Let’s see, today is Tuesday. I’m working a night shift tonight which means I have most of today free and will be off tomorrow at 11am. Thursday is a long day, (7am-8pm) but it’s my last day of neurology. I have Friday and Saturday off and on Sunday I start my next month in the ICU. EEKKKK!!!!
I can’t believe that this month has come and gone and that I completed 1/12th of my intern year! I have loved this month so much. I love the people I work with; all the upper level residents are the nicest and coolest people ever, all the consultants (what Mayo calls attendings- meaning the head doctors in charge) are kind and patient and love to teach. I’m so grateful that I’m doing my intern year at Mayo.
We’ve had a few really difficult cases on the service this month. Often, the diagnosis has not been obvious and we’ve had to really sit and think things through. Our attending taught us this mnemonic which I found very helpful: VITAMIN CDE. I’ve used the mnemonic CITIMITV but I think vitamin cde is way easier to remember!
It stands for:
E- Epilepsy (this one is specific for neurology)
I think this is a great way to piece out differential diagnoses if you have no idea what’s going on with a patient. When you separate out everything into categories and think, “what metabolic things could cause her symptoms? What inflammatory things could this be?” it helps guide your decisions about what tests you should order, etc.
One of our senior residents always asks, “how will this change management?” which I LOVE. Before we order a test we stop and think, “will this test change what I do for a patient?” For example, a few days ago I had a patient with a stroke. The CT scan done in the emergency room showed a small stroke in a certain area of the brain, but the patient had some strange findings on physical exam that didn’t fit with the location of the stroke.
We thought about doing an MRA or MR-Angiogram, which is an MRI that can specifically look at all the blood vessels in the brain and neck. The patient had multiple vascular risk factors, and we were worried that some of the arteries in his neck might have narrowed enough to cause a stroke or cut off blood flow to other areas of the brain that we didn’t see on CT scan.
So, my resident and I talked about whether it would change our management of the patient. If the MRA was positive, the patient might be a candidate for surgery and we might also change the medications they were on. If the MRA was negative, we wouldn’t do anything different. We knew that the vessels in the neck were the most likely to be compromised, and that a carotid ultrasound can see those vessels very well. An ultrasound in 398349834 times less expensive than an MRI so we decided to do the ultrasound first. If it was positive we would go ahead with the MRI. If it was negative, we wouldn’t do the MRI. Instead of just jumping into a $3000 MRI, we thought about it first and I really appreciate that.
Neuro has been a pretty relaxed month in terms of hours. Most weeks I’ve worked around 60 hours which is not a lot at all for a resident. Next month in the ICU, I’m expecting to work much closer to 80 hours per week and be exhausted. I’m really going to have to figure out how to fit in exercise next month- it will be a challenge no doubt!
I even had time to get get an eye exam and order new contacts! I had to go back to work after getting my eyes dilated- that was rough! I couldn’t see anything for a few hours! ***( I didn’t drive- Kyle picked me up and brought me back to work)
I still plan to keep blogging as often as I can! If you have any suggestions for blog topics, I’m all ears! My life is pretty simple these days, and I don’t know how many “I went to work and then I went to the gym and then I went to bed” posts I can write 🙂
Have a great day everyone!!