Yesterday, I performed my third circumcision, this time under the direction of my senior resident (my first was supervised by the Attending and a senior who served as my assistant but who had to help after the adhesions I broke turned out to be between the prepuce and the mucosal layer; the second was supervised by the Attending who had to glove up to make my cut a bit longer). This time, I required no extra hands to help; the senior just stood at the ready and offered feedback. My adhesion-breaking technique is getting better and I’m a little more dexterous with the tools but ever since I saw an Attending perform a practically bloodless procedure in less than 15 mins during which the patient peacefully sucked away on sucrose and made nary a complaint, I’ve been on a quest to perform the perfect circ. (more…)
Archive for the ‘PGY-1’ category
Note – this post was originally created on October 1st but you know, residency.
Residency is no joke! Just when you think you’ve reached some understanding or gained some competency, you’re thrust into a new situation that makes you realize just how little you know. The challenge is handling those situations as if you do know what you’re doing because even though you aren’t realistically expected to know it all (at least, not by one’s senior residents or attendings), you are expected to be on top of things. On inpatient teams blocks (‘teams’ or ‘days’), you are assigned to a max of 8 patients for the duration of their hospital stay (the average pediatric inpatient stay is 2 days but can vary wildly from 1 to 21 or more) and for these patients (and their families), you are their primary physician. The expectations are as high as the turnover rate and while there is the occasional laugh to be had, there were some tense moments, some strange standoffs and (for a crybaby like me), some tears shed.
If anyone had asked me on July 31st how I thought my NICU block would be, I’d have immediately responded with one word: awesome. Much of my desire to become a doctor in the first place was sparked by my fascination with neonatology; the epic stories my mom would tell about how I spent my first month of life in a NICU probably brainwashed me to the point where I felt like going to the NICU would be like a homecoming. The children’s hospital at which my residency is based has its own NICU where senior residents staff and take call but the interns are sent to the level III NICU of the local general hospital which is run by a team of attendings and neonatal nurse practitioners. It’s a state-of-the-art 60 bed facility where babies as young as 23 weeks are managed and ECMO can be performed if necessary. I remember how brightly I smiled on the first day, thinking of all the deliveries and resuscitations I’d be able to attend, all the tiny babies I’d be able to care for and all the things I’d be able to learn from the attendings. I’d even imagined myself well-prepared because I’d had a 4-week NICU elective in med school. Looking back, I realize how terribly naive I must have seemed. The shock of reality was like icy water in the ear.
note: this post was meant to be published on July 30th
To say that there’s a steep learning curve for Hematology/Oncology is an understatement. As a resident fresh out of the box, I don’t think I could have imagined a more challenging or intimidating service for my first month as a doctor. At the end of the first week, I had a nervous breakdown and cried myself to sleep. I’d never felt more out of my depth in my life.
Question for all the new docs on the block: have you ever had that awkward moment when you meet an attending who introduces him/herself saying “Hi, I’m Dr. So-and-so” and you’re unsure of how to respond? Replying with my title almost seems as ridiculous as it would if a five-year-old introduced himself as “Mr.” Usually I end up introducing myself as “Crys, one of the residents” to peers (accompanied by a giant grin and a little lilt in my voice because I still can’t believe how awesome it is to finally be a resident) and as Dr. B to patients. I certainly don’t want to be one of those people who is so enamored of their M.D. that they can’t resist letting everyone know about it (my mom does that enough for me) Has anyone else had this dilemma?
I don’t know how I could have thought that I’d have more time for writing as a resident than I did as a med student. I did have a post written for July but in the midst of a pretty intense first block and settling into my new city, I never had a chance to publish it (that will soon be remedied). However, I now have an opportunity to introduce the next series of 医者の卵: The Residency Chronicles! Read all about the trials and travails of a pediatric resident – all the awesomeness, all the zaniness and everything in between. Hopefully, I’ll be able to update at least once per block. I hope these humble ramblings are amusing, if not informative and interesting. As always, thanks for reading!