Scope for the Imagination

Since I started as the senior resident on the wards (ie inpatient medicine) team a week ago, I've:

- done 2 lumbar punctures (spinal taps - one of them was on a guy who had a seizure as I was inserting the needle. I did manage to get it, but it was no champagne tap)
- supervised 1 paracentesis (abdominal fluid tap)
- Managed 2 encephalopathic (confused and almost coma-like states) patients who became so because my interns continued home medications that the patients really weren't on (and should have been on in this hospitalization because of their various illnesses affecting how their bodies metabolize drugs) which I didn't catch until after we had problems waking the patients up (both are living, one has completely recovered, the other is slowly, slowly, slowly waking up). I've agonized for hours over their cases.
- Attempted to work up a patient with the strangest brain lesions I've ever seen on MRI, and finally, finally managed to get neurosurgery to get a biopsy, only to have the radiologist call me and state that they thought all of the lesions were "congenital" and didn't need the biopsy after all. Um, too late, bozo, you could have informed me of your "expert" opinion two weeks ago. Grrr.
- transferred five patients to the ICU, because they all seem to crump the moment I lay eyes on them. (Two of these, I transferred this afternoon. Yeah, there went my plans to leave early as I am very very very close to violating work hour restrictions)
- I'm too tired to remember the rest. All I know is that I'm usually not leaving until after 6 at night even when we're not admitting patients.

Did I mention that I'm responsible for a team of 18 patients? And that we'll be admitting 6 more tomorrow?

To add to it all, my attending is very disappointed in my intern's performance and it's becoming my responsibility to take her aside. I'm not good at these things, especially when I don't think she's quite as behind as my attending does, but I really don't seem to have any other choice. I'm also having problems with my other intern, as he doesn't listen to me, barely updates me in what's going on in his patients and to top it off is very serious and stuffy and I just don't get along with stuffy. It's stressing me out, I'm having problems sleeping (I end up dreaming about all of the tasks and problems that are going on)

I had started an entry last Tuesday when I was post-call but satisfied at the smooth transition into being a senior resident. Life was good (even though I was exhausted and irritated at having to admit all of the roll-over patients). I had great interns (including one with the most bewitching eyes and sardonic smile) and a great attending and I was so overjoyed at being back in the medicine department and NOT having to write daily progress notes (the bane of my existence). It was lovely. Even though it freaked me out every day of how much responsibility I have and how much I still have to learn to really effectively direct my interns and students in the care of their patients, I could see how much I've learned in this past year (I can be taught!). And my patients, even though they were rocks and refusing to leave the hospital, didn't sap me of my compassion either. It's all changed this week. I'm exhausted and weary and I'm tired of feeling the weight of responsibility and (my) ignorance.

In other news, I'm slowly making my way through Season 3 of LOST. I think DVDs are definitely the way to watch this show, the instantaneous answers providing the forest big picture so everything makes sense. Still love Charlie. FInally starting to feel the Sawyer/Kate love. Can't figure out Locke's motivation. Didn't even recognize Boone (Boone! I miss you!).

I didn't vote today. That's because Wisconsin's primary is in two weeks and since I always register as an independent, I will actually get to vote in a primary for the first time because it's open here. Yay! I could even waste my vote and select between the candidates for the green party if I so chose. So what if everything's going to be decided by then, I'll still have my say!

It's supposed to snow 12-18 inches in the next 15 hours or so. It's going to be great fun sliding to work, I'm going to have to wake up early to snowblow just so I won't be completely snowed in. The best part is that it's been warmish the last 2 days, up to the mid thirties and melted all of the snow, which has now frozen on my sidewalks. If I manage not to kill myself by falling in front of my snowblower tomorrow AND make it to work on time, it will be a miracle.

And on that note, to bed I go.