Wednesday, August 31, 2005
  EM: Day Two
Day two is complete - or should I say night two? Last night I worked 9p-5a, tonite I worked 11p-6a (supposed to be 11-7, but I got out early). It only gets more and more awesome!

Tonite, like I said, was my 2nd night. I mentioned procedures before, and tonite I got several. Let me see, what all did I do? I stapled a scalp back together, I did 3 lumbar punctures (spinal taps), and an incision and drainage of a paronychia. Pretty cool, huh? Ok, ok. I know I'm going to need to explain all this stuff, but I just got home, I've been awake for way too long.

I didn't see so many patients tonite, because after I saw a few, every time I went to see my supervising physician, he had another procedure for me to do.

Procedure list (thus far)
I still haven't done any suturing so far - I'm sure that'll come soon enough. I'd still like to insert a few chest tubes, but I'm not sure if I'll get to do that here. I don't know if they do enough chest tubes for me to get one. I figure I'll be pretty proficient at LPs, suturing, and I&Ds - if nothing else... :)

ok.. I'm tired now - I'm going to bed. I'll post more after I sleep and I'll try to explain some of this stuff over the next few days.
Tuesday, August 30, 2005
  Emergency Medicine: Day One
Well, last night was my first night on my EM rotation. If you don't know anything about me, I'm very interested in EM as a final career choice. In fact, I've been interested in EM since before medical school - I worked in the ED as a Registered Nurse for over 2 years in 2 states and 6 different cities.

Overall, I must say, the first night was pretty cool. Of course, it was only the first day, and I'm expecting it to get better as we go along. It's been awhile since I actually had to do a History and Physical, since my last 3 rotations included OMT, Anesthesiology and a study month for Step 2 of the medical licensure exams. So, it's been at least 3 months since I actually had to perform any real H&P-type stuff. Needless to say, I'm a little rusty. Fortunately, EM is rapid-fire H&Ps, so I'm getting it all back pretty quickly.

One of the great things about EM rotations is that you get to do lots of procedures, along with everything else. Last night was not a great example, but I did get to insert a femoral line. It wasn't my first time to insert a femoral line, but the practice was great. Maybe I'll explain about all these procedures later, when I'm not tired.

Anyways, I'm really enjoying myself so far - of course, it is really only the first day. Finally, after 3 years of training, I get to do what I love!! It's really weird, because I'm working at a hospital at which I worked before starting medical school - so seeing a lot of the same faces is kind of strange, especially since my role has changed so much from the last time I was there. It puts the difference between physician and nurse in stark perspective.

more later, I need to go to bed
Tuesday, August 02, 2005
  Anesthesia - Final Thoughts
Well, I have officially finished my month on my Anesthesiology rotation, and I'd like to offer a few thoughts to those few kind souls who read my words.

As I said before, I really enjoyed my anesthesiology rotation. As an afterthought, however, I think 4 weeks was too much time. I was comfortable with intubating almost anyone after 2 weeks of doing it day in and day out. The protracted time on the rotation did give me time to practice with multiple styles of intubation - different blades (MacIntosh vs Miller vs Phillips) and more practice with sedation and also LMA anesthesia. I also was able to get quite familiar with the anesthesia machine, so much so I was teaching the CRNAs a few things about them before it was over. Granted, the CRNA had not seen that machine yet (it was brand new); I was still teaching her about it...:)

Ok, ok, ok... I'm being stupid now.

Altogether, I really liked the rotation. The people were great to work with - everyone seemed to enjoy having students around. Everyone was very complimentary to me, which is probably why I liked them all so well - just kidding. It is true that several people tried to talk me into entering Anesthesiology - almost all of the attendings, in fact, and most of the CRNAs I worked with did. I just still can't see myself working in anesthesia for the rest of my natural working life. Especially since, as a physician, I would be mostly relegated to a supervisory role since CRNAs do most of the bedside work. Not that anesthesia is a bad gig: any job where you get to knock most of your patients out is a good one! Especially in this neck of the woods :) I'm just not the supervisory type (yet). I don't do well with taking or giving orders. I'm much more of a get out there and do it your own damn self type of person. I usually think it will get done much faster that way.

So, pointers for up and coming medical students who might want to complete an anesthesia rotation:

1. Be enthusiastic. The number one reason I got so many compliments is because I worked like I wanted to be there. You could not guess how many times I heard the words, "You're the first student we've had in a long time that actually does anything!!" They would say this as though they are surprised and shocked to see a medical student work. If you take the rotation, by God, work your ass off while you're there. You are there to learn anesthesia, not take a 4 week vacation. If you want a vacation, take a vacation month. The lessons learned in this rotation will serve you well no matter where you go - tell me a specialty where you will NEVER have to manage an airway, where noone will EVER code on you? That's what I thought.
2. Be nice to everyone. This should go without saying, but the CRNAs, scrub techs, and circulating nurses often get way more crap than they deserve from surgeons. They will look at you differently now that you are a 4th year and also in anesthesia. You get much more leeway to talk and joke with them. The difference between 3rd year in the OR and 4th year was like night and day. Don't believe me? Try it yourself.
3. If you think you are above the CRNAs and want to work solely with the anesthesiologists, think again. CRNAs are your legs as an anesthesiologist in a busy urban medical center. The hospital at which I was working had 10 rooms flying all day long (and sometimes 3 or 4 at night). All those rooms were serviced by an CRNA with anesthesiology oversight. That means the CRNA does all the work, the anesthesiologist gets all the money. That's right. However, if you want to learn anything, you'd better get in there with the CRNA and get busy!

Ok, kids. That's all I got for anesthesia. Just be the good kids I know you can be and you'll do fine.

What am I off to next? Now, I have an academic month to study for boards. Yup, step 2 is right around the corner, and if I'm going to keep up with my step 1 performance, I'd better get cracking. I spent the past 2 days reviewing step 1 info so I will be prepped and ready to start step 2 material tomorrow.

Enough for now. I'll keep you all posted!
Ahhhhh.. 4th year. If the rumours are true, this will be a cake walk. Herein is my online account of my 4th year of medical school - follow with me to see if the hype is true or lie.

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