Isn't it amazing how one simple letter can change your whole day? I came home from a relatively painless day at work, and checked my mail. Not unusual, I had a letter from Emory Alumni. I assumed they were asking for money as usual - I wish!
No, instead of asking for a few thousand dollars (which would have been less painful) - they wanted to invite me for my 10 year reunion. Not mind you my ten 10 college reunion - MY 10 YEAR MEDICAL SCHOOL REUNION!
I can't believe I finished medical school 10 years ago. I know it sometimes feels like a lifetime, but I tell myself that is just from the lack of sleep. According to my letter today, it was an ACTUAL lifetime ago.
Most depressing - I still don't have a "real" job. I'm going to bed and pulling the covers over my head.
Tuesday, January 27, 2009
Monday, January 26, 2009
Wilted!
I love this picture - it is so perfect for how I feel today. I am not sure it photographs that well, but I bought these beautiful flowers at Trader Joe's. It has become my new thing to buy flowers for myself each Friday. When I bought these, the daisies were of course not wilted. They were incredibly cheerful and energetic looking daisies. That was Friday. Today when I came home from work they looked exactly like this. I couldn't help but to burst out laughing. These flowers somehow had the same weekend that I did - I don't recall seeing them at the hospital, but they certainly look like they were there.
Friday, January 23, 2009
I drank the Kool-Aid
So for several years now, I have tried to convince myself that I was different. (I know that I am definitely unique, but I mean something else.) I have told myself that I am not the "typical" Thoracic surgeon (for this blog Thoracic includes both heart and lungs). As a specialty, we are often admired and respected, but not the ones that you are buddies with. I arrogantly believed that I was wasn't like them.
Today I found out differently. I was given the "opportunity" to go to a Medical Oncology national meeting being held here in Philly. Today's topic was the treatment of lung and esophageal cancer - so of interest to me. National association meetings are unique experiences. I can still recall my first trip the the American College of Surgery. Today was my first opportunity to see how the Medicine guys did it - let's just say differently.
Thoracic surgery meetings are funny to me. If you put a lot of Thoracic surgeons in a room, you are guaranteed a lively debate (if not a true fight), lots of arrogant bragging and an incredibly formal proceeding. For the meeting itself, everyone in the room will be in a black or dark blue business suit - including the women (few that they are). I wore dark green once and stood out like a sore thumb. For the evening events that call for casual - no blue jeans or dockers for us. Mean wear dress pants with a sports coat - tie still a necessity. Women wear nice pants/skirt with twinset or other equally formal top.
Although we think nothing of calling each other out during presentations, the rest of the conference has a very polite, but formal air about it. He may call you an idiot trying to kill people during your presentation, but will be smiling and telling you about a similar case that he had during the break. It is all about being seen and heard. You have to "play the political game". All conversations involve some topic that is being presented or relevant to the specialty. No small talk here.
Food is always plentiful, and coffee until noon and alcohol in the evenings is a must. The prime seating in the room is always the back rows. I think mostly because no one stays seated for long, too much ADD in the room. People freely wander around the back of the room and play on their Blackberries. Anyone feels comfortable interrupting the speaker at anytime for questions or comments.
This is my comfort zone. These are the things that I am used too. This is not how the medicine people do it - by a long shot. I show up in my suit (which I can finally fit into again), and am one of the few. The only others were all my Thoracic surgery colleagues. There were people in blue jeans - they don't even let our technical staff wear blue jeans. People quickly filed into the conference room and took their seats near the front. No one had to come out to the buffet and threaten people to come inside so we could get started. During presentations, no one spoke or got up or played on their phones. People only asked easy questions, and never openly disagreed with the presenters. During breaks, conversations were about children, sports and vacations. I felt like I was on Mars. Turns out I am much more of a Thoracic surgeon than I thought because it all felt wrong. Turns out I like formality and inattention and contention - it makes things interesting.
The content of the conference was okay. It reinforced what I already know. Medicine guys spend way to much time thinking about things that don't seem to make much difference in the long run. All I can say is pour me another glass. Turns out the Thoracic Kool-aid tastes pretty sweet to me.
Today I found out differently. I was given the "opportunity" to go to a Medical Oncology national meeting being held here in Philly. Today's topic was the treatment of lung and esophageal cancer - so of interest to me. National association meetings are unique experiences. I can still recall my first trip the the American College of Surgery. Today was my first opportunity to see how the Medicine guys did it - let's just say differently.
Thoracic surgery meetings are funny to me. If you put a lot of Thoracic surgeons in a room, you are guaranteed a lively debate (if not a true fight), lots of arrogant bragging and an incredibly formal proceeding. For the meeting itself, everyone in the room will be in a black or dark blue business suit - including the women (few that they are). I wore dark green once and stood out like a sore thumb. For the evening events that call for casual - no blue jeans or dockers for us. Mean wear dress pants with a sports coat - tie still a necessity. Women wear nice pants/skirt with twinset or other equally formal top.
Although we think nothing of calling each other out during presentations, the rest of the conference has a very polite, but formal air about it. He may call you an idiot trying to kill people during your presentation, but will be smiling and telling you about a similar case that he had during the break. It is all about being seen and heard. You have to "play the political game". All conversations involve some topic that is being presented or relevant to the specialty. No small talk here.
Food is always plentiful, and coffee until noon and alcohol in the evenings is a must. The prime seating in the room is always the back rows. I think mostly because no one stays seated for long, too much ADD in the room. People freely wander around the back of the room and play on their Blackberries. Anyone feels comfortable interrupting the speaker at anytime for questions or comments.
This is my comfort zone. These are the things that I am used too. This is not how the medicine people do it - by a long shot. I show up in my suit (which I can finally fit into again), and am one of the few. The only others were all my Thoracic surgery colleagues. There were people in blue jeans - they don't even let our technical staff wear blue jeans. People quickly filed into the conference room and took their seats near the front. No one had to come out to the buffet and threaten people to come inside so we could get started. During presentations, no one spoke or got up or played on their phones. People only asked easy questions, and never openly disagreed with the presenters. During breaks, conversations were about children, sports and vacations. I felt like I was on Mars. Turns out I am much more of a Thoracic surgeon than I thought because it all felt wrong. Turns out I like formality and inattention and contention - it makes things interesting.
The content of the conference was okay. It reinforced what I already know. Medicine guys spend way to much time thinking about things that don't seem to make much difference in the long run. All I can say is pour me another glass. Turns out the Thoracic Kool-aid tastes pretty sweet to me.
Wednesday, January 21, 2009
Academic days
In Academic medicine (doctors who practice at teaching institutions) there is something known as an "academic" day. For surgeons, it is a day where you don't operate or have clinic. The time is supposed to be used for academic pursuits - i.e. bench research, paper writing or other administrative issues. Of course the residents don't get these, but the attendings seem to enjoy them immensely. Yesterday I took my first ever Academic day.
We had no cases yesterday - not sure why, but it just worked out that way. Therefore, I decided it was a waste of time to even come into the hospital. (The second year resident was on call and had to be here anyway.) Now you are probably thinking - great, she finally wrote that paper and finished those two book chapters she has been complaining about - well you would be wrong. My academic day consisted mostly of grooming with a little inauguration thrown in.
I got up at regular time and went to the gym. Turns out that there is actually a decent number of people at the gym starting around 6 am. I showered and had breakfast. By then the inauguration was starting to get interesting so I spent the next 3 hours sitting on my couch. . . tears streaming down my face at times. (It was in my opinion a fantastic ceremony. I am so excited to be living in this Country at this Time.) I had a hair appointment at two which took 3 hours, but the good news is that I actually like it. No horror stories like last time. I went to a real salon. The hairdresser thought it was hilarious that I had been so traumatized that I had not had a haircut in 5 months. I followed the new do with nails and finally trimmed up that uni brow problem. By now it was 6:30. Guys just don't understand how time consuming grooming can actually be.
I actually did participate in some academic pursuits - we had journal club. Sitting around eating shrimp while several "famous" cardiac surgeons yell at each other is actually quite fun. I would highly recommend it. All in all I got a new President, hair cut and nails out of the day. I would say it was a very productive day for "academics".
We had no cases yesterday - not sure why, but it just worked out that way. Therefore, I decided it was a waste of time to even come into the hospital. (The second year resident was on call and had to be here anyway.) Now you are probably thinking - great, she finally wrote that paper and finished those two book chapters she has been complaining about - well you would be wrong. My academic day consisted mostly of grooming with a little inauguration thrown in.
I got up at regular time and went to the gym. Turns out that there is actually a decent number of people at the gym starting around 6 am. I showered and had breakfast. By then the inauguration was starting to get interesting so I spent the next 3 hours sitting on my couch. . . tears streaming down my face at times. (It was in my opinion a fantastic ceremony. I am so excited to be living in this Country at this Time.) I had a hair appointment at two which took 3 hours, but the good news is that I actually like it. No horror stories like last time. I went to a real salon. The hairdresser thought it was hilarious that I had been so traumatized that I had not had a haircut in 5 months. I followed the new do with nails and finally trimmed up that uni brow problem. By now it was 6:30. Guys just don't understand how time consuming grooming can actually be.
I actually did participate in some academic pursuits - we had journal club. Sitting around eating shrimp while several "famous" cardiac surgeons yell at each other is actually quite fun. I would highly recommend it. All in all I got a new President, hair cut and nails out of the day. I would say it was a very productive day for "academics".
Monday, January 19, 2009
Trouble with expectations
Why do I even bother? I make all these fabulous plans for my post call day, and fate always intervenes. Since you haven't heard from me since Wednesday, you can assume life has not been normal. My transplant Wednesday night actually went fairly well. We finished by 1 am so I foolishly thought - I'm going to get a couple of hours of sleep. I tucked him into the unit, made some quick rounds on the floor and was heading to the call room.
Didn't even make it past the door when I got called for a consult to the MICU. Can I just go on record as to how much I hate the MICU. For some reason, to work in the MICU you have to forget everything that you ever learned in medical school, and spend all of your time trying to figure out how to get surgery involved in your patient's care. As a cardiothoracic surgeon, I am usually protected, but not always. The incredibly frustrating part is that it was a ridiculous consult. I spent one hour trying to nicely explain to the intern, resident, fellow and ultimately attending why it was a ridiculous consult. At 3:30, as I saw my chances of sleep slipping away I became progressively less nice. I don't think I actually called the attending stupid to his face, but I did imply that he had no knowledge about that to which he was speaking.
I finally convinced them that I probably understood ECMO better than they and let the MICU. This time I actually made it into the call room, and had actually crawled into bed. I hadn't quite closed my eyes when my phone went off again. Type A aortic dissection being flow directly to the operating room. Needless to say that sucked up the rest of my night, and a good portion of my morning.
When I finally walked into my house Thursday, I crashed straight into bed. I didn't even shower first which I never do, but I was afraid I would fall asleep in the shower. I woke up briefly for an early dinner, and then fell right back asleep. I accomplished absolutely nothing on my list - not one single thing. Friday after work I ran to the grocery store. My plan was oil change on Saturday and grooming on Sunday. I made it to my car on Saturday, but unfortunately not much further. The President-elect was in town, and traffic was a nightmare. I grew frustrated and went back home. Sunday there was snow on the ground so I decided I could live with my unibrow for a little longer.
If you are keeping track - 1 for 7.
Didn't even make it past the door when I got called for a consult to the MICU. Can I just go on record as to how much I hate the MICU. For some reason, to work in the MICU you have to forget everything that you ever learned in medical school, and spend all of your time trying to figure out how to get surgery involved in your patient's care. As a cardiothoracic surgeon, I am usually protected, but not always. The incredibly frustrating part is that it was a ridiculous consult. I spent one hour trying to nicely explain to the intern, resident, fellow and ultimately attending why it was a ridiculous consult. At 3:30, as I saw my chances of sleep slipping away I became progressively less nice. I don't think I actually called the attending stupid to his face, but I did imply that he had no knowledge about that to which he was speaking.
I finally convinced them that I probably understood ECMO better than they and let the MICU. This time I actually made it into the call room, and had actually crawled into bed. I hadn't quite closed my eyes when my phone went off again. Type A aortic dissection being flow directly to the operating room. Needless to say that sucked up the rest of my night, and a good portion of my morning.
When I finally walked into my house Thursday, I crashed straight into bed. I didn't even shower first which I never do, but I was afraid I would fall asleep in the shower. I woke up briefly for an early dinner, and then fell right back asleep. I accomplished absolutely nothing on my list - not one single thing. Friday after work I ran to the grocery store. My plan was oil change on Saturday and grooming on Sunday. I made it to my car on Saturday, but unfortunately not much further. The President-elect was in town, and traffic was a nightmare. I grew frustrated and went back home. Sunday there was snow on the ground so I decided I could live with my unibrow for a little longer.
If you are keeping track - 1 for 7.
Wednesday, January 14, 2009
Post Call Days
I am on call today - so you might be wondering why I titled this blog post call day. The reason - post call days are the only thing that gets me through the call these days.
I am SO sick of call. I understand that I will be "on call" for the rest of my life. However, I only have 5 1/2 more months of in house call. In house call, for those who haven't had the joy of experiencing it, means that you come in one morning and go home the next day. You literally spend the night in the hospital taking care of the patients. I thought I had finally out ranked in house call after my second year at Vanderbilt, but they still do it here. Call nights are usually busy, but even the quiet ones are not restful. It is like standing under a guillotine waiting on the blade to fall.
Tonight is not a quiet call night. I am currently waiting on a pair of lungs to show up for transplant. In the meantime, we have 28 patients in the CTICU, 68 pts on the cardiac floor and my own thoracic patients. Unfortunately, I have never even met the cardiac surgeon that I am transplanting with tonight. He normally works at a different hospital and rarely takes call here - until tonight our paths have never crossed. This adds a little extra anxiety to the case because I have no idea how he "does things" so it is learning on your feet.
The one thing that makes tonight bearable is knowing tomorrow is my post call day. Prior to the 80 hour work rule restrictions, that statement didn't mean very much. You worked just as hard your post call day as you did any other day. However, the restrictions have been good for something. It is now federally mandated (so we do it most of the time) that we go home before noon the day after our call day. This may not sound like much to you, but this is a whole 6-10 hours of the day that I normally don't have to act like a normal person.
And boy do I have plans. The list of things that I would like to accomplish tomorrow is incredibly long - it always is. What will actually accomplish often depends on how bad the call night becomes. If I can pull off a couple of hours sleep, I am hoping for a mail run, Target run, oil change and pedicure/brow wax. If I get no sleep, I should go for the oil change, but will probably whittle down to the brow wax and pedicure (girl has to have her priorities).
Here's dreaming of post call days.
I am SO sick of call. I understand that I will be "on call" for the rest of my life. However, I only have 5 1/2 more months of in house call. In house call, for those who haven't had the joy of experiencing it, means that you come in one morning and go home the next day. You literally spend the night in the hospital taking care of the patients. I thought I had finally out ranked in house call after my second year at Vanderbilt, but they still do it here. Call nights are usually busy, but even the quiet ones are not restful. It is like standing under a guillotine waiting on the blade to fall.
Tonight is not a quiet call night. I am currently waiting on a pair of lungs to show up for transplant. In the meantime, we have 28 patients in the CTICU, 68 pts on the cardiac floor and my own thoracic patients. Unfortunately, I have never even met the cardiac surgeon that I am transplanting with tonight. He normally works at a different hospital and rarely takes call here - until tonight our paths have never crossed. This adds a little extra anxiety to the case because I have no idea how he "does things" so it is learning on your feet.
The one thing that makes tonight bearable is knowing tomorrow is my post call day. Prior to the 80 hour work rule restrictions, that statement didn't mean very much. You worked just as hard your post call day as you did any other day. However, the restrictions have been good for something. It is now federally mandated (so we do it most of the time) that we go home before noon the day after our call day. This may not sound like much to you, but this is a whole 6-10 hours of the day that I normally don't have to act like a normal person.
And boy do I have plans. The list of things that I would like to accomplish tomorrow is incredibly long - it always is. What will actually accomplish often depends on how bad the call night becomes. If I can pull off a couple of hours sleep, I am hoping for a mail run, Target run, oil change and pedicure/brow wax. If I get no sleep, I should go for the oil change, but will probably whittle down to the brow wax and pedicure (girl has to have her priorities).
Here's dreaming of post call days.
Tuesday, January 13, 2009
New Appreciation
So almost every day of my operative life, I injure the lattismus dorsi muscle in some way. I either move it out of the way of my axillary thoracotomy or plough right through it for every other thoracotomy. Of course these are the lats on other people (my patients precisely). Yesterday as I mentioned, I worked out my upper body for the first time in . . . well forever. This evening, my lats HATE me.
It is not that a little soreness feels good because you know you worked out thing. It is my arms can't be raised higher than waist height. I should be concerned about driving home. However my biggest concern is that I still have to go close a chest. I did a sternotomy so that ENT could take out a big thyroid cancer. Putting the sternum back together is mostly about technique, but some chest strength is required. I am going to be embarrassed if I have to ask the ENT resident to push a wire thru the sternum for me.
According to my schedule, I am supposed to work out lower body tonight. We will see what time I get home. I am on call tomorrow so should really suck it up and go regardless, but should and will are not always the same for me. Oh well, off to try to close a chest.
It is not that a little soreness feels good because you know you worked out thing. It is my arms can't be raised higher than waist height. I should be concerned about driving home. However my biggest concern is that I still have to go close a chest. I did a sternotomy so that ENT could take out a big thyroid cancer. Putting the sternum back together is mostly about technique, but some chest strength is required. I am going to be embarrassed if I have to ask the ENT resident to push a wire thru the sternum for me.
According to my schedule, I am supposed to work out lower body tonight. We will see what time I get home. I am on call tomorrow so should really suck it up and go regardless, but should and will are not always the same for me. Oh well, off to try to close a chest.
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