Hello, again!

June 17, 2015

Hi, Long Lost Readers!

My apologies for the extended break.  I had some busy rotations and then was studying for step 3.  So…7 months later, here I am!  I am beyond thrilled that I will be a PGY-2 in 13 days.  And too, found out just today that I passed Step 3!

When last we spoke, it was November.  I was just finishing-up outpatient peds and starting outpatient neuro.  Absolutely loved peds–was probably the happiest I’ve been all year.  Reaffirmed my decision to do child/adolescent psych.  (Interestingly enough, peds was my best age-group in terms of performance on Step 3).  Outpatient neuro was…jarring.  Everyone says it’s supposed to be so chill–don’t get me wrong, it’s great having holidays and weekends off, working 8:00-5:00ish, but you literally work with a different attending every day.  There are 7 or 8 attendings, so you never quite get used to any of them.  I felt constantly on my toes.  At least in most of the other rotations, you get to a point where you feel comfortable.  Oh–and there’s the same old accompaniment of off-service rotations–losing a weekend.  It’s where you have to go in and do dayfloat (cover ED and consults from 7:30-7:30).  For me, it was 4 days in a row Thanksgiving weekend.  Ugh.  Never. Again.

I had been wondering, for a while, how December worked.  I asked early-on, for December vacation time (we get 3 weeks of vacation per year but there are lots of rules about when we can take it) and was informed that I was not allowed to take additional time off in December (independent of what rotation I was on).  Everyone either gets Christmas week or New Years week off, outside of your 3 weeks of vacation time.  It’s nice unless, like me, you have to work the flanking weekends of that week.  Then it makes travel difficult (though not impossible).  Things on the unit slow down and you decide amongst your teammates who will be on short call and cover the unit each day.  It’s a pretty good month.

January started my month in the ED.  I heard it could be pretty hectic.  The first week was.  I would come in to several people waiting to be seen, then would see 10-15 throughout the day.  You start to learn what the upper years refer to as “b-s consults.”  There are many times we are called to consult on someone who does not have a psychiatric issue but because they are a liability, the ED docs decide they need “psych clearance” before they are discharged.  The only problem with this is, as I’m sure the ED doesn’t take time to notice, our consults are 6 pages long!  It’s not just a quick thing to walk in and make sure a patient isn’t suicidal.  You have to go through what happened leading up to the this event, determine if they have a substance abuse issue, argue with the ED over drug screening (no idea why they don’t do this BEFORE calling a consult), get a whole social history on this person [who just came in drunk], and do a cognitive eval on them [when they’re still sobering-up].  Then the ED wants a decision as soon as you walk out of the room…um no?  Often times, your attending that day will disagree with you or have additional recommendations–if you tell the ED that someone is clear, they will discharge that person before you have a chance to discuss them with your attending.  And then get mad at you for not giving them an answer quickly!  If you think they’re so stable, then why did you call the consult in the first place?!

After the whirlwind of ED, I was back on the inpatient unit.  Starting to get an idea of how things work and felt like I knew what I was doing, so this was a good month.  And it was my birthday.

The next two blocks were inpatient family medicine.  After my experience on inpatient internal medicine, I was nervous, but the family medicine folks were great.  They’re more laid-back than the IM folks and I felt like I had more autonomy on that service.  It was EXCELLENT review and learning in preparation for Step 3.  I decided that I would need to take Step 3 in close proximity of my family medicine blocks, while I was still in that medicine mindset.  2 weeks of the first block was night float–again, little nervous about that after my experience with IM–but it actually wasn’t bad.  We were steadily busy most nights, and I got to experience a code during one of the nights, which was a good learning experience.

I felt the pressure once family medicine ended.  I had 3 weeks before my Step 3, but also was starting a new rotation–outpatient addictions.  It involved learning the policies and practices of another facility, who just happen to do everything on paper.  Lots of new experiences for me–while I was a secretary in a paper-charting facility, having to find the chart to write orders or notes is a completely different experience.  Somehow, I still found time to study and prepare.  I was able to take some time off immediately before my exam, to clear my mind and review last-minute subjects–mainly Step 1 pearls and bio-stats.

Before I knew it, Step 3 was over.  Addictions rotation was over, and I was back on the inpatient unit for my last block of the year!  It’s second-nature being on the unit now, don’t really have to think about doing things before you find yourself doing them.  You figure out how to stay a few steps ahead of the patients and anticipate what they might need.  Because one of our attendings is leaving and in the process of moving to a different state, I have had the opportunity to work with some of the other attendings who are filling-in on the unit and have enjoyed my experiences with them.  It’s different than rounding with them on the weekends, different in a good way.

Now off to reply to everyone’s comments and requests.  Ta-ta.