek help, or find her inpatient care. I know it is silly and there is nothing else that I can do right now, but some days, it is difficult to let go.

The third challenge is the fear of patient repercussion. I am lucky that I am just starting out, and that my attending physicians are there to help and guide me. However, it is still so nerve-wracking to make all of the small decisions that lead to a final diagnosis: do these lungs actually sound crackly? Does the patient's heart rate mean that they are nervous, in pain, infectious, or have a heart condition that requires further evaluation? Should I order lab tests on this patient who has been here for the same problem ten times in the last 3 months, and all of the lab tests have been negative? What if this patient, whom I send home because I tell him there is nothing wrong, goes home and gets worse, and now the patient and his family want to sue me? What if the patient who I ordered labs on had something come back and I missed it? I try my best to make sure I see everything, but it is sometimes hard to be able to get everything done and do it fast. I think I am happy to stick to Family Medicine in this case. ER will help train me to think fast and act fast and know what is an emergency, and I will be able to go back to figuring out the whole story on Family Medicine.

The fourth challenge is the schedule. I have worked 70 some hours in the past 7 days. There are a few days in which I am barely home long enough to sleep and eat before returning to the hospital for my next shift. There are some days I don't know how I would function without constant coffee to keep me alert. It doesn't help that we are shorthanded this month, due to a fellow resident's family emergency. While I wish all the best to the resident, it also makes for some interesting times when there are 2 attendings and me. I do a lot of running. (Who says I don't exercise, Ma? I exercise all day long.)

ED month is busy, so I pretty much only do a bit of bedtime knitting, the occasional long stoplight knitting, and didactics knitting. I love didactics. It is the only time in my week when I can knit at work. All of my fellow residents know that I knit, and I have demonstrated to my attendings that I can knit and lecture my fellow residents on medical subjects, as well as knit and pay attention to the lectures at the same time, so they have not yet given me any trouble. Some days, I get a little more knit than others, but all in all, it is great for productivity and helps keep me awake. It is also Socktober, which is hard because I want to knit socks, but also want to work on my sweater. It is getting chilly here in Ohio, so I really want to finish my sweater so that I can wear it!

First, though, some yarny acquisition goodness. I won a prize in Socktober! The generous ladies of the Carolina Fiber Girls podcast are hosting Socktober, a month-long knit-a-long where all we knit are socks, and I was selected as a prize winner for posting in the forum. It came super quickly, and the colors were just up my alley! I can't wait to knit with it! And it make this past weekend's shifts so much more tolerable.

 2. Socktober Socks #1: I worked on some socks while I was at the health fair, hosting a table on hypertension, and they were the hit of the fair! I had so many pregnant women coming up to me, asking me how to knit. It was fun to have that as an attraction so that I could capture their attention and lecture on pertinent subjects.

3 Lolo House Special#2: I knew October was going to be ER month, and I ordered the Bar Maids box very early on because I thought I would need some cheering up, and I was right. It made my week to have the goodies show up unannounced. It was a great surprise!

 4. Socktober socks #2: Well, okay, I think the above socks were actually the second pair, but I worked on these socks while I was at didactics last week, and now they are done! The yarn was so great to work with, and I can't wait to get more Copper Corgi yarn!
Sorry for the long rant, but I needed to get some steam out. On most days, I am so happy and feel so lucky that I have the privilege to help people with my knowledge and skill. Having 6 shifts in 7 days makes that hard to remember sometimes. But with great support, wonderful friends and family, and the knitting community, I muddle through pretty well. Thank goodness for knitting!

Hope everyone is having a great fall! I'm so jealous of everyone at Rhinebeck right now!

Saturday, October 1, 2016

Quick update (non-yarny content)

Time passes by so quickly! How is it possible that September is already over? In either case, a quick update on life, with more to come:

September means outpatient family and OMT, which, as all rotations, comes with pluses and minuses:

-later start time, (yay, no more 4-4:30AM wake-up alarm!) I can sometimes see the sunrise with breakfast!
- More time with patients, and I get to know at least most of the story (though sometimes, more than I asked for...) 
- I love working with my office staff! They are always so cheerful and helpful. My MA (yeah, I have an MA. It's amazing and slightly intimidating), is so good with kids and always looks out for me to make sure I don't miss things
- Medical students who ask questions and are enthusiastic about OMT,  and help me to stay ahead of the clock
- my hard-working preceptor who takes on more than her fair share of work and still manages to raise her children and sometimes feeds us dinner 
- my fearless and funny chief, who always makes me smile and manages to out-quirk even quirky me
- the FM resident family, who all support each other
-my patients who want to help themselves get better and ask me (!) about exercises, stretches, and ways to stretch the treatment further

- patients who don't want to follow any of my carefully laid out treatment plans and yet ask for extra medications and referrals and want me to fill out paperwork for them stating why they should have their heating and electricity without paying the bill (If you don't want me to be your doctor, please find someone else to fill out your forms) 
- medical students who don't want to be there, and do a bad job with patients, then try to make it my fault
- patients who try to guilt me into prescribing them medications that they don't need
- bureaucratic nonsense that leads to wasted time doing the same modules again and again (I'm pretty sure that I know how to wash my hands properly, thanks all the same!)

My grumblings aside, I am so happy and lucky and privileged to be working and training at a fantastic facility with amazing residents and attendings. Although the new-ness factor has finally started to fade, I am still sometimes taken aback by how far the past 5 years has led me, and how privileged I am to be in a position to help others and make a living at the same time. I know that residency is there to challenge and guide and teach, and sometimes it is frustrating and difficult, but at the end of the day, I wouldn't have it any other way. Onto ER month! Socktober! Autumn!

Love and hugs,

Sunday, July 3, 2016

Non-knitting segment: What do doctors wear?

A bit of lighthearted fashion, in celebration of the start of the doctoring life. 

Friday was my first day of being a *real doctor*. On Thursday afternoon, I was notified to pick up my long white coat (only students wear short coats), and promptly discovered that my name was embroidered incorrectly. My coats were whisked away to be redone, leaving me in a panic on Thursday night. 

What was I to wear? 

I had counted on being able to hid behind the long white fabric, but now, I would have to wear something more formal to be able to convince patients that I was competent and a legitimate doctor. My blessing/curse of a baby-face complexion only serves to enhance my youthfulness and inexperience. I brought out outfit after outfit only to banish them all back to the closet: too tight, too short, too casual. Finally, running out of choices, I went back to my med-student standards of a bright cabled sweater and black pants, with black work shoes. Boring, but safe. No one said anything on Friday, and I sighed in relief. 

I wondered what the proper dress etiquette for young female doctors were, and was delighted to find several resources already analyzing the issue: 

Corporette, a fashion/lifestyle blog for women in the corporate world, did an analysis in 2015 and the advice of several women physicians and patients boiled down to this: 
1. No messy hair
2. Dresses or suits are fine, as long as they are comfortable  and not too revealing for your day's work (bending down to examine patients, etc) 
3. Comfortable, dressy shoes are a must (no open-toes for safety reasons)

The Atlantic stated that there is no single standard for professional wear, as studies asking readers to rate clothing revealed a wide range of feedback, from profession to "smart casual", "business" to "semiformal". Which means that as long as the above conditions are met: no revealing clothing, no messy hair, almost anything may be worn. Helpful and unhelpful at the same time. 

In a NYTimes piece from 2006, Dr. Erin Marcus lamented the state of the dress code and had this piece of advice, that women should not wear clothing that was too revealing, and that makeup could help increase board scores during oral exams. While I don't know that these are necessarily useful: I would hope that most young physicians who have going through medical school have already honed their dressing skills to not be too revealing, it is definitely interesting that these issues were brought up. 

I soon realized that while these articles are helpful, I had all the answers I was looking for: good common sense. I just had to spend some time shopping. With that, I'm off to the shops! 

Edited to Add: I did find a very interesting Corporette article about appearing too young, and tips to address this issue, here. They had some good advice on makeup and accessories.  

Saturday, July 2, 2016

New Home!

Welcome to Cleveland!
I have been operating on automatic mode for the last few weeks, and it really hasn't sunken into my brain yet about where I am. These last two months have been so crazy, from my travels to Europe and China, to graduating from medical school, to moving across the country to Cleveland, and starting my new job as a resident physician.

I've been in Cleveland now for almost three weeks. While I technically start working this Friday, I've been at the hospital for eight work days now, doing orientation. It is so surreal sometimes, that we are being taught all of these "big medicine" techniques and procedures, from doing intubations and putting in chest tubes, to running codes and ordering medications. Somehow, it all seems like a dream, like this is practice, that it isn't real. The journey has been a long one, to get to this place, to be a doctor, and I still can't quite seem to grasp the fact that medical school is done and over, and I don't have to ever worry about whether or not I'll pass another block exam. I am a doctor. Wow.

For the first time, I'm living on my own, on my own salary (waiting for that first paycheck!), and making my own decisions. It seems so crazy and surreal, this time and place that I've been hoping and longing for, to finally be here. And yet, somehow, not quite what I thought it would be. I would have thought future doctor me would be smarter, more efficient, and better able to manage under stress. Nope, still the same me, just older and with slightly more knowledge (and a lot more yarn).

The last four years dragged on, and yet seemed to fly by in a flash. I'm excited and nervous to see what the next four years brings. Hopefully, I will live up to my residency's expectation and become a competent, fully-fledged doctor!

 Now, onto knitting! In all my travels, I've also been knitting. I started a TGV shawl when I was in Europe (and actually knitted on it while I was riding the TGV between Paris and Barcelona), but wasn't able to finish it before I left Vegas, and had to leave it behind.

I also worked on quite a few pairs of socks, including reknitting Al's wedding gift socks and finishing Isal's promised Christmas socks from last year.

I am also working on a pair of socks for myself, out of Heather/Highland Handmades's sock yarn club colorway, which will also qualify for Into the Wool points. (I got a LOT of knitting done on these during orientation, lol.)

I also finished a shawl, for our knitting group's shawl exchange, which was our way of saying goodbye, as Sarah and I ventured on our separate, independent, adulting journeys. We knit the Darwin shawl, and I made it out of Verdant Gryphon's Age of Asparagus, and a picot edging using some gorgeous light blue yarn I got at Stitches this year, which I sadly can't remember.

I'm so excited and nervous for the year coming, but I am happy to know that I will finally be able to focus on the next step on my journey, and was relieved to find some friends in my intern class who also like the fiber arts! Can't wait to see what the next few months bring! Stay tuned!

Wednesday, June 8, 2016

Blessings and Privileges of being a medical student

For all the early mornings, the extra late nights, and super long days of studying, sometimes I am just taken aback by how lucky I am to be a medical student.

In the past year, I saw the best and worst of patients, from a traumatic attack case, where the patient was left intubated and his ear infected and falling off, to a patient getting a breast reduction. From a patient with phyllodes tumor and had a double mastectomy, to a tiny baby, 33 days old, getting a pyloric stenosis resection. From appendectomies to hysterectomies and D&Cs. I've had the privilege of birthing life into the world as well as comforting an elderly patient on his last breaths. I've stitched cuts together and advised patients on addiction resources. I've even searched for a lost tampon (gross).

At the time, none of it seemed to be a big deal. I was a medical student, and I was there to do my job, which was to take care of patients the way I was trained. It is only thinking back now, as I am about to leave Vegas for residency, that I can truly appreciate how blessed I have been to have had wonderful teachers, both doctors and patients, guide my way towards my next step. I have learned so much, about medicine and about human life in these last two years of clinical clerkships. I've had patients tell me their deepest fears and darkest secrets. I've seen the most dignified patients at their worst, and important persons unconscious. Through it all, I've learned that disease does not discriminate. It does not matter how old, young, rich, poor, unknown, or famous a person is, everyone gets sick sometime in their life. So enjoy health while you can, for it truly is a privilege.

Stay safe and healthy,