Thursday, July 28, 2011

Day in the Life of a Pediatric Intern

In an effort to decrease the number of "Is it like Grey's Anatomy" questions I receive (no, we don't shack up in the call room after every patient), I will share what different days as a Pediatric intern have been like for me. I can't say there is a "typical" day because every day brings unique issues, families and new diseases. Plus, every 4 weeks we switch to a different "service" so we are always moving. So I invite you to sit back, relax, and enjoy vicariously the adventure that is Residency!

A Day in the Life...on Night Float

Arrival Time: 630pm Sign out
Departure Time: Depends on how long sign-out takes, but usually by 7 or 730am

When we first arrive, we go to "Sign-out" room and receive sign-out from day team. This is where the Docs from the day shift present every patient on the Peds service to us, the night shift team. Once a patient is signed-out to us, the day Doctor is no longer responsible for the decisions we make as the night team. During the Day shift, there is a separate Doctor who covers the Newborn service, 5-Central and ER Admits (the Peds floor at CRMC downtown; can be 2 residents if we have a guest from Family Practice), and Neonatal ICU (actually 2 residents, sometimes 3 if we have a FP guest).

At night, there are only two of us - the Senior Resident and the Intern Resident - to cover all the above areas. Since we are "only" covering and not responsible for necessarily moving care forward, it isn't as bad as it seems. However, there are times when you have two babies born simultaneously, each requiring resuscitation, an ER admit and a regular newborn who needs screening and it all happens at the same time. That can be pretty hectic.

As the night Intern, I am primarily responsible for all Newborns who join our world at night and for any ER Admits and/or Consults that occur during the night. On some nights, this can consume all 12 hours. On other nights, not a single baby will be born, in which case we either read, sleep, snack, or round with the Senior resident on NICU. It must be noted that every senior resident I have worked with so far has been incredible. Patient, guiding, kind and smart. And every single nurse is always willing to help and offer advice or just a joke to help you smile and make it through the night. The NICU nurses especially are most kind and really know their stuff.

On my busiest night so far, I received 4 pages for newborns (yes, we still use pagers), one of my mommy's needed resuscitation and I handled a consult - all within the hours of 2am and 630am. It went from being a quiet night to suddenly non-stop action. And of course, two of my babies were from mom's who either a) didn't know they were pregnant until last week or b) knew they were pregnant, had good prenatal care, but had fevers going into delivery - something called "Chorioamnionitis", which requires that I treat the baby with antibiotics after delivery and observe for at least 48 hours to ensure that baby won't become septic. The clock ticks pretty doggone fast when you have to make lots of decisions quickly.

And then, after a night of carrying 2 pagers (my own and the Newborn one) and a "Vocera" (the NICU in-house walkie-talkie-ish phone), I get to hand over all but my own pager, sign-out all the patients to Day team, and go home and rest for a bit before coming back and doing it all again.

Stay Tuned for More "Day in the Life..."

Sunday, July 24, 2011

Wedding Bells Are Ringing!

Since midnight last night, Eastern Standard Time, folks in New York who identify as gay and lesbian have been afforded the legal right to marriage. A union between two people who love each other. One of the first couples to marry was a lesbian couple in their upper 70s and 80s - one using a walker, one in a wheelchair, who had shared their lives together for so many years, but not been recognized as a unified couple by the law.

Congratulations to all those who have been afforded the civil right to have their love for each other formally recognized by the State!

As a Doctor, I wanted to discuss this issue from the perspective of Medicine. Although it has been less likely to occur in New York, up until today Doctors and Nurses had a legal obligation to ask the "significant other" of a gay or lesbian couple to step out of the room when discussing the health issues surrounding the patient. Regardless of how many years the couple may have been together, the patient's loved one was not considered to have the legal right to make health decisions for him/her, unless they had the foresight to make a legal document naming each other as proxy to make health decisions. In a heterosexual marriage, it is assumed and legal that the patient's spouse has full legal authority to make health decisions for the patient if they are incapacitated. Now, with couples legally marrying, the same-sex spouse of a patient will also be afforded the legal right - and human dignity - of being in the room to make health decisions for their spouse.

No human being should have to spend their last few moments on Earth alone. What a blessing that this law will ensure that doesn't happen in NYC any longer for same-sex couples.

Thursday, July 14, 2011

Grade Inflation

Go to the link above - the NY Times has some AMAZING graphs on how grades have gone up, up, up over the last 40 years. It is staggering.

ONE possible explanation, in my opinion:
1. Private schools offer more 1-on-1 instruction and greater access to the Professors, therefore allowing students more tutoring access. They also have smaller class sizes, therefore allowing more evidence-based teaching methods to flourish and allow students to understand the material better.

That's it, that's all I've got and that only explains why private schools may have higher grades than public. Why grades have shot up overall is a study in the pressures Administrators place on Faculty to keep the numbers up...and that's a whole post for another day! For now, check out the startling evidence in the graphs.

Wednesday, July 6, 2011

I have come to the iPhone...

...and I LOVE it.

The phone is so friggin' easy to use. The designers obviously thought about the user experience and made something beautiful. I love my new phone and really am just wondering why it took me so long to purchase it!

iPhone 3GS (yup, I went with the older model because they are $49. And for me, 8 GB is more than enough memory space.

Otter Box phone cover. I really like the Otter Box because it doesn't add a ton of bulk to the phone, while still effectively protecting the phone quite well.

First App Downloaded: Epocrates. This is a medical program that helps me determine dosages for the various medications I prescribed.

Favorite App Downloaded: Words with Friends. It is addicting, although pretty frustrating that I have lost WAY more games than I have won!

Tip: If you can, but the phone somewhere OTHER than California (and I think NY) because these States apply tax on the original retail price! So tax on my $49 phone was more than the sale price of the phone. That stinks. In other states, the tax will be on the actual sale price.