Patients, Patience, Stress, and Dress

Sorry for my recent lack-of-blogging. I feel like sometimes all I do is talk about work which, obviously, just about equivalent to life right now. I'm not sure how interesting it is to hear about all the sick people I see every day, so I didn't have much to add last week. But here are some updates.

Patient care is tough. I was over at Kyla and Ben's house last night for a wonderful meal of lasagna (from the farmers' veggies!), and Kyla and I (Ben had to go in to work to the ER) talked for hours about the struggles of residency. It was very nice to be able to vent to someone who has "been there" and knows that it does get better-- she is an incredible role model and has been a great friend to me, too. Anyway, she verbalized something that I had been feeling exactly-- that the challenge is that work now really boils down to this: a balance between thoroughness, bedside manner, and efficiency.

As a resident, you are run around SO MUCH that it is just not possible to be ontop of, or good at, everything. You can't spend all the time you want hearing about all your patients' problems. There is just isn't time. You can't be as thorough as you want to be, but really have to hit the high, pertinent points, which ends up making me feel like I didn't do a complete job. And you surely can't be slow and poky. I think that this has been what has been frustrating me so much about intern year-- I feel like there are so many responsibiltities and things that need to get done that what I'm sacrificing what I thought were my strengths in medicine-- connecting with patients with a good bedside manner and taking very thorough and complete histories. It's sad, but a reality that something has to be sacrificed, that "something's gotta give."

It was obvious this week how thin I was worn when I got angry at patient of mine in the hospital. I had been bending over backwards, calling social work, calling prosthetics with a STAT consult, and talking to the respiratory therapists to help work with us to try to arrange for Mr. B to go home with a CPAP machine for apnea, which had helped him out of hypercapneic respiratory failure (too much C02 retention) that got him admitted to the ICU (once stable, he was transferred up to the floor). Every day I rounded on him, he told me he didn't feel like wearing the mask preceding night, but promised to do it the current night. I believed him. Trying to get him home with CPAP was the only reason he was still in the hospital and that I was still rounding on him, about 4 days later, even though he'd been completely stable to go home the day after his transfer. But he wasn't going to continue to stay well without the help we were offering. And I kind of snapped, saying, "Mr. B, why do you think you should still be in the hospital??? How do you think you're going to get better and stay well without the recommendations we give you? What good are we doing for you here?". He even apologized to me later and told the senior that, "I think the other doctor was mad at me because I didn't wear my mask." He was right. I was mad. I never thought that I could or would be mean to a patient. But I was. It is unfortunate that I wasn't able to be more patient and not let my frustration show.

Ah, patience. I am not a very patient person in general. But I'm finding that my patience, what little there was in the first place, is dwindling further the longer I am in residency. I don't have the patience for patients to grumble about their food, their nurse, why they're NPO for procedures and have to have an IV, among other things, when I have a string of others I have to see in the mornings. I don't have much patience when the nurses or pharmacy pages me. When they talk too slowly and don't give me the important, pertinent pieces of information right away, or if it's a question about something that has already been taken care of, I find myself getting very irritated. This lack of patience carries over into all aspects of life as well. I don't have the patience for grocery shopping and get antsy when I go to the stores without self check-out. I am so fast that I can get in and out within 10-15 minutes now. I find that I don't have much patience for super long phone conversations and find myself trying to end things sooner than I might have originally (sorry! But please still call me! :)). Partly it's because I have a gazillion other things I need to get done. I don't have the patience to be put on hold when I have notes to do and other responsibilities. It is really bad. But I'm getting faster with everything I do in life as, when you don't have time to do very much, you do everything at double-speed.

So onto stress. The baseline is very high during intern year, I'm finding. "You just have to get used to feeling like things are out of control, because that's how it is going to be this whole year," says my current senior resident. It's horrible. Every day, I wonder, "Is this really worth it?" Even if residency is a finite period of time, is it worth it every day to feel scared to go into work to see what faces you and whether you'll be able to handle everything/get your work done without exploding from stress? It is truly a terrible feeling to walk around jittery and anxious that someone is going to page you for an admission, or an order, or a discharge note, or all of the above, at the same time. But don't worry- I haven't cried in two weeks (woo-hoo!!) :)

Some people don't eat when they're stressed. I tend to eat more. Kyla and I were saying that it seems that you might eat to a point two notches above your stress level so, for example, if your stress level was at a 5, you'd eat to a fullness level of 7. So when your stress level is 8 or 9 (as mine feels much of the time), that means....

Yes. So I realize that it's a problem when your clothes don't fit very well. Going from OB to the VA, where our attending is fine with us wearing scrubs, I realize that, in the past 50 days or so, I've worn "normal" clothes maybe 7 days total. Kind of ridiciulous, eh? And, as I've said before, scrubs are very forgiving. And easy to wear. I don' t think that I've ever taken an exorbitant amount of time to get ready in the morning or anything, although now, thinking about having to choose things to wear seems horrific and like a time-sink to me. I know that I can shower, get dressed in scrubs, put on some mascara and earrings, throw some food in a bag, and hit the road in about 15 minutes flat (which was the case on Thursday, when I overslept, woke up around 5:55, and had to leave by 6:15).

I know scrubs aren't the most attractive article of clothing to wear, but really, who am I trying to impress? The vets, some of whom just make inappropriate comments anyway? (A guy I discharged a few days ago went into spontaneous atrial fibrillation [with RVR, or rapid ventricular response] during his hospital stay and when I asked, "Do you feel like your heart is racing or anything?" he responded, "Well, I didn't. But now that you're here, I do. Why don't you come hold my hand and see if that calms things down." Ummm.. I was happy when that one left the hospital). Nope. Not trying to do a whole lot of impressing right now. Yesterday, when I went to Kyla's, I had changed shirts when I got home, but when I went over there, I saw that I was wearing: a purple t-shirt, my teal scrub-bottoms, gray/red/blue socks, and black danksos, with my hair in a sloppy high ponytail with random clips holding up my short pieces of hair. Nice:) Don't think grandma would approve. But I don't see things changing any time soon. Maybe when I'm on vacation.

TWO WEEKS! :) And, in addition to today, I have two more days off before then :)

Cortisol trending downwards

I finally feel like the stress level has come down a little bit. I seriously think I might have developed an ulcer during my month on OB. Actually, I heard last week that one of the OB interns actually decided to leave the program (leaving us with 6, including me, until the spot gets filled-- I think we're interviewing already). Anyway, the first two days at the VA were a bit nerve-wracking, but once I figured out the computer system, everything became very fast and I feel that I can actually get things done quite efficiently. I have felt like saying, to my pseudo-adrenally-insufficient hospitalized medicine patients, "TAKE sOME OF MY CORTISOL!" When I can joke about stress, I know that things are headed in the right direction.

Maybe I'm much happier because I ACTUALLY GET HOURS OFF FROM WORK!

Let me tell you, there is a BIG, BIG, BIG difference between working 80+ hours per week without full 24-hour periods off and working 70. A HUMONGOUS difference. I feel like I have so much free time to myself when it's only seventy!! He he. How crazy is that?!

Yesterday, my day off for the first week, I took off and headed out to Lake Berryessa, a reservoir lake about 25 mi. in length, which is located west of here towards Napa Valley. The drive, through the "Golden Valley" that is the area surrounding Sac, was really pretty-- with golden fields and orchards, as well as ridges once I got closer to the lake. I just brought some magazines, and camped out by the lakeside reading and napping in the sun for a while, before I turned around and came back. It was a really nice escape :) There were a bunch of people swimming in it-- I forget that, unlike MN, it is so warm here that lakes are actually swimmable (I have to admit, MN has some beautiful lakes, but they are frigid!). I stepped in, and it was like bathwater. Now that's my kind of lake even though I hate bathing wear! Unfortunately, I had some camera battery issues, so don't have personal photos to share, but here are some I found online:

Last night, some of us got together for Thai food in Natomas. The pics ended up being more candid than I intended. "Why are you always taking pictures, Tara?!" people complained. "Why do we have to pose?!" "You better get used to it, folks," I replied. The blog must stay alive.

Noelle and Phi Alvin (head down in the Pad Thai) and Brenden (chewing), my fellow VA residents for this past week. Notice they're in scrubs b/c they had to work yesterday and came straight to the restaurant from the VA :(

At the VA, you never get a weekend (i.e. Sat. or Sun.) day off, but one day is your "good day" (where you don't admit-- a respite from every other day, when admits are fair game!), and the other is your "bad." Today was our team's "good day." Although I had discharge stuff to take care of and lots of notes to write (and Alvin was off today, leaving us senior-less and to fend for our own when our attending left after a.m. rounds), I was out by 5 p.m., which was unbelievable (nevermind that it was still a 10.5-hour day!)! I can't believe how much time that gives me in the evening (for an idea of how it might affect a significant other, check out Wendi's post 6 p.m. vs. 8 p.m.)! You actually come home when it's light out. I almost didn't know what to do with myself... I had a choice of how I wanted to spend my evening!

What did I do? I decided I would veg in my bed, read magazines, and do Sudoku. And now I'm blogging. And it's only 8:30. Awesome :)

I suppose that, now that I have time to actually sit down, breathe, relax, and think, I should respond to Wen's tag challenge. I don't think I'll be tagging anyone else (in fact, I'm not sure I have 8 friends to tag, it's been so long since I really connected with anyone!), but here are some random things I could share which you may or may not know.

1. I eat just about anything. At the moment, I can only think of two things I won't eat: 1) Vegemite, and 2) goat head (recall that this was tried earlier this year in Nigeria--see picture below). However, until I was about 21 years old, I boycotted green beans. Absolutely would not touch them. I think this might have been because we had mushy canned green beans at some point in my childhood and I thought all green beans tasted that way. Yech. Well, glad that misconception is fixed!

I love this picture! Wendi's expression says it all (Rebekah is dishing it up). It tasted equally as bad as (if not worse than!) it smelled!

1. I have no trouble falling asleep.... anytime, anywhere (and particularly at movies that start after 7 p.m.). And that's not just while in residency and from being constantly sleep-deprived. I feel bad for people who struggle with insomnia, because I think I just take sleep for granted. I slept through a 7.4 earthquake in San Diego about 15 years ago-- does that tell you something?!


2. I was a marching band nerd in HS. It might surprise you that klutzy me could actually play an instrument and walk (sometimes even backwards!!) at the same time, but (ask my family), it was somehow done.


3. Also back in the day of HS, I was a big tennis player. My senior year, I was the top seed on a team that went to the Virginia state semis (but then, unfortunately, lost). So much for my pre-Wimbledon days :) Now I just enjoy watching tennis (when I have days off, that is :)).


4. My absolute least favorite chore is unloading the dishwasher. For some reason, I just HATE this task. As a child, I was actually quite obsessive about cleaning things, at times running around the house in a little apron pretending I was Cinderella. That has since changed... a lot. However, I don't mind cleaning kitchens, bathrooms, doing laundry, doing dishes by hand, or any of that. Nor do I currently have a dishwasher or have I recently. But anytime I go home, to my parents' house, and have to do this, I hate, hate, hate it! Weird, huh?


5. I used to throw temper tantrums when I had to practice the piano. There. I'm kind of embarrased about that, but it's over with. Can you picture me with my face purple, screaming at my parents that they were so mean to make me practice?! They were right, after all-- I am glad that I took lessons for as long as I did.


6. Forget being a doctor... when I was younger, I thought the best job ever would be to be a data-entry clerk. My parents still laugh about this. I'd go through security or immigration lines at airports and tell them, "That would be so awesome-- to be that person who scans the passports and then types in all that information!". Maybe if I drop out of residency I can go back and train for that.


7. (really #8... somehow the #s got messed up when I inserted that pic) My stalwart Halloween costumes as a child were either... a bag of grapes, or a bag o' jellybeans (leotard plus a big clear plastic bag filled with either a) purple balloons or b) multicolored ones, respectively, depending on what was on hand!). I wonder what I can come up with this year... that is, if I have any time off to attend a frivolous party of sorts! I already know that Alex, one of my OB co-interns, is obsessed with Halloween, so I'll leave it up to her to plan the party.

Ok, that's enough weirdness and revelation for one post. Back to the vegging...

Interesting fluting

Eva sent me this link to a You Tube video of this guy playing Saint-Saens' Swan on a bicycle pump!

Like I even have time to play or appreciate music these days (I do like Saint Saens' music a lot!), but I did have time to watch this clip :) You have to check it out!

I like vets, (fairs and dogs, too) but still hate being an intern

So I switched rotations this week to internal Medicine at the VA hospital (Mather) outside of Sacramento. More on that in a bit. I thought I'd share some pics of the Cali State Fair that I attended this past weekend with Adeel and Brenden (woo-hoo for days off!!!!)

Brenden and me by the Golden Bear and sign
Adeel thought it was about time he tried a deep-fried Snickers bar

One of the serious rides they had there! They even had waterslides at this fair! Hard to believe!

Stunt jumpers who were fascinating to watch!

There was lots of animal life to be viewed!
Here is Adeel pretending to be a butterfly.
Cute floppy-eared bunny (yes, JB, that is its official Latin name)

A very Velveteen-y one I wanted to take home

Teeny tiny Japanese quail (this picture doesn't do justice to their miniature size!)

Piglets!!!!

..Which you could stand in line to pet. In contrast to my standing in the line at the MN state fair with a bunch of five-year olds (to milk a cow) I didn't do it this time, just to pet piglets. I did, however, have a very in-depth conversation with the animal expert by the cows about how the cows deliver their calves, malpresentation, cow placentas, cow c-sections, and more... :)

This is one furry pet I'd rather NOT have in my living room.

"This is how you correctly pet a chinchilla," the woman instructed me.

More neat news: Kate is in MN this week and next for her brother's wedding so I get to dog (and house) sit Lefty for at least a couple of nights, before he goes back over to Kyla and Ben's (they're both currently working nights). It's so nice having someone to come home to, even if poor Lefty has to be alone in the backyard for the whole 14 hours or whatever I'm gone! He wags his tail and is so excited to have company (as am I!). After VA signout tonight at 7 p.m., I rushed home to be with him, leaving my pesky discharge summaries to do while I have a furry friend next to me, after we went for a walk and played for a bit :) We'll see if he makes it onto the bed tonight :)

As far as internship goes... it still goes. I started at the VA on Monday. It was again a hard transition-- it's hard picking up patients (sick ones at that!) you don't know, to round on, come up with "plans" on, and discharge with summaries supposedly encapsulating their care during their hospital stay (which you were not a part of). We also admit every day, which gets very exhausting. Brenden, my co-intern, sits there amused as I constantly stress out about all the things I need to do... finish notes (all, even progress notes, are on the computer, which I haven't decided I really enjoy), call social work, call consults, figure out how to order labs (also all electronic which, at first, was very intimidating, but which I now like!), and the like. At the end of the day, it seems there are always admission notes and/or d/c summaries to work on and the day does not really end at 7 p.m. when night float comes on.

I walk around with a stressed look on my face saying, "I hate this. I can't do this. I can't spend another day working this long and this hard. I just can't. Why, why, why, why, why...." I do feel that time is so short that it's unfortunate I can't think more about these patients' medical problems... that you have to just do things via reflex. I think that being complete is getting sacrificed at the expense of efficiency and getting things done (I can't really think too in depth about patients' hypokalemia [low Potassium] but just have to replace it). Maybe as I get better, I will be able to *think* more critically.

I do feel as though we got a bit less "clinical" experience at Mayo (due to our third-year research trimester block), so I'm a bit lagging in knowing all the doses of things, ins and out of "hospital medicine," but I'm learning fast! Now, by day three, I'm feeling MUCH more comfortable-- with the computer system for one (although the labs are reported all funkily and not in my organizational style). Brenden actually did an intern year in CO before transferring, as well has spent the past two months of rotations at the VA so he has a bit of an advantage, I think, but that's why I go to him for all my IVF and electrolyte replacement and computer ?s! So far, I've admitted your run-of-the-mill cellulitis, CHF exacerbation, lower GI bleed, taken care of pts with pneumonias, HIV/AIDS, another who is undergoing chemo for metastatic b-cell lymphoma, and today admitted one 82-year old with new-onset painless jaundice, who, semi-predictably, has a big pancreatic mass suspicious for cancer. Yikes.

The vets are all very sweet, though. I came close to my first marriage proposal the other day :) It's kind of weird going from all women patients for really my first 2 months of residency, to all male vets (there is the occasional female/dependent that comes through the VA)-- from healthy pregnant (young) women, to men who have lived long, hard lives, and who often have substance abuse comorbidities, heart disease, and COPD (chronic obstructive pulmonary disease) amongst their 10-item-long problem lists. But, as it all has been, it's an adjustment. And I continue to learn.

As far as getting thing done outside of work: not so much of that going on. Still working LONG hours. But I have Friday off :). Trying to think of something fun to do. Maybe I'll finally get to Wendi's tag game. I can't really think of too many random, quirky things now that won't scare readers off and which aren't already common knowledge :)

Pace without Pause

I am done with my (first) month of OB. Phew. What a rough one.

I think the hardest thing for me has been getting used to the pace which, at this busy public hospital, is relentless. People kept telling me on Friday, "you just have to make it through today!" "You're right," I'd say, while reminding them that I had to take terminal Friday night call (grr); however, the day wasn't any easier to get through and I couldn't quite see the light at the end of the tunnel, I was so whipped. It was crazy, as usual.

We had a patient with preeclampsia by blood pressure and neurologic criteria (but normal labs) have an eclamptic seizure in Triage and have to be rushed back for a code-C-section for fetal bradycardia. We had a class C diabetic with a baby with multiple congenital anomalies being induced to deliver after a gestational abortion. We had the run-of-the-mill no prenatal care patients who were dating by 36-week ultrasounds in triage. We had another 26-week IUFD (intra-uterine fetal demise), a buttock abscess in triage, some more mild preeclamptics who got delivered, lots of people in triage with early pregnancies and abdominal pain, as well as a full "green" board (lots of laboring patients). Busy, busy, busy. Triage was hopping all night, and my pager again filled up with pages from the gyn-onc people. There is not even time to breathe.

I'm the learner type who kind of likes to sit down and go over (systematically) the rationale behind doing certain things, but honestly, there's just not time. You don't even have time to pause for a second to think about what you're doing. We have to round on so many postpartum patients that, if one of them has "issues," it really throws your whole plan and day off because you can't get to the other patients. I think it's horrible. And as someone who wants to be meticulous and thorough about everything, the suggestions that, "don't worry. You'll just stop caring as much as you go through this year" really bother me. I'm kind of poky in general (ask Hans who always finished med school tests first and last!), so this pressure really throws me off, but I still want to do a good job of taking care of patients!!!

I came home yesterday, after my 317-hour work month (somehow keeping me just under the 80 hour/week "average" cutoff) and just slept. And slept. I heard things buzzing periodically (ended up being my pager [DARN PAGER]) and my phone a couple of times), but didn't get up. I woke up "for good" around 10:40 p.m., mad because my whole day was gone. But I know that my body just needed to recuperate from my week/month of working my butt off. Two hours later, I was back in bed for the longest night's sleep I've had in a while :)

I don't think I really ever comprehended how hard it is to work 80 or more hours per week. I mean, in med school I might have done 70 sometimes, but the responsibility is much less. You also don't have to then come home and deal with dictations, returning patient calls, and checking up on labs. I don't have enough (waking) hours in the day to go to the store, pay bills, return calls or e-mails (which is really tough on me-- it's very unlike me to not be ontop of communication), or work on research papers (I'm kind of happy about that one, though, although it just means it will be hanging over my head for longer). I don't know how I can keep doing this, all year long. I really do feel like a big ball of stress-- like I'm constantly juggling like 12 things and rushing around trying to get them all done-- I'm multitasking with talking on the phone and cleaning my kitchen, writing patient notes and trying to frantically swat at the flies that have appeared in my apartment. I feel like I'm constantly treading water and never quite getting anywhere, and never quite getting a real break. Oof da, as they'd say up north.

I've been constantly battling what I do do in my days/time off. I actually have today entirely off, which is AMAZING (before I start up with Internal Medicine at the VA tomorrow)! Do I just veg at home and truly relax, or do I try to be social and get out to explore this fun place, because I know that being with people genuinely makes me the happiest?. I did make myself go for the Fleet Feet run this morning- Kate and Lisa also came. It was good-- we did about 65 minutes, and I feel better about not having been able to exercise much AT ALL on my own. Let's just say that scrubs are very forgiving and my pants are feeling very tight. I hope to correct this soon-- the half is on Oct. 7. I also joined them for brunch at Cafe Bernardo. In a bit, I am going to go to the state fair with some FP classmates. And after that perhaps dinner with Sarah and Aline. Not much relaxing going on, after all, but hey, I have to make the most of life (and time off), right? :)

The fast pace continues! Gotta run...

When all is messed up

I'm one day away from my last day on my first OB month, which, if you haven't already gotten the gist of my whining posts, has been really hard on me. It's mostly just hating constantly feeling not ontop of things-- that things are just on the verge of spinning out of control without you being able to do anything about it. You can only be in one place and do one thing at a time. I've been so frustrated because I'm realizing that hard work does not always guarantee success-- although I've never worked so hard or been worn so thin in my life, I still don't feel as though I'm doing things well. That makes the perfectionist in me mad and makes me feel utterly inadequate and hopeless. I know my expectations may be messed up, but still. I want to be good at what I do every day, and right now I'm not. Anyways.... other updates from this week include:

On Tuesday, I delivered a baby with gastroschesis, which is when bowels are herniated through the abdominal wall. I've only seen this one other time, which was at Mayo, when the mom delivered via scheduled C-Section-- I was actually surprised that these babies are actually more commonly delivered vaginally (Mayo may be more conservative, as it is in many other ways, too!). The shocking thing was that everyone was fine with me, the intern, doing the delivery! Weren't they afraid the bowel would somehow perf(orate) as I was pulling the infant out?! No worries. Baby came out fine, we slapped a warm saline towel right on those bowels when she came out, and off to the NICU team she went. She had surgery yesterday and is doing well.

Another shocker: yesterday, I was told that it was my job to to consent a woman for a post-partum tubal ligation as I would be doing the procedure today. THAT'S RIGHT!!! I had to fill out the scheduling request forms and things listing me, yes, ME, as the surgeon for the case. This really freaked me out. I was pretty distraught last night, and feeling really ill/nervous all through rounds and board signout this a.m. in antipication of the procedure. I hadn't been in any OR in over a year! But guess what-- it's done. It took a long time-- I know that the chief resident and attending, although patient-seeming, were probably groaning inside, as I timidly (and shakily) made the infraumbilical incision and required lots of hand-holding the entire time, from opening up the peritoneal cavity, hunting down and tracking the fallopian tubes, and then tying. I felt terrible also because the anesthesiologist, in there with us too, kept getting called b/c other women in labor wanted epidurals, but had to say "We're almost done in here." As crazy as it is, I somehow sterilized a woman this morning (permanently and successfully, let's hope). What's perhaps more messed up is that this woman, who already had 4 kids and had the pre-op diagnosis of "satisfied parity," as they say, was born in 1982!!!!!!!!!!!!!!!!!!!!!!!! Boy, does this make me feel old.

It is messed up when the chief asks you, "Doing okay? No breakdowns today?" while having casual conversation in the board room yesterday. "Not today," I answered. The day before? Check. Today? Double check. I completely lost it in triage just before lunchtime today. All the sleep deprivation has really gotten to me-- I am just so tired I can't even think straight or keep things together. Although everyone kindly tries to tell me that "It's ok. Everyone cries on OB. All the interns were crying last year, too," I still think that it is not normal to break down all the time while at work. I think patients tend to be a bit worried and unnerved when you walk into to see them with red,puffy eyes and a runny nose. I need to fix this, majorly, or at least find a way to hide it better.

This afternoon was my family practice clinic day, which feels like a vacation compared to being on the OB floor. It is messed up when, biking home at 5 p.m., after working for 12 hours, I was saying to myself, "Wow! I'm getting home so early today!"

I was able to join Kate, Amy, and Kate's friends Lindsay, Lisa, and Dave, for dinner at Centro (Cocina Mexicano) tonight for Kate's birthday. It feels like forever since I'd been "out" and done anything resembling a recreational activity/social event. It's messed up that the majority of any social interaction I've had over the past month has been because I've been at work. It's almost more lonely coming home; sometimes I wonder if I should just not pay rent and live in a call room instead :)

My apartment is horrendously messed up. I'm actually surprised how much mess one person can make, when I am never home and awake for more than 3 hours per night, but it apparently is possible to create mountains of papers and clothes in this time frame.

My sense of style is messed up. Having worn only scrubs for, really, the last 26 days or so, I'm finding that it is quite difficult to try to figure out what to put on for the day/evening and to think about coordinating shoes, earrings, etc. Sometimes life is just simpler when you exercise no choice and don't try to look snazzy :).

Today is Nicole's birthday. Happy birthday, Nicole! Life is so messed up that I accidentally called her yesterday on the wrong day. At least it wasn't a day (or more) late, eh?

It's messed up that there has not been one day, in the past 13 days (this will continue until Saturday morning), where I have not been in the hospital rounding. I worked (last week) Monday, Tuesday, Wednesday, Thursday, Friday, Saturday (+overnight), rounded Sunday and slept the rest of the day, then Monday, Tuesday, Wedesday, and Thursday, and am on tomorrow day and night until after rounds Saturday morning. I think I could manage to pick my head up if I just had a day off. It is really miserable to not ever have time to do anything at home. I know I'm whiny, but still. This is seriously messed up.

If I go to bed right this minute, I could get about 6 hours of sleep before I have to go in again for my 24 hour call again tomorrow. This, too, is seriously messed up.

Happy Birthday, Lesley!

This post probably embarrasses the heck out of dear Lesley, but I just love the girl and think the blog has been a bit heavy on the words (and whining :)) and lacking in the photo department. Some of these photos predate the blog, so enjoy some history and the memories! :)

I think this expression is hilarious and hope it was okay to include this pic here. This is at the Kits' old place our first year of med school!

From left: Sam, Drew, Tia, Les, me, Aaron, Sean (and Jeff, Tom in bottom left)

I wish I had some wedding photos from Lesley and David's wedding in June of 04, but that (and apparently the whole year of 2005) was in my pre-techie days :). It was a lovely ceremony!

Saving food at the Kits'-- Wendi's bday May, 2006
Hanging at the Kits' (summer 06)

Les and Wen, Summer 2006

July 4th, 2006 in the Rays' backyard
At the Original Starbucks, Seattle, January 2007 Pike's Place Market, Seattle, Jan. 2007 Superbowl 2007 (Kristen, David, and Brandon in the background)
Dance Dance Revolution at the Yuans'- Feb 2007
With Luke - spring 07
Kits' couch AGAIN- 2007
Match Day 2007 Bachelorette party- March 07 (with Tia and Erin)

with Nicole, Summer, and KatieCross-country skiing- March 2007
with Nicole
Bangladesh- April 2007
With Families (and Khiem, Les's little mentee)... Graduation Day- May 19th, 2007Dr. Jones (one of them!) graduating

Have an awesome day!!!!!!!!!!!!!!!!!!!!! I'm so lucky to know you! :) Love, Tara

Ninety-six

So tired.

These were the hours I worked last week-- M-F 5a - 7p and then Sat 5a-Sunday call, which was 28 hours of never-ending busyness ending earlier this am. Is this a good enough excuse for not blogging earlier? Usually I am all about socializing (and communiating) despite utter exhaustion, and was able to go to that baseball game earlier this week as well as hang out with my OB and FP/OB classmates at a double-booked Thursday evening outing (first, Three Sisters Mexican with Lucy and Charmian; then yummy Thai food with Kyla, Aline, and Antoinette). However, some of my FP classmates went out on Fri. night to celebrate Phi's 30th b'day on Thursday, and I had every intention of going; however, I just had to take a nap b/c I was too dang tired, and that just turned into a night of not getting out of bed in preparation to return to work early the next a.m..LAME.

Last night was scary busy. I think there were upwards of 10 admissions; about 6 people actively laboring at the same time, 3 pairs of twins in (one with vertex-vertex presentation, which is amenable to vaginal delivery and which I'd hoped to deliver on my shift but they weren't quite ready to start pushing!); a VBAC (vaginal birth after cesarean; comes with risk of uterine rupture), several no-prenatal care patients (makes the job, and gathering information, much more difficult!!), a code C-section as well as one other due to transverse presentation and failure to descend, and the scariest shoulder dystocia (when the baby's head comes out but the shoulders get stuck behind the pubic bone) I have ever seen. The baby had a long decel and had to be pushed out STAT; but it was a big one (9#14 oz) and it just got stuck. The clock was ticking... They (it should have been "my" delivery, but I just backed away I was too stunned) tried flexing the mom's thighs, suprapubic pressure, rotation-- none of it was working. They cut a generous episiotomy and, close to four minutes after starting to try, Dr. B was eventually able to reach in, grab the posterior shoulder and arm and pull the baby out, but holy cow. I stood there shocked and so, so frightened. The mom was in near-hysteria with fear. I had never seen a face that purple. Baby had an apgar of about1 at first- floppy, no breathing, and peds took over and took him to the NICU. The mom then had a pretty significant post-partum hemorrhage requiring methergine and rectal misoprostal. I hope baby does okay-- mom is stable. OB can be terrifying at times with the acuteness of the problems (sorry, Laura!).

We were seriously running the entire call. No one even really had time to sit down and eat. My pager memory filled up twice with pages. It was absolutely ridiculous. As far as clouds go, I am definitely a BLACK one (see Wendi's post from today :)).

I came home and slept the day away, but have to gear up again-- the week starts again tomorrow around 5 a.m.! Although it's generally not a good idea to do math post-call, I was interested in figuring out the hours I'm doing because it just seems like too much. These are the hours for the last three and the following week I'll do (five days plus terminal Friday night call): 75- 75- 96- 85.5. If you average this out over the "month," it is not 80. It is not under 80. It is 82.7 (VIOLATION!), but feels more like a million. And I certainly don't have a 24-hour period off this week. Rough stuff!

Good news? I think the hours at the VA (where I start my medicine month on Monday) may be a bit better..., although I hear you have to deal with sexual harrassment from the vets and nasty food (I'm sure it [meaning the food!] can't be that bad... at least it's free!)... You gotta just keep on truckin'... Residency is hard!!!!!

Adjusting (slowly)

So I'm two and a half weeks into my OB rotation. If you couldn't tell from my previous post, I am ecstatic at having been switched to days. And, as much as I thought I would never say this (in my previous misery of nights and feeling totally incompetent), I might actually be getting the hang of things.

Things were kind of stressful yesterday, when we had about 5 patients laboring at the same time. One needed a code C-section for a prolonged fetal deceleration, so off went the OB2, the chief, and the attending to the OR. I was a little panicky with being left on the floor by myself (there was one other attending, a UWH [university women's health] doc, I could call upon), but things went fine. I actually got to do three vag deliveries in the span of about an hour and a half, and all were accomplished without perineal lacerations, the way it should be! I just adore delivering babies... it was great to have this reminder of why I DID choose to do this (program), although Labor and Delivery is stressful, grueling, and chaotic much of the time.

I am constantly being called from Davis3, where is where Triage and L and D suites are, over to Tower3, where the postpartum patients are. I get a decent amount of exercise this way, I'm finding. But today, I figured out that we have a tube system!!!! This way, I can tube orders over rather than continually running down the hallway and back. Nice to know this now. It would have been even nicer to have known this two weeks ago! :)

I'm adjusting (albeit a bit painfully) to different chiefs' and attendings' ways of doing things. It has been really hard the past couple of weeks to nail down patterns of "if this, do this...." as we all get incredibly confusing messages from different people. I've checked people I was told not to and then, later, on a different patient in a similar situation, when I refrained, I was asked, "why didn't you check her?" I've ordered a Depo (Provera) shot prior to discharge for a breast feeding mom and was chastised for doing so, as it can "dry up milk" if given too early postpartum, but then am looked at as though I am stupid for asking why, in another case of a BF mother, it was okay to give the shot. I've taken wound dressings off skin incisions on post-op day #1 C-section patients and then been told not to do so until at least 24 hours after the operation, but, today, "got into trouble" (not really, but was talked to) for not stripping it off before 12 hours. Some people like to use miso for induction; others like foley bulbs and pitocin. Some are very conservative; others are minimizers. This is very frustrating for a "learner" like me who wants to just do things right and please everyone, but people tell me to not take things (i.e. "recommendations" of what I should have/could have done differently) too personally.

I'm getting used to seeing strange stuff on our service. We have a ton of patients who come in with little to no prenatal care. There are patients who come in who are either high or sometimes contracting secondary to drug abuse. We have pregnant patients come here from jail. We have people on our service with sickle cell crises. We had, for the longest time, a woman with spontaneous triplets on bedrest (who, unfortunately, went into pre-term labor, delivered, and lost all three babies). We see tons of preeclamptics and gestational diabetics. We've had a woman with a history of a nasty stab wound who had to have a repeat classical c-section for preterm labor. There have been people with perforated uteri, including one who got pregnant after a wayward IUD ended up in her rectum. The team delivered, the other night, a young woman with abdominal and cerebral aneurysms (from ana-positive vasculitis) and superimposed preeclampsia, at only 28 weeks with a 1-kilo baby. There was another woman yesterday who'd had an intra-uterine fetal demise at around 28 weeks. We had a woman with polyhydramnios with an AFI (amniotic fluid index) of 60 (normal is somewhere between 5 and 20), who came in because she had ruptured and was honestly flooding triage. I've delivered teenagers, including a 14-year old, and a 15-year old who was raped and impregnated by her stepfather. I'm not really surprised by too much any more. We see everything.

I'm getting used to (and loving!) speaking Spanish all the time! Words sometimes still escape me, but I feel totally comfortable doing everything en espanol. It gets a bit confusing sometimes-- I think we had three Ramirezes and three Garcias on our service at the same time, but I think it's all good.

I'm adjusting to the schedule. Getting up during the 04:00 hour is not pleasant, but, as long as you go to bed early enough (or, like I did yesterday, take a long nap between 7:30 and 9:30 p.m.!), it is doable. The gyn-onc intern (currently Gaea) gets to the hospital between 4 and 4:30 a.m., which is when she would take signout from me (while I was on nights). How horrendous is that?! As sad as it sounds, 70-75 hours a week has been the "norm" and I feel sort of used to it now. This week will actually have more hours, as I'm on 24-hour (ends up being about 28 hours) call from Saturday-Sunday morning, but honestly, when one's working close to 80, what's another 20? :) You don't have time for a life anyway!

I'm adjusting to life in Sacramento. It really does feel like "home" (or, at least the hospital does!) now, in that it feels like I've been here for a good long time (even though it's been less than two months!)! Minnesota seems a long and distant memory away... I rarely think about life there. I still wish I had more time to explore out here, but I'm sure I will... with time.

The delight of DAYS... (and other discoveries)

• I LOVE BEING ON DAYS!!!! Today commenced my two weeks of OB day float, and it is already infinitely better than night float. Not only do I NOT have to carry the gyn-onc pager or do post-op checks, etc., I have another whole resident helping me in triage (I kept saying, I LOVE YOU, Zhanna! Can I tell you again how much that I love you?!) and don't have to worry about "drafting" the list for the day! I may actually have time to go to and enjoy deliveries now :) We actually had time to sit down today and eat something quickly for lunch. I almost don't know what to do with myself, there's so much free time :) He he. Or maybe it's because I'm getting the hang of things and actually more efficient... who knows. There are a lot of variables going on; however, the bottom line is that it is BETTER.
• The only thing about days is that I have to get in around 5-5:15 a.m. in the mornings to round on PP patients.... I think it will be hard to continue to, every day, get up around 4:15 or so to bike there in the dark, but hey, IT'S BETTER THAN BEING ON NIGHT FLOAT. And there's minimal traffic at 4:45 a.m., so I get to work more speedily :). Today, I got let go a little early, around 6:30 p.m., but will, most days, be there till 7 p.m. So long hours, but still, let me say it again, BETTER.
• I've discovered that it really isn't that far to the locked-up bike cage where, from now on, I will be keeping my bike while at work (even with my current seat-leash) instead of just parking it out front of the hospital. I go in through the hospital by the ER entrance and find my way to the L and D floor.
• Dictating after being up for 24 hours is not a good idea. Yesterday, I went to sign an L&D discharge summary that I'd dictated on Friday, and there were all these blanks and nonsensical things that I must have, unknowingly, slurred while trying not to fall asleep. If I remember correctly, I think I did doze off once or twice while dictating. Good thing we have a chance to "edit" these before signing them and making them "official."
• Three of my new OB patients rejected me :( Of the new OBs I've seen recently in FP clinic, one decided to have a TAB (therapeutic abortion), another decided to finally switch her care upstairs to OB (she, if you recall, was the pt I was phone stalking earlier), and the third decided that she wanted to move and deliver her baby in CO. I guess I couldn't fight with her on that one-- I'd love to live in CO someday! Oh well. My advisor says I shouldn't worry too much about continuity deliveries, in that I will have plenty, with time, but I just feel like it will/would be so much more rewarding to deliver patients I know and have followed and am bummed that they left me!
• On a completely different note....The American River Parkway is a great place to bike/run. Yesterday morning, Kate and I went for the 50-minute run that kicked off our workouts for our half-marathon training. We plan to run the Cowtown (Sac) race on 10/7. I think there are other races that can also be weaved in to the fall, but I'm not sure I can work them into my schedule. From this month of OB (2 weeks of days left), I go to a month of Medicine at the VA, which Kyla tells me is WORSE (as in harder) than OB (It CAN'T BE, I keep telling her :)). I think the hours might be worse/longer, but the stress can't be nearly as bad. We'll see.
• I need to get used to spending 2+ hours each time I go to Sunday Service at Arcade. It was a very interesting service, missions-focused, with one woman who actually is doing women's health and needs OB doctors to go to Pakistan, and another Brazilian couple speaking about their mission work on the streets of Sao Paolo, but it did stretch quite a bit. I think my attention span has dwindled since medical school...
• I discovered a neat little coffee place, Coffee Works, on Folsom Ave., not far from my house. It currently has Persian and other rugs hanging up on the walls, is cheaper than Starbucks, and has free wireless-- it was a lovely place to spend Sunday afternoon, catchiing up on the Time, AAFP, and People magazines I haven't had time to read (okay, okay-- the People is from a free 3-month trial offer I got from signing up for this half-marathon training group--I didn't pay for that entertainment!), as well as working on (AGAIN!!! Does it ever end?!) my research paper revision.
• Ginger has been recalled in northern California, due to it being obtained from Chinese sellers who either did something bad or didn't do something good. I tried to get some at the groc store Sat. in order to make some Huli Huli chicken for our FP intern potluck get-together last night, and had to go with the pre-smushed stuff in jars!
• It can be cold in Sacramento in the summertime! We FP interns got together yesterday for a bbq/hangout session at Phi's, and were all huddled around the grill, shivering in in the windy weather, wearing our fleeces! We were going to maybe play some volleyball or frisbee, but it was too gusty!
• I think I've become wimpier in the 2 months I've lived here. We would be thrilled to have 70s and 80s in MN, but here, it's considered chilly!

Adeel and Fahtima

Jeremy manning the grill for a bit




Phi "flippin'" and Amy helping




• Raley Field is a cool place to go in Sac! Tonight, Kate, Amy, Amy's friend Michael, and I all went to a Sacramento River Cats minor league baseball game against Oklahoma. It was fun, BUT COLD!!!!! I wish I had had a hat or something! :) We left at the bottom of the 7th due to all having to get up early (and being cold!), but we were up 5-2. Go felines :)

View of the field from our lawn seats on "Home Run Hill"

Dinger, the River Cat (mascot)Michael, Amy, and Kate I was cold even with the blankie!

• I'm discovering that I'm probably going to get less sleep while on days than I did on nights, as I tend to want to stay up and "do stuff" during normal evening hours now, whereas previously, I didn't feel quite so guilty just coming home, crashing, and sleeping the days away. BUT I DON'T CARE!!! Days are way better than nights! :)

Fin de la Fortnight

Two weeks of nights is over. OVER!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Until October, that is, when I do another month of OB (four total this year). But I don't even care. I didn't even care that I had to go to post-call Friday FP clinic yesterday because that meant that my NIGHTS WERE OVER. I can not even express how happy I am. This might be the most relieved I have ever felt in my entire life. I was getting giddy around 4:30 a.m. on Friday morning with the thought that, in a few mere hours, my hell of solo nights (the most miserable two weeks of my entire life, I'd like to add) would be done.

I would have to say that Thursday night was not quite as busy or as bad as was Wednesday night, but it was still hard. Triage was really busy and I think they did 2 C-sections. I did get to do some rounding on postpartums, which was good. There was only one vag delivery overnight-- a VAVD (vacuum-assisted), which I didn't even get called on. But I didn't even care (which is really bad, as it is the deliveries that I love)-- I was too busy doing other stuff, particularly answering my pager. This thing went off so many times that my memory got full-- it had been totally empty and cleared of messages when I went in. It is nearly impossible to get ANYTHING done when your pager goes off every 4-5 minutes. Honestly, it is absolutely ridiculous-- just answering calls (from the tower 3 nurses taking care of post-partum patients [when, when there are like 30 people on your service, are going to have lots of questions], the gyn onc nurses, calls from pharmacy, and then the voceras from the nurses taking care of laboring patients), is like a full time job. You are constantly on the phone, and it is nearly impossible (or it was Thursday), to get anything-- post-op visits, seeing triage patients, delivering, etc.-- done.

So what happened when I walked out of the hospital around 8:30 a.m. to retrieve my bike and ride over to the ACC for FP clinic? I unlocked the thing, obviously in a daze because I didn't notice what I would shortly thereafter, when I went to sit down, which was that my seat was missing! Yes-- there was an empty hole where my seat post and seat should have been! I thought at first that I was hallucinating... or that perhaps I "knocked it off" while I was maneuvering it off the then-full bike rack b/c of all the day people that had come in. Nope. No seats-on-posts lying anywhere nearby.

I didn't know that seat-stealing happened much. Why me? Why then? There were all these other lovely bikes WITH seats parked next to mine... couldn't they have taken one of their seats instead? But those weren't probably parked there overnight. Silly, naive me. So I walked over to clinic a bit frustrated, but actually kind of amused because this was quite a fitting way to end my misery of night float. I consoled myself with thoughts that it actually could have been much worse-- that is, if it had occurred in the middle of the week, when I'd have to walk home and walk back to work the same day, like 9 hours later. Or if it had been something other than the seat, I guess.

Clinic was not the smoothest on Friday. It was really hard to get things done quickly because there seemed to be only one preceptor for all the residents that had clinic patients-- definitely not a good ratio, so we all had to wait in line to "present." This was making me grumpy. I also was losing patience with a patient I was seeing because she was told she needed to make an appt. before she could get her prescription refill.... one rx was for hypertension, another one (vicodin) was for pain which she told me she has "all over" but which she was unable to describe in position, quality, severity, or timing. Boo. When I tried to get a feel for how much vicodin she was needing/using and asked, "When or how often do you take the vicodin?" she looked at me like I was crazy and said, "What do you mean when? I take it when I have pain!" I did have other good interactions, including a Mexican girl I saw a month ago for her new OB appointment and who came back for an OB check. She hoped that I would do an ultrasound today so I could tell her the sex of the baby :) Despite all my U/S experience while on L&D Triage, I am still not trained to do this.

After patients (who I staffed with Sarah, the FP/OB who just graduated but who is staying on as FP faculty-- which saved SO MUCH TIME-- this was so sweet of her to do because she technically wasn't "working"), she and I talked in her office and I ended up breaking down AGAIN. I probably walk around looking miserable because so many people stop and ask me, "Are you okay?" which, for some reason, inevitably sets off the waterworks. I am mostly touched that people care, I think, and that I have a venue to vent (besides this blog, that is :)). She, as well as Kyla and Aline, have been so supportive during this whole time... paging me (these pages I like :)) and stopping by the board room to say hi and see how things are going. She was telling me that it is normal to feel how I've been feeling-- totally worn out, inadequate, stupid, inefficient, but that it does get better. I really, really, really want to believe her. She also went above and beyond and called her husband, Matt, to see if he could come pick me (and my bike) up so that I could get home faster and sleep. What awesome people there are here.

Anyway, when I got done sobbing and made it home, I wanted to take a picture of my seat-less bike, because I still found this mildy funny (until today, when I had to go to the bike shop and cough up the $$ for a new seat.. as well as a seat leash [to prevent this from happening again...can you believe there exist such things?!] and front light, which was also taken), except that MY CAMERA IS ON THE FRITZ. It was dropped at least once while we were at Yosemite, and took pics fine, but now shuts off as soon as the display warms up. And it's not the batteries, which I replaced-- in case you were all thinking I'm some dumb girl who doesn't think to try the easy stuff. So no pics of the bike, or much of anything, until we work that out.

Today, as Nicole and Bay were busy with pre-wedding "family stuff," I didn't drive to SF, which was probably a good thing, b/c of all the stuff I had to get done, although I do love to "explore." I had a filled morning-- first met Antoinette, another FP resident with a specific interest in OB, for coffee to discuss setting up something of a reading schedule to formally get through one of the main OB texts. Then I ran to the bike place and got my re-accessorizing sorted out. I went to the P.O. and was excited to figure out how to use the APC (automated postal center) rather than stand in the 50-people-long line, as well as to the grocery store (LOVE self checkout). I stopped at Circuit City to check out new camera options (I'm going through photo-taking withdrawal and feel obligated to post pictures here!) and to the UCD bookstore, where I had to pick up a book I won in an orientation raffle (they were getting on my case b/c I hadn't found time to get there to get that huge heavy thing-- it's hard to transport on a bike! Esp. a seatless bike) :)

And now I'm home. I've caught up on a couple of phone calls. But my bed is calling. You're probably glad because that means I'm done rambling... for now :) I'm trying to get back on a days schedule, but I think the bed is winning. Later :)

"It is what it is"

This is a saying that one of the OB attendings says all the time when people start talking about "what happened" and why, what could have been done differently, what currently is going on, and when people (i.e. I) start worrying about what could happen.

Last night was really the night from hell. It was Triage and admission night, where nothing really slowed down and I think we kept about 7-8 patients. It was spontaneous abortion night, where 2-3 patients came in with bleeding and were found to be miscarrying. It was pain night, with women coming in with 10/10 back pain and wanting narcotics. It was preterm labor night-- we admitted one woman at 34 weeks, another with twins who PROMed at 33, and had to move to C-section for another woman who was on bedrest but who started to bleed and whose cervix started changing. It was twins night, with the twins I mentioned before code C-sectioned because one started to come out, with hand presentation, and another preterm twins started on tocolytics. It was women-who-speak-Spanish-only night, with two of those SABs being hispanic women, an admission in active labor, a woman who had to be sectioned unexpectedly, prompting me to serve as translation for both the OBs and for anesthesia, and two discharges. It was rapid delivery night, with two people I admitted delivering within 2 hours of their walking into triage. There were three c-sections, three vaginal deliveries, one needing a repair, which the attending did over the course of an hour with two of us using retractors in the vagina because of a really strange tear that was poorly visualized and kept sort of bleeding. I was called on an onc patient for foot swelling and had to rule out DVT and another one with loose stools that plastics wanted to take to the OR today, but I could barely get off the floor because of everything that was happening. Because of the deliveries, I missed rounding on my postpartum patients and had to get covered by my other two co-interns, which I hated asking of them.

I have never worked so hard as on these nights. I honestly don't know how people can get used to handling the stress of this. Every day before I go in, to start my shift, I start to get an ill feeling in the pit of my stomach and constantly feel anxious/nervous the entire time I'm there, when sometimes I have someone talking to me on the vocera while I'm delivering someone else and have my gyn pager buzzing too. What bothers me the most is not that I'm working hard-- I have no problem being diligent and all-- but that I think we are all spread so thin that it compromises patient care. Patients wait in triage because there are emergent deliveries, sick patients off the floors, and c-sections being done. I know I still need a decent amount of supervision and have to always run things by the chief resident, but she is often busy and I hate being a huge "bother." I wish I could be more independent, but I just don't want to do anything wrong (which I definitely have done. Last night, I felt that I couldn't get anything right-- I neglected to ultrasound [for EFW/dating] one woman who came in in labor with post-dates but who'd gotten care at Planned Parenthood [the chief told me that if we don't have documentation of U/S dating, we have to do it ourselves]. I checked the one twins lady who PROMed, which apparently was a no-no, even though she was obviously ruptured and twin A was vertex).

Patients sometimes see me only for the delivery, as they call in the intern quite late, when the baby's delivery is imminent, which really bothers me. I mean, I know I'm supposed to try to get a lot of volume of deliveries, but I just really wish I had more contact/knew the patients better. But there's just not enough time. The second (or third) year on has to answer the ER pager and consult on/admit OB/gyn patients that are seen down there while at the same time taking care of antepartum patients and managing the laboring patients (and helping me). You would think that four people-- intern, resident, chief, and attending-- would be enough to manage all this, but I don't think it is true. It sure didn't feel like it last night.

The good news?

• I don't think there can be any more pregnant people in the Sacramento area because I saw them all in triage last night and they probably all delivered on our shift.
• Tonight is my LAST NIGHT on nights for this OB rotation. I cannot tell you how thrilled I am about this fact. I am sick of being the only intern on and cross-covering on gyn patients I don't know, while at the same time trying to do deliveries and learn the ropes and get familiar with everything on L&D.
• Tonight could not be worse or more busy than last night. I'll let you know if turns out to be.
• I am getting better about not dripping amniotic fluid on my pants-- this only happened one time last night despite all the SROMers.
• We are supposed to have Thursday potluck to start our shift tonight-- I'm crossing my fingers we have time to actually sit down, as last night, I never did.
• After tomorrow (and Friday a.m. clinic), I do not have to come into the hospital again until MONDAY MORNING. This is a beautiful, beautiful thing :)
• We got paid August 1st for our first month's work! Soooooooooo nice to have a bit more moola in the bank, although I wish we were paid biweekly.... :). I guess beggars (i.e. measly residents) can't be choosers.

Deep breath. Time to get ready to go in.