Category: Medical

This morning was the end of my first week of “Green Nights,” a week straight of 13-hour night shifts where I had to admitted patients into the hospital without the supervision of an attending. It was pretty interesting starting off my second year of residency with this because it helped highlight the growth that has occurred since the start of intern year. Did I feel grossly inept and inadequate at time, hell yes. Did I sometimes impress myself with the things I now know and feel comfortable managing on my own, also yes. It was also cool to work with some of my co-residents who are smarter than I am and learn from them. There was a group of 6 of us, 5 of us freshly minted 2nd years basically managing 60%(?) of the hospital. While I felt super behind my peers having done 1/2 the number of medicine wards blocks (and adult medicine in general) as them at this point, overall I felt ok with my performance and I definitely learned a lot.

I go back to the same thing in 1 week, and I’m kinda looking forward to another shot and trying to do better the second time around. Things I can work on are definitely being more efficient. I often found my self scrambling at the end to tie up things before sign-out, in part because I would spend so much time overthinking things through the night (often not meaningfully so), so I need to be quick with my schemas so that I can spend less time doing logistics and administrative stuff, and more time thinking which is the fun part.

After our team brunch to celebrate the end of our watch I also went home to see my new niece, Max(ine) who was born on Thursday during this stretch of nights, so unfortunately I wasn’t able to around the day she was born and I couldn’t wait to see her. So I hopped on a train home, sleep deprived, caught a couple, though minimal z’s and met the cutie. She was worth the mission and I am so happy for my sister and brother-in-law, and their beautiful baby girl. I’m very excited to be an uncle.

I’m officially done with my first year of residency. Transitions are always weird for me because for all the pomp and circumstance that goes into discussing and celebrating these life transitions, I never really feel all that different. But I think that has more to do with the fact that growth is a gradual process. Taking the time now to reflect on the doctor I was at the start of residency to where I am now, the difference is pretty significant, whereas the difference between today and yesterday is pretty small. It’s been a year of constantly being pushed outside of my comfort zone, of feeling inadequate on a regular basis, a year of learning from mistakes. It’s also been a year of some amazing human connections both with patients and colleagues and of surprising myself with what I am now capable of.

I expected intern year of residency to be the hardest year of my life, in large part due to the horror stories told to me by those who have gone through the experience before me (both 1 year ago and 50 years ago). And while yes it was very challenging at times, and not to forget the fact that residency is much different today than it was 50 years ago, I’d venture to say that this actually was one of the best years of my life.

I have felt so fortunate in that I get to do a job where I am constantly learning and get to learn new things everyday. I don’t dread waking up to go to work (90% of the time) and I love that I get to work in career that allows me to continue exploring and deepen my love for science while also giving me opportunities to work with and connect with other people on a very basic human level.

I’m excited for what second year is going to bring and looking forward to the opportunities to continue growing and to mentor the next generation of doctors.

One of the most interesting parts of this has been talking to parents about vaccines and some of the other routine stuff that we do for babies before they leave the hospital. It has been a good time for me to practice my spiel about vaccines and vitamin K with parents who have spent too much time on TikTok. Sometimes I’m successful in convincing hesitant parents to protect their kids against life-threatening and life-altering diseases, sometimes I am not, but the times that I am are very gratifying. Not in like an “I win” kind of way, but in a “I am doing the job that I came here to do” kind of way.

A big reason I went into medicine was not just to help heal people or cure disease, but to bridge the gap between the science of medicine and the humanity of the people in front of me. Not to prescribe meds and run blood tests just because the guidelines say so, but to help people understand why a certain med or test might be helpful, and be a resource and a guide to help them live they life that they want to live.

It’s been a little over week now that I finished my first block of medicine wards as a PGY1. Med wards thus far is the most similar to what I expected residency to be like. The days were long and the tasks seemingly endless often times, and yet the days also flew by because there was always something to do. Not all of those tasks were “doing medicine” in the way most probably think of it. It’s not like I spent 12+ hours per day prescribing medicine, doing procedures, reviewing blood test results and body scans. Many days the “medicine” seems to be the minority of of the work, with the rest being talking to patients, talking to families, coordinating care, and preparing for next steps. Through all of this, I couldn’t help but feel like this is where I am meant to be.

In my last week, one of the patients, Mr. P, who was on since the start of this block was being discharge to a SNF for rehab. He wasn’t the easiest patient, but not because he wasn’t an agreeable person, in fact he was a lovely person. He just had some difficult and conflicting medical problems. On top of that he mainly spoke Vietnamese, making it difficult to communicate with him at times, even with the use of a translator. I did the best I could to take the time to make sure he understood what was going on and address any questions or concerns that he had. He often took up the most of my time, despite being one of the most medically stable patients on my list at any given time.

On the day of his discharge, I went in to give him the news and say goodbye to Mr. P. After again answering any questions and addressing his final concerns I shook his hand and said goodbye. As I did, he held my hand tightly in his and in his broken English said, “Thank you… You are good doctor.” My gaze went from our hands to his eyes which were welling up with tears.

I wasn’t the one who fixed his broken leg, or the one that delivered his pain medication, or changed his dressing, but I suspect I was one of the few people who came in throughout the day to listen to him and talk to him, not just perform a task. That to me is what the art of medicine is about, and I’ll never forget Mr. P for reminding me of that.

Hard to believe my last post was over a month ago. Time feels like it has gone by really quickly, but at the same time I feel like I’ve been in residency for months already. I’m writing now because I’m on the night shift in the NICU which is not as busy as it may sound. Similar to nights in the MICU, most of the primary tasks are done during the day and at night we are just responding to calls and questions from the nursing staff, etc. We also go to any deliveries that happen overnight and admit any babies to the unit that need it, but nothing so far.

I keep telling people that ask that NICU while super different from the MICU in so many ways, is also kinda similar. The patients don’t talk to you and you are just kinda managing them without much input from them (of course if the adults are awake and conscious and have capacity they are always involved). There’s a lot of thinking and physiology talk which I like.

What is nice about the NICU is in most cases the patients are able to go home, and of course the babies are (usually) very cute.

There is a lot of optimization that happens here too. We are always looks at and adjusting patients in’s and out’s (I/O’s) which theoretically need to be carefully balanced, especially in the premature ones. We are constantly looking at their nutrition and how many calories babies are getting, how many macronutrients they are getting and how many electrolytes/ micronutrients they need, and assessing/ changing these things on a daily basis. It is interesting stuff, just very different than on the adult side where we do pay attention to this stuff, just not as closely.

As a side note, I had a really rough weekend personally. Still having a tough time, but kinda thankful to have work to distract me. Nothing I feel like elaborating on now because I’m still going/ working through it, just wanted to make a note of it.

So I got what I wished for: a busy, hectic day running around between patients and responsibilities. At times it was stressful, but at the same time it felt like I was doing more or less what I was supposed to. I got to field some calls on the VoIP, I had to put in urgent orders, I was interacting with the nursing staff and pharmacy and others like a real member of the team, which feels kinda lame to say, but this is also never something I really experience as a medical student, at least to this level. It always felt like playing as a doctor. It still feels like that sometimes, but when I see my seniors, and the fellows, and the attendings who are really doing the damn thing, it’s pretty cool to watch. So being a part of the team, and being a productive and valuable part of the team makes me feel like I’m getting a little bit closer to that which is nice.

Today was especially difficult from an imposter syndrome standpoint. All my patients got transferred or discharged today. Which may be a good thing from a patient health standpoint, but it also made me feel like I wasn’t taking care of complex enough patient, or maybe I am not being trusted with the more complex patients. This makes no sense of course, because this whole time we’ve pretty much been picking our own patients. I took on an relatively straightforward one today with the plan of taking on the first new admit. It never came. Meanwhile, my co-interns are dealing with multiple complex patients, many of whom were moving towards goals of care discussions or required extensive work ups, and working closely with the seniors and talking to families just made me feel a little less like a doctor today. Again this is all my own problem, and I feel guilty about having these selfish feelings because on the other side of this all are real people with real lives. But I think that’s also where some of these feelings come from. I feel like I’m not doing enough. But instead of wallowing in these feelings for too long, I want to use them to push me to be better. Also while I so appreciate my seniors and the fellows and the attendings being so nice and patient, I feel like a little constructive criticism, communicated tactfully, would be similarly appreciated.

Today we talk about hyponatremia — a topic that I’ve learned and been lectured on more times than I could count, and yet still get confused by. Today though our attending went over it in a way that I thought was really helpful, while also using a real world example of one of our patients. Creating frameworks rooted in physiology and in real work examples has always been really helpful for me. I’ll come back and maybe put together my own version of what we talked about to solidify my understanding.

There’s so much to be learned in the ICU on a day to day basis that I feel like I don’t do a good enough job solidifying what I learn in my brain. I’ve learned a lot each day about both the process of doctoring and the medicine itself. Since I feel like I’ve been kinda getting repetitive or at least somewhat stale in this posts, I feel like I will try to use this space to help nail down the things I am learning while still having space to put my reflections.

Today we talked about a few things. Pressure-volume loops in individuals with different types of airway obstructions. First there are fixed airway obstructions in which the loop is flattened in both the inspiratory and expiratory phases. Which makes sense; if you have a small opening for air to go in and out and it doesn’t change, the flow will be inhibited in both directions. Then there are variable intrathoracic obstructions and variable extrathoracic obstructions. The terminology was confusing to me at first, I think because I didn’t quite understand that we where talking specifically about airway obstructions and not just any kind of inhibition of flow. Thinking about it now, this actually will help a lot in me thinking about airway obstructions vs restrictions. Anyway, for variable intrathoracic obstructions, there is negative pressure in the intrathoracic space during inhalation so when the person inhales, the soft tissues is able to move out of the airway to allow air to flow unobstructed. During exhalation when that negative intrathoracic pressure is gone, the obstruction is then present, inhibiting flow on exhalation, therefore only the exhalation phases is flattened. On the other hand for a variable extrathoracic obstruction, during inhalation the negative pressure is in the airway lumen causing the obstruction to worsen, and then during exhalation when that negative pressure is gone, the airway can open up again and you get the opposite effect on the pressure-volume loop. From a Med+Peds perspective, this also helps me better understand possible clinical findings related to airway obstruction such as stridor and wheezing (just because these are probably more common findings in the younger hospitalized population), and know when we would expect to hear those abnormal breath sounds. That’s all for now.

Even though today was probably more busy for our MICU team as a whole, it was a little slower of a day for me. All my patients were pretty stable with mostly minor interventions. One of them did have some activity toward the end of the day was kind of exciting, but both in a good and a bad way. It’s kinda hard to watch people come out of sedation, at least when they appear to be struggling and fighting, or if they are coming out of it agitated.

On another note, I haven’t had to talk to any family members about their loved one in the hospital which is good, but also having those conversations is part of what I like about the ICU, not in the sense that I like it when people are sick and having to break that news to people. There is just something that feels special about being in this place between life and death, dealing out what hope you can, fighting against death, but at the same time trying to do you best to manage expectations and guide patients and families gracefully to whatever may happen. It feels morbid to put it down in writing, and I am not sure if that is even a good way to think about my time here, but I guess it’s how I feel none the less.

I started in the medical ICU today. It felt good to be back in the hospital, and especially starting in a rotation I surprisingly enjoyed a lot during medical school. I definitely still feel behind and honestly still feel like a medical student, but I know that the more time I spend doing it the more comfortable I will become with this new responsibility. I still find myself waiting for approval to do really anything, which I think is probably expected to some extent, but also I feel like if I was more confident in my skills I would definitely trying to take more initiative. That is going to be my motivation going forward to really hone in on my clinical skills, develop my workflow, and expand my knowledge base.

I’m feeling excited right now I just hope I can sustain it.