Why I Wish I Were a Resident Again (aka temporary insanity)

. . . or not. Okay, truth is, I am thrilled to be done with residency. But with my new job starting, and my Board exam coming up, there are just a few things I could have done differently.



1- Studied more. When I was in medical school, the Chief Resident in Internal Medicine had given me some sound advice: read EVERY DAY. It doesn't matter if it is five minutes or 20 hours. Just read. It could be a journal article, or a chapter, or a paragraph, or a chart, or a series of practice questions, anything. If you chip away at the mountains of information you have to learn throughout your medical training, then over time, five minutes a day adds up to a lot. So that is what I had done. Sometimes (mostly) five minutes a day, but sometimes more. Then, I started my Anesthesiology residency, and my program director told us that we were expected to read two hours a day, every day. We all kind of chuckled amongst each other about this. I stuck to the aforementioned five minute rule, with several days of more prolonged study sessions sprinkled in between. Now that I am in the thick of studying for my Board exam, facing mountains of unfinished textbook chapters, I wish I had listened to my program director a little bit more.


2- Asked more questions. Now that I am "on my own," I don't have an attending to turn to, to ask anesthesia questions like, "Why did you do induction that way?" or, "Why is it better to use this technique over that technique?" or "What could I have done better?" I also wish I could ask about business practices, like, "What did you like/dislike about private practice versus academia?" or "How do you choose the best disability insurance?" or "How do I know the senior partners are not going to screw you as a newbie?" I guess I could always call or e-mail them; most of them were very open about answering questions and offering up advice, and told me that I may contact them if I "ever needed anything." But most valuable questions are usually in situ questions, questions that are asked in the heat of the battle. "Why did she desat all of a sudden?" or "Why did the BP drop precipitously?" What makes me anxious is what many of my attendings said before I left: that the learning curve during your first year out of residency is a steep one. "You will learn more your first year as an attending than you did all your years of residency combined," said one attending. Yikes! I have more than four year's worth of material to learn in the next year????? Wish I had asked more questions when I was a resident.



3- Paid more attention. This goes along with, "asking more questions." So much happens in a hospital, it is hard to pay attention to everything around you. What you are able to take in, can be truly enlightening. I love watching and learning from other medical people in action, nurses, EMTs, RTs, surgeons, radiologists, gastroenterologists, cardiologists, many other docs, but especially anesthesiologists (duh!). Although what we do as anesthesiologists in scheduled cases follows a routine, everyone does it a little differently, from how we talk with and consent the patients, to how we place and tape IVs, apply and follow the monitors, push drugs, intubate, maintain anesthesia, and conduct emergence from anesthesia. Many of us by nature become set in our own routines; it is practically a job requirement to be a bit OCD. Some of my fellow residents and I used to joke about how you could tell who was on call just by checking the emergency C-section room. The equipment was laid out a different way by each of us: I like having my pulsox, EKG cable, and BP cuff on the IV pole, whereas KN liked having everything tucked in by the OR table. I liked having my syringes straight, whereas as JJ liked having them at a 30 degree angle. If I took over for OB, and the equipment was set up by someone else, I just HAD to change it. And so did each of them. OCD -a prerequisite for anesthesiology. In any case, I wish I had paid more attention to why the other residents, and particularly the attendings, did things a certain way, or how they reacted to certain emergencies. I mean, in a few days, I'll be doing cases on my own. No attending to turn to when I need help; no one to watch me and suggest, "Maybe you might want to go after that vessel from a different angle." Just me. And although I did watch what the others did, I am afraid of the time when I face a crisis, and my plan B doesn't work, and I wish I had everyone else's plan Bs to add to my arsenal.



It is easy to look back and wish that I had done more. And maybe I should have read more, asked more, and observed more. But realistically, I think I did the best I could. I did read a lot, and I did ask a lot of questions, and I did pay attention. I do have a Plan B, as well as Plans C, etc. But when I wasn't being a "good resident," I was busy being myself, doing something else, like sleeping, or spending time with my family, or sleeping, or exercising, or sleeping, or blowing off some steam, or sleeping. Okay, you get it. But the point is that everything I did was important somehow. Certainly, my family needs me. And taking care of them, as well as myself is a top priority. If I hadn't done all those things, my relationship with my family, my health, and my sanity may have been compromised. Do I really think I should have done more with my residency? Probably not, but I'll never really know answer. I will just say that I did what was right at the time. No regrets. No looking back. Now, back to studying.

Advice from the Sleep Doctor

http://www.latimes.com/features/health/la-he-nightshift24mar24,1,4012956.story?track=rss

This article talks about the detrimental effects of sleep deprivation. There is good evidence that lack of sleep affects one's ability to perform manual, as well as cognitive tasks. Furthermore, it affects one's physical and emotional health. In general, I don't like giving medical advice, but I do agree with this article . . . get some sleep. Most of us need 8- 10 hours of sleep a night. Most of us do not get that, mostly out of our choice. When we do lose sleep, it is important to "pay back" that sleep debt, but that debt can only be paid back to some extent, not all the way. The other important thing is to sleep and wake up the same time every day -have a regular circadian rhythm. It maximizes the sleep that you do get.

Myself, I love sleep. One of my favorite things to do. I even like putting other people to sleep -soothingly, calmly, and deeply. Waking them up is harder, whether it is my patients or my children, but I do like making an art of it. I try to wake them up gradually, in a soft voice -not loudly, abruptly like I have seen my attendings (and my husband) do. There is something very satisfying about having someone wake up very calmly, and feel well rested. Everyone should experience that feeling.

http://www.latimes.com/features/health/la-he-nightshift24mar24,1,4012956.story?track=rss

The Streak Continues

Last night I did the anesthesia for a combined heart and kidney transplant. Although it went rather smoothly (unlike the clusterf*cks I had been thrown into the previous two nights), it did go into the wee hours of the morning. I can't wait until I am off the night shift. The sleep deprivation is catching up with me. I have fallen asleep on the floor of my living room twice this week. Apparently my kids were using me as a trampoline, and I didn't even budge.

Sleep Deprivation

There was a study published in 2005 reporting that anesthesia residents are sleep deprived. Furthermore, they report that they are sleep-deprived on a regular basis, not just post-call. It was only when they were allowed to report to work at 10AM, were their EEGs consistent with true "awakeness." These are not unique findings. The results are consistent with findings from other groups on other residents, and other disciplines such as the airline industry. They all suggest that we underperform when we are sleep deprived, and are underestimating how truly sleep-deprived we are. They even give us tips on how to minimize sleep deprivation: work with the light/dark cycle, minimize caffeine and alcohol, SLEEP. How do I know all this interesting information, you ask? Let me tell you . . .

I am on the CVICU nightshift this week and next. I report to work at 5PM. On a bad night, I work all night, no breaks, no naps. On a good night, I work until about 1 AM, getting a 2 hour nap before getting called about morning labs, which are drawn at 3AM. If I manage to go back to sleep, I nap for another hour or 2 before it is time to go to morning conference. I struggle through morning conference, then am released to home for about 8 hours, during which I try to catch up on my sleep defecit and spend time with my kids, before I return to the ICU for more fun. Last night I was up most of the night, and didn't get to lie down until about 4AM, at which time I was trying to decide whether I would go to the next morning conference. I decided to go, since my husband had said that he would be taking the kids to school early, and I wouldn't be able to see them anyway (since we are required to go to 90% of the conferences, I might as well save "skipping" for when I can see the kids). Soon after I fell into a deep sleep, my alarm went off, nagging me to go to morning conference. I tried to gather my thoughts as I brushed my teeth and got ready for the morning. This morning's conference was supposed to be about fluids and electrolytes, and I had read the night before to prepare, but was still very cloudy in my thinking. I was still quite out of it, as I dragged myself to the conference room. I sat down and waited for everyone else to file in. After question of the day (we do a board question everyday before conference), the program director announced that the lecturer had a family crisis, and so instead of the scheduled lecture, he would show us a video tape. The topic? Sleep deprivation in anesthesia residents!!!!!!!!!!!! I allowed myself to fall asleep upon start of the video and woke up to the sound of someone else's pager with five minutes left on the video. I heard nothing of the talk, but decided to look up the topic later (Proc (Bayl Univ Med Cent). 2005 April; 18(2): 108–112). Enlightening. Truly. Oh the irony of forcing one's self out of bed to attend a lecture on the perils of sleep deprivation! Curse you, Dr. Program Director. Curse you!