Thursday, September 1, 2016

Summer in the city

It's finally summer in San Francisco!

While the rest of the country enjoys 80-100 degree weather all summer, SF is still smothered in the fog and cold until September. Someone (frequently quoted as Mark Twain) even said "the coldest winter I've ever spent was a summer in San Francisco." I feel sorry for the tourists who come to the city wearing shorts and T shirts and then having to buy Fisherman's Wharf sweatshirts downtown because it's way colder than they expect! We have 50-60 degree weather all year round until September, when we have 2 weeks of perfectly clear skies with temps reaching into the 70s!

Over the weekend, I finally finished my first month of medicine as a second year resident and spent the day outside on my day off enjoying the first days of summer.

Medicine wards as a second year is an entirely different beast as a senior resident. As an intern, I was the primary doctor for my patients, however the most I had at one time was 8 (at which point I was "capped"), a not insignificant number. I was in charge of the nitty gritty of every day, seeing all the patients, meeting with family members, answering their questions, answering nurses' pages, and doing my best to care for them.However as a second year, I oversee a team of 2 interns and up to 16 patients, as well as a third year medical student and a fourth year sub-intern. While I don't see every patient and I don't deal with the nitty gritty, I oversee the bigger picture of a patient's care, including discharge planning, end of life care, and their overall trajectory in the hospital. And then I also have to cover when one of my interns is off, doing both the resident's job and the intern's job (covering for up to 8 patients while still overseeing the care of the whole team). While initially it started off great, with less than 10 patients total and laid back attending, my work and stress level climbed as we accumulated more and more patients and discharged just as many every day. By my last week, we would be punished by being efficient by discharging 3-4 patients a day and getting just as many new patients back. One weekend call day, we had four overflow (new patients in the morning), admitted 5 new patients over the course of the day, and discharged 1 from the ED. I have to see every new patient every day and help my intern come up with the plan, so that day I saw a total of 10 new patients! While I never fully grasped this last year, the resident sees twice as many new patients as the intern and while we are admitting from the ED, the intern only sees every other admission (the resident sees all of them). While it's nice not having to write progress notes or answer pages, it's also a lot more responsibility and probably the same amount of work, making me just as happy to rotate off last weekend.
These pics were taken on the hill of Coit Tower on a beautifully clear day. Now that we have a car, it makes excursions around the city so much easier.



Afterwards, we walked around the North Beach (Little Italy) area, which I honestly haven't spent much time in because I always thought it was so tourist heavy. But alas, on a sunny, warm day, we were happy to play tourists too! The cafes and restaurants were all so quaint I thought I was strolling the streets of Europe, 20 minutes away from home.


 Trying to take a "walking in a the street" picture before I was foiled by a hearst
Little known fact - Chinatown and North beach are just separated by one city block! We crossed over one street and found ourselves smack dab in Chinatown, where we got a $1 hot dog bun and $15 massages. Oh the comforts of "home"!

 Pastries of Little Italy 
North Beach is also home to some of the famous tourist restaurants like Mama's on the half shell, Sotto Mare, and the Stinking Rose, a famous garlic restataurant. We walked past the restaurant maybe 5 times before the smell of the garlic drew us in, where we dove head first in a pot of garlic cloves in oil. Good thing we didn't go on any dates after that.

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