swallowflight

i think i am starting to get a little sleep-deprived.. the ironic thing is that i am hoping it gets better once i start working the night shift!! ha ha…that must be total wishful thinking!!

today was my last 8-hour day on the unit – sunday i start 12-hour shifts with my preceptor. there was a little smattering of this and that… my manager whisked me off for trauma morbidity & mortality rounds, with the trauma surgery team & the emergency team from residents on up. it was an interesting glimpse of the overall decision making and some of the big-picture stuff that is happening behind all the hustle and activity of getting someone in the door, trying to stabilize the person and figure out what happened and what needs to be done.

then, my preceptor and i spent the morning looking for anyone who needed an IV … and if we found someone it was that person’s lucky day to have me do it. (read: irony/sarcasm!) i’d been doing pretty well the rest of the week, and had either hit it just right the first time or had been able to maneuver things with a little help/guidance, but today my fingers were not so magical – three poor fellows were left with a couple of extra sore spots, but i nailed the last one (even with a pretty nervous patient and an audience of couple of family members hovering)… hopefully that will typify the continuing trend.  i felt terrible about the ones i missed, though even more motivated to improve. in addition to making patients less uncomfortable, i’m also seeing how important it is for the flow/time management aspect of things – i just don’t think i can afford to spend the time to repeat a procedure when there are other, more pressing things, waiting or coming along in the meantime.

i’m finding the transition interesting, if exhausting -i feel so much motivation to learn, but when i stop for lunch or get home at the end of the day, i find i’m spending a lot of time staring into the middle distance. (hoping the ol’ subconscious is occupying itself with sorting out some of this new information while i’m in zone-out world!!)

but other than that – i am so conscious of how i am learning and how things are fitting together, or where there are gaps – there is the level of practicing or acquiring skills – the iv’s, different routes of medication administration, the flow and layout of the space, types of supplies i need and where to look for them (you will notice i did not say ‘find’!), a new charting system — those are all the sort of task- and skill- related things that i know it will just take time to conquer. but then aside from that, there is a whole other level of really putting together the picture of what is going on with the person in front of me…. a much more subtle and intricate undertaking.

now, in a different setting, i definitely feel the specificity of my former practice – how there was an identifiable type of patient for whom i cared, with a certain set of typical issues and how that defines (and limits) my knowledge. of course there is overlap, so at least i feel i have a base where i can build, but at the same time there is so much that is totally new. and it’s kind of incredible to think about just how many people and different types of situations/conditions i’ve encountered over just a few days. i find myself thinking different kinds of thoughts sometimes – i look around the people on the train and check out their veins or wonder what might bring (or has brought) them into contact w/ the emergency room… (just said they were new thoughts, didn’t say they weren’t weird.)