Miraculously, I survived my 4 months of hell doing Peds Clinic/Peds Wards, Inpatient Surgery and Internal Medicine Wards back-to-back.  My longest shift was a 35 hour call (which I fudged my hours on hehe).  Looking back, on Peds I worked 60 hours Friday-Monday for two weekends and took a total of 14 calls.  I took 8 overnight calls during surgery.  3 overnight calls during IM and 4 short calls till 9PM.   That was alot of hours

I can say with confidence that I know what sleep deprivation is now.  You haven’t lived until you are forced to do a procedure on someone after going 30 hours without any sleep.   It’s kinda like being drunk without any shred of happiness.  Your mind is fuzzy and you are just trying to keep moving.  I have run off of the road twice driving home from call and luckily havent caused a wreck yet :P  The good news is that life should get a little bit better starting June 1st.  Ya see, I’m starting my PGY 2 year a month early due to someone taking a leave of absence.  This is a good thing and a bad thing.  The good thing is that they are letting me keep my week of vacation during that time and it is during a difficult rotation.  The bad part is I was scheduled for outpatient surgery during my last intern block which is fun and a cakewalk because you get to do all these cool surgical procedures by yourself and work Monday thru Friday from 8AM-4PM on average (A dream).  Instead I am doing pediatric wards and there are only two interns, which means many nights I will be alone running the floor and doing admissions by myself (Scary thought).  To add insult to injury, I will have to goto FM clinic after working a night shift for the morning.  So much for a nice easy ending for my intern year :(  No one said it was going to be easy though.

However, right now I am on OBGYN catching kids.  I have been on night float (5:30pm-7:30am) shift all week long and am “flipping” over to days by working a 24 hour shift today.  No one told me that weekend shifts start at 8am and I showed up 2 hours early this morning(Doh!).  I am very tired today, especially since my sleep schedule is completely screwed up.  I will be on day shifts next week (6:30am-6pm) and then flip back to nights again the following week.  Luckily the OBGYN staff at Carilion are actually pleasant to work with so it lessens the stress somewhat.  I have done 10 deliveries so far and I have an 11th pending right now in labor at the time of this writing.  I’ll probably pick up a couple more on this shift.  I’m still feel like I am learning the ropes but I am beginning to catch on.  Just need to do plenty more cervical checks. :/

Part of me is missing the safety net of being an intern but the vast majority of me is thinking “Good Riddance”.   I am looking forward to some lessened hours and increased responsibility in my 2nd year.  I’ve had really good evaluations thru my first year thus far but I am starting to lose steam I feel.  My health has been declining also.  I have gained 35lbs since starting internship, placing me close to a whopping 200lbs. :(    I start nutrasystem on Wednesday of this week for 6 weeks to aid in weight loss.  It’s nigh impossible to exercise when you are working 80+ hours a week, especially at odd hours.  You literally have zero energy and I always feel fatigued.  So if you are wondering why there is no music, you can rest assured the reason is that I’d rather sleep and spend what little time I have with my wife.

Maybe in a couple months, I’ll start being a happier person again and writing more humorous, crazy posts.  :P  I am convinced Internship causes depression.

So it’s been approximately 3 months since my last post on my own website.  Naturally I have been very busy with Internship.  So far I have done Inpatient medicine, ICU/CCU, Family Medicine Inpatient, Emergency Medicine, Pediatrics Clinic, Pediatrics Wards and now Inpatient Surgery.  Naturally with this comes alot of overnight call.  So many of you are wondering what internship is like, I’ll give you a brief run down.

The Hours

Generally you work 75-80 hours a week.  How you approach this limit depends on the amount of call you take.  On ICU rotation, I took 2 overnight calls a week, which is an automatic 60 hours (30 each call because they keep you till noon the next day most of the time).   However during the days not on call, I worked from 6am to 1pm which helps keep the hours low.  Plus you get an average of 1 day off a week.   On other rotations, like pediatrics, my schedule was very erratic.  One week I took call every third day and then finished the week by being on call Friday night and all day Sunday.  Yep, I did 60 hours over a weekend, it sucked.    Other rotations like Family Medicine inpatient, I had 2 weekends off, but I worked 12-14 hours monday-friday.   Thus it should be said that the hours vary but they always find a way during your internship year to get you near that magic 80 hours mark.    At my program, they do adhere to the 80 hour rule fairly well which is nice, but not all programs are like that.

What does it feel like to be an Intern?

During my 3rd year of medical school, I felt like I didn’t know anything and it was scary.  During my 4th year of medical school, I thought I was the man and knew everything!   Your first day of internship you realize that you know nothing again and all of a sudden, everything you do matters.  You can sign orders, sign notes, write scripts…the whole nine yards.   You often feel alone during internship but you always have some sort of backup in the way of a senior resident or attending physician you can call if you have a question about something going on with a patient. 

At times, you feel excited!  It’s like “Wow, I made it thru school and I’m a doctor, it’s really happening!” and other times you are like “Holy crap, what the hell did I get myself into?”  So naturally there are good days and bad.   When someone passes away, you cannot help but feel a little sad.  You are euphoric when you realize that you are post call on a Friday but have Saturday and Sunday off meaning a partial three day weekend!  But most of the time, particularly in the winter months like now, I feel depressed.  Depressed for a few reasons:  Stressing out about future rotations, knowing that I’ve got a rough month of inpatient internal medicine coming up; Not being able to spend alot of time with my wife; Being sleep deprived all the time; Gaining weight due to poor eating/constant stress/exercise habits; The knowledge that there is no end in sight to working 80 hours a week for the next few months; and the lingering thought that you can and will be treated poorly by nursing staff or malignant attending physicians (though I have not experienced much of that luckily) Overall, you desperately cling to the knowledge that residency too, shall eventually pass.

On the other hand, I really enjoy working with the physicians in my family practice program.  They really care about the residents and take time to teach us and get to know us as people.   The problem with internship year is that we see our family medicine faculty two months out of the year and 1/2 a day a week for continuity clinic the rest of the time.   I think life gets better as a senior resident, or so I am told.  Our program was just reviewed by the Residency Review Committee and received a full 5 years of accreditation, which is the maximum a program can get.  Naturally, our Family medicine residency program at Carilion Clinic is doing something right.  Glad to be on board something good.

Increasing Knowledge

I realize I am getting better daily.  Sometimes I don’t feel that way.  Heck, oftentimes I feel like a complete n00b however I am picking up on alot of things.  Some knowledge I acquired during medical school that did not make sense to be at the time really came together for me after actually managing patients on the floor.  It really does help to learn by doing.  There is something about knowing you are ultimately responsible for your knowledge base that seems to make your mind “figure” things out easier.   There’s a constant pressure too.  When you do attending rounds in the mornings and present your patients and their plans, you always have this nervous pit in your stomach, however that is how you learn best and at times you are able to have an epiphany during the discussion.    I do alot of reading, and usually keep a book in my jacket pocket at all times.  Mainly due to the knowledge that I will be taking my step 3 board exam to get my permanent license in the next couple months.  As a Family Physician, I am now faced with the reality that I have to know a little bit of everything and have a broad knowledge base.  I am further reminded of this truth every time I am in continuity clinic.  Like this week, I will see someone for rib pain that will need a follow up rib series (x-ray) and then 20 minutes later will do a pap smear and pelvic examination on someone who may have Polycystic Ovarian Syndrome.  Very broad knowledge base means I will be reading alot.   Did I mention I keep a stack of books by the toliet?  My wife gets a kick out of it

What is being on Call Like?

In one word: Scary.  When you are on call, you carry a pager.  You often times have a call room with a cot and sometimes a TV and a computer to enter orders in on.  Many times you get soft calls like “Mr. So-and-so can’t sleep, can you give him something for sleep?” and so you order some Ambien or some Trazodone.  Other times you’ll get a call because a patient is in pain or has vomited.  In the worse case scenarios your code blue pager goes off or you get called because a patient’s respiratory status is worsening.  At those times, you get your butt out of bed and see the patient immediately.  If things are bad you call the ICU and arrange for transfer for higher level of care.  If you are in the ICU, you intervene and call your senior resident immediately.  (always call your senior resident for ANYTHING bad). 

Admittedly, it’s tough getting out of bed and running to see a patient.   Everything is fuzzy under the flourescent lights but your adrenaline kicks in after a few seconds and you are going at full blast.    I often worry about missing pages but have not slept thru a page thus far.  Still I sleep very light on call nights and so the sleep you get (if any) is very low quality sleep.  When I was on pediatrics, I never slept more than an hour at a time.

What is the the worst thing about being on call?  Overnight Admissions.  Normally you get called to the ER to see a new patient.  Many of these overnight admissions are soft admissions (meaning that the patient really didn’t need to be admitted to the hospital in most cases) but all admissions being warranted or not need a complete history and physical.  Doing a decent H&P and writing admission orders on a patient takes a minimum of 45 minutes to do correctly, and in worse case scenarios, up to 2 hours.  Keep in mind you are still getting paged every so often during these admissions for other patients.  Thus, get 5 admissions overnight and you are talking about a very fragmented (if not non-existant) sleep pattern.   By far though, the absolute worse part of being on call is working the next day and presenting on rounds.  While you are sleep deprived you have to present the people you admitted overnight to your team and your attending physician who often pimps (read: asks multiple medical questions to increase your medical knowledge, make you look stupid or a combination of both) you and turns you to dust.  Why?  Because after sleeping a total of 15 minutes overnight, your brain does not work well which means you cannot recall as much medical knowledge during the next day.  Still this is the way interns have been trained year after year so learning to function in a chronically sleep deprived state is a skill every Intern needs.  Am I good at it?  Let’s just say I’ve gotten better over time.

Still, you do learn during your time on call because it is just you and a book making medical decisions based on what you know.  And if you don’t know? You call someone and ask or look it up yourself till you find the right answer.  I one time got to put in three internal jugular central lines in one call night in the ICU because we had two patients in septic shock and one surgical pt go into cardiogenic shock all within a 4 hour period.  That’s what you call on the job training.

What is the pay like?

Average Intern pay is about $9.46/hour.  Yes you read that right.  I am lucky though, my program is good to me and so I get $10.39/hour.   Are you shocked?  Don’t be

Do you have a life outside of Internship?

Yes but not much of one.  You see, residency completely engulfs your being for 3-5 years.  However, it’s really accurate to say that once you become a physician, that forever defines who you are.   But I still find time to take my wife out to eat or occasionally goto a concert with my wife.  We go out to eat with friends from school and work.  Our families do come to visit also which is a plus!    When I am not reading or catching up on paperwork, you can find me on Xbox Live under gamertag RichieTruxillo playing some Call of Duty 4 or Gears of War 2.  And of course I still play World of Warcraft on Dragonblight server (alliance) though I am severely lagging behind my guildmates who are all level 80.  (I have a 73 hunter and a 70 paladin and a 60 DK).  I was hopeful to goto the gym (we get a free gym membership) my first month when I was working 9-5 everyday during our introduction month, however that went right out the window when I started working in the wards and in the Internsive Care Unit.  It takes 18 minutes to get to the gym so by the time you get there and back, you have burned 2 and a half hours.  Normally I have a total of 3 and a half hours of free time when I get home in the evenings before I have to goto bed assuming I am not on call.    Again, I hear that life gets better next year so I am desperately clinging to that still ;)  Actually life is supposed to get a little bit better after next month (all the call months will be over) and I will be definitely looking forward to it. 

With all of that said…

So, with all of that said, please forgive me if my website has not been updated in awhile.   I have been kept extremely busy!  However, I am clinging to the knowledge that after next month’s beatdown, I will have a smidgen more free time to learn and live life a bit more.  Until that time, please say a prayer for me to continue this journey with my sanity and health intact!   And I’ve still got that sense of humor in me, just haven’t been able to sit down and write music and do stuff like I want to.  Anyways, thanks for reading this wall of text and best of wishes to you!  And next time you think your job sucks, remember the poor Intern and what he goes through.  Suddenly, your job won’t seem quite as bad

So it’s been awhile since my last post.  My wife so graciously has posted a happy birthday message for me. :)  Yep I’m 29 now!  I got some interesting emails this week from old Everquest players who were surprised to see be in medicine now.  Yeah, I remember playing Everquest with my friends and talking about taking my MCAT and applying to medical school.  Now here I am, Dr. Richie Truxillo the 1st year Resident, seeing patients prescribing meds and pretty much playing doctor everyday.  My my it’s been a long road.

This first month has really been an introduction month.  Patient care during the mornings (and occasional evening) with didactic teaching sessions in the afternoons.  I start working at the Salem Veterans Hospital on the 28th on the Internal medicine service and then the ICU/CCU.  So I’m getting hammered with experience right out of the gate.   Still, I enjoy it so far even though the hours are going to be long.  My main concern is getting to see my wife everyday and spend time with her.  I’ve also gained some weight and trying to get it off is awful.  In fact as soon as I finish this post I’m hopping on the Bowflex and then doing 30 minutes of cardio either with Taebo, my bike or Wii Fit (havent decided yet hehe).

I’ve made a couple posts on Realdealmedicine.com but thus far haven’t reached my goal of a post a day.  I celebrated my birthday this past Sunday even though it was on Monday.  Patty is out of town this week in Myrtle Beach with her family/  On monday I pulled 12 hours and came home to my solo dinner of 2 angus burgers I cooked on my new grill.  The phone rang and I turned my back for 2 minutes.  My dogs stole my dinner off my plate and gobbled it up just in time for me to turn around.  30 seconds later they gave it back to me as they barfed it ALL up on my kitchen floor.  The smell was horrid, like the smell you get when you eat chinese food and afterwards take a laxative to clear it out.  :(   Anyway, my birthday dinner ended up being a bowl of frosted flakes ;)  Such is life though! ha!

I’ve also found I don’t consider the little things anymore when I am tired.  Like this morning, I got up and let the dogs out to pee.  I walked outside in my underwear and waved to my neighbors and said hello.  Didn’t think anything of it! hehe  I guess it was a little drafty.

Well I need to cut this short.  I’ve got some studying to do and my gut isn’t going to get any smaller by sitting here at the computer desk. ;)   Leave some love on the comment box!  And Patty, if you read this, I love you and miss you.  Crap!  I just forgot, I gotta take the trash out too!

So graduation came and went, like a summer thunderstorm.  Some of my faimly came to watch me graduate and my best friend and his wife hooded me.  When I was up on stage, as soon as I was hooded, the wind blew really hard and knocked part of the stage down.  If anyone has video of that happening while I was up there, please send it to me!  I will pay to have the video shipped. :)  It’d be great Youtube video fodder!

I have sent out thank you cards to everyone who has given me a gift for the wedding and for graduation.  I’d like to take a moment and thank all of you publicly for your gifts as they have made moving to Roanoke and buying our first home possible.  :)  Thank you all so much!

It is June 26th, 2008 today.  I’ve been in orientation for what seems a week and a half now.   I have re-certified in Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced Life Support this week.  In addition, I’ve been to orientation for the Salem Veterans Hospital, the new EMR for Carilion (EPIC) and a short blurb on Carilion Clinic.  Tonight, we have the picnic where I can hang out with the new residents and meet their families.  It’s a pool party, looking forward to that

The Ebay stores are doing well.  I also am getting ready to crank up the seperate “Real Deal Medicine” project shortly, which will be blog posts based on what I learn during my rotations thru residency.  This is to serve a dual purpose:  1) To keep me honest on reading while solidifying knowledge by recording what I learn and 2) Provide somewhat of a knowledge base for med students and residents in layman’s terms.    There’s alot of information out there like emedicine and Harrison’s, but not really anything that breaks information down into layman’s terms.  You will find the project at realdealmedicine.com

All in all, things are going well.  I’ve got some other things coming down the pipe but looking forward to starting residency soon.   I am tired of being nervous about it and just want to sink my teeth into it and get this show on the road.