Howdy everyone! Fall is definitely here - with crisp, cool mornings, bright red and gold leaves and pumpkins! I'm finally getting the chance to enjoy it. October pretty much disappeared on the adult medicine wards. It was my hardest month yet - very challenging mentally and physically. I had the first and last weekends off but worked every day in between. My mornings started at 5:30 or 6 AM, and I usually worked till 6 or 7 PM if not on night call.
More than the long hours, though, the constant intensity of caring for really sick patients took its toll. In medical school, I did not have many opportunities to care for patients in intensive care. So it was quite overwhelming to take responsibility for patients on ventilators with blood pressures of 50/30. As with anything in life, experience is best teacher. By the end of the month, I was able to admit patients to ICU and manage their care with a bit more confidence. I could get through my morning rounds efficiently, and I didn't panic every time my pager went off. I still don't always know how to deal with every question or situation that comes up, but I feel much better equipped to handle tough cases than I did a month ago.
Now I am on pediatrics, which is a completely different world. I still have some pretty sick patients, some of them only weeks old, but in general pediatric patients are a little easier. They don't have a lot past medical history or multiple coexisting conditions. For example, my adult patients typically have heart disease, COPD, hypertension, diabetes, alcohol abuse and kidney failure, which, as you can imagine, makes their management quite complicated. Pediatric patients, on the other hand, have perhaps one underlying condition - such as history of premature birth or asthma. Some come in with no preexisting problems at all. It's still scary to take care of a kiddo with a severe asthma exacerbation or a newborn who can't breathe due to a respiratory virus. Fortunately, the pediatric attendings are really good about teaching and explaining things. I find that if I can get guidance on managing a specific case once, the next time I see something similar, I can usually figure out what to do. My team is really great this month too - I am the only intern with three upper levels, all of whom are fun to work with and very helpful. It will still be a busy month, including 60 hours of call over Thanksgiving weekend. But I think I'm going to really enjoy it.
Well, time to hit the pillows. Looking forward to a week in Houston over Christmas (Dec 24 - Jan 1). It's right around the corner!
