The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, August 05, 2007

Another Damn Update...

In spite of my current predicament, I have been really touched by the outpouring of support. Phone calls from my nearest and dearest (which I've been mostly avoiding since the slightest show of sympathy can make me burst into very un-Couz-like tears), posts to this blog, Facebook messages and e-mails from both long-lost friends (who knew they read my blog) to near-strangers offering me respite from my situation (thanks again, Kate!). It makes a girl in a desperate situation feel very loved.

But the week got no better after my post. In fact, my night of call was beyond brutal. By 11pm that night my feet were so swollen (in spite of my TED's support stockings) that I couldn't get my Nikes back on. I had to unlace them and leave them unlaced. The night was a blur, I never did figure out where my call room was (a moot point, since I didn't get a chance to sit down until about 5:30am) and I STILL didn't see any good trauma. I felt so sick on my post call day (nauseous, swollen and prone to fainting) that I ended up being sent home at a reasonable time (not long after noon-- so only 30 hours or so of nonstop work on my feet). There were literally no high points to my week. I drove myself home on Friday after work, in spite of the long weekend traffic, and was greeted after the long drive by my sister and her significant other who made me eat and rubbed my feet. It was nice.

The next morning (after about 12 hours of sleep interrupted only by disturbing dreams of people crashing on the floor and visions of my pager going off) I wrote a carefully worded letter to my program director. Thankfully, she is a very approachable ER doc who has been through a few pregnancies of her own, and has already been a great mentor for me through this experience. Here is the letter I wrote (some details have been changed, obviously):

Dear Emergency Medicine Program Director:

I'm really sorry to interrupt your long weekend, but I'm having some serious problems with my trauma rotation.

This rotation is not meeting my educational objectives in any way. Having already completed two months of general surgery as a PGY-1, I am honestly not finding this rotation helpful at all. I am the junior resident on the team, and my role does not extend past running the floor. Making this more difficult is that fact that no one at any point has explained to me how the hospital works, what exactly is expected of me or even things as simple as how to access x-rays. In fact, many of my duties are only identified as such the following day when they haven't been done and I am berated by various senior member of 'the team'.

My day starts at 6am, when I am expected to pre-round on the team's patients before the senior resident comes in at 6:30am. At that time, I will be quizzed on lab results, urine output and vital signs. A quick round are preformed before the senior heads to the OR, and I am left to run the floor all day. This leaves me running from one end of the hospital to the other for an average of 12 hours a day without breaks. Even my half day is not necessarily 'protected' time, as the other juniors are very hesitant to relieve me of the duty of covering my team's patients and holding the trauma pager. The policy in this centre is that it is your responsibility to find someone to cover for you and if you are unable because the other juniors are unwilling or unable, you simply don't get to attend half day. On Wednesday I was paged out of half day an average of every 5-10 minutes throughout the afternoon, and heard next to nothing of the teaching. Since this is quite clearly a service-based rotation as a opposed to one that values teaching, the Wednesday afternoon was my only chance to get any formal (or informal) teaching and it was a bust.

The only change from this routine comes when the trauma pager goes off. This happens anywhere from 0-2 times a day (in spite of the fact that this is supposed to be the 'busy' time of year for trauma, ironically). I respond, along with about 10 other people, and fight for room near the patient along with the team from anesthesia, the team from the emergency room and the team from orthopedic surgery. My 'role' in the trauma is restricted to doing the secondary survey (the primary is mostly handled by anesthesia), and waiting around while the patient is scanned to see what team the patient will be admitted under. Although in theory I am supposed to be the one to do the procedures, that has been restricted to inserting foley catheters. Honestly, I felt I was getting much more out of traumas in my home centre, where the ER doc would allow me to run through the entire trauma from start to disposition. In addition, I actually found that I had more opportunities to do procedures in the ED in my home centre than I do on this rotation. This experience has been extremely disappointing, and I find that I'm not actually getting anything out of it.

Ordinarily, I would probably suck up the experience and push through it, just to have it behind me. But in light of my current physical limitations, I am having a really difficult time meeting the physical requirements of this rotation. Between the swelling, the back pain, the GERD-associated vomiting that sneaks up on me at embarrassing moments and the pre-syncopal episodes that happen when I spend too long on my feet, this week has been really rough on me. I'm not sure what to do at this point. I honestly don't think I can physically complete the rest of this rotation, but I am concerned about the repercussion of taking leave. I am willing to explore any number of options-- doing extra TTL call during my ortho-plastics and elective rotations, doing a trauma rotation as an emerg resident (as opposed to a gen surg resident) at this teaching centre or elsewhere... I am open to pretty much anything. I think there are many other ways I can get the exposure the trauma I am looking for, because I'm really not getting it on this rotation.

I would be more than willing to discuss this with you as soon as you can. I am hoping there will be another way I can fulfill my trauma requirement for the program and another way I can spend the rest of this month. You can reach me at home this weekend or by e-mail.

Again, I have to apologize. I am in no way a quitter, and debated a long time about addressing this with you. As I said, my first instinct in this situation would be to suck it up and finish for the sake of having it behind me, but between my somewhat compromised coping skills and my concern about the actual educational experience itself I don't think that simply going through the motions for the sake of completing the rotation is my best option at this point.

Thank you for listening, I look forward to your reply.


Unfortunately, I am still waiting for that reply. I suspect she may have gone out of town for the long weekend. Since I don't feel right bailing on a rotation without the blessing of my program director, I may end up heading back to the scene of the crime tomorrow in order to report to work at my usual 6:15am on Tuesday morning. Sigh. Just when the foot swelling has gone down...


Blogger Double Headed said...

Oh Couz, I am so sorry you are having crappy time at the COTU. Good for you for trying to bail out. I hope she emails you back before you have to go back.
Please take care of yourself and the little one.

I actually was thinking of going to the Centre of the Universe for trauma rotation in April... Thanks for heads up... Change of plans it is...
Got yelled for sending med student to do a consult? You should come our way, most of the consults are done by students around here - surgical included... Prerounds are done by students too. Juniors show up together with seniors. And no big pond stink either.

12:03 AM

Blogger Lala said...

So sorry Couz, I hope things pick up soon. Good luck.

7:24 AM

Blogger Amanda said...

I hope you get a good response from this. It was of course, wise of you to offer other ways you are willing to meet requirements.

On the syncope.... are you drinking enough water? I know you are busy, and it is probably hard to take that time... and then time for the resulting bathroom breaks.

Also, I never felt good at all during either of my pregnancies. Just getting through an EIGHT hour day in the dr's office where I worked was hard. I can't imagine 30 hours at a time. Anyway, I lived on Carnation Instant Breakfast drinks. A dietician once told me they are as good as Ensure, but more tasty to me. I also ate a lot of peanut butter and jelly, and cereal. Maybe some of that will sound good to you.

12:08 PM

Blogger Christie said...

Couz, I hope that you get a positive response from your letter soon. Since I'm unfamiliar with how everything works in and beyond - is this mandatory? Will there be repercussions for not finishing this?

Take care - thinking of you.

8:28 PM

Blogger Nikki said...

Oh, what a nightmare. I'm so sorry. :( My gut is to say "don't go tomorrow, screw them!" -- but I understand that you're reluctant to just not show. Why don't you call in sick? You ARE sick - sick of all the bullshit!

10:13 PM

Anonymous Anonymous said...

hey hon... keep your chin up. i'm thinking of you, and i know you'll come up with a solution to this horrible mess. sounds like crazy seester did a good job of pampering you this weekend!

many hugs,


11:11 PM

Blogger ERnursey said...

Dear Dr. Couz, try TED hose. Helps with the swelling of the legs and the orthostatic hypotension. Definitely not a fashion statement though. Also look into a belly band, any good maternity shop should have them. Gives support to your expanding belly which will help with the back and abd. pain. make sure to stay well hydrated, dehydration can bring on contractions.

12:50 AM

Blogger ditzydoctor said...

dear dr couz! may it go well with your letter. you make wish scared of OnG. but i hope things get better for you!!!

10:39 AM

Blogger Midwife with a Knife said...

I am so sorry they're treating you so badly. Your EM program should just pull it's residents out of that situation entirely. Clearly your learning needs aren't being met, and it sounds like the hospital in question is simply taking advantage of you. Never mind the fact that your current pregnant status makes the torture just that much more bad; you simply haven't been treated or educated appropriately from the beginning! Kudos to you for explaining that to your program director. Maybe it will save some of your peers similar torture.

5:59 PM

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7:12 AM


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