Call

I have managed to survive my second night of call as an intern. Let me explain. I am on a rotation in the CCU--the Cardiac Care Unit. The patients we admit either have a previous diagnosis of heart disease, or they are being admitted to our service because they have experienced "chest pain" and need to be "ruled out" for having a heart attack or MI (myocardial infarction--fancy way of saying heart muscle injury). Monday, Aug. 1st, was my first day in the CCU, we change rotations on the first day of each month. I was on call. My first night of call as an intern. Call means that we show up to the hospital at 6 a.m. one day, see our current patients, and admit any new patients to to the cardiology service to our team. We do that all day and all night until 7 a.m. the next morning. Then we round with our attending (see previous post for hierarchy of doctors) and go home (hopefully) by noon, 18 hours after we entered the hospital. We go home, sleep and show up at 6 a.m. and start all over. Call is q4, meaning that every 4th night this month I will spend the night (not that I get to sleep there, mind you) in hospital admitting new cardiology patients and taking care of small issues with our current patients.
Call #1: Aug 1st. Starting a new rotation was ALWAYS unnerving as a medical student. Your grade depended on how well you performed and how well the attending and residents liked you. As an intern...It's worse. You show up at 6 a.m. and have 4-8 patients that assume in 5 minutes you will know their entire medical history, what brought them to the hospital, and how best to take care of them and send them home...All before the first (of many) bottles of diet coke has had time to settle in your stomach. And to top it all off, Day #1, I'm on call and carrying the CODE PAGER!! That's right, if someone in the hospital codes (their heart stops beating or they stop breathing on their own, or both) and a code blue is called, the code pager (I'm carrying one of many such pagers) goes off and alerts me (and a whole bunch of other epople) to the patients room number, where it is expected that I will show up in a matter of seconds and begin resuscitation efforts on that patient.

In case there's any doubt in your mind, this is one of the scariest things about being an intern. We all have to take ACLS (Advanced Cardiac Life Support) and learn how to "run a code," but until you show up and see one in progress and have someone asking you (me) what drugs to give to get this person's heart beating again...You have no idea what to expect.

So, of course, at 2 a.m. my first night in the CCU, my first night of call, the code pager goes off. Thankfully, I was not the first doctor there and therefore did not have to make any decisions. I would like to tell you that I put on my Superman cape, ran into the room, and in a moment of brilliance saved a person's life. It didn't happen that way. This patient was being well attended to by the time I got to the room, but I might as well have been 3 years old...I had no idea what to say or do. I don't know if I've ever been more intimidated in my whole life. I never went to a code as a student and like anything you do for the first time, you don't know what's expected or what to do or how to handle the situation until you've been there. [This is the main reason people without children (myself included) are so STUPID (again, me included) when they start talking about how they could raise someone else's child better, or how they would NEVER let their child do this or that] (This attitude has probably ensured AT LEAST 2 or 3 temper tantrums in Wal-Mart or a museum from children that I hope to have someday...Sorry Mom and Laura, that's not today, or even this month, really, not even this year. The next code I go to, I will be a bit more prepared for and hopefully will handle the pressure better.

Call #2: As I type this, I am post-call. I went to the hospital yesterday at 6 a.m. and got home around 12:30 this afternoon. I would like to say that in a city of 4 million people, no one got sick, no one had chest pains, and that no one came to the hospital. ALAS! None of that happened! Was it a full moon last night? I went to the ER about 3:00 a.m. and it looked liked a rock concert gone bad. There were people EVERYWHERE! Thanks to the same ER last night, and the nurses of 3 Cullen (the main floor where the cardiac patients go) I got a grand total of 30 minutes of sleep last night, and fortunately, not all 30 minutes were at one time (insert sarcastic voice here).

There's so much more I could tell you about last night, but let's face it, I've had little sleep and rambled on enough, even for me. Regardless about what (or how) you read the above...I'm loving it! I am doing what I've been waiting my whole life to do. I have MUCH to learn, but man, this is good stuff.

p.s--As I went back and read the above verbage, I realized how vulnerable saying these things can make me. It's hard to admit your failures or weaknesses and there are some who would say that they would have handled the code much better than me. And they would be correct. But they've been there and done that before. My friend, Keith, from medical school, who is currently in Iraq serving his country, was a paramedic before medical school. He ran TONS of codes on the back of an ambulance. As a 3rd year student, Keith happened to be outside a patient's room as they coded. Keith stepped in (as a 3rd year STUDENT, mind you) and began to run the code in spite of his attending and others there who were "??more qualified??" than he was to run the code. I was not there, but the story goes that someone asked Keith's attending (as Keith was performing CPR and yelling at nurses to push drugs) if he was capable of "running a code". The attending very matter-of-factly said, "Yes. And probably better than you or me." I will be in a code situation again, and by the time I finish my intern year I may not be a good as Keith (this guy is amazing) but I will be better at handling codes.

Lost

No, not the TV show (which I've never seen). My wedding ring. It disappeared Wednesday night or Thursday morning. I have no idea. Beth and I went to dinner with my Aunt and Unlce and my mother's 2nd cousin (apparently he and I are not related at all, no 3rd cousins, no 2nd cousins twice removed). He is related to my mother and my mother is related to him and his father, but he and I are not legally related. That was an interesting conversation. I had no idea. But I digress. I remember having my ring at dinner. When we came home that night I put everything (at least I think I did), my keys, wallet, watch, my Alpha/Omega ring from Beth for graduation and my wedding on the "bar" ledge from the living room into the kitchen. I leave for the hospital early in the morning and often get dressed in the dark. So, I left everything in the living room. I got up Thursday morning and went to work. I don't remember NOT putting my ring on. As I was speaking to a patient's family member, I went to play with my wedding ring. It wasn't there. I have gotten into the habit was playing with it more lately. It's loose and comes off easily. At that point I thought I had simply forgotten to put it on that morning when I was getting ready. I knew it would be there waiting for me.

It wasn't.

It's been 3 days and no sign of my ring. Fortunately, Beth has NOT flipped out. I have. It makes me very sad. I know it's only material...but still, I wasn't planning on throwing it away or trading it in any time soon. One thing is for sure though, I will have to get a new ring soon. I can't stand the feel of there being nothing on my left ring finger. I hope that as soon as I do get a new ring, the old one will show up.

If you happen to find it, let me know.

I crashed a High School Reunion

It was my high school reunion...sort of. For those of you who don't know, a brief explanation. I lived in Abilene, TX from Feb. 1986 (3rd grade) until July 1993 (end of soph. yr). This weekend was Abilene Cooper's 10 year reunion. I went. I only spent 2 years in Tyler and I can only think a 5-6 people who will be at that reunion that I would want to see.

On the other hand, this weekend in Abilene, I had the extreme pleasure of seeing some of my oldest and dearest friends. Friends who taught me how to laugh, how to love, how to cry, how to be me. I AM SO BLESSED!!! Many of these friends I had lost contact with after leaving Abilene. For some, it had been 12 years since I had seen them. This weekend, I felt like we were 16 again and that nothing had changed. NOT that I would want to BE 16 again! We had an absolute BLAST this weekend. Even Beth, my wife, who basically knew no one (and LOATHES these sorts of things) had a good time. As she will tell you, "Two makes a family." Looking as most of my former classmates, Beth and I are WAY behind in the baby department. Some had 3, THREE, kids. We have 2 dogs.

I had such a great time this weekend and I want to thank the "true" Abilene Cooper Class of 1995 for letting me continue to be a part of them. And thanks for helping Beth feel like a part of the gang.

Becky--your name is mud for not showing up. I hope you're ok.
Rachel and Jason--I'm sorry I didn't get to meet Buddy (name changed to protect the innocent) but I love you guys--see you soon.
Eric and Christina--Christina I'm glad I got to meet you, see you at the wedding. Eric, I hope that we always stay in touch--
Lara--your husband is a riot, I think he and Beth bonded (should we be scared?). I'm so glad you're happy. You look GREAT!
Em--you sure know how to throw a party!!!! It was SO GOOD to see you! Next time, I'll help!
Leya--I never knew your mom liked me so much, HA! I could have used that...your little girl is beautiful. Best of luck to you and Brian
Ann--I vote you, "THE ONE WHO STAYED MOST THE SAME" and I LOVE IT!!! You look happy, confident, and at peace. You're an amazingly talented woman and I expect great things. Perhaps the Mrs. and I can make it to AZ to see you!
Alison--you're too cool for words. Not many have the gumption to show up to a reunion unemployed! Best of luck...we need to have a mini reunion in D/FW (since almost EVERYONE from our class lives there!)
Shea--you're one of the funniest people I know. Don't worry, it's a good thing. I'm glad that you came and that you're doing well. Good luck with grad school. Hopefully you can join the mini reunion.
Rachel H-M--you're a dear friend--good luck with the one of the way. Your boys are too cute and I know that they'll love having a new brother/sister. Call us ANYTIME you're in Houston. Until next time, there's always email.
Ben-We have too many mutual friends NOT to keep up! Taiwan will be a challenge. Good luck with Mandarin
Andy--I'm sure we'll keep up through IM. I'm sorry it had been so long before this that we had talked.
Jackson and Erin--you guys look great, I know that you're already FABULOUS parents. Jackson, I know that you're patients are in GREAT hands. Good luck whereever life leads you.
To the rest of the Class of 1995, Emily L., Dave B., Tiffany H, Sherry S. Zac and Bru, Jurel, Emily C, Christy, Justin, and whomever else I've left off this list. Thanks. I can't wait to do it again 5 years from now.
To those from the class that are missing and that couldn't make it. You need to be found, and you need to show up in 2010. It really isn't the same without you.

I go to sleep tonight happy. Happy because this weekend I was able to relive some of the best years of my life with some of the best friends I've ever had. I'm a lucky man. Call me anytime.

End of the First Week

I guess it's safe to say I survived my first week of internship. And no one died. At least none of my patients. I did feel bad for one intern...they came in one morning and one of their patients had died overnight. No, the intern didn't kill this patient. They were very sick and died of natural causes. But imagine how the intern must have felt. No one called to let them (I'm being gender neutral so there is no HINT of a HIPPA violation...I'll explain later) know that the patient had died. The last few days have been interesting.

In hospitals, the team of doctors taking care of patients changes every month on the first of the month. For me, this year...I will spend 5 weeks on the Renal Ward Team because interns started 1 week earlier. That meant that on Friday, me and the other intern got a whole new upper level staff. The resident was post-call from his June month, so he was at the house asleep. The Renal Fellow, who just finished her Internal Medicine Residency, was day 1 as a Fellow. And the Attending was new as well. Not a new attending, but new to the service. Let me explain the higherarchy that is Medicine.

Medical Students--what I was 2 months ago. Basically, can't do anything legal and therefore help their intern AS MUCH AS POSSIBLE!!! They are usually the ones running to x-ray or finding out lab results. We call this kind of work SCUT. And medical students are affectionately called Scut-Monkeys.

Interns--that's me--Graduated medical school 1-2 months ago. New MDs.
Interns are in their first year of their residency (3-5 yrs. depending on the specialty). Interns report to the Resident.

Residents--2nd,3rd,4th...yr of residency. They have supervisory responsibilities of the interns and medical students. Residents report to the Fellow (if there is one) or to the Attending

Fellow--done with Residency. A Fellow has chosen a sub-specialty--cardiology, Nephrology, CV Surgery, Oncology, etc. A Fellowship is 2-4 yrs and most always involves research. Fellows report to Attendings.

Attending--Staff--done with training. Could operate in Private Practice. Board Certified in their filed of training. Eligible to make more money than me, which is less than $40,000 during residency for 80+ hours/week.

So, it's a new month with a new team. My fellow intern was given 4 days of vacation around the 4th of July and won't be back until Thursday the 7th. In Internal Medicine, we all get 4 days vacation around a holiday...he just happened to get the 4th. That stinks for him. Mine are around Thanksgiving in order to attend the wedding of my friend and fellow (not Fellow) Pediatric intern, Jeremy Dalton. So, for the next 4 days, it's me, the resident, and the Fellow on the team. That translates into more work for me!

Happy 4th of July! I will work until noon and then go home and get ready for a little grill time.

In His grace.

Day 1, OVER

Well, I guess you could say that I've survived my first day as a doctor. I actually had a nurse call me and ask what to do about a patient with chest pain. And let me just say...I've not often had quite so odd a feeling as I did today when I wrote a prescription for pain medicine for a patient to take to Walgreens or CVS, and signed MY NAME to it. Uh, that's weird.

Day one as a Med/Peds Intern began at 6:00 a.m., that's when I arrived at the hospital. I was up at 5:00! Thanks to the modern advances of technology, I was able to look up SOME information on my patients last night from home. Please understand that when speaking about patients or things I MIGHT have seen, I must be vague and general. HIPAA regulations guarantee patients the right to privacy and I personally could be fined THOUSANDS of dollars if it's found that I violate that privacy. So I won't. Anyway, I began to see my patients, introduce myself, and write notes in their charts that will forever, good or bad, be a part of their medical history.

It's all a little surreal. Today was not a bad day. Yes, it could have been better. Yes, I wish my resident had held my hand a little more..he didn't even check the prescriptions I wrote...we just sent the patient home...but at the same time, it's here. It's real. The chance to make a difference.

I covet your prayers that God will watch over me and guide me. That He'll make His presence felt, especially in those dark hours that are sure to come.

Please don't email me and ask for narcotics. The answer is no.

Jeremy L. Brown, M.D.
Internal Medicine/Pediatrics Intern
364 of 365 days as an intern to go

Graduation cake made by Lorinna Hopping
Posted by Hello

Life moves on

It's been 6 weeks or so since I've lasted posted. MUCH has happened! I will briefly recap. Beth and I moved into our new home on May 21. My dad came to visit on 3 days later and I don't know that he's EVER going to come back. After giving Lowe's Home Improvement store more money that I should have, we spent the next 4 days hanging celing fans, mini blinds ( a WHOLE house full) and 2 garage door openers. We didn't even get to the surround sound. We bought a lawn mower and weed-eater...after all the yard isn't going to mow itself. And then I HAD TO HAVE a grill, which will be used for the first time this Monday. Mary Fritz and I planted flowers. The splinkler system was installed and grass laid in the backyard. THEN family came. We ate, ate some more, went to my graduation from MEDICAL SCHOOL (yes, you can call me doctor), ate some MORE, then came back to the house and threw a party for 50-100 of our closest friends and family. It was more than a little nuts around here. Did I mention that Beth's friend from Oregon flew in Saturday afternoon about an hour before those 50-100 people showed up at our door? Jo Sandifer brought more work, in the form of Shasta Daisies and some Mexican Hair Grass which is now planted in the flower bed, which I LOVE! One of Beth's favorite flowers is the daisy. I can't wait for them to bloom. Billye Sims brought some fine ice cream and Jenny Fagg brought cherries. Mom and Grandmother brought banana punch (until the glass ladel broke and it had to be dumped out), banana cake and banana bread (do you sense a theme here...who knew I liked bananas so much!) Lorinna Hopping made an AMAZING cake...which I will post a picture of here when I'm done rambling. Mary Fritz brought pigs-in-a-blanket which were gone in 5 minutes. Someone in my family (at my request) brought wings from Hooters. (Please hum "These are a few of my Favorite Things" quietly to yourself. I'm sure that there are others that brought something that I have forgotten. Please DON'T shoot. I am grateful for EVERYTHING EVERYONE did to help out. Kristina and Eric were kind enough to bring my precious niece, Tori, to see us on Thursday at which time Dad quit working. She played and we all fell in love with her all over again. Please see rosesareredheads.blogspot.com for my sister's blog about, yup, the red-headed Tori. Laura, Will and Grandpa Henry came to help us celebrate and we are SO thankful for them and their help. I don't think the entertainment center would have gotten finished without Grandpa Henry!
I just got back today from a 1700 mile road trip that took me to Southern Illinois to my mother-in-law's house. She gave me and Beth Beth's Dad's desk. It was hand-made by a family friend. It's GORGEOUS! It's HUGE! And the only way to get it to Houston was for me to go get it. It took 13.5 hours to get there, we spent the next day and then loaded up to come home. When I say we, Chris H. went with me. I'm not sure 1700 miles was his idea of a good time, but I know it beat the alternative. You know how 16 year-olds get in trouble, right? Well, he did, and rather than sit in his room staring at the ceiling...he rode with me for 1700 miles listening to me sing everything from Evanesence to Simon & Garfunkle to Rent. Someone should tell his parents that he's been tortured enough and I'm sure he'll never do what it was that got him into trouble in the first place. Yes, I know what that was, but it's not for me to rat him out on the internet. Thanks Chris, I couldn't have done it without you.
It's good to be home. We close on the condo in a few days, I think. The buyer keeps changing her mind. July 1-June 17-July 1.
Training for me starts Tuesday with PALS (Pediatric Advanced Life Support) and then 2 days of Neonatal Resucsitation Program. Then hospital orientations and banquets to honor those completing their residency, and then June 24th is the first day on the job. I'm not even 100% sure where I'm starting. I bet they tell me before I have to be there though.
My 10 year high school reunion is about 5 weeks away. I am going back to Abilene even though I didn't graduate from there. I lived there for 8 years until the summer after my sophomore year of high school and 90% of my pre-college friends are there. So I am crashing their reunion and going back to catch up. I can't wait!

For those I have seen or been in correspondence with lately, your thank you note in soon coming in the mail. Until then, please know how truly blessed I know that I am to have such wonderful friends and family. Blessed that you care enough to call, write, or come and help Beth and I celebrate an important milestone in our life. God is good, and faithful, and he has blessed me beyond measure. More than I could have hoped for. To Him be the glory and may He continue to guide me in this next phase of my life.

My love and thanks to you all!