I started inpatient neurology last week --- I'm loving it so far! It's reinforcing my goal of specializing in neuroradiology. My favorite day of the week is Friday, when we have 1-hour neuroradiology rounds to review interesting head CTs/MRIs of hospitalized patients. Last Friday, the radiologist presented a classic MCA stroke --- complete with the hyperdense MCA sign and insular ribbon sign. Unfortunately, the patient developed a massive parenchymal hemorrhage after tPA, herniated, went to the OR to relieve the pressure, and died while in surgery. Other interesting patients that I've seen include a 20-year-old with dural venous thrombosis, a 30-year-old with sudden onset of headache and hemiplegia (migraine vs. stroke), a 60-year-old with four strokes during the past two years who presented with new left-sided weakness and numbness (and found to have complete right ICA occlusion and significant left ICA occlusion), and 40-year-old with a three-year history of dizziness and one month of seizures found to have a massive tumor on head CT.

Call is supposedly not too bad. According to interns who've been on the service before, 0-1 admissions is typical and 3 admissions would be considered a bad night. I got 6 admissions on my first call night! Hopefully things even out next time.

I've finished the first week of my new rotation, GI-oncology. It's another surgical service. In some ways, it's easier than trauma surgery because there are fewer patients (9 on GI-onc vs. 30 to 40 on trauma). This means that I can get work done without getting paged too frequently. On the other hand, I have to wake up earlier that I did for trauma because I have to pre-round on my patients. (On trauma, given the sheer volume of patients, there was no pre-rounding. Instead, the patients were seen by the entire team.) Also, the patients are really sick --- we see lots of pancreatitis, pancreatic cancer, gastric cancer, HCC, and enterocutaneous fistulas, with the occasional inguinal hernia or cholelithiasis. A good portion of the patients are in the ICU or the step-down unit.

My hours right now are 4:30 a.m. to 7:30 p.m., with a bunch of overnight calls thrown in for fun. I'm not gonna lie ... I've had more enjoyable rotations, lol. I wouldn't mind the hours if I enjoyed what I was doing during the day. I just have to remember that this schedule is temporary and that I'll be doing what I love next year. I just need to pay my dues.

I survived my first trauma surgery call. It was crazy! Lots of MVAs/auto vs. pedestrian/auto vs. bike, a guy whose hand was shot off, a person with bilateral lower extremity cellulitis (complete with tons of maggots), a kid who fell from a zipline and cracked his skull open, and of course the obligatory drunken trauma patients. None of the trauma cases that presented to the ER required emergent surgery, which allowed my team to catch up on surgeries for our floor patients in between traumas. (Well, actually, I take that back --- the guy who lost his hand needed surgery, but it was a plastics case.)

Harbor-UCLA doesn't have a general surgery department, so routine cases like appendectomies and cholecystectomies are the responsibility of the trauma surgery teams. We did a lap chole, an inguinal hernia repair, and an abdominal abscess I and D last night. When I say "we," I mean "they" --- my team. Since I was the intern on call for all of the trauma teams, I had a ton of floor work to do. And the other teams' patients were really acting up. One had to be transfered to the SICU for pending respiratory failure (RR 46, HR 140). Another patient complained of chest pain at 2 am, which seemed to be gastrointestinal when I examined her (worsened by epigastric palpation), but the EKG suggested a possible ST elevation in the inferior leads and the troponin/CKMB were elevated. And another patient with a stab wound to the left chest (and with a chest tube already in place) started having sudden onset pleuritic chest pain, worse when supine and worse with inspiration ... so pneumothorax vs. pericarditis vs. MI (I know, it's a stretch) had to be ruled out.

Anyway, it was a super long night with absolutely no sleep. I feel kind of gross today (after napping for three hours), but tomorrow is my day off, so hopefully I'll get some rest.