It's May!

As I started this month, I thought a lot about countdowns. The countdown to my vacations. The countdown to the end of Intern year. And the countdown to finishing this ridiculously hard and yet, at then end of it, extremely educational stretch of 13 days without break. I know that many of my friends and fellow residents have worked much more than that, and maybe I am making a bigger deal of it than it needs to be, but it is actually spelled out in our duty hours requirements that we should only work 80 hours per week (I worked 83) and that we should be relieved to have mandatory day off every 6 days that we work. But reality and requirements are not often the same thing, and reality was that someone needed to be on call and work night shifts and weekends while my fellow residents took care of babies, attended weddings, worked on their marriages, and attended conferences. I cover for them, just as they will cover for me when I go to China to see my grandmother, and take care of her in the precious time that we have together.

I'm back on internal medicine this month, which means managed insanity. Insane schedules, insane work hours, and insanely noncompliant patients. While I completely understand autonomy for the patient, I am also somewhat perplexed sometimes why patients who refuse all medical care come to the ER and want to be admitted to the hospital. There are cheaper ways of obtaining 3 meals a day and an air conditioned room with crappy television service.

Knitting has been interesting, as I start working on the Fairy Hill Shawl!

I'm excitedly waiting for my beads to arrive. I have the perfect yarn that I bought at Stitches Midwest 2016 last summer, from Dramatic Knits, in their Cherry Blossom Colorway. It screams spring in the most polite manner, and will be elegantly paired with citron colored beads. It will be the perfect thing to work on during the long plane rides, though at the same time, perhaps sleep deprivation is leading me to insanity, as the thought of hundreds of tiny beads scattering throughout a trans-Pacific airliner jet when we hit turbulence sickens me to my stomach.  Stayed tuned!

August/Sept, and Into The Wool Fiber Retreat!

I discovered this in my drafts folder, and felt so embarrassed I hadn't published this! I had meant to! ~ZT

Ya'll, August was a tough month. I was on my surgery rotation, and it was rough. The hours were technically 5:30am-ish to 5:30pm, but that also meant that I was getting up early to round on the patients, and there were more days than not where I stayed until 7 or 8pm to do double rounds with the OMT team. It was by choice, but it was still a bit rough. I felt bad for my OMT preceptor as well, since she also had to stay late to make sure that I got my numbers in. The surgical team typically does not do surgical consults, and so it makes things a bit difficult when my graduation requirements state that I must treat at least 50 surgical patients with OMT over 4 years. Thankfully, since I was on surgery, every patient I treated with OMT was one more that I could count towards that number. Most days, I came home too tired to do much more than cook, eat, and sleep. A few days, I didn't even make it to the bed and fell asleep on the couch.

Of course, Olympic season also did bad things to my sleeping schedule. I love the Olympics. I love the sportsmanship (or lack thereof), the competitions, and the general joy of celebrating athleticism and the power of the human body. As a former media translator who helped cover the Beijing Olympics, I think it is safe to say that I am obsessed with the Olympics. Thus, the fact that I had to get up at 5AM and the fact that most of the interesting events were broadcasted at 9pm primetime did my sleep no favors.  NBC, you are the bane of my existence. I understand you need the numbers of viewership for your commercial sponsors, but still.

Thus, it was with great relief that surgery rotation ended and I was able to look forward to something I've been waiting for a long time: my first knitting retreat!

I was so privileged to attend the Into the Wool Fiber Retreat 2016, hosted by Dana of Unwind Yarn Company and Just One More Row podcast, Wendy/Sillyfru of Sassy Pants Knitter podcast, and Ashley of Twist Fiber Studios. I've been watching Dana and Fru's podcasts for a long time, and I was also a big fan of the Caffeinated Knitting podcast, whose co-host Daniela was one of the former hosts of the ITW retreat. For the past 2 years, as I watched all of the fun and shenanigans reported on the podcasts, I promised myself that if I got through the craziness of medical school alive and found a residency, I would find a way to get to ITW. ZK, SSK, and Rhinebeck are on my list of yarny things to do, but ITW seemed such a special retreat to be able to go to, and it was hosted by some of my favorite podcasters.

Indeed, the retreat was spectacular. I had so much fun, and made so many friends, and I just feel so lucky that I got to be a part of something special. I drove 18 hours roundtrip, but I don't mind it a bit.

The beginning of the retreat was a bit hectic. I arrived just barely in time (at 4:45pm) for check-in, which closed at 5pm, but the Ashley and Fru who checked me in were gracious and so nice. I found my way to my cabin, said a quick hello to my fellow cabinmates and unpacked my stuff, then ran my car back to the parking lot. I couldn't find a single person afterwards, and I panicked a bit as I walked around trying to find the opening ceremony gathering area. Fortunately, I ran into two lovely individuals, Jen of Daizie Knits, and Willow they set me straight. They took me to the gathering area, and I was able to find people to sit with.

The next few days passed in a blur, and I had a wonderful time.

Seasons of Love

You know the song: 525600 minutes...

Now that we have that earworm going in the background. I just wanted to take a moment and think about the fact that I have been a doctor officially for a year. It has been an amazing process, and I am constantly learning more about what I need to learn, but somehow, in the past 6 months, I have stopped feeling embarrassed when people call me doctor. I have learned to proudly step into the role and instead of shrinking back because I don't know something, I step forward and state that though I don't know everything, here is the information that we have and here is the plan going forward.

Somewhere, in the past 3 months, I have learned how to better deal with patients. How to tell them I need to go in the most polite terms, and how to look and them and ask questions to get a better answer and get the answer that I was looking for.

I learned to stand up to nurses, and that even the best nurse does not have the same knowledge base that a doctor does. We learn and approach patients from different standpoints, and while I constantly learn from my nurses, I also learned that sometimes it does take a physician's standpoint and critical thinking skills to say that no, this patient does not require this drug and yes, really, they do need this lab value.

Somewhere in the last month, I learned that present myself with the passion, compassion, and composure of a physician. I stopped thinking of myself as a glorified medical student and started becoming a little less scared that I would be found out as a fraud and be sent back to medical school.

Somewhere in the last 12 hours, the clocked ticked past midnight, and the Seasons passed by, to make me an official 2nd year resident, a "senior".

I have had to excuse myself out of a room to cry after I gave the patient their cancer diagnosis. I have watched as patients I performed CPR on die in front of my eyes. I have intubated patients who appeared in front of me and could not breathe. I have called patients with the good news that they were losing weight, and counseled patients as their HbA1c continued to climb despite their best efforts. I have delivered babies and put their mothers pelvis back together after delivery. I have injected patients' knees and watched as they walked out of the room pain free without a limp. I have performed OMM on patients who swear they had 10/10 chest pain, and watch their face in amazement when their pain resolved.

It has been quite a year. Here is to another great year, and to the incoming interns, good luck. You got this. You can do it.

End of March: Convocation 2017, Sweater and Teaching Dr. K to knit!

March ended so quickly, and it was a much better finish than the start. I learned that I passed my COMLEX 3 boards (medical boards step 3), which meant that I was pretty much done with standardized tests until my licensure examinations in 4th year of residency. I am so relieved to finally be done, as I had visions of failing. And yet, I actually did better in my step 3 than I did in my Step 1, finalizing that my experience is always more than I imagined.

I had such a great time in March, more than I had initially expected for my orthopedics rotation. I learned to read Xrays, and how to vocalize the reads, I learned how to do knee injections quickly and efficiently, and I learned how to be faster in doing clinic encounters. I did not enjoy the 6am start times, but I learned that getting for cases was much better than trying to get up just for clinic. I liked having that little jumpstart to the day, learning about the different cases that orthopedics managed. I peeked into a few OR cases, and renewed my love for the OR, but was happy that I didn't have to scrub in for too many cases. My suturing skills were quite rusty.

I was also happy with the generosity of the orthopedics residents, in allowing me to go to Convocation, the premier and ultimate annual conference for the American Academy of Osteopathy. I had a blast, getting to see my OMM friends and colleagues again.

Now the Knitting content:
I am almost done with my sweater!

I worked on it quite a bit when attending the lectures, and it actually made me pay attention more. I was alert and listening instead of getting bored or frustrated that I could not take down the information fast enough. I listened to what was being presented, and only took notes on the pertinent topics. 

I brought yarn and needles, and accomplished the impossible: I taught my advisor how to knit! She picked it up pretty quickly, in fact, and it was so fun to do that. On the other hand, I also tried to teach my senior resident to knit, and that turned out hilariously bad, as he slipped all the stitches in an attempt to "knit more quickly", however I suspect he was trying to do it badly so that he would get out of further knitting lessons. I took the hint rather quickly, and settled for making him things in the future instead of making him create his own.

 In addition, I spotted some knitters and crocheters in the wild! A spouse of one of the physicians had a baby blanket she was working on, and she stated that she always brought along a blanket to work on "at these types of events".

 In addition, I spotted another physician working on a hat on the first day, so I quickly snapped a picture during lecture. I should have known, as osteopaths are fairly tactile people, but it was good to have proof nevertheless.

 All in all, March was a wonderful month.

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.

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.

Knitting
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,
~Z

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.)

Knitting
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!
~Z