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The emergency department doesn’t sleep, and quite frankly, my sleep schedule is consistent with the hours of my ED shifts. I work all of them. Day, evening, swing, unit clerk, tech, sitter, triage, 8s, 12s, 16s, and now, the occasional…night shift. And that’s the thing. I usually don’t work a stretch of nights. I’ve worked 1-2 in a row at most and transitioned back to normal, but not necessarily with ease!

In fact, I hadn’t pulled an all-nighter ONCE in my life until I worked my first night shift last summer… I was always the kid at sleepovers who wanted to go to bed before midnight. If I’m being honest, I dreaded this moment – the one where I had to work while the rest of the world sleeps. I didn’t want to mess with my sleep schedule, I didn’t know what to expect or how things are run, and I had a lot of anxiety about it.

But surprisingly enough, the girl who was dreading nights ended up enjoying night shift – would maybe go as far to say preferring it!! Much of my anxiety with these stemmed from not knowing what to expect. When will I take my break? How busy is it during the night? What if I get too tired to function? From someone who had no idea what they were doing, or what to expect, here’s how I can ease YOUR way into nights – all the things I wish I had been told.


BEFORE night shift:

  1. Shower & brush your teeth.

For no other reasons besides the fact that a shower wakes you up, makes you feel clean & refreshed, and smelling good throughout the rest of your shift. Before my first night shift, I forgot to brush my teeth that night. TMI…? yup. I wish someone had told me that it makes a huge difference. But that’s why I blog. 😉

2. Glasses > contacts.

If you wear glasses/contacts, take your contacts out and swap for your specs. Tired eyes are not fun, but they’re even worse when you have contacts in. Just do yourself a favor and wear your glasses!

3. Don’t bother wearing makeup.

Ladies, if you happen to meet your future spouse on night shift, I guarantee he/she will not care what you look like either. This gives your skin a chance to breathe. Even though you’re not “supposed to,” rubbing your eyes feels great, too. Just be comfortable and moisturize your face well. 😀


DURING night shift:

  1. There are less people around.

Guess what? At 3 am, there aren’t as many people roaming the hallways of the hospital. Most people in the world are sleeping. Now, no guarantees here, but this usually means you have less patients, too. You tend to be a little more “free.” For me, this means wearing a sweatshirt over my scrubs to stay warm and taking a 4 am coffee break.

2. Eat when you’re hungry.

Don’t eat because you feel you have to take a break at a certain time. I usually don’t bring a full “meal” with when I work nights. Instead, my go-tos are usually:

  • a banana
  • a protein bar
  • water/sparkling water
  • raw, chopped up veggies – like bell peppers!

In fact, I find myself feeling the need to eat, but when listening to my body, I’m not actually hungry. Eating small snacks throughout will make you less full overall and probably decrease your chance of feeling nauseous in the middle of the night, like we have all experienced. Oh, and drink lots of water to stay hydrated.

3. It’s a normal shift.

Sure, you’re working when the world sleeps, but (especially) if you’re in the emergency department too, it’s just like any other shift. I am assigned the same tasks as I’d carry out during a day shift. The ER is a well-oiled machine that functions 24/7. The only difference with night shift is that you’re working in the middle of the night. This is great to tell yourself if you’re any bit anxious about how the night will go.


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Stella was yawning too. Or maybe just that happy to see me when I got off work.

 

AFTER night shift:

1. Brush your teeth and shower.

Yup, you probably just did this before your shift. Get those hospital germs off before you sleep. Wash your face and hair, and brush your teeth. In other words, make sure you take care of yourself.

2.  Sleep for 4 hours.

Yes, 4 hours. Think of this like a nap. If you feel ok, get up and go do things. Make lunch, exercise, do what you have to do. If you’re too tired to function, sleep for a few more hours or watch an episode or two of The Office or Grey’s Anatomy until you can get up to “normal” human function. This is hard on your body – it doesn’t like to be awake throughout the night, after all! Be nice to yourself, too.

3. Melatonin. 

There it is. If I know I’m going to have trouble falling asleep, I will take 2.5-3 mg of melatonin anyway. But after a night shift or two, I take 5 mg (the max dosage recommended dose one should take is 6 mg) about 2 hours before I want to be sleeping. It knocks me out and keeps me asleep. I usually feel great when I wake up. Because your sleep schedule is all out of whack now, I take half that dosage of melatonin (2.5 mg) the following night. I’ve had no problems since. 🙂

What else?

  • The environment seems to be much more relaxed. My department turns the lights down in the nurses’ station, we wear jackets to stay warm, and
  • It’s a lot easier when you go into work if it’s bright out. My department doesn’t have windows, so if I go in when it’s bright outside, it never really “feels” like nighttime. That’s because of the melatonin production secreted by the pineal gland in our brains. Melatonin is released when the receptors in our eyes pick up light. Science is cool.

 

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It’s a tiny little structure!!!

 


And with that, I present to you, the night shift, as told by the non-night-shifter. Comments? Questions? Feedback? Shoot me a message!

All my love,

xx,

M

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My preceptor has assigned me plenty of reads to enhance my experience as a student-nutritionist this summer. Without getting into specific details about the clinic I work at, I can say that a large portion of our patients are refugees, immigrants, or both. I have been enriched by various cultural experiences right with my own patients. This book was extremely fitting.

The Spirit Catches You and You Fall Down is a story about a Hmong family who immigrated to the United States in the 1980s. The large family settled in Merced, California among other Hmong families. The Lee family had a healthy daughter named Lia who later developed a seizure disorder when she was 3 months old. This story describes the challenges with a language barrier, and not only that, but the lack of similar terminology across different languages. During certain parts, when Lia was brought to the emergency department, I couldn’t stop reading.

If you plan on going into medicine, nursing, pharmacy, or any other allied healthcare profession, READ THIS STORY.

In the United States, we nearly unanimously agree with modern medicine and our healthcare system. When you go to an ER, you expect to wait. You trust the physicians to diagnose you based on how they examine you, what your scan looks like, and how your labs come back. We believe and trust our doctors, and if we don’t, we can get a second opinion. What if something goes horribly wrong in our care? A misdiagnosis that leads to mistreatment? We have options. But if those things cannot be communicated, much less understood, would you feel safe trusting these professionals?

This story is a reminder of perspective and that our system in the US is simply one way of tackling the healing process. That’s all it comes down to; wanting the best for our patients and their families and making them feel better. That’s why we choose medicine. If you choose to read this story, which I highly encourage, you will learn so much about the US medical system, you will learn about the Hmong culture, and you will learn to be more culturally sensitive. Find it here.

Happy reading!

xx,

M

 

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The name of the book sounds…scary. And as we all know, the food industry in the United States can be rather that way. You are probably aware that obesity rates are increasing and not showing any signs of letting up, in fact, it continues to increase over time. You probably know that sugar is “bad,” and high fructose corn syrup is even worse as far as long term health consequences go. You have probably been told that burgers should not be a staple of your diet. But what SHOULD you eat? Read this one to find out. You’ll find that it’s a lot more simple than you’d think!

Dr. Furhman, a family medicine-trained medical doctor takes the current research behind diet and nutrition and applies it on a smaller scale. He also takes American history and gives insight as to how some of the deprivation we face has started – something I had hardly thought of previously. And not only does Dr. Fuhrman take the historical context of our country, he discusses the current socioeconomic disparities throughout the US; part of which is to blame for our current SAD (Standard American Diet). My nutrition program focuses on health disparities and working on solutions to these problems, so his aim resonated with me and what I hope to become as a future physician.

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Dr. Fuhrman also discusses food additives, preservatives, saturated fat, ketogenic (or high-protein, low carb) diets, epigenetics and genomics, eating intact grains and how to cook them, and some of the psychological effects of food. He does a great job decoding some of the daunting terms and explains them in a way that the non-scientist can understand. Each time I read a book written by either a physician or a nutrition professional regarding nutrition, I am inspired and enriched by their knowledge and passion to change the food industry, and help other live healthier and more purposeful lives.

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The best part about this book is that I found it at a closing bookstore (sad, yes), and it was 75% off !!!!!! I do not remember how much I paid for it, but if you desire to read this one, which I strongly recommend, you can find it on Amazon for about $16. 🙂 Click here for Dr. Fuhrman’s website, and find him on Instagram. ALSO, Dr. Fuhrman has written several books that have caught my eye… Don’t be too surprised if you catch me reading those too. 😀

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ANNNNND… my personal favorite image from the book. 😛

As always, happy reading!

xx,

M

 

 

 

A morning with an on-call cardiologist can be as variable and exciting as the days the emergency department has graciously prepared me for. Here’s how I spent my morning:

I started the day chatting with Dr. G’s nurse about the schedule, procedures, and variability in patient cases in cardiology. After Dr. G, an interventional cardiologist, had finished rounding for the morning, I joined him to see his first and only clinic patient of the day. The individual had a new onset of shoulder pain when beginning a new exercise regimen, and after both a negative EKG and stress test, was cleared. Dr. G did an exceptional job of explaining everything to his patient, reaffirmed by the genuine “thank you” and kind words he received. This was an excellent reminder of the clinician I aspire to be.

After finishing up with the sole clinic patient of the day, Dr. G and I headed to the cardiac catheterization (cath) lab. Dr. G was on call, but simultaneously had two scheduled angiograms to rule out occlusions.

The first procedure, I observed from the station with the cath lab techs and nurses who explained the procedure to me. I quickly realized how brief the procedure was (only about 15 minutes start to finish), and then reviewed the pictures with Dr. G. It was negative, but very interesting to watch the contrast flowing through the coronary arteries!

The second procedure, another angiogram, Dr. G invited me in the cath lab. I donned surgical scrubs, gowned and gloved (and masked), and wore lead to prevent radiation exposure. This time, I was able to see Dr. G thread the radial artery and inject dye through and into the heart. Unlike the previous angiogram I saw, there was notable blockage and Dr. G concluded that the patient would need either triple or quadruple bypass surgery rather than cardiac stents.

The photo depicts an image similar to what I had seen on the left.

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coronary angiogram – A: before cardiac catheterization (notable blockage) B – after cardiac catheterization; occlusion notably improved **not my image** (see below for image credit)

After talking to Dr. G about conscious sedation, he explained that he uses Versed and fentanyl and only the smallest amounts to start, because it isn’t necessary to completely sedate the patients during the procedure. He explained that he can always increase the dosage if the patient is uncomfortable.

Lastly, Dr. G got a page from the internal medicine doctor for a patient on the floor. This too, presented a learning opportunity for me – I listened to abnormal breath sounds and heard a heart murmur for the first time.


A few things that drew me in:

  • the opportunity to educate patients about their health and how to make lifestyle changes.
  • the near-instantaneously relief that interventional cardiology provides in such a small, minimally invasive procedures.
  • the high-acuity and helping sick, sick individuals recover.

 


Three takeaways: 

  1. Interventional cardiology is more reactive rather than proactive.
  2. Educating the patient is probably the most effective way to not only achieve greater patient satisfaction, but will also increase the probability that the patient will be motivated to make changes. 
  3. The correlation between heart disease and diabetes is notably strong. 

Shadowing physicians and being in the hospital, especially at the beginning of a long semester reminds me why I still choose medicine every day. The opportunity to spend an entire day with the gift of having the ability to improve someone’s quality of life sounds like a career I still hope to have.

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I look like a surgeon.

For my guide to having a positive shadowing experience in the hospital yourself, click here!

Thanks for reading!

xx,

M

 

**Image credit: https://www.researchgate.net/figure/Coronary-angiogram-A-Total-occlusion-of-the-mid-RCA-and-70-narrowing-of-proximal-RCA_6875106_fig2

My friend over at @heardtohealed on Instagram, Stephen Groner, has combined his experiences of being an ENT patient, and having a career in speech-language pathology and wrote a book full of simple ways for you and I to improve our interactions with patients – making our jobs more enjoyable, and our patients’ satisfaction greater!


Stephen breaks down bedside manner into three chapters:

  1. Starting: Impressive First Impressions
  2. Listening: Giving Them the Mic
  3. Talking: What to Say and How to Say It

In my clinical experience so far, I have found that it can be challenging to relate to patients, relay information, and rationalize a scenario with a patient or their family when they are angry, frustrated, or feeling other hard-to-cope-with emotions. Though these situations tend to get easier the more one experiences them, it remains difficult to know if you are doing or saying the “right thing.” According to Stephen, you’ll learn that sometimes silence is better, and a gesture means more than finding the right thing to say.

Read this book, a quick read (under 70 pages), and reference it when you want to refresh your approachability and success with your patients and your interactions with them. Find it in ebook form here for only $7! I am so glad I read this book, not only for how I can work on the dynamic I have with my current emergency department patients, but also with skills I hope to integrate in my future practice as a physician!

Happy reading! And while you’re at it, go check out Stephen’s page for inspiration and humility!

xx,

M

 

Just a few short days ago, I asked the surgery residents at work if I could put on a cap and mask on and shadow a sterile procedure in our department. I quickly made myself a fly on the wall and remained out of their way.

One of the residents then asked, since I was in the room, to help hold the patient’s arm out of the way of the procedure underneath the sterile field so her arm would not tire and get in the way. I was a very minimal part of this procedure overall, but the role I held came with standing in the same position for over 30 minutes, and included holding the weight of the patient’s arm up.

I now have even more respect for surgeons who perform lengthy operations and endure gruesome shifts. I am also extremely grateful for the opportunity to have a job that allows me to experience these types of things. Not many people get to go to work and help with sterile procedures every day. It is a privilege to say the least!

But what does this have to do with sweat?


Why do I hit the gym? Well, let me tell you!

1. Stress relief. Feeling good. Endorphins.

Having a busy lifestyle requires some form of stress relief. Lifting weights or hitting tennis balls gives me a a sense of clarity and helps me focus on the tasks I have to complete after I’ve gotten a good workout in. It’s been proven to facilitate good overall mental health and stress relief. If this alone was the only reason, I’d still be exercising.

2. Leading by example.

When we tell our patients to make lifestyle changes such as diet and exercise, we better be doing those things ourselves. I want to be the physician that can help guide patients with proper lifestyle habits by doing them myself.

3. I want to play with my grandchildren.

Whoa. That is a bold and profound statement. Not only does exercise increase longevity, but it improves quality of life. There are chronic diseases that have a strong autoimmune component to them (such as arthritis), but many other well-known chronic diseases such as diabetes, heart disease, and obesity can be prevented with lifestyle medicine.

4. Lastly, to do my job and my future career.  

Helping the surgeons reminded me again, I don’t have trouble doing the physical component of my job. Being physically fit helps me to better help transport my patients without worrying about not being strong enough. It helps me make it from point A to point B with ease in an emergency scenario.

It helps me help others and that’s exactly what I hope to keep doing throughout my current job and future career.


Think about this: why do you work out? And if you don’t, why should you?

Thanks for reading, much love!

xx,

M

The emergency room will always have a special place in my heart.

Regardless of anything I have personally experienced, it is well know that the ED is its own entity; its own unique branch of medicine that is nothing like the other areas of the hospital.

We see people at their very worse, sometimes grasping by straws for a chance at survival, and others, aren’t as patient with the wait time. There are sprains, strains, fractures, and lacerations all day, critically ill stroke codes, STEMIs, and traumas all night – well, not necessarily in that order. The department doesn’t sleep and any emergency personnel can tell you a plethora of stories that you might think are too bizarre to be true, but trust us, they are not!

This is best illustrated in the story by Dr. Paul Austin in Something For the Pain: Compassion & Burnout in the ER.

With my continuing experience in the emergency department, I enjoyed reading the struggles and triumphs Dr. Austin faces as an attending emergency medicine physician.

Dr. Austin discusses specific cases he has faced throughout his career and training, but not only that, he talks about how these patients and their stories affect him as a person and his family overall.

Having a career in emergency medicine is a high-stress at high stakes career. Dr. Austin describes how this career nearly ruined his family. It is a reminder that medicine is a rewarding, yet demanding career that proves that if you do not feel that you are taking care of yourself, you will not be best-fit to take care of others in what may be their most desperate times of need.

Read this one to gain insight into life from the trauma bay, the stories on night shift, the forbidden “S” and “Q” words in the emergency department, and the selfless side of medicine that the doctor taking care of you faces each night they try and sleep.

Dr. Austin’s website describes his book more and will give you a preview of his second book.

Find it on Amazon for about $10.

Happy reading, as always!

xx,

M