The Golden Weekend

Ah... the golden weekend. Two glorious days in a row with no responsibility to the wards. Where I can nap, clean, shop, read, rest, renew and rejuvenate.

Last night Beth and I hit up a show at the gorgeous Pantages theater here in Tacoma (old photo of the Pantages looking a lot like it does now). It was the opening night for the season and there was some hoopla with speeches before the start of the show. They recognized the president of a great Tacoma magazine: City Arts. A great resource for all things artsy in the South Sound. But most interesting was the announcement that this part of Puget Sound is notable for being so culturally rich, it is second only to Manhattan Island! I kid you not. Ben is probably guffawing, or rolling his eyes at this (my townie co-intern) but it is apparently true.

I had a conversation with Beth last night. We hit up Tully's for some post-show hot cocoa and while moseying back up the slope of St. Helen's we passed a gay bar, (well, at least a bar with lots of neon rainbows, one reading "PRIDE"), colorful closed storefronts with whimsical antiques and funky clothing selections, and were looking out over the docks. I revealed that sometimes I feel like Tacoma is is great secret I'm dying to tell everyone. Last night I really felt I was in a cultured city with a multitude of resources - art, music, theater, nature...

The show itself was fun. For all ages. It was called Cirqueworks Birdhouse Factory. There were acrobats and contortionists, dancers and jugglers. It was really amazing to watch. Reminded me of the days when I would catch Cirque du Soleil on TV and just sit there, mesmerized as people were dangling from hoops with one toe or twisting in pretzels and sitting on their own head. I found particular delight from a sequence involving a trampoline and three men bouncing around like hot popcorn (at least, that's what I thought it looked like).

Medicine is winding to a close. I have two more calls and 6 more days (Mon-Saturday). Then I begin a much less grueling rotation (or so I hear). I discharged a patient last week that I had been seeing pretty much every day for nearly four weeks. We weren't able to help her much. We gave her electrolytes when they were low, blood when she was too anemic, fluid when she was dry, diuretics when she was too overloaded, but all in all, she is terribly sick and there's not much we can do. The catch was, she was rather young, and this illness was new and we kept hoping she would turn a corner. She never did and eventually we sent her home, stable, and on 12 new medications that keep her that way. From her room I could see my apartment windows. From my apartment I could see her room. It took me a few weeks to realize this but, once I did, I started having dreams about her. Mostly about her getting better. Talk about no escaping work, eh?

I promised I'd mention in my blog a little walk I took with KP (who still insists that Tacoma Pride is lame) and her poodle, Blue. Along the way there was a young emo guy taking pics of rocks he made into heart shapes. KP, knowing a good opportunity for poodle-fame when she sees one, offered Blue to make the pictures more.. poodley? Now, somewhere out there in the ether (or perhaps the internet?) is a picture of a scruffy black poodle in a heart of rocks. We may have to dub Blue the Rocky Love Poodle from now on.

Quote of the week: Liza, animated, describing why she so loves colonoscopies: "It's so exciting when you get to the cecum!! You're like, 'Yay! I made it!'"

Photo of the day: Candy man. Don't know where, don't know why, but I love it. I just hope he's wearing sun screen.

The Black Weekend

I started another post about internal medicine a few weeks ago, but it never got finished. Regardless, I felt the need to post something today. I'm about to enter my third black weekend of residency. Today (Friday) I got to get out at a reasonable hour. Only 10 hours worked today (definitely my shortest day in the last 4 weeks). Call has been rather difficult of late. So has my service, in general. Two of our patients have died in the hospital over the last few weeks. Several more have gone to hospice care. We've diagnosed terminal cancer after terminal cancer. Patients dying is kinda hard to take. You don't have any time to process and once a patient dies you're technically freed up to start seeing more patients immediately.

My calls have been busy. Like I said, I cross-cover the two other services in addition to taking care of my own. Pediatrics is probably the most challenging on cross-cover. Peds is a whole different world. The nurses can be very protective and can pick up on any hint of insecurity or indecision in a fresh intern (am I still fresh at this point?) and can take advantage or make you feel very small. The parents have a knack for wanting a complete update and overview of everything their kid is going through and why at 2 AM and all you know about the kid is his/her name, their allergies, their med list and why they are there.

I'm getting much more efficient at admitting patients. But it is still exhausting. Last overnight call I was admitting a patient a little after midnight and she kept falling asleep mid-sentence. I would gently wake her and she would forget where she left off. By the time I reminded her she would doze off again and we'd be back where we started. Eventually I just gave up talking to her and started my physical exam - which she slept through for the most part.

The catch to our hospital is that, unlike the medicine services at UM, we don't cap for admissions. To clarify for my medicine friends, we admit to three services that cap at ten but also will admit the overflow patients and patients for private docs as well sometimes. And, also different from the academic setting, we admit to all services every day. We did that at Chelsea but Chelsea was a fraction the size of TG. I have no idea what the record is for admission on call but the other weekend I know they had at least 15 admits on Saturday.

Anyway, it's a lot of work, obviously, and I expected as much. I'm looking forward to my next day off (Sept 15th) and my first vacation (early November). And I really look forward to going to bed about right now.

Before I retire - an abstract from an article from a British Medical Journal. It's about surgeons but I think it applies to all residents.

Background Considerable interest and concern have been expressed about junior doctors' hours. This study was carried out to evaluate the emotional and cognitive effects of a weekend on call in a surgical ward.

Methods Ten surgical house officers were assessed, in counterbalanced design, on four Monday mornings, twice after a weekend off duty and twice after a weekend on call. Cognitive functioning was assessed using the Cognitive Drug Research computerized cognitive assessment system, and emotional state was evaluated by means of the Aberdeen Mood Rating Scale.

Results Following a weekend on call, significant impairment in concentration, speed and power was observed, and the doctors felt less confident, less energetic and more confused. Impaired attention, working memory, long-term memory and confusion were most closely correlated with number of hours worked on Sunday, and tiredness and confusion were related to number of hours slept.

Conclusion A weekend on call has significant deleterious effects on cognitive performance and mood. The findings have implications for staffing levels and the design of duty rosters.

Common sense to some, but not realized by many.
Until later...