I’m exhausted. The long nights with little sleep are catching up to me. Everyday I feel more and more like a doctor here. I feel more comfortable with crises and procedures here in the unit. Today I did my first procedure under fluoroscopic guidance. Fluoroscopy is like a continuous x-ray in real time. We had placed a central line that, instead of going into his heart, made a left turn at his neck and went up into his skull. Under the fluoroscopy machine, I set up a new central line kit, withdrew the catheter until I could see that it was no longer headed north, advanced a new guidewire and nudged, pushed and pulled until I saw teh wire flip around and head down towards his heart. Yahoo! It was so cool to see it happening w hile I was doing it. Most of the procedures that we do are done “blind” and you only find out after you order an x-ray if the tubes, lines and catheters are really where you wanted them to be. This one I knew for certain was in the correct spot, because I guided it in real time!

While I was finishing up the procedure, the cardiovascular surgeon came up to me and saw me dressed up in the lead suit with sterile gown & gloves on top, and the large videofluoroscopy equipment sitting in front of the room. It was right around 4 o’clock, when the evening staff comes on, and my upper level resident was down in the CT scanner with another patient, so I was doing the procedure by myself. All that fluoroscopy equipment looks pretty fancy and intimidating, so when the evening staff and the other attendings all stopped by to see what was going on in the room and saw me there handling everything by myself, I felt pretty good!