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,

Tuesday, June 7, 2016

Decision 2016: Cleveland!

No, not that decision. I have little interest in debating politics on this blog. I did, however, match into my first-choice residency in Cleveland, Ohio. So I'm packing my bags, boxes, and a gigantic tub of yarn, and heading to Cleveland for the next leg of this journey!

The house is a mess right now, as I frantically try to remain organized and calm while dismantling my childhood bedroom. My parents have hinted that they would like to rent the house out now that we children are leaving, and this means that not a speck of personal material must remain within the confines of the fours walls I've known so well.

The only knitting I did was for a good-bye shawl exchange my knit group and I completed. It's the Darwin Shawl by verybusymonkey, and beautiful, though I did have to rip it out twice. So worth it in the end, though, because I got to make something for someone I love and admire. Note to self: pack the blocking boards. 

More knitting content on the next post. As for now, some pictures from my trip to China last month. Enjoy while I return to my frantic packing. Love!

Making dumplings!

Chinese Holiday traditions.

My grandmother at her sewing machine!

 A traditional Chinese teahouse!

 Lots of liqour. 

OMG dumplings. 

Saturday, February 13, 2016

January's End: Waiting

Things have gotten both more and less hectic around Casa de Z:

For January, I had my very first rotation in Anesthesia. It was nerve wracking, since I wanted to do well, and everything was so new to me, even in 4th year. It would have been so easy just to ride the currents of cruising by, since I had a different attending physician every day. but in many ways, my inner type-A made me somewhat miserable, as I was torn between being physically and mentally exhausted from interview season and wanting to learn and do well.

 I was very privileged to have so many attendings who wanted to teach, and became very familiar with many styles of anesthesia, since everyone had a different preference in how and when they administered drugs. I learned how to approach different types of intubations, and intubated 4 patients and inserted supraglottic airways on 3 other patients. I learned how to assess each patient's airway status, medical status, and surgical risk, and became comfortable with the medications administered from beginning to end of a basic surgical case.

And yet, in other ways, this month was difficult, as I frantically put my materials in order for my residency Match process, tried (in my bumbling, clumsy ways), to ensure that I told my potential residency places how much I wanted to be there and how high I would be ranking them, without saying too much or sounding too desperate. I submitted my applications, my ranking list, and now, the hardest part: The Waiting. Waiting, for February 8th, for the Match list to come out. To know IF I matched, and where I will be (hopefully) spending the next 4 years of my life. To know what kinds of preparation I will need, and what the timeline is going to be like. To know what style of OMM I will need to learn, and what kind of patient population I will encounter.

Thankfully, most of the places I am looking at are fairly cold places, so I am knitting like mad, both to stay sane and to prepare myself for the future to come.

<Knitting starts here>
I've finished quite a few things in the last month or so, between catch-up on Christmas knitting and the various KALs I've been participting in.

First, I finished some socks for my parents: 1 pair for my mom, in the Batman colorway from Gnome acres, and 1 pair for my dad in the Lollipop Yarns

Second, I finally finished my rainbow socks! I had started them much earlier, but the Knitpicks needles I used broke just as I was turning the heel on the first sock, and then I just gave up during audition season, trying to fuss with finding new needles, and waited until I was home to redo the heel. These are OMG socks, in the  Nothing says Screw You like a Rainbow from White Birch Fiber Arts. I am participating in the Rainbows and Unicorns KAL with Twisted Stitches podcast, the Knityobawls and Don't Hoard the Precious KAL from Sassy Pants Knitter podcast, and the 12 in 16 with Just one More Row podcast.

Third, I finished my first pair of socks with yarn from Nomadic Yarns! I LOVE her gumballs, and it is currently (thankfully), still easy-ish to get a hold of her yarn. I finished a pair of Leprechaun socks that I started back around St. Patrick's day, but then I got distracted by other shiny pretty things, like the Knitted Wit gumballs (more on that later).

Finally, I also finished a baby sweater! Not for me, but for my friend Whitney's baby. I started this sweater, oh probably in March or April, when she first told me she was expecting. I worked on it, finished it for the most part, but had some finishing to do when audition season/interview season hit, and then I just never had time to give it to her. I finally picked it back up again when I saw her at the beginning of the month, when we had to recertify for BLS. I told her about the sweater, and then when I found out that we were both going to be at the same recertification class for ACLS, I promised to bring the sweater. But when I picked the sweater back up, I realized that I still had quite a bit to do: knit elbow patches, pockets, sew in the buttons, weave in ends, etc. I worked on it while I was going through the ACLS videos and quizzes, but fell asleep. I brought it into class, along with my needles and crochet hook, and wove in ends and sewed on the buttons while we went over the details for the new ACLS guidelines. It turned out so much cuter than I thought: the buttons definitely make the sweater! The Knitmore Girls were right!

I have quite a few things on the needles right now:

1. I still have one pair of socks from Christmas that I need to finish for my aunt, which I had to reknit the entire second sock. In early December, I had knitted the first sock, and had just started on the second sock when I flew from Maine to Miami for an interview. I packed the sock (on wooden Knitpicks needles), and looked forward to the long plane rides when I could work on the socks and finish them in time for Christmas. However, somewhere between the security line and sitting down on the airplane, one end of the needle had splintered and broken, leaving me with one decent end and a stub. Since this was 8pm on a Sunday, there would be no way that I would be able to get another needle, and I had 3 hours on a plane. I made do the best I could, scooting the needles around so that I could knit with the good end (thank goodness for magic loop!) , and praying that I would not get splinters from the broken end. I made painfully slow progress, and was determined to get a new set of  metal needles in the morning after my interview. I had a great interview, and then set off in the balmy 70-degree December afternoon to Knitting Garden, where I met a group of lovely Cuban women who picked out my first pair of Addi Turbo Lace. I happily set on my way, excited to finish the sock at last. Over the next two weeks, between long days at the hospital doing inpatient family medicine, the sock practically flew to the heel and up the ribbing. I pulled out the other sock to see how much ribbing I needed to do, and that is when I saw it: the second sock was 1 whole size bigger than the first. How did this happen? I was knitting on 1's, same as the other sock! Then. I read the second, tiny line on the needle package: Size 1, 2.5mm. My Knit Picks were Size 1, 2.25mm. Not the same at all. I couldn't quite deal with reality at that moment, sleep deprived as I was, so I shoved the sock back in the bag and worked on some other, pretty, easy, shiny projects:

2. Mittens: I happened to see on Facebook and Instagram that Carrie Bostick Hoge and MJ Mucklestone were going to do a book signing at Knit Wit, a yarn store in Portland, so I rearranged my call schedule so that I would be able to go to the book signing. It meant that I had 2 overnight shifts the next week, one on Wed and one on Friday, but it was worth it. I bought my first Quince and Co yarn that was used in the book, and began casting on right away once I got home.

4. Socks for Isal: My medical school big sib, and all around awesome mentor and friend, Isal, moved to Pennsylvania this past year for residency. Since she is from Las Vegas and California, it's been fun helping her get ready for winter. I promised her some socks for Christmas/birthday, but things got in the way, so I am working on these now. It's taking me a bit of time to do these, since her shoe size is itty-bitty: women's size 4.5-5! I've had to cast on and rip out 3 times already, but it's worth it. She's given me so much help, guidance, and support for all of med school, and I look up to her as a friend and a mentor.

5. Leg warmers for Amila: On our somewhat-monthly Google Hangout session, my friend Amila mentioned that she bikes to work in leggings and scraped herself landing wrong. I asked her if she wanted legwarmers, and she agreed. At least the wool would cushion her when she fell. It took some back and forth to settle on the perfect yarn, but now we have  agreed on it: pink, gold, and purple striped with sparkles, Turtlepurl's City Girl on a sparkle base. I have this yarn for socks in the future, and I look forward to making these for Amila.

Stash Acquisition:
I posted earlier about the yarn I bought during audition season, but since then, I have purchased a few things, including a beautiful Anne of Green Gables bag from Little Skein in the Big Wool, and a few skeins of yarn from Big Sky Alpaca for a Chilkat Cowl.I'm excited to finally start working on fun projects and be done with gift knitting!

Will try to post pics later, but wanted to get this up, so look out for pics!

Hope everyone is safe and happy and warm!