Block 4: General Medicine Wards

Wards. Of all the many tasks and rotations we do in our 3 years of internal medicine residency, we do this rotation the most. Plain 'ol, mostly boring, general medicine wards. Despite the utter boredom that is seeing the same problems OVER and OVER in patients who, for the most part, don't take care of themselves thus keep getting admitted OVER and OVER for these SAME problems, it is my favorite rotation.

Why, you might ask, is general medicine so boring? Don't people go into medicine for the intellectual challenge, the opportunity to evaluate, diagnose and treat folks w/ a wide variety of illness? Maybe that's why we go into it, but it sure isn't the reality. The reality is that we are well trained factory workers. We come to work and do the same thing day in and day out like people who work on assembly lines or who have cubicle desk jobs. And we don't even have our own cubicles.



5 medical problems make up probably 80% of the patients we see in the hospital on the general medicine service: congestive heart failure, "chest pain" (could be due to cardiac disease but mostly is not), chronic obstructive pulmonary disease and asthma, end stage renal disease, and infections (pneumonia, urinary tract infections, and skin infectious being the most common). And let me tell you, I can take care of these folks with both hands behind my back, blindfolded, and probably without even talking to the patients. It is the same treatments over and over. To the layperson, this should give you some confidence. When you or your loved one comes to the hospital with one of these problems (though since this is a blog geared towards runners I doubt many- if any- of you have these problems), your docs know exactly what to do. It's like a mechanic fixing a car, a Mcdonald's employee making a cheeseburger or your accountant doing your taxes. We'll do it right and it will be easy for us. It's nice to feel competent and able to handle your daily work-load. At the same time, this repetitiveness breeds a passivity that we as professionals have to keep at bay. Because you never know when you will finally get a patient that has a twist in their story- something that makes them different and interesting compared to the backdrop of BORING, BORING, BORING.



So, given this boredom, why is wards my favorite rotation? 3 reasons:



1. I know what's expected of me.

--In medicine you spend all of medical school and most of intern year trying to figure out what people want from you. What am I supposed to learn? How are these people going to grade me? How can I best help my resident? What does my attending like in presentations? It goes on and on. As a senior resident on wards, however, I know exactly what I need to do and most of it is fun--> serving as a resource for my interns/sub-intern and teaching the 3rd year medical students. Easy!



2. The hours are good and controllable.

--NO OVERNIGHT CALL. There is nothing I hate more than being forced to stay up past 8pm. Occasionally, rarely, I will stay up past 9 to socialize w/ friends, attend a wedding, or travel. But, only rarely. If I'm not in bed by 9, I'm miserable. Wards means sleeping in my own bed every single night and being home by 5 most days.



3. It's fun to work in a team room.

--On wards, each medical team sits in a room together. The 'team' consists of 1 resident, 1 or 2 interns, 1 sub-intern (4th yr med student) and 2 3rd year medical students. We sit in a room, each in front of our own computer and do work while we make jokes and laugh. Working with fun people makes going to work every day enjoyable, or at least less painful!



So what do we do all day as inpatient doctors on general medicine wards? There are 4 different types of days for us:

1. Call day- We get new patients from the ER, clinic, or outside hospitals. We evaluate, work-up and manage these patients.

2. Post-call day- We present all the new patients from the call days to our attending

3. Pick-up day- We get new patients from the overnight residents

4. Nothing day- No new patients- hurrah!



Day to day schedule:

7am: Get to work. "Pre-round" on our patients which means looking up their vital signs, labs, radiology studies and consult notes from the previous day). If we are on "pick-up" we hear about the new patients from the nightfloat residents who admitted them.

7:30-8:30: Educational conference called "Morning Report"

8:30-11am: "Rounds". This is when the entire team including the attending physician (our 'boss') goes form patient room to patient room to discuss the patients. We formally present new patients, discuss the past 24 hour events for the old patients and make daily plans for all the patients. This is the part of the day that fluctuates dramatically based on the attending. It can vary from fun with lots of jokes to very painful with lots of criticism. I've dealt with both.

11:00-noon: Mad dash to get our work done before noon conference.

Noon-1pm: Educational conference

1pm-3pm: Finish daily work. Our work includes writing a progress note on every patient, calling consults (cardiology, oncology etc), working on discharge papers, putting in orders, calling families and outpatient physicians to give updates.

3pm: Go HOME! Unless we're on call in which case we are busy seeing and admitting new patients from the ER. Then we can't leave until after 7, usually b/t 7-9.

Well, this post is long enough. That's a day in the life of an internal medicine resident on general medicine wards. As with most jobs, your days are made or ruined by the people you work with and, in general, the folks in medicine are smart, fun folks who like to laugh a lot. That's the main reason I'm still a doctor!

Recent Running Music

Inspired by Candice at I Have Run, I decided to post my most recent ipod downloads. I use my ipod just for running (and occasionally for sleeping on international flights) so I only buy songs that are either upbeat for fast running or musically interesting enough that I can "get lost" in them during long runs.


Here are some of my most recent fast run songs:

The Bravery "Time Won't Let Me Go"
The Bravery "An Honest Mistake"
Ke$ha "Tik Tok"
Joy Ride "The Killers"
Keane "Somewhere Only We Know"
MGMT "Kids"
Lady Antebellum "Need You Now"
Franz Ferdinand "No You Girls"


My current favorite long run music:

Arcade Fire's newest album "The Suburbs"
Caribou's album "Swim"


And I was so angry after the Chicago Marathon that I went old school with:

Pearl Jam "Once" and "Jeremy"

Hope this gives you guys some ideas!

2010 Holiday Bootie Buster

Amanda over at RunToTheFinish recently posted her Holiday Bootie Buster Challenge. It sounds like this was something folks in the blog world did last year as well but since I'm new to blogging, it was new to me. It's basically a way to stay motivated to stay in shape and not gain weight during the holiday season. You get various numbers of points for different types of physical activity (running, weights, biking, etc) as well as for healthy eating. Click here to see all the rules and details.

I'm going to participate this year and you should too! Any extra motivation during this season of dark, cold weather, pumpkin pie, eggnog and pumpkin spice lattes is a good thing!
run/walk/snowshoe)

Math in the the Morning: Not my Strong Suit!

On the days when I work past 5pm, it's really hard for me to get a work out in before preparing for bed at 8:00 (goal=to fall asleep by 8:30 or 9:00 at the latest), so I've started to get up in the morning to do my workouts on those days. I've never been very good at working on in the morning. Getting up early is hard, getting my heart rate up is hard. But I'm going to try.

I'm been successful twice this week. Tuesday I went swimming and yesterday I got up to do my speed workout. However, I didn't get anywhere close to finishing! And this is because I can't do math.

My plan was to do a warm-up, then intervals of increasing speed/decreasing distance:

1600m--->1200m---> 800m-->400m

I was supposed to do the whole loop 3 times with a 2 min recovery in between. Then a cool down.

Somehow I got it in my head that since it was "speed work" it wouldn't take that long so I allotted 45 minutes. Obviously, this is absurd! My 1 mile warm-up and 1 mile cool down will take 20 minutes total. Then since each cycle is 2.5 miles long, each will take about 20 minutes.

So 10+20+20+20+10= 80 minutes. And I allotted 45. Who's an idiot? Me! So I got through less than 1/2 of what I planned. But at least I got up and ran. For some reason I was inspired by JerBear's post about listening to good songs on repeat (though it broke her ipod, sure hope that won't happen to me). Here's what I did:

1 mile warm-up at 6.0 (Keane=Somewhere Only We Know, 2.5 times)
1600 at 6.7 (Ke$ha= Tik tok, 2.5 times)
1200 at 6.8 (Kevin Rudolf= Let it Rock, 2 times)
800m at 6.9 (Muse=Starlight, 1 time)
400m at 7.0 (ipod shuffle)
1 mile cool-down (ipod shuffle)

Success: I got up early and ran
Failure: I didn't run nearly long enough and will have to make up for it later this week. AND I apparently need to get up at 4:15am instead of 5 to complete my intervals. Arg! That's early:(

Hope everyone gets their workouts in today!!

Big Plans: Maui Oceanfront Marathon

I am now officially registered for the:

January 23, 2011

AND...Adam is registered for the 1/2! Yippee! I'll expound on this later but for now I better hop to it with this week's workout schedule:

Tuesday
AM: Swim: 30 minutes

PM: Run: Intervals (long): 1600-1200-800-400, start at tempo pace then get faster w/each (x3)
Weights: 20 minutes

Wednesday
Run: 5 miles at 10K pace

Thursday
AM: Swim: 30 minutes

PM: Run: 5 mile recovery

Bike: 30 minutes, easy

Weights: 20 minutes

Friday
Run: 15 miles, fast

Saturday
Swim: whatever Adam tells me to do!

Sunday
rest vs LT 8mile w/ 4 at 10K pace

Let's see how this ambitious schedule goes.....

New England Vacation 6: Bass Cottage Inn

One the best parts of this trip was the wonderful luxury B&B we stayed at in Bar Harbor. I spent a lot of time researching places to stay in and around Bar Harbor, reading on-line reviews and such and the Bass Cottage Inn sounded wonderful. It greatly exceeded my (already high) expectations. The house the inn now resides in was built in 1885 during what the inn's web page refers to as "Bar Harbor's Golden Age", basically when a lot of very wealthy East Coasters vacationed on Mount Desert Island. As I mentioned in a previous post, a huge fire burned much of the area in the 1940s so only a few of these original homes remain.

This particular house has been an inn for many years. The current owners, Terri and Jeff, bought the place in the early 2000s and did a complete internal renovation, modernizing yet keeping much of the key architecture and fixtures that give the place its charm.

Terri and Jeff were absolutely amazing hosts. You really felt like they were welcoming you into their baby, which I'm sure it is given how much time, energy, and certainly money, they've spent on the place. Our visit began with a tour of the common space of the house, which is the entire first floor. The multiple rooms were warm and welcoming. One had a baby grand, multiple rooms had fireplaces. They had books to read and games galore. I'm pretty sure we would have been content to stay in the inn for the entire 3 days! Here are Adam and I making use of a few of the common rooms:

Here I am reading one of the menu books provided by the inn. They collect menus from all the local establishments as well books w/ reviews of some of the best restaurants in town.

Here's Adam enjoying post-dinner drinks by the fire.

Moving on from the common sitting areas, Terri told us about the 3 course gourmet, homemade breakfasts we would be enjoying each morning and informed us of the homemade afternoon snacks (apple crumble, cookies etc) that were made available all afternoon and evening. She showed us the common pantry with glassware for every possible drink of choice as well as complimentary non-alcoholic drinks and fresh fruit.

The breakfasts at this place are AMAZING. Three of the best breakfasts I've ever had in my life. Each morning, we'd make our way to the dining room at our leisure and would immediately be greeted by Terri and Jeff (they like to serve the guests personally) offering coffee, tea and juice. Next up were just-out-of-the-oven homemade muffins. I'm not really even a muffin person but these were soo good. We had Maine blueberry w/ lemon twist, banana walnut and cappuccino chocolate. Next up was fresh fruit in some form. Very fresh. Each day there were 2 options for the main course. It's funny to talk about a main course at breakfast, but that's what they were! Each day there was a sweet and a savory option. I always went for sweet (pancakes w/strawberries and fruit infused sausage, creme brulee french toast, and waffles w/ applewood smoked bacon) and Adam went for savory (Bass Inn special recipe huevos rancheros, quiche, souffle). I really wished I had an additional stomach- or more room in mine- so I could eat every last bite! We had no need for lunches on this trip (except the day with the lunchables and cheetohs, of course!).


Having such wonderful accomodations that encourage taking it slow and relaxing really made us to do just that! It's easy on vacation to find yourself going from place to place trying to squeeze in lots of fun since vacation doesn't happen nearly often enough. I think the Bass Cottage Inn is just what we needed to remind us to slow down, drink some wine, chat with each other, read books--> all the things that are fun that don't involve running from place to place. We had 3 extended happy hours, each night in a different room. The last night, we spent on the front porch, watching the shadows grow before we headed off for our first of 2 lobster dinners. 3 perfect nights in my book!

I wholeheartedly, and without reservation, recommend Bass Cottage Inn to any adults (for the love of god, don't bring kids here!) traveling near Bar Harbor. Really. Don't even bother looking at other places. I can't imagine any way they could be better than this delightful place.

New England Vacation 5: Acadia Hiking

We spent one day hiking in Acadia. It was your classic "wear layers" day. We ranged from t shirts on top to coats w/ hats and gloves depending on which side of the mountain we were and the altitude. Above I'm on top of Cadillac Mountain, the tallest mountain on the US Atlantic Coast. People say this is where you go to be the first to see the sunrise. We did not do that. Sleep > important than sunrise at this point in my life!


We also hiked up Dorr Mountain, the 3rd highest mountain in the park. It was chilly and WINDY up there. We tried to set the camera on a rock for a self-timer shot of both of us but by the time Adam ran to join in the shot the wind knocked the camera a bit producing this shot:














Me on the Dorr Mountain Summit:



On the climb up to the summit we were treated w/ all kinds of beautiful leaves (see the Acadia Leaf Peeping post). The only other people we saw were rangers working on the trail. They were whistling, had very strong Maine accents and generally seemed very jolly. Not a bad gig, right? Here are some of the views:

Another summit shot:






The walk back down was almost entirely in a gorge. Very pretty. Great mid-afternoon lighting. This first show was taken by Adam. Absolutely stunning:







People in Maine were so nice. An older couple offered to take this shot of us:

A day well spent. But we were still home in plenty of time for happy hour(s)............