Is there time to use the restroom during 3rd year?

[Spinach Dip]

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What if we need some water to stay hydrated? Do we get NG tubes?

What if we need to breathe? Should we all have tracheostomies?

 

[Law2Doc]

What if we need some water to stay hydrated? Do we get NG tubes?

What if we need to breathe? Should we all have tracheostomies?

Well running IV fluid into yourself is something I actually have seen done in residency, generally in the setting of illness on call. An NG tube is not an efficient way to hydrate yourself.

 

[dr zaius]

Well running IV fluid into yourself is something I actually have seen done in residency, generally in the setting of illness on call. An NG tube is not an efficient way to hydrate yourself.

I was working in the peds ED a few weeks ago and one of the residents had a bit of gastroenteritis. She wheeled around her IV pole from patient to patient.

 

[Spinach Dip]

So a resident with an IV pole is "normal", but one with a catheter hidden under their clothes is a "maniac"?

😕

 

[WhovianDO]

I was working in the peds ED a few weeks ago and one of the residents had a bit of gastroenteritis. She wheeled around her IV pole from patient to patient.

I'd wonder why my Dr. was working with an IV. :-/

 

[MilkmanAl]

Interns don't do 30 hour calls anymore, so relax. But I was talking about around 10-11 hours before you come up for air, food, bathroom, which can happen once in a while.

I honestly haven't had that issue. I've been massively busy with frequent codes simultaneously and/or back-to-back, admissions, other people trying to die or assault their nurses, nurses who page when their patient exhales too hard, etc., but there's always time for a bathroom break. You might feel like you don't have time to stop and pee, but you definitely do if you make it. There aren't people coding literally all day or all night, and even if there are, chances are you're not going to be inextricably involved in all of them.

 

[dr zaius]

I'd wonder why my Dr. was working with an IV. :-/

It's a bad idea to work when you're sick, but if there is no one to cover for you then I guess you have no choice.

What's your opinion on the issue, law2doc?

 

[Stellar Clouds]

So a resident with an IV pole is "normal", but one with a catheter hidden under their clothes is a "maniac"?

😕

Haha...you are finally starting to understand

 

[113]

What if you have to take a dump, and you take long dumps?

How long are we talking? You should get more fiber in your diet.

 

[HughMyron]

or you could cut down on the caffeine usage...it's kind of like an asthmatic continuing to smoke, and then complaining about the shortness of breath.

Then what do you use to stay awake if not caffeine?

 

[Law2Doc]

...There aren't people coding literally all day or all night, and even if there are, chances are you're not going to be inextricably involved in all of them.

Chances, schmances. It happens.

 

[Law2Doc]

So a resident with an IV pole is "normal", but one with a catheter hidden under their clothes is a "maniac"?

😕

You won't get a UTI from a peripheral IV.

 

[KnuxNole]

Chances, schmances. It happens.

Thankfully, if they are on different floors, it's easy to take a few seconds to tinkle before running to the next code. Or tell them "I'm coming in a minute", and take a quick run to the restroom before having to do CPR. Unless they have unrealistic expectations and expect instant transmission when they page you 😱

 

[Law2Doc]

It's a bad idea to work when you're sick, but if there is no one to cover for you then I guess you have no choice.

What's your opinion on the issue, law2doc?

In very lean running residencies you wont always be able to get coverage on short notice because there simply aren't enough spare bodies and someone is going to run afoul of duty hour rules. And there will be times when you are, say, 5 hours into a night shift before you realize you are ill, and by then theres really no way to get reinforcements and you just need to muscle through. And finally (and least popular a concept on SDN, but true nonetheless) there are certainly some specialties where the culture is that you simply show up if you aren't totally incapacitated (ie dead, comatose, etc).

 

[Law2Doc]

Thankfully, if they are on different floors, it's easy to take a few seconds to tinkle before running to the next code. Or tell them "I'm coming in a minute", and take a quick run to the restroom before having to do CPR. Unless they have unrealistic expectations and expect instant transmission when they page you 😱

You won't even remember you have to urinate when someone is calling you to a code and the adrenaline is pumping. My whole point is you do what you have to and by the time you come up for air you realize "gee it's been like 10 hours since I hit the rest room or ate anything".

 

[45408]

Hate to break it to you but there will absolutely be nights during intern year where multiple codes occur and your pager never stops going off and all your patients are trying to die on you and when you actually come up for air you realize it's been about 10 hours since you urinated, ate, etc. It's not an everyday thing, but it would be a lie to suggest it doesn't occur. Has nothing to do with inefficiency (actually the oppisite-- if you were inefficient more of the plates you are keeping spinning would have crashed and broken much quicker.)

There's a huge difference between realizing you haven't gone all day and trying to hold it in all day. I've never had to hold it in all day, and I'm over halfway done with a surgery residency.

I know some people who definitely minimize their hydration, salt intake, caffeine, etc, on days they are likely to get pulled into long cases.

I literally do this every day. I don't drink soda unless I know I'm not going to be doing any cases for a few hours, and I don't drink coffee. Drink milk. You can hold that indefinitely, and the fat/protein keeps you going longer. I went ~6 hours yesterday without even getting thirsty or having to go to the bathroom. I eventually scrubbed out when there was a break in the action, but I didn't need to.

Chances, schmances. It happens.

I can walk out of a code and take a leak if I need to. It's not like there aren't another dozen people in the room anyway. The last time I was at a code, we had the code team (ED physician and medicine resident, along with a handful of nurses, CRNAs, techs, blah blah blah), myself, a surgery chief resident, and a staff surgeon.

 

[StereoSanctity]

Fair, but waht about people have a UTI or cystitis or, bowel issues not well-controlled by meds? Should that bar people form being drs?

For anyone who's legitimately worried about this (or similar) conditions - this is what your school's Technical Standards / Accommodations Committee is for!

Step 1: You jump through the hoops with your University's ADA Office (here, this involves getting your doctor to fill out some forms and sending them to the office).
Step 2: The University ADA Office makes a recommendation (example: We recommend that Student X be allowed frequent restroom breaks).
Step 3: The medical school's Accommodations Committee determines if the proposed accommodations are reasonable, if so, they're approved.

This gives you a vaguely worded letter to give to the relevant people (Course Directors, Attendings, etc) that says something like "Student X is allowed to take frequent restroom breaks due to a disability". At least at our school, the diagnosis is never revealed, and they won't/can't fail you for stepping out to pee (as long as you've given the letter to the appropriate people before it becomes an issue).

Source: I'm on my school's Technical Standards Advisory Committee.

 

[113]

For anyone who's legitimately worried about this (or similar) conditions - this is what your school's Technical Standards / Accommodations Committee is for!

Step 1: You jump through the hoops with your University's ADA Office (here, this involves getting your doctor to fill out some forms and sending them to the office).
Step 2: The University ADA Office makes a recommendation (example: We recommend that Student X be allowed frequent restroom breaks).
Step 3: The medical school's Accommodations Committee determines if the proposed accommodations are reasonable, if so, they're approved.

This gives you a vaguely worded letter to give to the relevant people (Course Directors, Attendings, etc) that says something like "Student X is allowed to take frequent restroom breaks due to a disability". At least at our school, the diagnosis is never revealed, and they won't/can't fail you for stepping out to pee (as long as you've given the letter to the appropriate people before it becomes an issue).

Source: I'm on my school's Technical Standards Advisory Committee.

No one will laugh at you behind your back for having an official peepee note. Nope. No one.


Sent from my Nexus 7 using Tapatalk HD

 

[FirefighterDoc]

I was working in the peds ED a few weeks ago and one of the residents had a bit of gastroenteritis. She wheeled around her IV pole from patient to patient.

Ive done this one before and seen this one done before in the ED by a doc. In both instances we both just hep-locked it while seeing patients. Doc hid it with his white(grey)coat and i hid it with my employee jacket. It happens





Speaking of the grey coat, has anyone started adopting this at schools? Last two places I worked, the docs wore grey and then light blue coats. I understand why seeing as how everybody and their mother wears a white lab coat now. Just wondering if all the white coat ceremonies still distribute "white" coats.

 

[calvnandhobbs68]

Ive done this one before and seen this one done before in the ED by a doc. In both instances we both just hep-locked it while seeing patients. Doc hid it with his white(grey)coat and i hid it with my employee jacket. It happens





Speaking of the grey coat, has anyone started adopting this at schools? Last two places I worked, the docs wore grey and then light blue coats. I understand why seeing as how everybody and their mother wears a white lab coat now. Just wondering if all the white coat ceremonies still distribute "white" coats.

Soo you couldn't just call in sick as an ER tech...you decided to hook yourself up to an IV instead?

 

[Spinach Dip]

This thread has confused and terrified me so much....

 

[fluoropHore]

Soo you couldn't just call in sick as an ER tech...you decided to hook yourself up to an IV instead?

It's attitudes/culture like that that scare me away from being a dr. a lot of people have invisible disabilities (or temporary illnesses) that sometimes hamper giving good care. how is this acceptable? is the ultimate irony that the workers on the forefront of sickness and disease not get to take care of themselves when they get sick?

 

[D elegans]

It's attitudes/culture like that that scare me away from being a dr. a lot of people have invisible disabilities (or temporary illnesses) that sometimes hamper giving good care. how is this acceptable? is the ultimate irony that the workers on the forefront of sickness and disease not get to take care of themselves when they get sick?

Yup

 

[GalenAgas]

Colostomy.

I swear to god I'll do it....

I'll make a "Is there time to change your colostomy bag during 3rd year" thread

 

[kexy]

I have heard stories about male surgeons wearing condom catheters... Kind of wish there were a female equivalent.

 

[FirefighterDoc]

I have heard stories about male surgeons wearing condom catheters... Kind of wish there were a female equivalent.

Ill have to remember that one. Good ol' Texas cath 👍

 

[FirefighterDoc]

Soo you couldn't just call in sick as an ER tech...you decided to hook yourself up to an IV instead?

Long story, no I wasnt sick. Doc was though and was getting fluids when not seeing patients.

 

[sevenmints]

What if you have to take a dump, and you take long dumps?

Lol DRE.

 

[Arbor Vitae]

What if you have to take a dump, and you take long dumps?

You let a little out when you can and pinch that **** off and get back to work.

 

[p30doc]

No you have to hold it until fourth year.

 

[deleted92121]

Did a transfer once from Pittsburgh to DC with a vent patient in the middle of rush hour on the beltway. Stopped at a restaurant for food and bathroom break. Took ten minutes to accomplish said tasks. Make time.

 

[Dral]

My school gave us the choice of either restroom or eating privileges during third year. I chose restroom. Not eating guarantees no number 2, so less restroom time. win-win.

Several of my evals commented on how they were overly impressed with how little I used the restroom and how efficient I was when I did have to use it. I think I honored a few rotations because of that.

 

[JGimpel]

My school gave us the choice of either restroom or eating privileges during third year. I chose restroom. Not eating guarantees no number 2, so less restroom time. win-win.

Several of my evals commented on how they were overly impressed with how little I used the restroom and how efficient I was when I did have to use it. I think I honored a few rotations because of that.

That sounds like a smart way to plan things.

Time it so you're using the restroom and eating when your attending is and you should be fine. I knew I had a Whipple as the first surgery of the day, so I got everything out of the way at home, then again after I changed into my scrubs and didn't have any problems during the 7 hours of surgery (salvage surgery for pancreatic CA with lot's of mets) that followed. If you've got a partner in rotations, take turns at who will be scrubbing in next and plan on that time to grab a quick PB and cracker snack or hit the restroom when you're not scrubbed in.

The staff in the clinic/OR is keeping an eye on your breaks even if your attending isn't and they do have input into your comments section of your eval.

 

[DrSnips]

If you've got a partner in rotations, take turns at who will be scrubbing in next and plan on that time to grab a quick PB and cracker snack or hit the restroom when you're not scrubbed in.

I remember trying that and the chief resident got pissed that we weren't in round the clock cases. The next day he signed me up for every single case from 7am - 6pm. Attendings were yelling at me for not having read up on cases I didn't even know I would be in. It was terrible.

 

[Law2Doc]

Attendings were yelling at me for not having read up on cases I didn't even know I would be in. It was terrible.

they will again in intern year too (regardless of the specialty you choose). Anticipating this kind of stuff so you seem borderline prepared is an art you will endlessly strive to develop.

 

[JGimpel]

I remember trying that and the chief resident got pissed that we weren't in round the clock cases. The next day he signed me up for every single case from 7am - 6pm. Attendings were yelling at me for not having read up on cases I didn't even know I would be in. It was terrible.

If you've got a toxic chief or attending, that's when things can get really difficult. I've had that happen to me too. Don't plan on breaking scrub at all for a break in this case, no matter how long the surgery takes. Learn who the anesthesia people are and how long between when they see the patient and when they take them back is and time your bathroom break in there if you've got dueling ORs for the same surgeon. Make sure that you're there to take the patient to the OR, stay with them for the entire surgery and bring them back to recovery, but sneak in breaks in any way possible.

 

[eject]

Regarding caffeine (and a desire to minimize fluid intake), has anyone ever tried this caffeine gum? I'm going to try it.

 

[Raryn]

Regarding caffeine (and a desire to minimize fluid intake), has anyone ever tried this caffeine gum? I'm going to try it.

I've used this one before. It's decent, and tastes like normal gum too.

 

[Wordead]

Regarding caffeine (and a desire to minimize fluid intake), has anyone ever tried this caffeine gum? I'm going to try it.

This reminded me of classmates that used to dip while they studied. They claimed it was better than coffee.

 

[Law2Doc]

Regarding caffeine (and a desire to minimize fluid intake), has anyone ever tried this caffeine gum? I'm going to try it.

This is a bad solution. You aren't needing to urinate just from the fluid in caffeinated beverages but from the diuretic properties of the caffeine itself. This, along with things like caffeine pills, only mean you will both have to urinate more and run a higher risk of dehydration if you minimize fluid intake.

 

[eject]

This is a bad solution. You aren't needing to urinate just from the fluid in caffeinated beverages but from the diuretic properties of the caffeine itself. This, along with things like caffeine pills, only mean you will both have to urinate more and run a higher risk of dehydration if you minimize fluid intake.

I don't have time to really look into it, but there is apparently some doubt about the extent of the diuretic effect of caffeine among habitual users. Who knows. But all things being equal (that is, assuming some diuretic effect of an equivalent dose of caffeine), my hunch is that I'd be peeing less with gum than an 8 oz coffee. I will run some tests. 🙂

 

[ophthope]

Found a picture of Law2Doc:

they will again in intern year too (regardless of the specialty you choose). Anticipating this kind of stuff so you seem borderline prepared is an art you will endlessly strive to develop.

What if we need some water to stay hydrated? Do we get NG tubes?

What if we need to breathe? Should we all have tracheostomies?

Seriously though, sometimes it's best to be prepared, sometimes it's best to just take things as they come. You can't predict when you'll have a horrible attending that expects you to do things that are literally impossible to accomplish given the number of hours in the day and physical limits of the human body.

Something that no one tells you is that medical school success during the clinical years requires mainly social engineering and risk mitigation skills. You just need the residents and attendings to like you, so do everything you can to show interest in what they do while staying out of their way or helping make their jobs easier. Mirror their personality a little - sarcastic, joking, dry, blunt, or whatever they're like so that they can feel more comfortable interacting with you. If you're doing that, they're probably not going rupture an aneurysm when you ask to go pee. And at the end of the day, if you're about to crap or pee yourself you're a freaking adult. Go pee, deal with angry scrub and circulating nurse by being especially vocally thankful, and move on. Don't spend time worrying about some absurd thing over which you have no control.

Well running IV fluid into yourself is something I actually have seen done in residency, generally in the setting of illness on call. An NG tube is not an efficient way to hydrate yourself.

I know sometimes Law2Doc seems like he is presenting the extremes, but it's not that crazy to get a bag of IV fluids at work. If you've got a decent case of gastroenteritis you'll feel better once you get that bag in you and you'll keep from getting dehydrated while you're NPO because you vomit every time you eat. To the outside world this may seem a little crazy but even when you're working with awesome people you find yourself in the situation of "well I could call Joe and I KNOW he would cover for me and say it's no big deal and he's happy to do it... but I could just run a liter of NS into my arm and feel good enough to finish this shift so I'm gonna try that first." It just seems crazy because at home you don't generally have access to IV NS, but at the hospital it's so easy to get.

 

[Siggy]

I was told to hold it the entire time. So depends up

Condom caths work better.

 

[Siggy]

Hate to break it to you but there will absolutely be nights during intern year where multiple codes occur and your pager never stops going off and all your patients are trying to die on you and when you actually come up for air you realize it's been about 10 hours since you urinated, ate, etc. It's not an everyday thing, but it would be a lie to suggest it doesn't occur. Has nothing to do with inefficiency (actually the oppisite-- if you were inefficient more of the plates you are keeping spinning would have crashed and broken much quicker.)

There's a big difference between holding it in and being so busy that you never realize in the first place that you've just spent 12 hours without visiting the facilities. As an OMS3, I've never not had an extra minute to go to the restroom when I felt I had to go. That doesn't mean that there were equally similar days that things went to heck and once everything calmed down I was like, "Hmm... time to hit the head... wait... has it really been 7 hours since the last time I used the facilities?"

 

[Siggy]

(if we can get a chuckle here to think that the student was "needed" in the OR )

The student is very very important in surgery.

By the end of the general surgery rotation, the 3rd year medical student shall master all of the following skills.

1. Cutting suture lengths to too long or too short.
2. Suctioning bovie smoke.
3. Adjusting the lights proactively, just not too proactively.
4. Acting as a whipping post for any slight or problem, regardless of how minor or the culpability of the student. The attending's iPhone played the same song twice on random? That's the medical student's fault.

 

[Law2Doc]

There's a big difference between holding it in and being so busy that you never realize in the first place that you've just spent 12 hours without visiting the facilities..."

absolutely there's a difference. A mental component. But since the question was whether you would always have time for pretty regular bathroom breaks, I stand by my statement.

 

[Law2Doc]

Condom caths work better.

Actually whether or not they leak is very size dependent.

 

[Stellar Clouds]

The student is very very important in surgery.

By the end of the general surgery rotation, the 3rd year medical student shall master all of the following skills.

1. Cutting suture lengths to too long or too short.
2. Suctioning bovie smoke.
3. Adjusting the lights proactively, just not too proactively.
4. Acting as a whipping post for any slight or problem, regardless of how minor or the culpability of the student. The attending's iPhone played the same song twice on random? That's the medical student's fault.

+1

 

[ArcGurren]

The student is very very important in surgery.

By the end of the general surgery rotation, the 3rd year medical student shall master all of the following skills.

1. Cutting suture lengths to too long or too short.
2. Suctioning bovie smoke.
3. Adjusting the lights proactively, just not too proactively.
4. Acting as a whipping post for any slight or problem, regardless of how minor or the culpability of the student. The attending's iPhone played the same song twice on random? That's the medical student's fault.

Don't forget hours and hours of retracting fat. That's always an *essential* task that requires a medical student in the room.

I'm not sure whether people in this thread are serious or not (obviously the posts about sticking in a foley aren't, but still). I have never, *ever* been told by my residents or attendings that I'm not allowed to go to the bathroom, and the vast majority of my evals have been pretty good. The most that's happened as a result is the scrub tech getting a little annoyed at me on surgery for having to rescrub - which I was able to do on my own without much of his/her help.

Seriously people, if you have to pee, go and goddamn pee. It's better than wetting your pants during a surgery or on rounds.

 

[Siggy]

absolutely there's a difference. A mental component. But since the question was whether you would always have time for pretty regular bathroom breaks, I stand by my statement.

You used to be a lawyer in a past life, right?

😀