August 8: Thursday
Survived my first shift. It’s an odd feeling to look around for an attending and then realize, “Oh, I am the attending.” I’m not used to suddenly being the one in charge. But really, it wasn’t actually sudden. Quite the opposite. It was a four-year residency process during which I took care of several thousand ED patients, under the direct supervision of board certified EM docs (and that was all after finishing 4 years of medical school, 2 years of graduate school, and 4 years of undergrad). I put in my time. I earned my stripes.
It sucks to be yelled at by a patient’s family member when I’m trying to do the right thing for the patient. I appreciated when they apologize an hour later. I get it though. It’s their worse day, whereas for me, it’s just another day at work.
August 9: Friday
At a different site today, a teaching hospital, and for the first time I will be supervising residents and medical students. Teaching hospitals have medical trainees ( integrated into their structure. The residents work under the supervision of the attendings, with senior level residents having less supervision than the newbie interns and medical students. In the emergency department, seeing a patient entails taking their medical history, doing a physical exam, determining which labs and imaging studies to order, which medications to give, and then putting all the information together to come up with differential diagnoses, a final diagnosis, and plan for either admission, observation, or discharge. When working with residents, it’s their job to do all the legwork, and it will be my job to supervise them, teach them, and guide them towards an appropriate work up and plan. One of the attendings from my own residency program advised, “Love your residents like you love your children – differently.” He went on to explain that each will have their strengths, their weakness, and their quirks. Different residents will need guidance in different areas, and of course the interns and junior residents will need a lot more supervision.
On arriving to the ED, I sat at the computer in the front center part of the ‘doc box’ where the attending typically sits. The ‘doc box’ is a long rectangular space near the front entrance of the ED, filled with computers, and with windows on most sides in order to be able to observe the ED. Most of the team sits in there, including residents, med studs, social workers, pharmacists, case managers, the clerk and other staff (while the nurses typically sit at computers right outside the patient rooms). The atmosphere is collegial and collaborative. Sitting at the front center seat, I had the strange sensation of being a captain in charge of a crew. Except that I was a captain who had never been on that particular sea, and didn’t even know where the bathroom was, let alone who else was on board the ship or where we were going. Fortunately, the rest of the crew was enormously helpful and guided me through the first day. The senior residents, having been at that hospital for three years already, managed their patients efficiently and appropriately, allowing me to spend time keeping an on the junior residents and the intern. I introduced myself to every person I met, knowing full well that I was the newest face there. Waves of patients passed through our doors – chest pain, belly pain, muscular aches and pains, infections and injuries and so on – and although the system was new to me, the medicine wasn’t new. Patients and came and went, and the afternoon and evening flew by.
Seeing the ED for the first time from the perspective of an attending is quite different. In addition to ensuring that the patients get the best care possible, there is the added awareness of the overall pace and flow of the department. For each resident, I mentally questioned how much faith I had in what they were telling me. From a first impression, having only done one shift, I think I prefer to see my own patients. That might just be because I am finally an attending and I just want to go and be a doctor, not supervise and training and teach others. We’ll see. Many of my friends have gone the route of academic medicine (ie: working with residents at teaching hospitals) and love it.
I texted my mentor, The Boss. about my first time working the residents. The first time I shadowed her in the ED, which was over 10 years ago, I was just a pre-med! Wow time has flown.
August 13: Tuesday
My second day at the teaching hospital. The residents are off at conference today so myself and a few other attendings have the department to ourselves.
The bathroom is located in the back of nurse’s break room. On entering the room, I came across two male nurses who I hadn’t met before. Seeing an unfamiliar face, one smiled at me and joked, “You have to do 10 pull-ups before you can cross and go into the bathroom” while nodding to the pull up bar on another door. I shrugged and jumped on the bar, counting aloud as I started doing pull-ups. I heard him then say, “Holy shit, she’s actually doing it!” Upon finishing my 10, I walked up to him and his wide-eyed face, shook his hand and stated, “Hi, I’m Stephanie Benjamin, one of the new attendings, nice to meet you.”
It was a busy shift but with the help of the nurses and everyone else, I’m starting to get the hang of the culture and workflow around here.
August 14: Wednesday
As an EMS fellow, in addition to my shifts in the ED, I spend a lot of time in meetings. There are workgroups and committees on topics ranging from hospital preparedness, disaster response and epidemics, to water and air emergencies, resources utilization, and quality improvement. As I settled into my seat around a large horseshoe of desks for the first meeting of the day, I suddenly heard, “Around the left!” followed by the crunch of gravel, the unmistakable sound of rapid-fire gunshots, and then what sounded like a bomb exploding. Before I had a chance to be concerned, the other attendees nonchalantly explained that it was just the police training academy running drills outside the building. Like it was the most normal thing in the world to be having a meeting with the background noises of gunfire and the occasional explosion. By the end of the meeting, the blasts and yells from the yard below barely registered.
Back at home with my hubby, who is truly my better half. We’re loving our new neighborhood and checking out the local spots. Our house is starting to look like a home, and nearly every box is unpacked. The backyard is peaceful, and our garden is planted. My brain still occasionally thinks we’re on vacation and that this house is an Air B&B, but overall I’m starting to feel settled.
The family in the home before us had children and they built a small platform in the large rubber tree that sits in the middle of our yard. It’s a beautiful little spot to sit and watch the sunsets with a glass of wine. My husband and I, being the mature people that we are, converted the platform in a pirate’s hideaway, complete with pirate flag, treasure chest, solar lighting, and of course, rum.
Recipe: Physical Fitness - Climbing (aka vertical yoga)
Climbing outdoors is an exhilarating rush. The feel of the rough rocks under your fingertips, the fresh air, the beautiful views, and the joy of spending time outside with friends.
Climbing didn’t come easy. To start, I was 31 years old and hadn’t really worked out in nearly 8 years. I was scrawny as could be and had no upper body strength (or really, any strength) to speak of. My first attempts at climbing were comical. I wasn’t sure much climbing as awkwardly climbing to rocks while the person belaying me practically pulled me up the wall. Eventually I got too scared and asked to be let down. I think I made it a whole 10 feet high. I was barely above my friend’s heads.
I kept trying. Little by little I relaxed the death grip I tended to have while attempting to climb and improved my technique. For people who aren’t afraid of trying new things, climbing to the top of a rock wall may seem like a small achievement. Or not even an achievement at all. But I grew up afraid of EVERYTHING. I’m afraid of normal things like spiders and small spaces, but then also caves, heights, depths (another fear I overcame while learning to scuba diver), horror movies, Ferris Wheels, even the haunted house at Disneyland. The list goes on. Trying new things always triggers a fear reaction but I wanted so badly to reach the top of a route.
Foot by foot, I started being able to climb higher, and was soon able to reach the top of the climbing wall in the gym. I started to pack weight onto my small frame. Over the course of months, I slowly made it higher on the climbing routes I attempted outdoors. I recall vividly the first time I completely a route outdoors. Sweating, my hands aching, sitting in my harness, I looked around and took in the view. It was unreal. Overcoming paralyzing fear is a adrenaline rush like no other. I reveled in the hard-won feeling that I could accomplish anything.
We don’t start off strong. We get there by perseverance and dedication.
Once I got to the top of that first route, I kept going. I would climb multiple times a week, always pushing myself to get better. I began to think of climbing as vertical yoga. Just as in yoga, you need control, balance, flexibility, patience, strength, and perseverance to improve. And, if your mind wanders you fall.
I introduced my husband to climbing and he fell in love with the sport, too. Now that we’re on the West Coast, we’re spoiled with incredibly outdoor climbing not too far from home. You may not think of climbing as a prepper skill, but I’d argue that being able to climb random things safely and efficiently is a great skill to have. Climbing could allow one to reach a higher vantage point for recon or mapping an area, reaching a safe hiding place, and again, it’s great full-body workout. But more than that, it’s just fun.