room for improvement

well i've got a presentation to do- so that means i'm about 6x as likely to blog in an attempt to procrastinate...

I'm officially moving back to Nashville on Saturday May 3rd- that's cool

This rotation has really been heating up the last week- actually to put it another way- Last week was really bad for me. Suffice it to say I did not know anti-arrhythmic drugs that well, as a class before this rotation... and when we got to our atrial fibrillation (aka: "A-fib") lecture- I looked bad- seems like before that talking about other disease states i was all over it... those months spent in am-care had really prepared me for the chronic disease states (diabetes, heart failure, hypertension, anti-coag) and i even did OK on the first part of Afib, but when they got to the cardioversion/rythm control part that happens in the hospital- I looked bad-and as with anything you don't know- i got the usual "you need to go look that up tonight and we'll talk about it next time..." and I actually did- had me a big old stack of papers and made it through everything and on friday when we had our next topic she asked me about everything and i had very satisfactory answers- i was going through the laundry list of side effects, pharmacokinetic parameters, and unique toxicities of a drug called "amiodarone" used for arrhythmias and as i was going through a mnemonic in my head (C.O.R.E.G. H.C.D. for any of you interested pharmacy people) i got about halfway and she said "ok thats good but there's still..." and i was like "well i wasn't done yet" and finished out the list and I think she was happy with that...

... I thought up to this week I had done pretty well and she even gave me a good evaluation on my mid-point review on Monday afternoon... but Monday and Tuesday were really bad days- i guess it's just a coincidence that those 2 days i had to take about 90 minutes out of my regular schedule during the morning to do some extra tasks that the resident felt i could help out with... its kinda like- before that i was just barely able to keep up with our full list of patients and those 90 minutes just killed me... there were gaping holes in my patient presentations that afternoon- and I came off looking bad- like i didn't know what was going on anymore with the patients... the second day of that I had just managed to read a note that my patient had a 2D ECHO yesterday afternoon and that their new EF was 35% and from there i was just able to make it downstairs to meet and i got totally nailed because i hadn't already come up with the appropriate treatment for this person's (new) CHF (aryan- that part was for you)... and I think it came across looking like i didn't KNOW the right answer when I could barely get to everyone's chart for a quick glance... i wanted to say "hey- i understand CHF and i know what they need to be put on- i just read the chart..." but the resident just really got on my case about that (the preceptor wasn't there that day)- it was just completely embarrassing- i know my face was glowing red- I wish she could have tried to do that where there weren't other doctors/nurses around... it was right there on the floor for where anybody who wanted to see could... and when it was over i just had to walk away with my head down- i saw a couple of people look at me... when i talked to the girl in my class who had this rotation last month she said they'd only give her half of the list to keep up with/present... and looking back when the resident (who was also new to this rotation this month) said she thought she'd try to let me handle the whole thing, i was probably biting off more than i could chew when i said i'd do it... of course i didn't really have much of a choice... but it's been bad... i think I'm going to do well on the final test and i think i'll do decent on the final presentation (last month's super awesome record-setting 103 gave me some confidence on that front- I do need to get some credit to mr. Randy Hude for that one... he made me sit down and actually study all the stuff we had talked about that month and it really helped a lot... ) Thursday was actually decent and friday was much improved because i was able to redeem myself for my shortcomings on Monday and Tuesday... but man... i HATE letting people down- i really hated letting down my preceptor on tuesday with the afib discussion... what a horrible feeling to know that you fell short of someone's expectations... it's just gut-wrenching for me- I think i can end on a high note this Friday- I just always get pretty stressed out the last week of each month because it all comes crashing down-- its usually one of those emotional things to get through the last day of a rotation- you're really tired- you've just given a speaking presentation to a group of experts on their subject matter, and you've just taken a big test and you are the only one who took the test- the only test the "teacher" will look at and grade- and then you're evaluated on everything you just did- i remember seeing some of the upperclassmen finish up a tough clinical month somewhere and thinking "yikes- they look like crap"


on a related note- here's me now! :)