Missionary Orthopod in the Making

So I noticed that over the past couple of months I haven’t commented on what I’ve actually been doing as a resident. Starting in late December I began my general surgery rotations that are required as part of my orthopaedic surgery residency. It is kind of the luck of the draw in terms of which particular rotations you get but mine worked out to be 1.5 months of Vascular Surgery, 1 month of ICU, 1 month of Plastic Surgery, 1 month of Surgical Oncology and Endocrine Surgery, 1 month of Trauma Surgery, and 1 month of Pediatric Surgery. The last rotation of my intern year is actually anesthesia which is wonderful because its a low stress rotation and will allow me to rest up before the infamously terrible ortho PGY-2 year arrives.

Plastic Surgery

I already commented on my time on Vascular Surgery and ICU. Plastic Surgery was truly a pleasant surprise. I must admit that I had no true concept of the scope of operations that plastic surgeons performed, but my month plastics opened my eyes. They were doing masseter nerve transfers for kids who lost function of their facial nerve after a tumor was resected to breast reconstructions, to repair of carpal and phalangeal fractures to closure of complicated spinal wounds, to in utero repair of spina bifida defects, etc. They did so much more than just the characteristic comestic surgery and they truly do work everywhere on the body. I loved the variety of sutures and the realitive healthiness of the patient’s which is what also drew me to ortho. During one of my last days on plastics one of the attendings liked my closure so much that she said I should consider switching to plastics, lol. I must admit, there really weren’t many other fields I liked besides ortho but after this month I could definitely have seen myself doing it. I don’t think I had the medical school grades to get into plastics, but I found out that you can actually do a plastics fellowship out of any surgical residency, including ortho, ENT, general surgery, etc. Doing another 3 years of plastics after my 5 years of ortho really isn’t palatable to me, but it was nice to fancy the thought for a bit.

Surgical Oncology/Endocrine Surgery

If you lined me up beside 1000 other ortho and non-general surgery surgical residents I would likely be ranked close to number one in terms of my disinterest in bowel surgery. So clearly I was dreading have to go through all day Whipple cases. However I was somewhat pleasantly surprised that most of the cases I scrubbed in on during surgical oncology were related to liver resections and I had no idea how cool liver surgery was. Our attendings here both preferred open approaches so I got to look directly at the biliary system, hepatic veins, and portal venous system. One time we were resecting a tumor that had incorporated itself into both the liver and the IVC that ran through it. When we got the last piece of tumor out a small hole appeared in the IVC and boy…DAT MOFO CAN BLEED, lol. I definitely have to give it up to general surgeons who on a day to day basis deal with life and death situations and barely break a sweat. Coming into medical school I thought I wanted to be that guy, but I’m too much of a softey to have my patients die on a somewhat consistent basis. Ortho is definitely for me, but again I was pleasantly surprised by the Hepatobiliary Surgeons here.

As for Endocrine Surgery, I must admit that the thyroid is by far the least exciting structure in the body. I guess what really made me not like the cases was that the field was too small. Every tool was itsy bitsy tiny, and you had to constantly worry about retracting too much. This is probably the reason why hand surgery so far hasn’t appealed to me. Who knows, that could all change.

Trauma Surgery

This is the rotation that I am currently on and its amazing how variable my night could go (I’m currently doing 5pm to 5 am shifts). One night this past week, we had like 3 gun shot wounds come into the ER; they all came in as trauma arrests so the room is just full of people doing compressions, placing lines, putting in chest tubes etc. They all ended up passing away which was terrible…more dead black Baltimore 20 year olds. I can see how people who do this stuff for a career can get jaded. Moving on, last night, when I was on, there was not 1 trauma and the nurses decided not to page me for anything on the floor patients. So I stayed up and watched documenteries on Netflix and slept a couple of hours. You truly never know what the night will bring on trauma surgery. So far though I like it because again it teaches me how to take care of pretty sick surgical patients and it also gets me back to interacting with my ortho brethern since we consult them often.

Yesterday, Johns Hopkins dedicated its new, 1.1 billion dollar hospital:

We move into the hospital on the 29th of this month and guess who the administration has volunteered will wheel the patients from the old hospital to the new? Of course the interns; we have expertise in this sort of thing lol. Honestly though the process is supposed to be pretty straight forward in terms of when we are to transport a patient to the new hospital but I just forsee huge mishaps along the way. Its my hope that no patients get lost or misplaced .

The hospital has 6 trauma bays decked out with all sorts of technology. The ER is huge and should hopefully alleviate me having to see patients in the waiting room as I have often had to do. What this means for me also is that after spending all intern year learning how the Hopkins system works and where to find everything, I will have to relearn it again 2 months before the new interns arrive. But you can’t impede progress and quite honestly it will be cool working with stuff that is finally brand new.

There there ya go, that has been my general surgery experience so far. In other aspects of my life, my wife matched into an OBGYN residency in Baltimore City so I am still praising God for that. We also are moving out of downtown baltimore and into the suburbs of the city which are much nicer than anything you have seen on TV about Baltimore. Anyways, I will report back on any new events that occur in my residency.

Like most residency programs, my program has a hall that has the pictures of resident classes dating back multiple decades. When I first arrived on campus I walked the hall in our department, looking to see when the first black resident was accepted.  It took me awhile, because everyone looks the same in black and white, but I finally found him in the picture below (can you pick him out?):

For the longest time I wished I could meet him, but I figured he was probably retired or dead. Well last month I got the chance to meet him by chance at a department homecoming of sorts. I got his number and couldn’t wait to hear his story; I just knew that he faced an environment similar to the Little Rock 9 kids who desegregated our public schools. Imagine, in a field as undiverse as orthopaedic surgery, being the first black resident at a place like Hopkins? His true story was actually quite different and less dramatic.

He told me that he was treated with nothing but respect from the orthopaedics department at the time. The only time that he ever received rascist remarks were from some of the general surgery attendings (who happened to be from the south) when he did his 2 years of general surgery that was required at the time. He also mentioned that whenever a patient made it clear that they didn’t want to be treated by a black orthopaedic resident, that their chairman would show the patient the door. We talked about a lot more but it was so amazing to hear that his experience was so pleasant, but in hindsight not really surprising at all. One of the main things that attracted me to Hopkins was that second to Howard University’s ortho program and perhaps UVA, Hopkins had just as many minorities and woman. To me it spoke of a program that took the best regardless of what they looked like. In honor of black history month, I think its important to remember all those who came before us to make our opportunities even possible. If that first black resident really sucked, who knows when Hopkins would have taken their 2nd one. In the same way, where ever we end up, we have to strive to not just be on par, but be the best, to continue opening up doors for those behind us. And when we reach the top, we have to remember to BE AVAILABLE as mentors. Okay, I’m off my soapbox .

I’ve seen people die before. The very first post of my blog shows the first person that I saw die; he came in with a gunshot wound to his chest, a thoracotomy was performed, but he didn’t make it. Since that shadowing experience in college through medical school I have certainly seen patients pass away, but never was it MY patient. For the first time during residency this happened to me and it was the most sobering experience of my life.

Just 30 minutes before I was talking with the patient, reassuring him/her that they would be leaving the hospital the next day. We had already set up the rehab location and the patient was ready to finally leave the hospital. The patient didn’t show any signs that anything was wrong with him/her at that time; no chest pain, no shortness of breath, no change in mental status, no decrease in oxygen saturation, nothing. I walked out of his/her room and 20 minutes later I heard a nurse scream and call, “CODE BLUE, CODE BLUE!!!”. I was in the physicians work room and for a second I froze…although I was on the surgical floor, there were some patients who were being managed by internal medicine…perhaps it was one of their patients. But reality set in that 98% of the patient’s were mine on that floor or at least my cointerns’ and I at least needed to see who it was. Lo and behold people were running towards MY patient’s room.

I ran into the room and it took one look to realize that my patient wasn’t breathing…her eyes were wide open. I knew a code team was coming so I started doing chest compressions, praying…praying that he/she would come back. The code team arrived and followed the normal steps, 1) intubate 2) hook up defibrillator pads 3) analyze heart rhythm. He/she was in asytole; we gave him/her epi, atropine, we defibrillated him/her multiple times, we kept at it for 30 minutes, but he/she still didn’t have a pulse or a rhythm that we could defibrillate.

When the doctor running the code team called it I was still doing chest compressions. I know it sounds soft and ridiculous but I wanted to cry. This was MY patient, who was supposed to leave the hospital the next day. While he/she was in very poor health, most vascular patients are, and most of those people eventually leave the hospital. I talked it over with my chiefs and they all said it was just one of those times when an old person with multiple comorbidities just has a heart attack or a massive pulmonary embolism. There really aren’t many other explanations for sudden death like that. Of course the family of my patient did not want an autopsy, and how could I blame them. While the autopsy would have given me closure as a doctor, it delayed them being able to bury their family member by 3-4 weeks. If it was my mother/father I would have chosen the same thing.

When I left the hospital I had to drive around for an hour before I went home. There were too many emotions swirling around. The only solace I could take was that I hadn’t caused his/her death, but it did not take away the pain of losing someone you spent weeks taking care of. But unfortunately this is an experience that every resident will have. While it is hard to admit, I am not a superhero…I can not assure that I will be able to pluck all of my patient’s from the edge of death. It is hard not to view each death as a failure in your life’s calling, but if you do hold this view you will not last long in medicine.  It is one of the costs you pay for attempting to save the lives of people who would otherwise pass away.

For the past 2 weeks I have been on my first General Surgery rotation called BayView Red. The service is primarily composed of vascular surgery, thoracic surgery, and trauma surgery. Needless to say these patients are much sicker than the orthopedic patients and I can truly say that I’m learning how to keep patient’s alive. Just in the past 2 weeks I’ve had patients how couldn’t breath anymore or who had acute mental status changes or who were having a heart attack. These situations would have scared the poo out of me when I was on ortho, but I’m becoming much more comfortable with managing them now.

Before medical school I was really gung-ho about becoming a general surgeon because that was all that I had been exposed to initially. In particular I had been exposed to the trauma side of general surgery and I was completely enthralled. Then when I did general surgery as a 3rd year medical student I was put on a completely GI service with colostomies, anal abscess, etc and I vowed that I would never do general surgery. Since then I’ve had a mild distaste for the field primarily because of the bowel…I hate bowel. However these 2 weeks on the BayView Red have truly made me appreciate how diverse the field of General Surgery is. In a given day you could be in the OR dissecting through the neck to stop the bleeding caused by a gunshot or you could be doing a thoracoscopy to resect a lobe of the lung or you could be taking out a gallbladder. None of which involve the bowel, lol. I’ve been getting a lot of OR time on this rotation too, slowly honing my suturing and bovie skills. As a medical student watching residents use the bovie and the scalpel numerous times I always thought it would be easy to do it myself. But when the attending is looking at you and you are making the first cut its a whole different ball game, but its also exhilarating.

I’m slowly becoming a surgeon. Its an insidious process, but slowly you start to make decisions more definitively, slowly you are unfazed by taking 1 foot of gauze out of someone’s wound and repacking it, slowly arriving at the hospital at 4 am is becoming normal, etc. One day last week I was feeling really sad because all I wanted to do was be home with my wife and little girl, however when I went into the OR and did a couple of cases I completely forgot about my homesickness. Its experiences like this that have reassured me that I belong in surgery. But experiences like this have also reminded me that if I’m not careful, becoming a surgeon can destroy my family, which is unacceptable. Finding the right balance will be my life’s achievement.

Attending: DoctaJay, please describe this lesion.

Me: Well its a intramedullary lesion, with clear rings and stiples denoting cartilage. There also appears to be an oblique fracture traversing the distal femur.

Attending: What is the diagnosis?

Me: I would call this a fracture with an incidental finding of a enchondroma.
———————–

This is what I did for the past month and I truly loved it. Our attending is a world reknowed bone pathologist who also did an orthopaedic surgery residency. He basically tells us to read a chapter from his book, let’s say on primary bone tumors. The next day, he gives us a couple of folders filled with x-rays and corresponding histology slides. He gives us an hour to come up with a diagnosis based on the xray findings and the histology. After that he comes in with another huge stack of xrays and pimps us on every single aspect of the various bone lesions.

This month was such a breath of fresh air as compared to the 3 months I spent on inpatient orthopedic surgery.When I was on ortho trauma I barely saw my family and barely got any sleep. This month on pathology I got to sleep in until 8 am, chill with my family all day, read about bone lesions (which I didn’t think I would find as interesting as I did), and just overall have a normal life. Rotations like this remind me of how lucky I am to be a resident here as not many ortho interns get introduced to ortho oncology so early. Anyways, next month I start general surgery, so the vacation will be over!

This past week I witnessed and participated in something I would say is akin to the secretive and mysterious process of choosing a pope…ranking ortho sub-interns.

For the uninitiated, sub-interns are 4th year medical students from Hopkins or from other medical schools who spend 2-4 weeks rotating at our hospital to find out if they would want to spend the next 5 years here as a resident and to give the residents and attendings here a chance to see if we would want them here. There are a lot of things that go into doing a good job as a sub-intern but I will go into that in some future post.

The ultimate job of ranking sub-Is is done by the chairman and program director. However many residency programs value the input of the residents because we have had the most contact with them and we will have to deal with their shortcomings if they match here. Here at Hopkins we have a powerpoint presentation with the pictures of all the students who rotated at our program. As each rotator’s picture is displayed the residents as a whole have the opportunity to voice how much they liked or disliked the applicant.

It was truly a surreal experience to be part of this process because just 1 year ago I was still a 4th year medical student, rotating at Hopkins, hoping that I had impressed them enough for them to rank me highly. Seeing the process now as a resident I saw how easy it was to rise quickly to the top of the rank list or drop to the bottom. It lead me to offer this advice to MS-4s who are are rotating around the country for different residencies:

• Try to get to know as many residents as possible at the program, because you want multiple residents vouching for you during the ranking process
• It was very rarely mentioned that such and such student was smart but really couldn’t suture well. Don’t fret if you mess up once in the OR. That will not hose you as much as pissing off a resident or attending in some other way
• Students rose to the top of the list when it was mentioned that they were 1) extremely hardworking not just in front of attendings but residents also and 2) were cool to hang with outside of the hospital
• Students who’s pictures popped up and no one could really remember them rotating were shot down to the bottom of the list. Meaning, if you spent 1 month at a program and no one can remember it, you did not do a good job
• Never ever ever lie. If you are caught in a lie while rotating you are finished.

Sitting through this process as a resident, I remember being a MS4 and fretting about messing up on a subcuticular stitch. After that day I was sure that I had completely destroyed my chance of matching at Hopkins. But there is a lot more to being a good rotator than perfect suturing skills. You will definitely learn those manual skills as a resident. What most programs seem to look for are hard workers who are fun to work with. I saw many  a high board scorer drop low on our list secondary to not working hard enough or having personality that wasn’t interesting to be around.  With that being said, if you have the combination of good scores and a strong rotation, then you are golden.

Part of me wished I could have been a fly on the wall last year when these same residents were discussing my rotation. Who liked me? Who advocated for me? I will never know, but I truly praise God for the favorable outcome.

Being an intern is like constantly being embattled. You are responsible for everything that happens to the floor patients, and every aspect of their care. If you miss something related to their care, no matter how small or big then “you suck”. Honestly, even on my best day, I miss something, and I tend to come down really hard on myself, which isn’t healthy because this is in addition to what I may get from my seniors. I arrive very early (usually get the first spot in the parking garage) and I leave late, and still things slip through the cracks. That is why medicine is composed of teams, so that whatever the intern misses, the PGY 2 or 3 will catch. And then whatever they don’t catch, the PGY 5 will catch, or the attending. It doesn’t however negate the fact that something was missed by the intern, and it doesn’t negate the pain inflicted upon the intern when it is brought to his/her attention.

With all that said, I really am thankful to God for being an intern here at Hopkins. The ortho service is actually really detail oriented here, and its training me to pay extremely close attention to every aspect of my patient’s care so that they have the best outcomes. Its a painful process however to be trained in this way, but it is better for me in the end…or at least I tell myself that every morning when I wake up at 3am, lol.

When I started this 2.5 month ortho rotation, I thought I would have time to read every night and spend time with my wife and child, etc. But that is just not the case. By the time I get home, I am so burned out and tired that  I have no time to study, or time to study but not time to play with my daughter. Thankfully the new intern work our rules have giving me about 8 hours, uninterrupted, to spend with my family each friday, which I am very thankful for. However the thought that next year when I am a PGY-2 and don’t have work hour restrictions that things will be worse is sobering. I can see how many divorces occur to surgical residents; and I just will not allow that to happen. I am still trying to find that balance between excelling at work and at family life, and I refuse to give up on that ultimate goal of doing well in both.

I am the only intern out of the 5 to do ortho trauma for 2.5 months straight without other rotations in between and it truly has been grueling. With that said, the rest of my intern year will be much more chill in comparison. My next month will be spent doing ortho pathology and radiology. My seniors have told me that by the end of that rotation I will be able to look at almost any lesion in a plan X-ray or any histology slide and diagnose the mass/tumor. We learn a lot of ortho tumor here and I really enjoy it actually. There is just so much to learn that I never even heard of in medical school in this field, particularly in orthopaedic oncology.

After my 1 month of ortho oncology, I start my 6 months of general surgery. And while anyone who knows me knows that I hate anything dealing with bowel, I have actually heard that life is much better for ortho interns on general surgery because 1)intern work hours mean that I have every Friday night and Saturday off 2)we are not pulled in 1000 directions as a g.surg intern as we are as a ortho intern. I will actually probably have more time to spend with my family during those 6 months of gsurg than I have had in the last 2.5 months. I really plan to read a lot during my g.surg time because I truly love ortho and I don’t want to be the least knowledgable in my class all because I have a wife and kid.

I had another ethical dilemma because the orthopaedic in-training examination (OITE) is coming up next month and it is traditionally always held on Saturday. The Lord blessed me to match at Hopkins I believe because I honored Him by not interviewing on the Sabbath when I was applying for residency. However I started to waiver again when I learned about the OITE only being held on Saturday. I didn’t want to be the only resident to cause “trouble” by requesting to take it on another day. But I also wanted to honor God and His Sabbath day. I was encouraged by a fellow Loma Linda classmate of mine who matched into ortho at Mayo. His words encouraged me to just sit down and talk with my PD about my faith and desire to take the OITE on another day. My PD was so receptive and within a couple days I was cleared to take the OITE on a Friday instead. Praise God!

This is another testament to standing up for your beliefs not matter what arena you are in. For all of you who are not in environments where God is talked about, don’t let others suppress your beliefs. Trust me, you will be respected more for adhering to your beliefs than wavering at the first sign of resistance. Honor God and He will honor you.

Last week I took overnight call for the first time as Orthopaedic resident and its was…exciting. It was exciting not only because it was my first call, but because Hurricane Irene was also bearing down on the East Coast, ready to bear all sorts of carnage. On the drive in to work, I saw this in my neighborhood:

Of course since I was driving in at night (I took this on my post-call day) I almost hit that tree, not expecting it in the streets of Baltimore. But this was only the continuation of my “exciting” call since when I woke up on my call day I had no power due to the hurricane showing Baltimore Gas & Electric who’s boss.

I finally arrived at the hospital, and at that time I got sign out from all the services, Trauma, Spine, Peds, Hand, and Sports. They all gave me their pagers, and I was left to fend for myself. Okay, just kidding, they also left a PGY-4 from Union Memorial to help me through my first call too, but it didn’t change the terror I felt of having 5 pagers on my waist. At around 5:30 pm all the pagers began to go off. Its a known fact that you get the bulk of your pages about floor patients around the time that nurses are getting ready to switch off. By 10 pm many of the patients started to go to sleep, so the pages that started coming in then were ER consults, because everyone with a fracture decides to wait until Friday night around 11 pm to come in to the ER.

The night was pretty eventful and the one thing I noticed immediately that was different from being a medical student on call was that the option of sleeping just wasn’t there. Often as a medical student when things started to slow down at around 2 a.m. the resident would tell me to get some rest. I wrongly assumed that the resident himself/herself were also heading to their call room for some shut eye. But this just is not possible; when you are not getting paged about floor patients  to come change Mr. X’s IV pain med to PO, or that Mrs. X started to get tachycardic and is complaining of 10/10 pain; and when you are not getting paged by the Adult or Peds ED to see such and such patient who they have been sitting on for like 3 hours before they call you, then you are typing up all the consults that are required to be done before 6 am the next day when the attending comes in to round on the new consults. In addition to that, you also have to present all the consults you saw at “The Board”. The Board is where the resident on call pulls up all the X-rays of the consults they saw in the ER or on the floor and describes the fracture/problem, and shows how they fixed it/splinted it, etc, and what the overall plan is. You are doing this in front of all the residents and a couple of key attendings. Most times this can be a stressful but benign event, however if your splint looks sub-par on X-ray, or you missed something important on X-ray, or you are asked a pertinent question about the fracture classification and don’t know it then the event can get particularly stressful. As a new intern, really just 2 weeks into being in the hospital, on my first call, I had to make sure that I had my presentations for The Board down pact.

So really all this equates to the fact that you just can not sleep at all when you are on call for ortho at Hopkins. There is too much to prepare for even when the ED isn’t harassing you. However this was the aspect of the program that I really liked as a student. I liked the fact that even though its an academic institution, you work very hard. Its better to put in the hard work now than suffer and stumble through things later as an attending.

I’m writing this currently after finishing my second call as an ortho resident and it was even more busy. Although I must say that I did learn a bunch; I learned how to put on a spica cast, I learned how to evaluate a deep laceration of the forearm for tendon and muscle damage; I put on a sugar tong splint and ulnar gutter splint without supervision, which is truly the only way to know that you do or don’t know how to put one on correctly; I learned how to deal with patients calling the on-call pager for pain scripts or cast care, etc. There truly is so much new information to learn in the field of orthopedics and I’m excited to even get the chance to do this. I’ve still be struggling with having devotion during this ortho rotation, but I know that at some point I have to make it a priority over other stuff I do in my limited downtime.

So my honeymoon is over. This past week marked the beginning of my 2.5 months of orthopaedic trauma and it is a doozy. I had to think so much on my first day that I had a headache by 10 a.m. This past Friday was especially crazy since I had the floor pager, the ED consult pager, and my personal pager on my hip…all of them going off every 20 min. As I would be walking to a certain floor to check the wound of such and such patient, I would get a page on another pager about a patient in the ED with knee pain, then as I start walking towards to the ER I would get another page about patient so and so having lots of pain.

It was really challenging this week to decide which page would get my attention first. I suppose I will get more efficient at everything, but its pretty amazing how I never really understood how much you work as a resident until I started. After a full stressful day of floor work or ER consults, I can see how you can fall into the trap of using profanity all the time or drinking your sorrows away.

Either way I am just praying that God gives me strengths using these next couple of months.

So July 1, 2011 just passed and thus began my life as a resident. A lot of things happened before my start date including taking ACLS and ATLS certification classes, getting my LONG WHITE COAT (oh yeah baby baybay!), sitting through 1.5 weeks of orientation by the general surgery department, meeting the other surgical interns, learning about my schedule, having my ortho orientation, lots of free dinners and outings, and finally getting my pager and my ID badge. It has truly been a whirlwind, but I must say that the thing I’m most excited about is what I saw on Hopkins’ website on June 30th (see below):

Something about seeing it on their website made it a lot more official for me than even having the long white coat, lol. Anyways, during that orientation time they gave us a 1hr long lecture on social media and what we can and can not post on the internet. The general idea is to basically NEVER EVER NEVER EVER NEVER EVER mention ANYTHING about a patient. Even if I have completely deidentified a patient in my description, its still somehow a HIPPA violation. They gave me enough examples about residents being let go over social media issues that I certainly was scared into submission. So I will continue to blog but I really can’t talk about patient care at all. I do however plan to describe as much as possible about what it is like to be an orthopaedic surgery resident.

So how did my first day of work go? It was actually extremely cool. I got into the hospital around 4:45am along with my fellow ortho intern in order to work on the list. Normally it takes a seasoned intern about 30 minutes to get the patient list ready for the day. However since this was our first day, we wanted at least 1 hour to figure everything out and make sure our computer log ins worked. We got the list done and then met with our chief resident who divided the patients up among us. He thankfully didn’t assign the interns any patients and instead told us to follow a PGY-2 to see how its done. The first patient I saw we walked into their room and the PGY-2 introduced himself has Dr. So and So. For the past 4 years I’ve been introducing my self as the medical student or Student Doctor Brooks. This time however I said Dr. Brooks and I felt as if I had told the patient a lie. I know I graduated last month, but I still felt like I had to earn the title of Doctor, lol. Over the course of the day it got a little easier to say Dr. Brooks but the feeling of speaking incorrectly didn’t go away. After we saw our patients I watched the PGY-2 write a note for each of them. Hopkins is now completely electronic so instead of the quick hand written progress note that I wrote when I was a Sub-I here, we actually had to sit down and type everything out…times are a changin.

After the notes were written, we met with the chief again to give an update on our patients. Then we went to Boards, which is a session in which the on-call-resident presents all of the patients they saw overnight in the ED including their X-rays and the attendings have the opportunity to pimp the resident. When I start my ortho rotation in a couple of months I will be sitting in from of all those attendings doing the same thing….yeah scary, lol.

After Boards, the PGY-2s, 3s, 4s, and chiefs went to the OR and I immediately learned what interns primarily do…we take care of the floor. I vaguely understood this as a medical student but not really because as a student you go to the OR in order to spend as much time with the attendings who would be writing your evaluations. But now as an intern I write orders, write discharge summaries, order meds for discharge, check labs, and see consults down in the ED. If I’ve taken care of all of this THEN I get to go to the OR. Its going to be hard to get used to this new role but I’m sure it will be second nature very soon.

I really want have many interesting things to blog about this month because I am technically on PM&R which isn’t an ortho or general surgery rotation. In August when I start ortho I will have a lot more to say. Let me end with telling you what my schedule will look like for my intern year:

PM&R (1 month) –> Vacation (2 weeks) –> Orthopaedic Trauma/Oncology (2.5 months) –> Radiology/Pathology  (1 month) –> Vascular Surgery (1 month) –> Surgical ICU (1 month) –> Plastic Surgery (1 month) –> Surgical Oncology (1 month) –> Trauma Surgery (1 month) –> Pediatric Surgery (1 month) –> Anesthesia (1 month)