hello, doctor

I'm over halfway done with my first real rotation of residency.  Working in the Emergency Department has been great so far.  It helps a ton that I know a lot of the people in the department through Sief.  

The weirdest part is still the fact that I can write orders for medicines or radiology studies and they will actually happen!  It's what I've been waiting years for.  I finally have my own clinic and am gathering a patient panel.  I'm their doctor.

It's still so weird that nurses (who many know more than me) call me doctor.  Nearly everyday, when I'm wandering about the Emergency Department, either lost because I took a wrong turn, or looking for something - I'll nearly walk right into a nurse or EMT.  They quickly say, "oh sorry doctor."  I want to say, doctor?! what - really, you don't need to say sorry - I'm the one last wandering aimlessly about.

You gotta love the nurses and everyone will tell you, especially when starting out to make friends.  I got to sew up my first laceration in a long time the other day.  My attending sent me out to get the supplies.  I asked the nurse to help me gather them - she asked "what type of suture would you like?"  I looked at her...hmm....good question, I thought.  She answers for me, "how about 5-0 proline."  I smiled and replied, "That sounds good to me."  It worked out just fine.

I also got to put in my first central line the other day, too!  This is similar to an IV, but the catheter (tube) is put in a central vessel.  In my case, we put the catheter in the internal jugular vein.  The procedure was done using ultrasound as a guide.  It was pretty awesome, not for the patient, but for me.  At first, I thought I had lost the procedure, because technically I'd never seen one placed.  I had practiced before with the equipment in a simulation type setting.  Sief was on shift with me then and just recently observed one.  The old adage is "see one, do one, teach one."  When the attending asked if I'd ever seen one I reluctantly replied "no," while looking at Sief thinking he was going to get to do the procedure.  My attending was awesome and said, "well it's your patient and you're going to get your hands dirty."

So, residency has truly begun.  So far so good.  I'm still getting used to being called doctor.  I have not felt the urge to switch over and become an Emergency Medicine doc since being on this rotation.  It's a completely different mindset.  There are so many things I want to treat as a family doctor, but don't need to in the Emergency Department, because it's not an emergency!  It's been fun, but I didn't miss my calling by not joining the ranks of ED docs around the globe.  Glad that their are people to do it though.  I love preventative medicine way too much and continuity of care.  Also, I realized I'm not a fan of the stress or having to think quickly when someone comes in acutely ill - maybe that'll change as I become more competent in my medical skills.

I have a Penny story, but I'll save that for another day!

P.S.  Did you know they have bunnies in the desert?  I didn't!  This is taken right outside my house.

One month down

One month of residency is already down.  Granted it was orientation, which was a great way to get to know some of my fellow residents and get settled into my new home.  Now reality begins.  "Hello - 80hr work week."  Actually I'm pretty lucky in that I start off with 2 relatively light rotations.  For the next 3 weeks I'll be spending my time in the Emergency Department.  It's a great place for me to start, because I know all of Sief's co-residents who are many of the people that I will be working with.

This past weekend, I went to the National Family Medicine Residency Conference in Kansas City that I have gone to for the past 3 years.  This year I was on the other side of things trying to recruit applicants to my program.  It was exciting, because this year there was an increase in the number of students in attendance.  I'm hoping for another big match year for family medicine.  It looks like their may be a shift back to family medicine and maybe away from the specialties?

On my way back from KC, I looked over a tourist guide that Kevin (a co-resident of mine) brought along for students to look at and now I have a huge list of things I plan to do while in Tucson.

- Biosphere 2
-  See the Sonoran Desert
-  Ski Mt. Lemmon (mountain about 45 mins from Tucson that is 8,000+ ft in elevation and at the top it doesn't feel like you're in arizona anymore - I took a drive up there last weekend, but sadly left my camera at home)
- Hot air balloon festival
-  Desert museum
-  Kit Peak Observatory
-  Scavenger Dash around the city
-  golf?  (i threw that in for my parents :)
-  and so much more!

Come visit (well actually wait a little while longer until I have a bed in my spare room, unless you don't mind sleeping on an air mattress) - there's tons to do!

Penny meets cactus

This morning I took Penny for a walk around the block.  7am and already 86 degrees out.  I was sweating by the end and she was panting.  I guess I have to get up earlier to take her for her daily walk.
As we're walking, she travels off the sidewalk a little bit to smell.  No big deal - that's pretty normal.  We continue our walk, again same thing, but...this time I see she is standing on a cactus.  Not a growing cactus but a broken off dead piece of cactus.  There are lots of little dry dead pieces lying on the ground at this point in our walk.  So naturally I tug her leash and say lets go.  Out she hops from the side with a 2-2.5 inch piece of thin (probably 1/2 inch diameter) piece of cactus stuck between her chest and into the pads of her paw.

Great.  How am I supposed to grab this with my bare hands and yank it out.  She's standing there with her leg out because there's essentially a stick pushing her paw away from her chest - we're literally as far from our house on the block as you can get.  I reach down and try to grab the cactus as best I can without getting stuck myself.  I successfully remove the large piece of cactus and there are 2 thorns left in her front paw.  I put Penny under one arm and grab a thorn with my other hand - and yank it out.  I try for the 2nd one.  No success.  Penny's in pain - when I grab and yank she opens her mouth and goes ahhhh.... - like a screaming sound.  She thankfully doesn't try to bite me or swing her open mouth around wildly near my face.
I try on the 2nd thorn again and...nothing.  I pick her up and am about ready to walk her home to wake up Sief (not like he can really help because Penny's afraid of him).
Then I decide to try one last time and I got it!
I set Penny down and she walked the rest of the way home as if nothing happened.  Except she got hot and tired.  I had to walk to get the mail by myself.

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Residency update:  We've continued to have orientation for the past 2 weeks.  I have taken a medical Spanish course which lasted 4 days.  I have spent a little bit of time in the hospital just getting used to the system, etc.  2 half days have been spend in clinic where I actually have my own patients!  I love clinic and all of the nurses have been so wonderful so far!  Also, I've become certified in Advanced Trauma Life Support.  No time to blog, because Sunday was my first day off in 2 weeks!
Welcome to residency - it only gets tougher from here....

Tuscon Pics

Ok, so I finally gave up on cleaning before taking pictures and posting.  I figured it might be a while before anyone saw pictures if I waited until I had a chance to clean the house.  Both Sief and I work this weekend.  I work through the week and next weekend am going on a retreat with his residency, so as I said it'll be a while.

View of the mountains from the balcony/front of the house.  (will post later a pic of the front of the house - the other picture is on my old computer)

Not so pretty cacti that house birds and live right over the side of our fence.  The birds are nice, except for they are the ones put those holes in the cacti.

The cute chandelier that hangs over Sief's and my bed.  Eventually it may get painted a cream or antique white, but mom and I didn't have time for that when moving in.  Let me tell you this chandelier taught mom and I a very important lesson.  We hung the light fixture ourselves, because the bedroom didn't come with anything.  Ok, no big deal, right?!  This shouldn't be that hard to do.   Well....there were 3 wires coming from the ceiling - red, white, and black and 3 wires coming from the chandelier - green, white, and black.  so.....we figured white connects to white, black connects to black, and.... the colors must go together.  Well, lets just say a few days after we hung the chandelier and finally had light bulbs in it - we flipped the switch and POP!  I was in the bathroom at the time and thought a light bulb had exploded!  Well, not exactly - the pop came from up at the ceiling where we had wired the light and...we flipped the circuit and the entire master bedroom went dark.  Soooo.....my mom uttered a few potty words and we tried to call an electrician to see if we made a really really bad boo boo.  

Finally, I said lets call Uncle Doug (my electrician uncle).  He said to check the wires and call him back. I told him what we did and he laughed at us - he said "green is ground all the world around."  So... apparently color does not go to color.  There was a ground wire, but we didn't see it because it was super small and painted over.  I rewired the chandelier and then we flipped the switch...nothing.  I rechecked the other connections and the white wire had been cut - so fixed that and....perfecto - there was light.  Lesson learned - green=ground!

Let's just say that was probably the worst of our lighting experiences, but we had other failures with fixtures in other rooms of the condo, but....you don't want the details of that.  Let's just say in terms of our electricity skills it was a long week.

Laundry room shelf with homemade laundry detergent and cute dryer sheet holder.  There were some issues with the shelf - stripped a screw, but we fixed it.  Carpentresses are we.   haha

So far the homemade laundry soap is working good.  

The office and my favorite part of the house - my FUN yellow chair, which is more comfortable to sit in than it looks.  You can also see Penny's new bed under the desk.

Over our kitchen table 2 picture shelves!  Still looking for little goodies to go on there.

Another view of the mountains.

Our new gigantic couch.  Sief's preference.  Super comfy though and that's an ottoman covered by my pink/purple quilt.  At least we have plenty of room for people to sit when they come visit.  Or an extra place to crash if visitors have a little too much to drink.

Front yard full of rocks and can you see the 2 small patches of green?  Those little green patches are Penny's plants.  I had to plant her some plants, because she looked so sad out front without anything to smell.  Eventually these are supposed to grow into big bushes with really pretty red and orange flowers.

Could I have a blog post without a picture of Penny?

The new kitchen! and.....the most important piece of the kitchen pictured below! Ta Da!!!

One more view of the mountains!

Full Grown

  It took 4 years, but I knew someday that growth spurt would arrive.  It has finally arrived.  My white coat as grown!  It's reached full size!  I'm a big kid now :)

Now... I just have to fill the pockets.

Living in a Desert

The original plan was to clean the house and post some pictures of the new place this weekend.  Well, guess what....that didn't happen.  Instead I went car shopping with the boyfriend and also bought a couch and a tv.  I also made 2 batches of cookies in my new Kitchen Aid mixer (thanks grandma) and  homemade pasta sauce to freeze.  All in all a productive weekend, but as you can imagine the house is no cleaner.  So instead you get to learn about what it feels like to live in the desert.  S

You know you live in a desert when...

- when the AC in your house never gets turned off
- when you will park in the furthest possible spot at Walmart if it means you get a sliver of shade
- when you are afraid your water bill will be high, not due to watering the lawn or long showers, but due to the 3,000 glasses of water you manage to drink everyday and still be thirsty!
- when it's over 90 degrees out at 7am
- when yards are filled with rocks instead of grass
- when you turn on the cold water faucet and it's luke warm
- when your skin is almost as dry as a Pennsylvania winter (well not quite, but close)
- when you used to be a person who didn't drink ice water because it made you cold, but now crave an icy drink at every turn
- when your dog is only allowed to go for rides early in the morning or after the sun goes down
- when you have to wake yourself up in the middle of the night to drink water, otherwise you'll wake up with a throat that feels like cotton and a dehydration headache
- when roadside landscaping mainly consists of cacti

New Beginnings

I have officially survived my first week of residency.  Mom has left, but she did drop me off on my first day, just like elementary school.  It was such a weird feeling to start.  Things were so crazy with the move there was hardly anytime to think.

The night before residency started, Sief and I both expressed the sentiment, "I hope we're happy here."  Hershey wasn't our favorite place, but we had some good times there and I made some great friends.
It is such an odd feeling to know that tomorrow is the first day.  It's the beginning of what will be the hardest year of our life, we are about to meet our co-workers, who we will spend more time with than each other and our families.  The people who will see us at our worst and the people we will spend the next 3 years of our lives with.  That's a pretty big commitment.  It is a lot like the first day of school.  I hope I make the right first impression, I hope I get along with them, etc.  It is not like I haven't done this before, I've done it many times throughout my life, but it never is a comfortable feeling.

Laying there the night before, knowing Sief was in the same boat and by my side made it that much easier. We both know we are taking a chance, because both of our residency programs are brand new.  That means we are the first class of residents - there is no one above us.  I didn't meet anyone from this program "to fit in with."  That's what they tell you - when you are on the interview trail, look for a place where you can see yourself fitting in with the residents, because they will become your family.  This program doesn't have that.  We're the pioneers - we are the ones that will make or break this residency program.  I'm hanging my hat that my program director can make good on all the things he wants this residency to offer - urban and rural sites, university & community hospital, an extremely diverse patient population, the opportunity for procedures and hopefully the ability to do c-sections.  The list goes on.

So....week one down - all orientation, just a lot of listening to people talk at us, computer training, etc - nothing exciting.  Does the program live up to what I thought it would so far?  YES!  My co-residents are great.  We are an extremely diverse group of people, but everyone is very laid back and extremely nice.  Sief's co-residents are just as great.  Will we all best friends?  No probably not, but at least I get along with everyone right now and can see myself working with them and learning from them over the next 3 years.  There's an excitement in the air here.  We have had combined orientation on many of the days this week and the new programs have a different vibe.  There is an energy that runs through us as a group that doesn't exist in the other programs.  Maybe it's because I'm biased, or maybe because we are the first residents.  We know we are the ones to make this program into what we want it to be - to form the culture and the traditions that will live on in the years to come - it's up to us.  The faculty is here to listen and they are here to help us have the most amazing experience that we can.

I'm excited and also scared.  I know the long hours will wear on me.  I know it will be extremely difficult when I am on other services and not with my family medicine co-residents, but I also know that there are a ton of resources out there for me to reach out to if needed.  So here's to new beginnings and here's to hopefully one of the best and pretty definitely one of the toughest years of my life.