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.

Wednesday, August 01, 2007

Quick Update

I know I promised more uplifting posts, but it's just not going to happen. Not anytime soon, anyway.

After being spoiled by starting my EM year by actually doing a month of emergency medicine (astonishing, I know), I am now in hell. I have been shuttled down to Large Teaching Hospital in major Canadian city also known as the Centre of the Universe (or COTU, semi-affectionately). So in my fragile emotional state (for more illustration of this, see last post) I have been sent to a sterile little apartment far from my home, my husband, my fur-babies and everything familiar to me to be overworked, belittled, abused, demoted and generally made miserable. Why is this happening to me? Because I'm reliving some of the darkest days of my medical education... my days as a junior surgical resident.

This is allegedly my 'Trauma' rotation. Bullshit. If this was a true trauma rotation, I'd be working with the TTL (trauma team leader) running the trauma from start to finish. Instead, I respond with the trauma team to all incoming traumas and traumettes (little traumas, or minor injuries that might require a chest tube or something), do a quick primary and secondary survey and then sit around and pick my ass until the patient has been scanned. Then after all of the injuries have been identified, I define which ones are directly relevant to the general surgery team and report back to the staff. Not too bad, right? Particularly since I get first dibs on some of the more invasive stuff (chest tubes, femoral pokes, art lines, etc.). So why am I miserable?

You'll be sorry you asked. My day starts at the hospital at about 6:15am. I am expected to pre-round on patient results and conditions for all of the team's patients (both trauma and regular general surgery patients) before the senior comes in. To add to the fun, the ward is often locked that early in the morning and I have to buzz the intercom for a good 10 minutes before someone will let me in. Which then makes me behind, and I get yelled at for not knowing everyone's Tmax (maximum temperature, indicating fevers and such) over the past 24 hours. My days last about 12 hours long. That's an average. On my feet. Spent running around from one corner of the hospital to the other, mostly completing scut while my senior is in the OR. I rarely have time to eat, and I don't really have the urge to anyway. I am nauseous most of the time, whether it's from being exhausted or stressed I don't know. Thanks to pregnancy hormones, I am quick to cry-- and considering the number of times a day I'm frustrated or overwhelmed, I have had to choke back humiliating displays of emotion more times than I can count. I save it for the 2-3 hours between the time I get home and the time I go to bed to have a hope in hell of waking with my 5:15am alarm.

Doing this pregnant was the stupidest idea ever. My feet are swollen by 8am, thanks to a combination of being on my feet constantly and the 40 degree heat. My back and abdomen cramp constantly, again probably thanks to the time spent on my feet. I've started having those lovely pre-syncopal episodes again, probably in part due to my ongoing blood pressure issues and part due to the fact that I'm back to minimal food intake.

Pregnant or not, this rotation sucks. I am the whole team... just me and the chief resident, who just stays in the OR. I'm trying to do everything, but no one will tell me what 'everything' is or how I'm supposed to get it done in a hospital system that is completely foreign to me. There is no one to answer my questions, and the only time I find out that I was supposed to have done something is the next day, when I'm being yelled at for not doing it.

And to add to the fun, my 'protected educational half days' (teleconferenced lectures from my home school) are anything BUT protected. Today for half day I had to beg someone to take the trauma pager, and he wouldn't cover my call for the afternoon. So I barely even heard any of today's lecture because I was too busy answering pages every 5-10 minutes. Then I got yelled at by my senior for sending a med student to do a consult-- she was placated when I explained that I had already seen all of the urgent consults and assessed them for the OR, and that this consult was VERY non-emergent and the staff requesting the consult admitted on the phone that the patient wasn't likely a 'surgical candidate'... but still.

I've done this already. I've put in my time as a surgical scut monkey. I'm not here to be anyone's lackey, I'm here to learn to run trauma. And I'm getting very little of it. It would have been MUCH more useful to do this as an EM/Trauma rotation. I'd still see the same stuff, but from a perspective that is pertinent to my role as an emergency physician.

Now any other time in my life I probably would have sucked this up and just counted down the days until I was done. But my coping skills have already been recently taxed to their maximum. I'm doing my call tonight, working a full day tomorrow (going home at noon post-call is not an option here on this service... particularly not when your staff surgeon has booked a clinic with 42 patients on your post-call day), back on Friday, then I'm going home. Home to my husband, my dogs, and my crazy sister who is visiting for the weekend with her significant other. There I will carefully construct a letter to my program director explaining my case, my issues, and how difficult this has been. I will emphasize how little I am getting out of it. I will offer to do extra Trauma call during my easier rotations, or even over my maternity leave. But I want to come home.

I just can't do this anymore.

I'm not even reading this post over. Excuse the disjointedness. I might regret posting this later, but what the hell-- you want an insider's look at medical education, here it is. Often, it sucks. And I am too tired to keep sucking it up right now.


Anonymous geena said...

Sounds downright crappy. I stopped working 12 hour days as a nurse by the middle of my pregnancy and went to 8 hours.

I know it's hard. I hope you get a chance to take care of yourself this weekend.

Better yet - I hope the hubby and sis take care of you!

5:27 PM

Blogger Future Doc said...

I can't even begin to imagine how hard it must be but I hope you know you have the support of your readers. Write that letter and get home as soon as possible!!!


6:26 PM

Blogger Xavier Emmanuelle said...

Oh Dr. Couz, that sucks so much. You shouldn't have to be a scut monkey to start with, but especially not when you're in late pregnancy!

8:44 PM

Blogger Dr. J. said...

I have posted my view on medical education several times before. I hope that your program is progressive, I hope that they view what has happened to you as a major red flag for that particular rotation (a rotation that is failing to meet specific learning objectives for it's residents) and evaluates the rotation instead of you.
I occasionally toy with the idea of returning to some kind of further residency training, and when I read posts like this realize that I couldn't. I'd calmly call bullshit on this sort of nonsense a few times, and then the program director would call me in for a meeting to say things weren't working out...

I hope this goes well for you....for me it's incomprehensible why programs support these sorts of rotations that only breakdown their residents rather than meet any sort of learning objectives....Good luck

9:35 PM

Blogger MedStudentGod (MSG) said...

Enjoy your weekend, get that letter written, and take care of yourself and the Bean. What an ass your senior is being.

10:50 PM

Blogger Shannon said...

I'm horrified for you and I'm kind of horrified at the medical system as a whole, if this is the kind of expectations they regularly miss.

I hope they will transfer you out. Ugh.

9:46 AM

Anonymous Anonymous said...

Seriously, you say the word, and I'll go after your senior's knees, Tonya Harding style.

Be prepared for me to love you and squeeze you and force you to eat and not let you stand up even to pee (your husband is bringing home a bed pan, at my request) for a whole weekend. Oh, and be prepared for the dags to be worked up into a frenzy. Because I can. And because you're the most pregnant girl I know.

You're a champ, and the only person I know who could deal with this many challenges at once and not end up in the psych ward.


Crazy Seester

1:44 PM

Blogger PE Mommy said...

Oh dear I am so sorry. I have easy office jobs and couldn't even fathom what you have been doing. Go home, go to bed, and sleep till you can't sleep no more. Let your husband and sister pamper and love you. Then look at everything with a fresh perspective on Sunday. Hugsss.

9:21 PM

Blogger RugbyGirlMD said...

And while you're at it, go get yourself some prescription strength compression hose. Wear them every day. (TEDs if you can't get the big mommas)

Seriously improved my mood when I was on surgery. For some reason simply not having swollen legs made me feel SOOO much better.

Good Luck!

8:33 AM

Anonymous MLO said...

I hope you are able to get reassigned as it sounds like this rotation is being used as an excuse to fill what should be a staff position.



10:15 AM

Blogger Foxy said...

Awww, you poor, poor thing. That is really awful. I'm glad you went home, though so sad that I didn't get to grab a frappucino or anything of the sort with you while you were here.

Take care of yourself, lady.

5:34 PM

Blogger Couz said...

I'm only home for the weekend. I've gotten in touch with my program director via e-mail, explaining the situation, but I don't feel like I can just not show up on Tuesday morning without her okay.

So as things stand, the rotation is still on. :-(

7:22 PM

Blogger Amanzi Down Under said...

I turned into a GrumpyBoots last night when I realized that my senior had added a 10 hour ER shift to my Roster next week (I'll now be working a 34 hour week!) Of course I can handle this, I've handled 120 hour weeks before! Thanks for putting things into perspective for me.
You are doing a fantastic job! Kudoes for surviving thus far. I respect your willingness to stand up for yourself when you're being abused and your diligence in continuing with it until you've been given the go ahead to leave.

9:03 AM

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7:16 AM


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