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Treva

ATLA: Treva pounds it out in the Earth Kingdom

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Watchwords for this challenge are: Tough like Toph, and Rock on/Rock steady.

 

tenor.gif?itemid=8139048

 

 

I'm at a fitness level, weight, and body shape that I'm happy with.  I made great mental progress in the last few months and I even feel I may have grown a little as a person!  Now I want to take the next month from hell to cement it all together.  

 

FYI, Not sure how I’m going to put this together, but I’m sort of trying to run my challenges with my clinicals, so we start this challenge tomorrow and end at the beginning of march.  I’ll figure out Fire Nation stuff when I get there.

 

 

For my Earth Kingdom/Trained by Toph challenge, I want simple goals I can stick to no matter how bad it gets.

 

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Diet: Eat Healthy in Three Easy Steps

  1. Don’t eat junk food because sads

  2. Don’t let fear of buying lunch once a week keep me from eating healthy.

  3. Whatever you do, don’t drink the coffee.

 

Exercise: Prioritize.

  1. KB--always

  2. Strength training (ABC rotation)--if time

  3. Cardio--weekends and free time

 

Music: Prioritize

  1. Lead Rehearsals and have Bells Play in Church--Always

  2. Practice at home whatever you can--if time

  3. Read books--weekends and free time

 

Personal Development: Rules to Live By

  1. Whatever you do, don’t let panic or fear make the decision for you

  2. Say no.  Leave on your own schedule.  Be rude and get on with it.

  3. Don’t let anyone make you feel less than you are.  

 

giphy.gif

 

 

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4 hours ago, Treva said:

Whatever you do, don’t drink the coffee. 

I recognize all the words, but this makes absolutely no sense to me.  None what so ever.  Are you feeling ok?  Is this code? 

 

Otherwise - very clear goals and rules.  Regarding "be rude and get on with it" - I've been finding lately it's helpful to think in terms of setting expectations - both yours (which your challenge clearly does), and those of people around you.  You're getting people trained to expect to interact with you within your designated schedule or according to other needs.

 

It puts a spin of politeness on top of taking care of your own time. Things like "I'm so sorry, I can't meet right now.  I'd be happy to schedule time with you later though" have been incredibly helpful for me, along with then setting a time to talk/meet/whatever.  It's something I'm working with more and more, and again, it's been pretty darn helpful.

 

One of these days, I really need to finish Avatar, and then dive into the Legend of Kora. 

Edited by ChrisWithaStick
Of, dammit...OF, not OR
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I agree, nice goals.

 

@ChrisWithaStick has some good suggestions. Dumbledore has been struggling with the same issue. He is working on saying "This has been great, but I need to go. Would you like to get together again latter?". No one is going to be surprised when a doctor is busy and has to go do other things.

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On 2/3/2019 at 6:06 PM, Treva said:
  • Say no.  Leave on your own schedule.  Be rude and get on with it.

 

I need to do this more.

 

Good challenge!  And Toph! <3

 

On 2/3/2019 at 10:13 PM, ChrisWithaStick said:

 

Otherwise - very clear goals and rules.  Regarding "be rude and get on with it" - I've been finding lately it's helpful to think in terms of setting expectations - both yours (which your challenge clearly does), and those of people around you.  You're getting people trained to expect to interact with you within your designated schedule or according to other needs.

 

Thirding this suggestion.  Again, things I need to do more.

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On 2/3/2019 at 10:13 PM, ChrisWithaStick said:

I recognize all the words, but this makes absolutely no sense to me.  None what so ever.  Are you feeling ok?  Is this code? 

You know I love that this was your reaction.  It makes me feel warm and fuzzy inside.  Coffee has been upsetting my stomach lately, and it's been interfering with me getting a good night's rest.  I've been sticking to caffeinated tea for now, and aside from totally missing how to calculate something I didn't know I could calculate at work, I've been able to stay on the ball.  

 

On 2/3/2019 at 10:13 PM, ChrisWithaStick said:

Otherwise - very clear goals and rules.  Regarding "be rude and get on with it" - I've been finding lately it's helpful to think in terms of setting expectations - both yours (which your challenge clearly does), and those of people around you.  You're getting people trained to expect to interact with you within your designated schedule or according to other needs.

 

It puts a spin of politeness on top of taking care of your own time. Things like "I'm so sorry, I can't meet right now.  I'd be happy to schedule time with you later though" have been incredibly helpful for me, along with then setting a time to talk/meet/whatever.  It's something I'm working with more and more, and again, it's been pretty darn helpful.

THIS IS SO HELPFUL THANK YOU.  I may borrow that phrase, in an effort to be less rude.  

 

On 2/5/2019 at 12:38 PM, Mistr said:

 

 

@ChrisWithaStick has some good suggestions. Dumbledore has been struggling with the same issue. He is working on saying "This has been great, but I need to go. Would you like to get together again latter?". No one is going to be surprised when a doctor is busy and has to go do other things.

O.O  

Oh.  Right.  People do assume doctors are busy people.  I forget that.  I got so used to "make time for meeeeeeeeee" that I didn't realize most normal humans recognize that doctors are on call and stuff.

 

15 hours ago, RisenPhoenix said:

Good challenge!  And Toph! <3

Thanks!!! Toph is an inspiration

 

 

Okay!  End of week 1!!!

giphy.gif

Diet:

Did not eat sads: 5/6

Healthy lunch: 6/6

No coffee: 6/6

 

Exercise: 

KB: 5/6

Strength: 4/6

Cardio: 3/6

 

Music:

Rehearsal: 1/1

Practice:  4/6

Read: 0/6

 

Personal

Don't panic: 4/6

Say no: 6/6

You are worth it: 6/6

 

Gestalt Grade: Pretty good

 

 

Relevant Emotional Regulation developments

2/4 In lecture on how to give presentations, teacher asks "how many of you would feel comfortable giving a lecture in front of ten thousand people"? and I'm like OF COURSE I am fine with this, I've fallen on my face on live television.  oh.  Wait.  Don't say that treva, your experience is not shared and no one will like you for being a smartass.

2/5 Entry reads: Really like crit care.  badness.  No.  Practicing so important.  YIKES

2/7-2/10 did not panic and text people when afraid they were mad at me.  Waited it out and sent short concise non-charged messages instead

This week's Learning Point: I get mad at myself for not knowing things, and try to compensate by saying more words.  Also, feeling overwhelmed by numbers is a thing that happens to me.  So much data, no idea how to analyze it.

 

I've planned today to do some practicing, go to the gym, and polish off meal prep tonight.

First week on Shock Trauma Crit Care: AMAZING.  I feel so at home.   This is medicine As Freakin Advertised, and What I Thought Being a Doctor was All About.  It's complicated and confusing and I have to know my bleep (which I do not but am working on, because I didn't know what precedex was until monday), and my boss is great and hilarious and my fellows are Genuinely My People and I have to Stop Being So Excited so I can Function and Not Be Annoying.

Also, my brain is finally no longer on fire.  Instead of having a section devoted to Constant Panic, it has been converted to screaming "F*** that noise" to anyone who told me not to go into critical care medicine.

tenor.gif

 

 

I know I need to see how the month goes, and if I can manage the schedule and be okay with everything.  I'm giving myself 7-9 months to decide if I want to go into this professionally, but personally I just want to never leave the unit.  I think the biggest challenge for me is having the right knowledge to recognize what's going on with my patients, and the confidence to tell my team what I think we should do. 

I'm afraid I'd be too dumb to go into critical care medicine.  My fellows assured me that the reason why I don't know the things they do is that people do residencies and fellowships to learn how to do the medicine.  I'm just mad at myself because I should be able to recognize a freaking metabolic alkalosis, but I didn't, because I'm an idiot.  But aside from not knowing drugs, and not freaking understanding electrolytes, or, you know, medicine, I guess I'm okay.  

 

Otherwise, accurate depiction of me on the unit:

source.gif

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On 2/10/2019 at 9:03 AM, Treva said:

Relevant Emotional Regulation developments

2/4 In lecture on how to give presentations, teacher asks "how many of you would feel comfortable giving a lecture in front of ten thousand people"? and I'm like OF COURSE I am fine with this, I've fallen on my face on live television.  oh.  Wait.  Don't say that treva, your experience is not shared and no one will like you for being a smartass.

 

Bonus points for recognizing a trap and avoiding it.

 

On 2/10/2019 at 9:03 AM, Treva said:

First week on Shock Trauma Crit Care: AMAZING.  I feel so at home.   This is medicine As Freakin Advertised, and What I Thought Being a Doctor was All About.  It's complicated and confusing and I have to know my bleep (which I do not but am working on, because I didn't know what precedex was until monday), and my boss is great and hilarious and my fellows are Genuinely My People and I have to Stop Being So Excited so I can Function and Not Be Annoying.

Also, my brain is finally no longer on fire.  Instead of having a section devoted to Constant Panic, it has been converted to screaming "F*** that noise" to anyone who told me not to go into critical care medicine.

 

I know I need to see how the month goes, and if I can manage the schedule and be okay with everything.  I'm giving myself 7-9 months to decide if I want to go into this professionally, but personally I just want to never leave the unit.  I think the biggest challenge for me is having the right knowledge to recognize what's going on with my patients, and the confidence to tell my team what I think we should do. 

I'm afraid I'd be too dumb to go into critical care medicine.  My fellows assured me that the reason why I don't know the things they do is that people do residencies and fellowships to learn how to do the medicine.  I'm just mad at myself because I should be able to recognize a freaking metabolic alkalosis, but I didn't, because I'm an idiot.  But aside from not knowing drugs, and not freaking understanding electrolytes, or, you know, medicine, I guess I'm okay.  

 

How many times have you actually seen a human with metabolic alkalosis before?

 

You have to see it at least once to have any chance at all of recognizing it. Learning that such a condition exists is a completely different thing. Helpful, no doubt, but not sufficient. Your fellows are right. Learning these things is the whole point of doing rotations and residencies. You can take full advantage of your current status to ask ALL THE QUESTIONS. They expect you to not know anything. No one is going to think less of you for it. In fact, asking questions shows that you want to learn. Just pick the appropriate moment when they have the time to answer.

 

Yay for finding your people!

 

I suspect that the main criteria for critical care staff is not freaking out. Most people cannot handle the stress of dealing with other people in dire situations for hours on end. If you can do that, all the other stuff will come with practice.

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On 2/11/2019 at 2:33 PM, Mistr said:

 

How many times have you actually seen a human with metabolic alkalosis before?

 

You have to see it at least once to have any chance at all of recognizing it. Learning that such a condition exists is a completely different thing. Helpful, no doubt, but not sufficient. Your fellows are right. Learning these things is the whole point of doing rotations and residencies. You can take full advantage of your current status to ask ALL THE QUESTIONS. They expect you to not know anything. No one is going to think less of you for it. In fact, asking questions shows that you want to learn. Just pick the appropriate moment when they have the time to answer.

 

On 2/11/2019 at 7:59 PM, ChrisWithaStick said:

^^^^ What @Mistr wrote.  ^^^^ 

 

Mastering any complex applied science (or any applied subject, really) takes time, practice, and lots of study. 

 

 

On 2/13/2019 at 6:54 PM, Kishi said:

Thirding @Mistr.

 

On 2/14/2019 at 12:16 PM, RisenPhoenix said:

Seconding Chris and Kishi!

 

*sigh* thaaanks guys.  That's very generous of you and I appreciate it.  I probably haven't seen it much before, purely because...uh, well.  We don't routinely get people's pH levels, and it's really hard to tell if someone is acidotic or alkalotic without a pH level.  This is good advice.  I have started saying in quiet moments "hey, do you have time to answer this question?"  Which has been okay so far.  It is still hard to know when good moments are because the team is always so busy.  But I'm studying lots--I make up little cheat sheets to bring with me to work--and I'm reviewing my notes and old presentations.  You're right.  It's a lot of practice and work, and I forget that I'm still new and the youngest member on the team, so my plans are going to be the least complicated.

 

That said, my team is not happy I am leaving, because they have said this is the essence of how they feel about me re: getting tasks done.  

tumblr_m9nerhrF2x1qb0pjao8_400.gif

I did things and was credit to team and got stuff done.  it was nice.  

 

YONKERS IT HAS BEEN A WEEK

Diet

Did not eat sads: 5/7

Healthy Lunch: 6/7

Don't drink the Coffee: 7/7

I think this one is the easiest to manage.  For Sads, I've been so engaged and busy at work that I don't really feel sad, or when bad things happen I just make sure I don't eat the junk food at home.  I found a fun healthy lunch that I like (Salad + Roast beef + blue cheese and cream cheese + craisins), and all the people at work have provided positive reinforcement of "YOU MADE THAT? It look so gourmet."  

Also all I have to do is brew my fancy tea in the morning and I feel great.  Also positively reinforced by both one of my attendings and one of my fellows also only drinking tea.

 

6k9TiHa.gif

 

Exercise:

KB: 4/7

Str: 4/7

Cardio: 4/7

So I realized either intentionally or unintentionally, I'm not doing any combat.  Which is weird.  I think before I was trying to force myself to do it to prove something to myself (Find a martial art!  Be a badass!  Make them know you are a badass!  No one will *bleep* with you if you have a freakin sword).  Now I want to do it because it is fun exercise.  Also sticking people with the pointy end.  I will let this one come naturally as the month goes on, and also FENCING SOON.

I also realized that I come home wiped out and no time for anything else if I do KB AND Strength training AND cardio all in one day.  I was late to doing things with my brother, and any time my work interferes with my family time is when I do a reset.  I might do the following thing:

Alpha Day: KB+10 pushups+1 set baby pull ups+swings+ 1 set ballet of choice+cardio

Beta Day: KB+ Strength Day (Traditional A, B, C)

Gamma Day: ALL THE THINGS

Alternating alpha and beta days, with the occasional gamma day thrown in for fun/when I'm off and have NO THINGS.

 

Music:

Rehearsal: 0/1 (not me, missing people)

Practice: 2/7

Read: 0/2

Not practicing because SO Much Gym Time.  Reassessing as above.

 

Personal:

Don't panic: 4/7

Say No: 6/7

You are worth it: 5/7

Some of the biggest progress I made at work this week was when we had crises on the floor, I found ways I could help and things I could do.  After trialing my first 28 hr shift (for fun and education), I also came up with a new system for organizing (and saving) my to do lists and my handoffs.  The traditional note we have in the computer actually has too much information on it for me to find it useful for tracking what happens to my patient. 

tumblr_ltpbv6v47l1r1nmpao1_r1_500.gif

At the end of my long shift my presentations were a disaster; I even forgot what we had talked about the morning before!  Keeping my daily to do lists and the handoffs with the more concise version of labs and imaging on it made it much easier for me to follow, keep track of, and present my patients yesterday.  I didn't have to run my plans with my resident, and my attending actually listened to me and took my suggestions.  I still didn't get to make all the decisions on medications and drips, but I felt really confident in my presenting, and could tell the team about the experimental medications I had researched.  Instead of desperately trying to "find another paper" on a patient, I was using their problems to spur further learning and look for better ways to help them.  Twice now an attending has said "If you were here longer, we'd have you research that", and I've been able to come back with "Actually, I did some research this morning/earlier this week, and here's what I found."

 

In long term life goals, the crit care unit has also been one of the only places where we regularly cite large research studies on rounds, and discuss their validity with regards to our patients.  It's really refreshing to be on a team that heavily incorporates accurate, cutting-edge information so we can provide the best care to our patients.  I really love how busy, engaging, and challenging the work is.    

 

atla_tophwhoiam.gif

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On 2/17/2019 at 9:27 AM, Treva said:

That said, my team is not happy I am leaving, because they have said this is the essence of how they feel about me re: getting tasks done.  

tumblr_m9nerhrF2x1qb0pjao8_400.gif

I did things and was credit to team and got stuff done.  it was nice.  

 

Yay! That is great feedback. :D 

 

On 2/17/2019 at 9:27 AM, Treva said:

Some of the biggest progress I made at work this week was when we had crises on the floor, I found ways I could help and things I could do.  After trialing my first 28 hr shift (for fun and education), I also came up with a new system for organizing (and saving) my to do lists and my handoffs.  The traditional note we have in the computer actually has too much information on it for me to find it useful for tracking what happens to my patient. 

 

At the end of my long shift my presentations were a disaster; I even forgot what we had talked about the morning before!  Keeping my daily to do lists and the handoffs with the more concise version of labs and imaging on it made it much easier for me to follow, keep track of, and present my patients yesterday.  I didn't have to run my plans with my resident, and my attending actually listened to me and took my suggestions.  I still didn't get to make all the decisions on medications and drips, but I felt really confident in my presenting, and could tell the team about the experimental medications I had researched.  Instead of desperately trying to "find another paper" on a patient, I was using their problems to spur further learning and look for better ways to help them.  Twice now an attending has said "If you were here longer, we'd have you research that", and I've been able to come back with "Actually, I did some research this morning/earlier this week, and here's what I found."

 

In long term life goals, the crit care unit has also been one of the only places where we regularly cite large research studies on rounds, and discuss their validity with regards to our patients.  It's really refreshing to be on a team that heavily incorporates accurate, cutting-edge information so we can provide the best care to our patients.  I really love how busy, engaging, and challenging the work is.    

 

Go Treva! You demonstrated learning behavior in how you deal with 28 hour shifts and track information.

 

Now you know where to find your people. I hope you can get a residency with them or a similar team at another institution.

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On ‎2‎/‎17‎/‎2019 at 10:27 AM, Treva said:

I think this one is the easiest to manage.  For Sads, I've been so engaged and busy at work that I don't really feel sad, or when bad things happen I just make sure I don't eat the junk food at home.  I found a fun healthy lunch that I like (Salad + Roast beef + blue cheese and cream cheese + craisins), and all the people at work have provided positive reinforcement of "YOU MADE THAT? It look so gourmet."  

 

I have to admit, that does sound really good.

 

On ‎2‎/‎17‎/‎2019 at 10:27 AM, Treva said:

I also realized that I come home wiped out and no time for anything else if I do KB AND Strength training AND cardio all in one day.  I was late to doing things with my brother, and any time my work interferes with my family time is when I do a reset.  I might do the following thing:

Alpha Day: KB+10 pushups+1 set baby pull ups+swings+ 1 set ballet of choice+cardio

Beta Day: KB+ Strength Day (Traditional A, B, C)

Gamma Day: ALL THE THINGS

Alternating alpha and beta days, with the occasional gamma day thrown in for fun/when I'm off and have NO THINGS.

 

Good for you. It's wise to rebuild things from time to time as necessary. Hopefully the new routine lets you stay with your family and let you get the results you want. And fencing in the future!

 

On ‎2‎/‎17‎/‎2019 at 10:27 AM, Treva said:

At the end of my long shift my presentations were a disaster; I even forgot what we had talked about the morning before!

 

After 28 hours awake? Yeah. I don't think anyone would do well presenting with complicated medical info. Presentation in general is complicated enough with full night's sleep!

 

On ‎2‎/‎17‎/‎2019 at 10:27 AM, Treva said:

Keeping my daily to do lists and the handoffs with the more concise version of labs and imaging on it made it much easier for me to follow, keep track of, and present my patients yesterday.  I didn't have to run my plans with my resident, and my attending actually listened to me and took my suggestions.  I still didn't get to make all the decisions on medications and drips, but I felt really confident in my presenting, and could tell the team about the experimental medications I had researched.  Instead of desperately trying to "find another paper" on a patient, I was using their problems to spur further learning and look for better ways to help them.  Twice now an attending has said "If you were here longer, we'd have you research that", and I've been able to come back with "Actually, I did some research this morning/earlier this week, and here's what I found."

 

In long term life goals, the crit care unit has also been one of the only places where we regularly cite large research studies on rounds, and discuss their validity with regards to our patients.  It's really refreshing to be on a team that heavily incorporates accurate, cutting-edge information so we can provide the best care to our patients.  I really love how busy, engaging, and challenging the work is.

 

Yeah. This sounds like a good place to be. I guess you do have to keep going on your rotations and such, but it's always good to find an area of practice that you like. Hopefully you get to come back, unless an opportunity for the Dream Practice comes along.

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