first day back

and boy was it a doozy.

when i'm on days my responsibilities generally center around being an ICU doctor/criticalist. i take over all of the ICU cases from the previous evening. i do a physical exam on each patient and write new orders for the day - medications, monitoring instructions, further diagnostics, feeding/walking instructions, etc. i also have to put daily exam notes in the computers detailing my physical exam findings, my assessment of the patient, and the plan for the day. further, i have to contact owners, write discharge instructions for those leaving the hospital, contact referring vets about their patients that are with us, and spend oodles of time on VIN (veterinary internet) looking up diagnostic options, treatment recommendations, and drug doses on the cases i am overseeing. on top of that, i am technically the internal medicine bitch - meaning that i help with internal medicine cases (which i really do enjoy doing - when i have the time).

i am the only ICU doc for the day. the nice thing is that often maybe 1/4-1/2 of the patients will transfer to the care of the internal medicine service. on a typical monday, i'll probably have 5-7 patients under my direct care.

depending on the weekend - monday can either be a relaxed(ish) day or a day from hell. i've had as few as 2 patients in my care. today was the latter, unfortunately. when i walked in there were approximately 20 cages occupied. of those - only ONE was due to transfer over to the care of the internist. unfortunately, as i was discussing the case with the overnight clinician in front of the cage, the dog died. resuscitation efforts were unsuccessful.

the rest of the 19 cages were my patients. from the moment i breached the threshold of the door at 8am till well after 1pm, i was bombarded with questions about every patient present, owners calling for updates and discharge times, questions from the pharmacy, reports that my previously stable patient was now vomiting, bloodwork results...blah blah blah...

still - by 1pm, i had examined all of my patients, written treatment orders, and started my paperwork.

it was busy, but the day flew by. i like days in the ICU - it helps me hone my skills in case management. nights and weekends are fun, challenging, stressful, depressing, and everything in between - but one thing they are short on is the long(ish) term management of cases. i'm learning to triage like a madwoman. i'm learning to really figure out who is critical and who can wait for further diagnostics the following day (at the cheaper regular vet). i'm starting to trust the clinical judgement i am developing. the only thing i don't learn on strictly emergency duty is how to manage and monitor long term cases. that's why days are such an important part of this experience. i can manage cases while bouncing my ideas off the internal medicine specialist on duty with me.

in other, somewhat related news: i received a fairly firm offer from the hospital administrator/head doctor today for a job next year. as in this conversation: "you know what i said the other day about working with us next year? i really meant it. it's something you should be thinking about. the money is good, it would help you pay off your loans. we would really like to have you here with us."

food for further thought. but i am lonely here. i don't know how a nearly 30 year old person who works insanely long and erratic hours makes friends. my hobbies (reading, writing) are mostly solitary. i want to branch out and meet people, but i don't know how. and i miss my best friends terribly (2 in our hometown, 2 in florida, 2 up north - NYC and jersey). i miss my family too. **Sigh**