Disorientation

My posts have been few as of the last few months with my move to Sacramento, starting residency and such. I write you today after completing my "orientation" at UC Davis Medical Center (or was it dis-orientation?) and having worked my first shift as an Emergency Department MD! It was much more intimidating than I had expected. My last two rotations as a 4th year medical student were the Trauma/Surgery ICU and Pediatric EM at Children's. Both rotations dealt with patients that have the potential to evoke extreme "sphincter-factor" as I call it. Still, I was calm and unpressured throughout. I had the approach of a 4th year student, all pressure of evaluation off... the realization I was not truly responsible for anything and as such my mind and psyche were free to learn in a relaxed atmosphere. I was aware of this and was revelling in the last few "responsibility free" rotations of my medical career.... well, that is all over now.

I had trouble sleeping the night before but eventually managed to get about 7 hours of fitful sleep before my first 12-hour shift in Area 1 of our ED. No prophetic dreams and no nightmares I am happy to say. I woke in the morning, had my usual cup of tea and a small bite to eat and then I biked to the ED in my scrubs stolen from Harborview in Seattle... :) They are the ONLY scrubs I have found that fit my 36" inseam and I don't know what I will do when the 4 pairs I own fall apart as every other pair of scrubs I have tried here could fit a wine barrel as long as it was short. My legs poke out in a most unprofessional manner... I arrived and the place was already busy at 7am but everyone was friendly and helpful. I jumped in along with Vivienne, one of the other interns, and we both took a long deep breath and started introducing ourselves as "doctor" to our first patients. It was a little weird and we both felt a bit like a fraud. Our medicine was rusty and we had a million questions but the residents, nurses and attendings are no strangers to this time of year and all were patient with us!

The most challenging aspect of the day was the computer medical record system. A forest of menus and radio buttons, you hunted and clicked and pecked and guessed and hoped that some sort of legible account of the patient encounter resulted. I can say this is one of the LEAST intuitive EMR's I have used around the country, but once I learn the ins and outs I am sure it will serve the purpose. As new interns they have a list of very basic procedures they want us to all get in before the end of this 4-week block. I was happy to see they were all things I have had plenty of experience at doing in places like Harborview... peripheral IV's, EKG's, pelvic exams and other similar items. I cranked off a few IV's and EKG's and then I was lucky enough to be the intern closest when an unconscious alcoholic "found down" was brought in.

When an alcoholic is "found down" you have to assume they were involved in some sort of trauma, so they have a C-collar on to protect their cervical spine and they are handled as if they could have an injury until you prove otherwise. This gentleman had a Glasgow Coma Score of 6 and was needing to be intubated when the attending asked if I had done any intubations in medical school! "Yes, I took anesthesia at Harborview and did about 30 direct intubations on surgical patients there!", I was happy to say. He said, "Well then, you want this?" I jumped in and had the chance to use a "Video-Mac" which allows me too intubate like normal and puts it all on a large LCD screen so the attending can monitor my technique and teach or rescue as needed. It felt pretty good to have a 3rd year resident assisting me and an attending pushing the rapid sequence drugs as I did the intubation, which went as smooth as pie and before you knew it I had a full view of the cords and the patient had an 8.0 tube in place. Breath sounds were good, I had CO2 and the portable chest X-ray confirmed placement (a little high, but correct). I was now the first intern that had gotten an intubation on their first day and succeeded on their first attempt. I could not complain... this was the start I needed.

For the rest of the day I continued to struggle with the EMR, feeling lost and inadequate much of the time, but with just enough confidence to believe that I could learn what I needed to learn and that eventually I might just be able to do this. Twelve hours is a long time for an old guy like me to work so hard and by the end of the day I was beat. I came home, stuffed my face in a most unhealthy manner and went to bed. My challenge in these first few weeks will be finding my footing and learning how to find time for all the reading I will need to do while managing to fill out all the daily forms, checklists, paperwork and required residency documentation that must be done. At the same time I need to develop a life OUTSIDE this world of medicine and maintain some sort of balance, exercise, leisure and down-time. It is going to be hard.... so I better get to it. Part of all this will be finding a few minutes to write each week. We will see.....

PS: (this is a photo from the internet... not me and not my patient, but it conveyed the general feeling of that intubation)