July Third Year:
I always knew my sister was a keeper. I idolized her from the start. There was the time when she slipped a diagram under our bedroom door, replete with a picture tutorial of how to escape my time-out via the bedroom windows. There was the time she let me ride bikes downtown with her to buy her latest pet and then let me take over care for said pet (hahaha!). There was the time she let me listen in to the recounting of her latest dating misadventures, even though I was only 12 but dying to be grown-up enough to hear . And there were the million other times she has screwed my head back on straight when I've started talking crazy. Growing up, I just wanted to be like her*. And now I just want to be with her, so it's a good thing we only live 20 minutes apart.
Yesterday we left our little ones in the capable hands of grandmas/nannies (with the exception of her nursing infant, who is so quiet, she doesn't really count) and headed out to Leesburg for the love of a good deal. We're both re-decorating right now, so we each had our wish list. And maybe it's the karma of sisters, but we both found just what we were looking for.
Somehow we managed to get it all into her mini-van (oh the wonder!):
We celebrated our spoils over lunch at Friday's. A sister knows that after you've both ordered your salads, and just as the server is walking away, it is the right thing to say, 'actually, can we get a side of fries with that?' Since I'd been thinking exactly the same thing, I added, 'with a side of ranch?' Perfection!
I could write a page long list about the things I love about my sister (beautiful! brilliant! spiritual! kind! funny! talented!), but as we talked, with the easiness and understanding that comes with a shared lifetime, blood and history, I realized that the heart of the matter is this:
God made sisters because He knew there would be things that only He and she could understand.
And I'm so grateful He gave me one. Cause Heaven knows I couldn't do it without her
Tuesday, November 2, 2010
Archives: Winding Down
April Third Year:
I can tell that the end of my official medicine training road is drawing near.
Nostalgia has always been my go-to emotion...never very far from the surface. Lately, though, it comes in more noticeable and frequent waves.
Last night, for example: I was the back-up call resident. In the last few months of residency, that is usually a blessed thing where you review ER patient's with the 2nd year resident on the phone but stay home unless someone is sick, sick, sick. It almost feels (oh happy day) like not being on call at all. Still, I had never made plans to do anything on a call night. You know how the cosmos can be.
This week I couldn't resist an invitation to join some of our friends for dinner at their home. I joked to Rockstar, "surely this will mean that things won't go as planned."
We walked into their lovely home, and immediately my cell phone went off. It was the 2nd year resident. She had two patient's to admit at one hospital and another waiting at the other hospital. The pager was exploding. She was freaking out. "I have never asked for help, but I am drowning...could you answer the phones for me?" Ha! Told you so. After thirty minutes spent trying to figure out why the pager system was malfunctioning, I was able to log in and start covering the messages for her.
My gracious host never batted an eye as I darted in and out of the dining room, and turned their lovely dinner party into a harried scene. The food, by the way, was divine.
As we were leaving their house, I checked in with the 2nd year again and discovered that 2 or 3 more admissions had come in to the hospital she was at. Panic was evident in her voice and her mind was showing signs of being lost entirely. I've had nights like that. I felt for her. "Just breathe, we'll get through this. I've got the phones covered. After I put the baby down, I'll head to the other hospital and take care of that admission." Palpable relief rushed through my earpiece as she sighed, "Thank you. so. much."
I got to the hospital late, during that hour when the ER is still crazy, but the rest of the halls are quiet. I actually love the hospital during that time. It is quiet, sacred and feels strangely like home. I should've known I'd end up as a doctor when hospitals ranked up with bookstores, libraries and The Disney Store as enjoyable places during my childhood.
I don't spend as much time at this particular hospital anymore. I'm there on occasion, but spend more time at another local hospital. It felt good to be back. Walking down a deserted hallway with only the clack of my shoes to fill the space, scenes from my time here popped up like TV episodes in my mind: surgeries assisted on, residents worked with, patients cared for. Emotions came rushing back: grumpy over-tiredeness, satisfaction, desperation, relief.
I should not feel nostalgic over thirty hour shifts, 80+ hour work weeks, and days that make you feel like your emotional, intellectual and physical reserves are being taxed completely. But somehow I do.
I walked down a corridor between the main hospital and the heart center. My white coat hung on my shoulders in the comfortable way that it has ever since it stopped feeling like a costume a few years ago. I smiled at the few families who were still in waiting rooms. They smiled back with that smile imbued with subtle gratitude. 'Thank you for being here and taking care of patients', it seems to say.
I found my patient. "Hi, I'm Dr. *," I began. Like so many times before. I finished up my work and then retraced my steps back to my car.
Why the nostalgia? I feel nostalgic over things that I know I'll never get back or experience in quite the same way again. I feel nostalgic over things that have meaning, over things that I'm grateful for and over things that have shaped my person. And becoming a doctor has done nothing if not shaped me into something new, and hopefully, better.
I feel nostalgic because my training reminds me how much joy is found in unexpected places, including at the end of any given rope. I feel nostalgic because the hard was worth the good, and I would never have guessed that. I feel nostalgic because I've built relationships that can only be built in the trenches. And I'll miss that bonding but not the fire. The fruits but not the labor. I'm grateful that it's done--that I did it--yet sad to see it go. Make sense? Still sorting through it, as you can probably tell.
All I really know is that I'm nearing a very big milestone, and it will be interesting to see where the road goes next.
Thanks for coming along for the ride. :)
I can tell that the end of my official medicine training road is drawing near.
Nostalgia has always been my go-to emotion...never very far from the surface. Lately, though, it comes in more noticeable and frequent waves.
Last night, for example: I was the back-up call resident. In the last few months of residency, that is usually a blessed thing where you review ER patient's with the 2nd year resident on the phone but stay home unless someone is sick, sick, sick. It almost feels (oh happy day) like not being on call at all. Still, I had never made plans to do anything on a call night. You know how the cosmos can be.
This week I couldn't resist an invitation to join some of our friends for dinner at their home. I joked to Rockstar, "surely this will mean that things won't go as planned."
We walked into their lovely home, and immediately my cell phone went off. It was the 2nd year resident. She had two patient's to admit at one hospital and another waiting at the other hospital. The pager was exploding. She was freaking out. "I have never asked for help, but I am drowning...could you answer the phones for me?" Ha! Told you so. After thirty minutes spent trying to figure out why the pager system was malfunctioning, I was able to log in and start covering the messages for her.
My gracious host never batted an eye as I darted in and out of the dining room, and turned their lovely dinner party into a harried scene. The food, by the way, was divine.
As we were leaving their house, I checked in with the 2nd year again and discovered that 2 or 3 more admissions had come in to the hospital she was at. Panic was evident in her voice and her mind was showing signs of being lost entirely. I've had nights like that. I felt for her. "Just breathe, we'll get through this. I've got the phones covered. After I put the baby down, I'll head to the other hospital and take care of that admission." Palpable relief rushed through my earpiece as she sighed, "Thank you. so. much."
I got to the hospital late, during that hour when the ER is still crazy, but the rest of the halls are quiet. I actually love the hospital during that time. It is quiet, sacred and feels strangely like home. I should've known I'd end up as a doctor when hospitals ranked up with bookstores, libraries and The Disney Store as enjoyable places during my childhood.
I don't spend as much time at this particular hospital anymore. I'm there on occasion, but spend more time at another local hospital. It felt good to be back. Walking down a deserted hallway with only the clack of my shoes to fill the space, scenes from my time here popped up like TV episodes in my mind: surgeries assisted on, residents worked with, patients cared for. Emotions came rushing back: grumpy over-tiredeness, satisfaction, desperation, relief.
I should not feel nostalgic over thirty hour shifts, 80+ hour work weeks, and days that make you feel like your emotional, intellectual and physical reserves are being taxed completely. But somehow I do.
I walked down a corridor between the main hospital and the heart center. My white coat hung on my shoulders in the comfortable way that it has ever since it stopped feeling like a costume a few years ago. I smiled at the few families who were still in waiting rooms. They smiled back with that smile imbued with subtle gratitude. 'Thank you for being here and taking care of patients', it seems to say.
I found my patient. "Hi, I'm Dr. *," I began. Like so many times before. I finished up my work and then retraced my steps back to my car.
Why the nostalgia? I feel nostalgic over things that I know I'll never get back or experience in quite the same way again. I feel nostalgic over things that have meaning, over things that I'm grateful for and over things that have shaped my person. And becoming a doctor has done nothing if not shaped me into something new, and hopefully, better.
I feel nostalgic because my training reminds me how much joy is found in unexpected places, including at the end of any given rope. I feel nostalgic because the hard was worth the good, and I would never have guessed that. I feel nostalgic because I've built relationships that can only be built in the trenches. And I'll miss that bonding but not the fire. The fruits but not the labor. I'm grateful that it's done--that I did it--yet sad to see it go. Make sense? Still sorting through it, as you can probably tell.
All I really know is that I'm nearing a very big milestone, and it will be interesting to see where the road goes next.
Thanks for coming along for the ride. :)
Archives: Pockets
June Third Year:
I know I've been quiet on here lately. With multiple major life transitions all converging on the month of June, I just gave myself permission to totally slack. In this respect, anyway.
It turns out that there are a myriad of i's to dot and t's to cross as residency comes to a close.
And it turns out that moving into a house (that we own!) takes a considerable amount of time and planning.
And it turns out that taking your last set of boards takes some effort.
And it turns out that I can still find time for 'So You Think You Can Dance.' Ha!
And with all the madness, I've been waiting for my thoughts to coalesce and make sense. Usually, I go about my day with thoughts swirling around. Suddenly, they come together in a flash-bang kind of way, and I go write them down. It hasn't happened recently.
So, yeah. I've been quiet.
But then the juices have started flowing as I've been sifting through the pieces of my life in the packing process. Oh the nostalgia!
Last night I finally decided to conquer my medical bags. Over the last several years, I have basically lived out of the pockets of my white coat. Trinkets, books, paper, drug company paraphanelia all weighed me down as I walked the halls of my hospitals. And every time I washed my coat, I would empty my pockets into a safeway bag. And when I put it all back, I usually selected only the important items to go back in. Which meant that I had scads of bags full of old medical junk/treasures. And I couldn't quite throw it all away. So I ended up with something like this:
And sorting through it proved an interesting walk down my medical lane.
I found this:
My very first pager from med school. It looks so old school, now, seeing as it is not a text pager. But it was my first one...the one which seemed impossibly cool at first blush...only to seem impossibly unbearable a thousand midnight interruptions later. It woke me up for transplants and sick babies and ER admissions. It introduced me to medical life. It sat on my hip through my first two years of life-changing, oft-terrifying, humbling hospital training. And now it sits unceremoniously among trinkets, like it never did anything very important at all. Dear Pager: I won't ever forget you.
And I found this:
I could still have free lunch at a hospital! But the thought of eating the same foods I lived on as an intern, appeals to me less than free food. And that's saying something.
This:
Cause even tired doctor's need sassy lipgloss?
And a way to make sure there's no lettuce in your teeth? Heaven knows every other bit of vanity goes straight out the window.
This:
My on-call notes. I have so many of these pages! Sometime illegible scrawlings with phone numbers to call back, symptoms to evaluate, and sometimes angry remarks at the unfairness of the on-call universe. This is practically my journal! My record of my labor! How do I throw this all away? (Don't worry, Mom, I did.)
This:
Parking passes for garages I'll never visit again.
This:
A list of vital signs looked up for our census of patient's during my surgical 'Acting Internship.' These were hard-won vitals signs, as I had to arise at 4-something to gather them. Isn't that worth something? This piece of paper is not a piece of paper. It is a badge of honor
This:
My notebooks of 'beginners pearls'. Little notes about important things I might want to remember. Tips from those who'd gone before. My first attempts to keep track of the seemingly endless line of facts to be learned. I think I'll want these when I'm 90.
This:
Cards of questions I'd written down...things to look up at a later date. And how amazing! I know all these answers now. In fact, they seem like second nature. So I think: I guess I'm really a doctor. Those index cards show me how far I've come.
And finally, this:
Okay, so she wasn't in a Safeway bag, but how lucky am I to have picked up this treasure during my medical training? I never dreamed I'd graduate Residency with the most joyful little girl at my side. And it was the greatest gift of all.
So here we are.
11 days from the end.
11 day from the beginning.
I know I've been quiet on here lately. With multiple major life transitions all converging on the month of June, I just gave myself permission to totally slack. In this respect, anyway.
It turns out that there are a myriad of i's to dot and t's to cross as residency comes to a close.
And it turns out that moving into a house (that we own!) takes a considerable amount of time and planning.
And it turns out that taking your last set of boards takes some effort.
And it turns out that I can still find time for 'So You Think You Can Dance.' Ha!
And with all the madness, I've been waiting for my thoughts to coalesce and make sense. Usually, I go about my day with thoughts swirling around. Suddenly, they come together in a flash-bang kind of way, and I go write them down. It hasn't happened recently.
So, yeah. I've been quiet.
But then the juices have started flowing as I've been sifting through the pieces of my life in the packing process. Oh the nostalgia!
Last night I finally decided to conquer my medical bags. Over the last several years, I have basically lived out of the pockets of my white coat. Trinkets, books, paper, drug company paraphanelia all weighed me down as I walked the halls of my hospitals. And every time I washed my coat, I would empty my pockets into a safeway bag. And when I put it all back, I usually selected only the important items to go back in. Which meant that I had scads of bags full of old medical junk/treasures. And I couldn't quite throw it all away. So I ended up with something like this:
And sorting through it proved an interesting walk down my medical lane.
I found this:
My very first pager from med school. It looks so old school, now, seeing as it is not a text pager. But it was my first one...the one which seemed impossibly cool at first blush...only to seem impossibly unbearable a thousand midnight interruptions later. It woke me up for transplants and sick babies and ER admissions. It introduced me to medical life. It sat on my hip through my first two years of life-changing, oft-terrifying, humbling hospital training. And now it sits unceremoniously among trinkets, like it never did anything very important at all. Dear Pager: I won't ever forget you.
And I found this:
I could still have free lunch at a hospital! But the thought of eating the same foods I lived on as an intern, appeals to me less than free food. And that's saying something.
This:
Cause even tired doctor's need sassy lipgloss?
And a way to make sure there's no lettuce in your teeth? Heaven knows every other bit of vanity goes straight out the window.
This:
My on-call notes. I have so many of these pages! Sometime illegible scrawlings with phone numbers to call back, symptoms to evaluate, and sometimes angry remarks at the unfairness of the on-call universe. This is practically my journal! My record of my labor! How do I throw this all away? (Don't worry, Mom, I did.)
This:
Parking passes for garages I'll never visit again.
This:
A list of vital signs looked up for our census of patient's during my surgical 'Acting Internship.' These were hard-won vitals signs, as I had to arise at 4-something to gather them. Isn't that worth something? This piece of paper is not a piece of paper. It is a badge of honor
This:
My notebooks of 'beginners pearls'. Little notes about important things I might want to remember. Tips from those who'd gone before. My first attempts to keep track of the seemingly endless line of facts to be learned. I think I'll want these when I'm 90.
This:
Cards of questions I'd written down...things to look up at a later date. And how amazing! I know all these answers now. In fact, they seem like second nature. So I think: I guess I'm really a doctor. Those index cards show me how far I've come.
And finally, this:
Okay, so she wasn't in a Safeway bag, but how lucky am I to have picked up this treasure during my medical training? I never dreamed I'd graduate Residency with the most joyful little girl at my side. And it was the greatest gift of all.
So here we are.
11 days from the end.
11 day from the beginning.
For Better or Worse
March Third Year:
I was on call last week during the snowstorm. We always work the afternoon/evening acute care clinic when we're on call, and, ostensibly because of the bad weather, the schedule was mercifully light. However, as we were preparing to pack-up, a mom and her 6 year old son (we'll call him Joe) walked into the office hoping to be seen. Joe had been snowboarding when his right under-eye area wound up on the wrong end of an encounter with a board edge. The half-moon gash wasn't deep but was wide enough to leave a permanent scar. Mom brought him in to find out if he needed stitches. Joe was terrified of this possibility.
I took a look and delivered the bad news, "There is going to be a much smaller scar if I put a few stitches in there to hold it together." Joe started crying. Mom looked distressed.
"Oh," she said, "I was hoping it wouldn't come to that. But I guess we'll do what we have to do." Her son was quivering at her side.
"I'll be right back after I get together my supplies."
Before I walked back in, my attending suggested I bring in the papoose, 'just in case'. The papoose is, um, sort of what it sounds like. You strap a kid to a backboard, and it allows you to do things (like stitch up their faces) that any self-respecting 6 year would normally kick/scream/yell/thrash around to keep you from doing.
I entered the room and set up my supplies. Mom picked up her purse. "I'll be in the waiting room."
And then she bailed.
?????
I was flabbergasted. Her terrified son was sitting on the exam table, looking at me like I was the firing squad. And he was alone. Now I had to be mommy and doctor. I sat next to him and smoothed his hair while he cried. "It's going to be okay, Joe. I promise you. The numbing medicine is going to sting a little, but then you won't feel anything."
I spent the next 30 minutes in a song and dance routine with Joe. I'd get close to his face with my needle. He'd bravely say it was okay. My needle got closer. He suddenly darted away. I'd comfort him. He'd say, 'okay, try again'. He'd change his mind. Tears kept flowing. I'd say 'maybe I should get out the papoose.' He'd somehow get brave again. Finally, the numbing medicine was in. And even though he was through with the worst, we went through the routine all over again when it came to sewing his wound closed. There was just the nurse and I during this time: comforting, talking, doctoring though we'd only known Joe for a matter of minutes.
I was so relieved when the stitches were finally in. I went and got mom. She also seemed relieved. She kept hugging her son and saying, "I need a hug!" And I'm thinking, 'Lady, your son needs the hug. You need something else entirely.'
In talking to my colleagues afterwards, I expressed dismay that she would leave her son alone during such a traumatic experience. My attending said, "Well, maybe she knew she would faint or something." Like it was no big deal.
But it is a big deal. I mean, I realize that sometimes we want parents out of the room. When we do spinal taps on babies, for example. It's easier for everyone. A baby has no idea what's going on and often looks at the parent with betrayal. "How could you let them do this to me?!"
Joe was not a baby. He was a 6 year old, fully aware of what he was about to experience. He, at such a young age, had to pull it together and get through a difficult experience. But his mom didn't? What message does that send to the child? "This is going to be so bad that I can't watch. But good luck with that!"
I don't know. I guess I just feel like it's part of the job description. As a parent, you have to be there for your kid when the going gets tough. You have to force yourself to do uncomfortable things. I had stitches when I was 12. My dad was there with me and it made all the difference. I remember burying my head into his shoulder and clenching his hand until it was through. I can't even imagine what it would have felt like if he'd bailed on me.
So, I pose the question to you dear readers: is it okay what that mom did? Is it okay to leave a child alone for a difficult procedure (and let's leave babies out, since I do think that's different)?
I think you know where I stand. ;)
I was on call last week during the snowstorm. We always work the afternoon/evening acute care clinic when we're on call, and, ostensibly because of the bad weather, the schedule was mercifully light. However, as we were preparing to pack-up, a mom and her 6 year old son (we'll call him Joe) walked into the office hoping to be seen. Joe had been snowboarding when his right under-eye area wound up on the wrong end of an encounter with a board edge. The half-moon gash wasn't deep but was wide enough to leave a permanent scar. Mom brought him in to find out if he needed stitches. Joe was terrified of this possibility.
I took a look and delivered the bad news, "There is going to be a much smaller scar if I put a few stitches in there to hold it together." Joe started crying. Mom looked distressed.
"Oh," she said, "I was hoping it wouldn't come to that. But I guess we'll do what we have to do." Her son was quivering at her side.
"I'll be right back after I get together my supplies."
Before I walked back in, my attending suggested I bring in the papoose, 'just in case'. The papoose is, um, sort of what it sounds like. You strap a kid to a backboard, and it allows you to do things (like stitch up their faces) that any self-respecting 6 year would normally kick/scream/yell/thrash around to keep you from doing.
I entered the room and set up my supplies. Mom picked up her purse. "I'll be in the waiting room."
And then she bailed.
?????
I was flabbergasted. Her terrified son was sitting on the exam table, looking at me like I was the firing squad. And he was alone. Now I had to be mommy and doctor. I sat next to him and smoothed his hair while he cried. "It's going to be okay, Joe. I promise you. The numbing medicine is going to sting a little, but then you won't feel anything."
I spent the next 30 minutes in a song and dance routine with Joe. I'd get close to his face with my needle. He'd bravely say it was okay. My needle got closer. He suddenly darted away. I'd comfort him. He'd say, 'okay, try again'. He'd change his mind. Tears kept flowing. I'd say 'maybe I should get out the papoose.' He'd somehow get brave again. Finally, the numbing medicine was in. And even though he was through with the worst, we went through the routine all over again when it came to sewing his wound closed. There was just the nurse and I during this time: comforting, talking, doctoring though we'd only known Joe for a matter of minutes.
I was so relieved when the stitches were finally in. I went and got mom. She also seemed relieved. She kept hugging her son and saying, "I need a hug!" And I'm thinking, 'Lady, your son needs the hug. You need something else entirely.'
In talking to my colleagues afterwards, I expressed dismay that she would leave her son alone during such a traumatic experience. My attending said, "Well, maybe she knew she would faint or something." Like it was no big deal.
But it is a big deal. I mean, I realize that sometimes we want parents out of the room. When we do spinal taps on babies, for example. It's easier for everyone. A baby has no idea what's going on and often looks at the parent with betrayal. "How could you let them do this to me?!"
Joe was not a baby. He was a 6 year old, fully aware of what he was about to experience. He, at such a young age, had to pull it together and get through a difficult experience. But his mom didn't? What message does that send to the child? "This is going to be so bad that I can't watch. But good luck with that!"
I don't know. I guess I just feel like it's part of the job description. As a parent, you have to be there for your kid when the going gets tough. You have to force yourself to do uncomfortable things. I had stitches when I was 12. My dad was there with me and it made all the difference. I remember burying my head into his shoulder and clenching his hand until it was through. I can't even imagine what it would have felt like if he'd bailed on me.
So, I pose the question to you dear readers: is it okay what that mom did? Is it okay to leave a child alone for a difficult procedure (and let's leave babies out, since I do think that's different)?
I think you know where I stand. ;)
Archives: The Boy Who Cried Wolf
February Third Year:
Among our practice, there are a group of patient's who we refer to as frequent fliers. They are folks who wind up in the ER on such a regular basis, that we all know them well. Some, unfortunately, have medical problems that are resistant to outpatient control. Despite their best efforts and ours, they just keep bouncing back.
Then there are the GOMERS. Aptly named by the book "House of God", a GOMER is a 'get out of my ER'. It doesn't sound very charitable, but believe me.
These are patient's who mix in a lot of crazy with a little bit of illness and know how to work the system. They usually come in with the same complaints that can't be objectively proven and are often attached to some secondary gain. When the ER calls us to say that 'miss cyclical vomiting syndrome' is back again, there is much eye rolling to be had. If anyone had ever seen her vomit, or had evidence that she was in need of anything except more narcotics, there wouldn't be such a reaction.
But I got to thinking today: It's a dangerous game, this letting ourselves roll our eyes at the patient's we've come to expect melodramatic reporting from.
I got a call on a patient of mine who was back in the ER with the same pain complaints she has always had. The ER is so tired of her coming in for this, that they barely even initiate a work-up before giving her massive doses of pain meds. I walked in to her room with a pre-conceived notion of what she would say and need. And, for the most part, I was right.
Except there was one new symptom that she brought up. Could be part of her previous syndrome, I thought. Could be something new. I stopped. 'What would I do if I'd never met her before? What would I order if I had no idea her history of coming back again and again with these symptoms?"
It changed my management. I'm not sure if anything will come of it, but it was a humbling moment. Usually continuity is the thing that makes good medicine tick. But every once in a while, the past only obscures our view of the present.
In our friendships, in our work relationships, in our families, we've all come to expect certain things from certain people. But sometimes, we need to let that go. We need to believe that people innately have the ability to surprise us, and leave our doors open to be receptive to that.
Because at some point, we're all going to be the one asking for belief and a chance. And we all deserve to be heard.
Among our practice, there are a group of patient's who we refer to as frequent fliers. They are folks who wind up in the ER on such a regular basis, that we all know them well. Some, unfortunately, have medical problems that are resistant to outpatient control. Despite their best efforts and ours, they just keep bouncing back.
Then there are the GOMERS. Aptly named by the book "House of God", a GOMER is a 'get out of my ER'. It doesn't sound very charitable, but believe me.
These are patient's who mix in a lot of crazy with a little bit of illness and know how to work the system. They usually come in with the same complaints that can't be objectively proven and are often attached to some secondary gain. When the ER calls us to say that 'miss cyclical vomiting syndrome' is back again, there is much eye rolling to be had. If anyone had ever seen her vomit, or had evidence that she was in need of anything except more narcotics, there wouldn't be such a reaction.
But I got to thinking today: It's a dangerous game, this letting ourselves roll our eyes at the patient's we've come to expect melodramatic reporting from.
I got a call on a patient of mine who was back in the ER with the same pain complaints she has always had. The ER is so tired of her coming in for this, that they barely even initiate a work-up before giving her massive doses of pain meds. I walked in to her room with a pre-conceived notion of what she would say and need. And, for the most part, I was right.
Except there was one new symptom that she brought up. Could be part of her previous syndrome, I thought. Could be something new. I stopped. 'What would I do if I'd never met her before? What would I order if I had no idea her history of coming back again and again with these symptoms?"
It changed my management. I'm not sure if anything will come of it, but it was a humbling moment. Usually continuity is the thing that makes good medicine tick. But every once in a while, the past only obscures our view of the present.
In our friendships, in our work relationships, in our families, we've all come to expect certain things from certain people. But sometimes, we need to let that go. We need to believe that people innately have the ability to surprise us, and leave our doors open to be receptive to that.
Because at some point, we're all going to be the one asking for belief and a chance. And we all deserve to be heard.
Archives: Listen
January Third Year:
It's taken me a while to write this:
Sometimes the way God can align my life's little stars amazes me.
I mentioned a while ago that I'd had to tell one of my patients that he had lung cancer. It was so. hard.
But, as it turns out, what comes after a terminal diagnosis is infinitely harder.
J (alias) was stoic, but his wife needed my hand for holding. I was happy to offer up what little effective medicine I had.
The brevity of the time from diagnosis to near-death astonished me. The chemo, done in an effort to stave off the metastatic disease for a month or two at most, had destroyed most of his normal organ function as well.
Finally, the family decided, it was time for hospice care. If nothing else, they wanted to see his pain relieved. They settled into a strange new--albeit surely shortlived--normal and prayed that J would somehow make it to meet his first grandbaby. I prayed too.
They were often close to my thoughts.
Except not at 1 o'clock in the morning, which is what time it was when I finished up an admission during a brutal call night. I grabbed my coat and headed for the door. I still had to drive over to the other hospital we cover and admit another patient. These nights have taught me to just put my head down and keep moving.
Before I left, I checked the online ER charting system to see if any other patients of ours were in the ER. Our practice wasn't listed in the PCP (primary care physician) column for any other patient's. Phew. 'Maybe you should just ask the ER doctor's if they know of any patient's who might need to be seen." 'No, no,' I thought back, 'I just need to go get started on the next one. No one's listed in the computer anyhow.' But the thought persisted, as the good ones are so prone to do, and so I relented.
I stopped by the doctor station. "Anyone have a patient of ours pending?"
"Uh, yeah, actually I do," one doctor piped up.
NOOOO, I thought. Why, oh, why did I ask? There's always this fear that if you ask, the ER doctors will ask you to see and/or admit someone they otherwise would have sent home.
"Really? There's no one listed in the computer."
"Yeah, actually, I think he's your patient. You know J, right?"
"J's here??"
"Yeah, I wasn't going to call you until later, but since you asked. He is having some difficulty breathing. I know he's on hospice care, but his wife got scared. If you want to talk to them..."
"Yes, yes, of course. Thank you for letting me know."
What a strange coincidence, I thought.
I went into their room. "Dr. *!" They were relieved to see a familiar face. The wife's face was lined with panic and J's face was lined with fatigue. The work of breathing was taking a toll. He looked very sick, but was still awake, alert, talking. I examined him. Let's keep him overnight, we decided. Yes he was supposed to be on home hospice, but the staff wasn't being as attentive as they should have. I stepped out of the room so that I could write up his orders. I was tucked away in a little cubby working on them when I heard someone start wailing. Yikes, someone really sick must have just come in. I kept working.
Suddenly, a frantic nurse poked her head around the corner. "Your patient is dying out here!" she barked.
"What?!" My papers spilled to the floor as I stood up and raced toward their room. I could see the wife. Wailing.
I walked in, trying to offer up some calm in a tempest. I assessed the situation. J was staring straight ahead, not seeing, not responding. Not looking very 'with us.'
"Is he dead, Dr. *? Is he breathing? Is he BREATHING?". The rise and fall of his chest, and a heartbeat on the monitor, let me know that he was still, on some level, alive.
"Yes, he's still alive." More questions, more answers. I mainly tried to defray the fear.
We put an oxygen mask on, we gave him pain medicine, and then we waited. He was a DNR (do not resuscitate) so we did not do more.
The wailing softened into crying and expressions of love. It became clear that these were his final hours. They passed. His oxygen level began to drop. His breathing slowed.
"Can he still hear me Dr. *?"
What do you do when you don't have all the answers? "Yes, he can hear you."
Family and friends filled the small ER room. I held J's hand. I thought of what a good man he was and how well he had endured this illness. I thought of all the people who were in this room, and of all those who loved him. It was time to say goodbye.
After the final breath was taken, they looked at me. I went through the technicalities required to 'pronounce' someone.
"He's gone."
And it was back to wailing as the finality of it all settled in. Followed again by peaceful mourning. I wondered what to do next. There were technicalities to be dealt with, but they seem so out of place in these situations. Somehow we worked them out. We sat quietly and we hugged. Then I finally excused myself to go admit the patient at the other hospital.
"I can't believe you happened to be here tonight," the wife said before I left.
I know. I know. They usually go to the other hospital. I'm one of several doctors who share call. If I hadn't asked...If I hadn't listened to a thought....The ER doctor surely wouldn't have called me until it was too late.
She said she'd call me with the funeral information, and then I left.
I arrived home during the early hours of the morning. Almost daybreak. I slipped my key silently into the lock and let myself in. I didn't want to wake my baby or my husband, though I wanted desperately to hold them. I walked to the guestroom and fell to my knees.
'Heavenly Father,' I prayed. And then I talked to Him about what was in my heart. About the equal parts of depression, gratitude and astonishment that were filling up inside of me. About the meaning of life and suffering and death. About how grateful I was to Him for paying attention: to one small doctor on call and to one of a million families who was suffering. For putting us at the same hospital at the same time at the same hour on a Saturday night. About miracles and healing and my small part in those things. And about my understanding of eternity, and more importantly, eternal families.
I put my pager on the nightstand. My white coat lay crumpled next to the bed with my stethoscope inside.
Then I laid my head on my pillow, and I waited.
Sleep never came, but peace finally did.
It's taken me a while to write this:
Sometimes the way God can align my life's little stars amazes me.
I mentioned a while ago that I'd had to tell one of my patients that he had lung cancer. It was so. hard.
But, as it turns out, what comes after a terminal diagnosis is infinitely harder.
J (alias) was stoic, but his wife needed my hand for holding. I was happy to offer up what little effective medicine I had.
The brevity of the time from diagnosis to near-death astonished me. The chemo, done in an effort to stave off the metastatic disease for a month or two at most, had destroyed most of his normal organ function as well.
Finally, the family decided, it was time for hospice care. If nothing else, they wanted to see his pain relieved. They settled into a strange new--albeit surely shortlived--normal and prayed that J would somehow make it to meet his first grandbaby. I prayed too.
They were often close to my thoughts.
Except not at 1 o'clock in the morning, which is what time it was when I finished up an admission during a brutal call night. I grabbed my coat and headed for the door. I still had to drive over to the other hospital we cover and admit another patient. These nights have taught me to just put my head down and keep moving.
Before I left, I checked the online ER charting system to see if any other patients of ours were in the ER. Our practice wasn't listed in the PCP (primary care physician) column for any other patient's. Phew. 'Maybe you should just ask the ER doctor's if they know of any patient's who might need to be seen." 'No, no,' I thought back, 'I just need to go get started on the next one. No one's listed in the computer anyhow.' But the thought persisted, as the good ones are so prone to do, and so I relented.
I stopped by the doctor station. "Anyone have a patient of ours pending?"
"Uh, yeah, actually I do," one doctor piped up.
NOOOO, I thought. Why, oh, why did I ask? There's always this fear that if you ask, the ER doctors will ask you to see and/or admit someone they otherwise would have sent home.
"Really? There's no one listed in the computer."
"Yeah, actually, I think he's your patient. You know J, right?"
"J's here??"
"Yeah, I wasn't going to call you until later, but since you asked. He is having some difficulty breathing. I know he's on hospice care, but his wife got scared. If you want to talk to them..."
"Yes, yes, of course. Thank you for letting me know."
What a strange coincidence, I thought.
I went into their room. "Dr. *!" They were relieved to see a familiar face. The wife's face was lined with panic and J's face was lined with fatigue. The work of breathing was taking a toll. He looked very sick, but was still awake, alert, talking. I examined him. Let's keep him overnight, we decided. Yes he was supposed to be on home hospice, but the staff wasn't being as attentive as they should have. I stepped out of the room so that I could write up his orders. I was tucked away in a little cubby working on them when I heard someone start wailing. Yikes, someone really sick must have just come in. I kept working.
Suddenly, a frantic nurse poked her head around the corner. "Your patient is dying out here!" she barked.
"What?!" My papers spilled to the floor as I stood up and raced toward their room. I could see the wife. Wailing.
I walked in, trying to offer up some calm in a tempest. I assessed the situation. J was staring straight ahead, not seeing, not responding. Not looking very 'with us.'
"Is he dead, Dr. *? Is he breathing? Is he BREATHING?". The rise and fall of his chest, and a heartbeat on the monitor, let me know that he was still, on some level, alive.
"Yes, he's still alive." More questions, more answers. I mainly tried to defray the fear.
We put an oxygen mask on, we gave him pain medicine, and then we waited. He was a DNR (do not resuscitate) so we did not do more.
The wailing softened into crying and expressions of love. It became clear that these were his final hours. They passed. His oxygen level began to drop. His breathing slowed.
"Can he still hear me Dr. *?"
What do you do when you don't have all the answers? "Yes, he can hear you."
Family and friends filled the small ER room. I held J's hand. I thought of what a good man he was and how well he had endured this illness. I thought of all the people who were in this room, and of all those who loved him. It was time to say goodbye.
After the final breath was taken, they looked at me. I went through the technicalities required to 'pronounce' someone.
"He's gone."
And it was back to wailing as the finality of it all settled in. Followed again by peaceful mourning. I wondered what to do next. There were technicalities to be dealt with, but they seem so out of place in these situations. Somehow we worked them out. We sat quietly and we hugged. Then I finally excused myself to go admit the patient at the other hospital.
"I can't believe you happened to be here tonight," the wife said before I left.
I know. I know. They usually go to the other hospital. I'm one of several doctors who share call. If I hadn't asked...If I hadn't listened to a thought....The ER doctor surely wouldn't have called me until it was too late.
She said she'd call me with the funeral information, and then I left.
I arrived home during the early hours of the morning. Almost daybreak. I slipped my key silently into the lock and let myself in. I didn't want to wake my baby or my husband, though I wanted desperately to hold them. I walked to the guestroom and fell to my knees.
'Heavenly Father,' I prayed. And then I talked to Him about what was in my heart. About the equal parts of depression, gratitude and astonishment that were filling up inside of me. About the meaning of life and suffering and death. About how grateful I was to Him for paying attention: to one small doctor on call and to one of a million families who was suffering. For putting us at the same hospital at the same time at the same hour on a Saturday night. About miracles and healing and my small part in those things. And about my understanding of eternity, and more importantly, eternal families.
I put my pager on the nightstand. My white coat lay crumpled next to the bed with my stethoscope inside.
Then I laid my head on my pillow, and I waited.
Sleep never came, but peace finally did.
Archives: Love is a Beautiful Thing
May 2nd Year:
I walked into a patient room last week and was immediately grateful that I've learned how to conceal shock or surprise as a part of my profession. My patient was in a wheelchair but had no arms or legs. None. She was in her thirties, plain faced and blonde. She looked tired--sick. Three black straps across her torso held her into her chair. I'm not sure I'd ever seen someone with that exact disability and it affected me. "Can you imagine's" filled my head.
She was suffering from bronchitis and after I'd examined her we discussed treatment options. A handsome young man, probably also in his thirties, accompanied her. I had assumed that he was a friend or an aide or what not. She said, "I really want to get better soon. We're getting married in two weeks." She blushed and he smiled.
Some surprised delight must have been evident on my face as I enthusiastically responded, "Congratulations! That's wonderful."
I couldn't stop thinking about it all day. And it made me so happy.
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I had to call a male patient the other day and let him know that his tests had come up positive for chlamydia. As you probably know, this is a sexually transmitted infection, and really can't be caught in other ways.
The man was surprised when I told him this. "My wife and I don't have any other partners--there must be another way this can be contracted."
Crickets.
Can he put the pieces together? Don't make me be the one to say, "Maybe you should double check with your partner on that."
He had recently traveled abroad and so he asked, "Could it be caught in a public bath?"
I repeated the question aloud, while my co-resident, was working nearby. I happened to glance at her face and she smirked, having realized what we were talking about. Seeing her face nearly made me lose it. I've never come so close to laughing at such a terribly inappropriate time. I didn't. Again, the poker face is a hot commodity in medicine.
It can be hard to deliver news to patients--for many reasons--but especially when you're giving out a bitter pill.
I walked into a patient room last week and was immediately grateful that I've learned how to conceal shock or surprise as a part of my profession. My patient was in a wheelchair but had no arms or legs. None. She was in her thirties, plain faced and blonde. She looked tired--sick. Three black straps across her torso held her into her chair. I'm not sure I'd ever seen someone with that exact disability and it affected me. "Can you imagine's" filled my head.
She was suffering from bronchitis and after I'd examined her we discussed treatment options. A handsome young man, probably also in his thirties, accompanied her. I had assumed that he was a friend or an aide or what not. She said, "I really want to get better soon. We're getting married in two weeks." She blushed and he smiled.
Some surprised delight must have been evident on my face as I enthusiastically responded, "Congratulations! That's wonderful."
I couldn't stop thinking about it all day. And it made me so happy.
-------------------------------------------------------------------------------------
I had to call a male patient the other day and let him know that his tests had come up positive for chlamydia. As you probably know, this is a sexually transmitted infection, and really can't be caught in other ways.
The man was surprised when I told him this. "My wife and I don't have any other partners--there must be another way this can be contracted."
Crickets.
Can he put the pieces together? Don't make me be the one to say, "Maybe you should double check with your partner on that."
He had recently traveled abroad and so he asked, "Could it be caught in a public bath?"
I repeated the question aloud, while my co-resident, was working nearby. I happened to glance at her face and she smirked, having realized what we were talking about. Seeing her face nearly made me lose it. I've never come so close to laughing at such a terribly inappropriate time. I didn't. Again, the poker face is a hot commodity in medicine.
It can be hard to deliver news to patients--for many reasons--but especially when you're giving out a bitter pill.
"Hi, OnCallMom"
Sunday 2nd Year:
When I was a first year medical student, Nancy (one of my bff's) and I would head almost nightly to the Georgetown Barnes and Noble. We would stake out a table, lay out our respective grad school books, and think about studying. Then we'd talk and eat scones instead. We learned quickly that we were better friends than study partners. ;) Anyhoo, one night after this routine had first started, I interrupted to say:
"Oh, it's 7:00. I have to head up Wisconsin to an AA meeting."
Before I had a chance to explain that this was a school requirement and I was merely observing, a surprised, albeit not judgmental, look crossed her face.
After I'd explained why I was going, she offered to tag along and up we went. It is sort of an awkward thing to walk into a meeting like that and say, "Hi, I'm a medical student and I'm here to observe your meeting. Please just act normal."
So I didn't.
We tucked ourselves into a back corner and tried to look inconspicuous. Nancy stepped out to the restroom and while she was gone, a middle-aged, slightly shaggy man approached me.
"Is this your first time here?"
"Yes." Not a lie.
"When I was new here, someone approached me and told me that I could conquer my alcoholism. Just them saying that was an inspiration to me and I hope I can be the same for you. I want to give you something."
"Okay." Gulp.
"Hold on."
He left the room while I contemplated the various ways this situation could unfold. I could not now see how I could possibly admit that I was a med student observer.
He came back and handed me The Big Blue AA Book.
"Here," he said, "I've inscribed it to you. If you have any more questions or want to talk, I'll be here after the meeting."
"Okay." I tried to look grateful and not terrified. He would probably have thought either was appropriate.
The meeting started. 'Was anyone new here', the group leader wanted to know? [insert many meaningful stares in my direction]. I played with the edge of my notebook and tried to look invisible. They asked again later. And again after that. Each time the silence that filled the room felt heavier. 'Poor thing,' I imagine they thought, 'she can't quite admit that she has a problem.' I worried what my blue book-giving friend would think. I hoped he didn't feel like a failure for not inciting me to stand and introduce myself.
I thought how easy it would be to stand up and say, "Hi, I'm OCM, and I'm an alcoholic." "Hi, OCM." Except that that would be a lie and I don't like to lie. Even if it makes kind, shaggy-haired men feel better. But hey, maybe I lied when I didn't make my true identity known.
When the meeting ended, we raced out of there. Why, by the way, didn't anyone offer Nancy a book or stare at her like she should stand up and introduce herself? She must have looked convincing as my support person--as the one who'd coerced me into coming.
When I got home that night, I opened up the Big Blue Book. There was a very sweet inscription from a very encouraging man. He believed in me. I wanted to read that inscription after re-telling that story recently (sorry weenston, for making you hear it twice) but then I remembered that its no longer in my possession. So sad. Once, when Chris's 'let's trim the fat' spirit rubbed off on me, I unloaded a ton of old school books to goodwill. Without realizing it, I shipped off my blue book as well. When this came to my attention, I tried to no avail to find it at the goodwill. Someone must have needed it more than I did.
But the memory of that night still makes me smile for so many reasons. Because Nancy and I know each other like sisters now and its funny to think of how it must have initially surprised her.
Because I love to think about how bad I felt about not being an alcoholic. What a disappointment!
Because its so great that there are strangers who surprise you with their generosity and goodness.
And because it reminds me that I should never clean out my bookshelves. (Just Kidding sweetie!)
I hope you all have a magnificent Sabbath!
When I was a first year medical student, Nancy (one of my bff's) and I would head almost nightly to the Georgetown Barnes and Noble. We would stake out a table, lay out our respective grad school books, and think about studying. Then we'd talk and eat scones instead. We learned quickly that we were better friends than study partners. ;) Anyhoo, one night after this routine had first started, I interrupted to say:
"Oh, it's 7:00. I have to head up Wisconsin to an AA meeting."
Before I had a chance to explain that this was a school requirement and I was merely observing, a surprised, albeit not judgmental, look crossed her face.
After I'd explained why I was going, she offered to tag along and up we went. It is sort of an awkward thing to walk into a meeting like that and say, "Hi, I'm a medical student and I'm here to observe your meeting. Please just act normal."
So I didn't.
We tucked ourselves into a back corner and tried to look inconspicuous. Nancy stepped out to the restroom and while she was gone, a middle-aged, slightly shaggy man approached me.
"Is this your first time here?"
"Yes." Not a lie.
"When I was new here, someone approached me and told me that I could conquer my alcoholism. Just them saying that was an inspiration to me and I hope I can be the same for you. I want to give you something."
"Okay." Gulp.
"Hold on."
He left the room while I contemplated the various ways this situation could unfold. I could not now see how I could possibly admit that I was a med student observer.
He came back and handed me The Big Blue AA Book.
"Here," he said, "I've inscribed it to you. If you have any more questions or want to talk, I'll be here after the meeting."
"Okay." I tried to look grateful and not terrified. He would probably have thought either was appropriate.
The meeting started. 'Was anyone new here', the group leader wanted to know? [insert many meaningful stares in my direction]. I played with the edge of my notebook and tried to look invisible. They asked again later. And again after that. Each time the silence that filled the room felt heavier. 'Poor thing,' I imagine they thought, 'she can't quite admit that she has a problem.' I worried what my blue book-giving friend would think. I hoped he didn't feel like a failure for not inciting me to stand and introduce myself.
I thought how easy it would be to stand up and say, "Hi, I'm OCM, and I'm an alcoholic." "Hi, OCM." Except that that would be a lie and I don't like to lie. Even if it makes kind, shaggy-haired men feel better. But hey, maybe I lied when I didn't make my true identity known.
When the meeting ended, we raced out of there. Why, by the way, didn't anyone offer Nancy a book or stare at her like she should stand up and introduce herself? She must have looked convincing as my support person--as the one who'd coerced me into coming.
When I got home that night, I opened up the Big Blue Book. There was a very sweet inscription from a very encouraging man. He believed in me. I wanted to read that inscription after re-telling that story recently (sorry weenston, for making you hear it twice) but then I remembered that its no longer in my possession. So sad. Once, when Chris's 'let's trim the fat' spirit rubbed off on me, I unloaded a ton of old school books to goodwill. Without realizing it, I shipped off my blue book as well. When this came to my attention, I tried to no avail to find it at the goodwill. Someone must have needed it more than I did.
But the memory of that night still makes me smile for so many reasons. Because Nancy and I know each other like sisters now and its funny to think of how it must have initially surprised her.
Because I love to think about how bad I felt about not being an alcoholic. What a disappointment!
Because its so great that there are strangers who surprise you with their generosity and goodness.
And because it reminds me that I should never clean out my bookshelves. (Just Kidding sweetie!)
I hope you all have a magnificent Sabbath!
Archives: Tiny Dancer vs. The Pager
November 2nd Year:
Sleepless nights are nothing new for me. The things that have changed since the arrival of my lady love: the sound of the awakening agent and the frequency of said nights. Before inundating you with more evidence of my 'new parent picture-taking hysteria', I thought I'd analyze the nature of both types of night-time interruptions to decide which is preferable. (And, yes, I do realize that the outcome is obvious from the outset. Please exercise the willing suspension of disbelief as we go through the following blog exercise.)
#1
Pager: Beeps can reliably be stopped with the press of a button.
TD: Cries do often responds to bouncing/feeding/diaper changing, but would not call this responding 'reliable'.
#2
Pager: Sometimes requires me to leave not only my bed but my house and to drive to a hospital.
TD: Mercifully allows mom to meet most of her night-time needs from the comfort of her bed or her comfy rocking chair.
#3
Pager: Cannot generally be counted on to be quiet for at least two hour intervals.
TD: Cannot generally be counted on to be quiet for at least two hour intervals (although to be fair to her and the pager, they have each at times given me up to five hours of quiet).
#4
Pager: Gets passed on to the next resident for a few days in between visits
TD: Would be very sad (and hungry) if she was to get passed on to anyone but mama for a night
#5
Pager:Looks like this. (see above picture.)
TD: Looks like this. (see above picture as well as glut of pictures below).
#6
Pager: Made of Plastic
TD: Flesh of my flesh, bone of my bones
#7
Pager:Prompts me to call people who are frequently frustrating and occassionally crazy.
TD: Prompts me to cuddle an adorable infant who I am sure will never be frustrating or drive her parents crazy.
#8
Pager: Cannot be taken care of by dear hubby.
TD: Responds quite well to diaper changes and burp sessions by Daddy.
#9
Pager: Looks like this. (again see above picture.)
TD: Looks like this (I'm not sure this point can be underscored enough.)
#10
Pager: Will hopefully one day be a thing of the past
TD: Will occupy my heart forever. (What? You thought I'd make it through this entire post without getting sentimental?)
Congratulations, Tiny Dancer! Your prize is a lifetime supply of diaper changes, feedings, hugs, night-time soothings and...well, a lifetime of those who love you meeting your needs the way our lovely parents did for us. :) A grand prize, indeed
Sleepless nights are nothing new for me. The things that have changed since the arrival of my lady love: the sound of the awakening agent and the frequency of said nights. Before inundating you with more evidence of my 'new parent picture-taking hysteria', I thought I'd analyze the nature of both types of night-time interruptions to decide which is preferable. (And, yes, I do realize that the outcome is obvious from the outset. Please exercise the willing suspension of disbelief as we go through the following blog exercise.)
#1
Pager: Beeps can reliably be stopped with the press of a button.
TD: Cries do often responds to bouncing/feeding/diaper changing, but would not call this responding 'reliable'.
#2
Pager: Sometimes requires me to leave not only my bed but my house and to drive to a hospital.
TD: Mercifully allows mom to meet most of her night-time needs from the comfort of her bed or her comfy rocking chair.
#3
Pager: Cannot generally be counted on to be quiet for at least two hour intervals.
TD: Cannot generally be counted on to be quiet for at least two hour intervals (although to be fair to her and the pager, they have each at times given me up to five hours of quiet).
#4
Pager: Gets passed on to the next resident for a few days in between visits
TD: Would be very sad (and hungry) if she was to get passed on to anyone but mama for a night
#5
Pager:Looks like this. (see above picture.)
TD: Looks like this. (see above picture as well as glut of pictures below).
#6
Pager: Made of Plastic
TD: Flesh of my flesh, bone of my bones
#7
Pager:Prompts me to call people who are frequently frustrating and occassionally crazy.
TD: Prompts me to cuddle an adorable infant who I am sure will never be frustrating or drive her parents crazy.
#8
Pager: Cannot be taken care of by dear hubby.
TD: Responds quite well to diaper changes and burp sessions by Daddy.
#9
Pager: Looks like this. (again see above picture.)
TD: Looks like this (I'm not sure this point can be underscored enough.)
#10
Pager: Will hopefully one day be a thing of the past
TD: Will occupy my heart forever. (What? You thought I'd make it through this entire post without getting sentimental?)
Congratulations, Tiny Dancer! Your prize is a lifetime supply of diaper changes, feedings, hugs, night-time soothings and...well, a lifetime of those who love you meeting your needs the way our lovely parents did for us. :) A grand prize, indeed
Archives: Dress Code
September 2nd Year:
A few weeks ago I was on a week of hospital service, which is always capped off with a Sunday call. On a weekend call, we are required to go into the hospital in the am and round on our patients. After that, if no one is requiring admission to the hospital, you can answer the nursing/patient calls from wherever you would like until someone does come in (which they always do at some point). I, being a little optimistic, decided to dress in my Sunday best. Our church starts at 1:00, and so I figured that I could be done rounding by the time church started and hopefully head straight there.
I guess I forgot to knock on wood.
After I finished rounding at one hospital, I headed over to the other hospital we cover, where the third year resident was finishing up her morning rounds. Upon arriving there, she told me that she was just heading to the ER to do an admission. She'd gotten called about this gentleman earlier in the morning, but since things had been so busy with their existing patients and the ER doc was keeing an eye on this supposedly stable patient, she hadn't been to see him yet. Right before I walked in, she'd gotten a call from the ER saying that this 60-some odd year old man had suddenly deteriorated and had required intubation. They weren't sure what was going on, but an ICU doc had been called as well since things were rapidly going south, and mostly unexplainable. I offered to go over and help her get stuff ready on the patient.
We headed over to the ER and found our patient in his room. I have seen many, many intubated patients, and since most alert people wouldn't tolerate a breathing tube down their throat very well, they are usually heavily sedated. But this man looked different. He looked dead.
I commented as such to the third year after we had finished examining the patient and stepped outside to write the admission orders. We sat down, and within five minutes, were interrupted by the nurse stepping outside of the patient's room. "Um, could someone call a code please? His heart just stopped." "Call a code in room 2!" I spoke loudly, while the third year and I ran back in.
The things that were already were in our favor: He already had a central line (a large centrally placed IV that makes it easier to give hard-hitting drugs) and a breathing tube.
Things that were not in our favor: His heart was flat-lining and he had no pulse.
When someone is flat-lining, you can't actually shock their heart. You have to have at least some electrical activity for that to work. So instead, we started giving the man drugs to re-start things and doing CPR to get said drugs circulating. One of the nurses started doing chest compressions, but looked like she was tiring after a little while (it actually gets exhausting pretty fast). I took over for her while we waited for reinforcements in the manpower department.
"one-and-two-and-three-and..." I counted to myself as I kept my elbows straight and got into the rhythmic pattern of resuscitation. As I thumped away, I had a few thoughts:
1)This poor man's family...I don't see this ending well
2)Thank you, little baby girl, for not sticking out too far and making this task impossible.
3)I am in heels and a Sunday Dress, 8 months pregnant, and doing CPR. My life can be really odd.
That moment in that room is a memory that I think will be glued to my brain forever.
And in case you were wondering, we were able to bring the man back, but only temporarily. He passed away peacefully less than 48 hours later. His rapid descent into acute illness remains somewhat a mystery, but his loving family handled the situation with amazing grace, and let him go when it was obvious the way things were going to go. It can be the hardest but most merciful gift a family can give, I think.
I have more to post here soon--pics from our last pre-baby weekend away and baby showers, so I promise to be back soon. I've been blog-slacking, but am going to improve. I swear. ;)
A few weeks ago I was on a week of hospital service, which is always capped off with a Sunday call. On a weekend call, we are required to go into the hospital in the am and round on our patients. After that, if no one is requiring admission to the hospital, you can answer the nursing/patient calls from wherever you would like until someone does come in (which they always do at some point). I, being a little optimistic, decided to dress in my Sunday best. Our church starts at 1:00, and so I figured that I could be done rounding by the time church started and hopefully head straight there.
I guess I forgot to knock on wood.
After I finished rounding at one hospital, I headed over to the other hospital we cover, where the third year resident was finishing up her morning rounds. Upon arriving there, she told me that she was just heading to the ER to do an admission. She'd gotten called about this gentleman earlier in the morning, but since things had been so busy with their existing patients and the ER doc was keeing an eye on this supposedly stable patient, she hadn't been to see him yet. Right before I walked in, she'd gotten a call from the ER saying that this 60-some odd year old man had suddenly deteriorated and had required intubation. They weren't sure what was going on, but an ICU doc had been called as well since things were rapidly going south, and mostly unexplainable. I offered to go over and help her get stuff ready on the patient.
We headed over to the ER and found our patient in his room. I have seen many, many intubated patients, and since most alert people wouldn't tolerate a breathing tube down their throat very well, they are usually heavily sedated. But this man looked different. He looked dead.
I commented as such to the third year after we had finished examining the patient and stepped outside to write the admission orders. We sat down, and within five minutes, were interrupted by the nurse stepping outside of the patient's room. "Um, could someone call a code please? His heart just stopped." "Call a code in room 2!" I spoke loudly, while the third year and I ran back in.
The things that were already were in our favor: He already had a central line (a large centrally placed IV that makes it easier to give hard-hitting drugs) and a breathing tube.
Things that were not in our favor: His heart was flat-lining and he had no pulse.
When someone is flat-lining, you can't actually shock their heart. You have to have at least some electrical activity for that to work. So instead, we started giving the man drugs to re-start things and doing CPR to get said drugs circulating. One of the nurses started doing chest compressions, but looked like she was tiring after a little while (it actually gets exhausting pretty fast). I took over for her while we waited for reinforcements in the manpower department.
"one-and-two-and-three-and..." I counted to myself as I kept my elbows straight and got into the rhythmic pattern of resuscitation. As I thumped away, I had a few thoughts:
1)This poor man's family...I don't see this ending well
2)Thank you, little baby girl, for not sticking out too far and making this task impossible.
3)I am in heels and a Sunday Dress, 8 months pregnant, and doing CPR. My life can be really odd.
That moment in that room is a memory that I think will be glued to my brain forever.
And in case you were wondering, we were able to bring the man back, but only temporarily. He passed away peacefully less than 48 hours later. His rapid descent into acute illness remains somewhat a mystery, but his loving family handled the situation with amazing grace, and let him go when it was obvious the way things were going to go. It can be the hardest but most merciful gift a family can give, I think.
I have more to post here soon--pics from our last pre-baby weekend away and baby showers, so I promise to be back soon. I've been blog-slacking, but am going to improve. I swear. ;)
Archives: A Shock to the Heart
May Intern Year:
Things are busy around here. Busy, but good. I'm taking Step 3 of my boards in a little over 2 weeks. Yikes! Studying for the first two sets was hard enough when I had an entire month off to prepare. Now, in addition to working 80 hours weeks, I'm supposed to use my, uh, spare time, to study for a test. It is so much fun. Anyhoo, it will be over soon. And the more exciting piece of news is that I only have two--TWO--call nights left in my intern year!! In June I'll be working in the ER, which means that while I'll work some odd hours, it will never be more than 10 or 12 hours per shift. None of this 30 hour business that I've somehow become accustomed to. Plus, a vacation coming up. Plus, two family weddings coming up. Plus, Mary's baby will be born soon. With so many fun things on the horizon, it's hard to feel to stressed about boards. And maybe that's why I'm a little worried about it. :)
So, a few calls nights ago, I headed back to my call room in the wee hours to lay down. My pager interrupted my not-so-beauty sleep about an hour later. It was the PCCU (post cardiac care unit) callling. I knew which nurse would be at the other end of the line when I called back, and which patient it would be about, because she had called me several times earlier in the evening with various issues. I had hoped that the patient would somehow stay stable and well until at least 6 am, but as tends to happen, 4 o'clock proved to be the bewitching hour.
"Dr. *, this patient is in sustained V. Tach. Would you mind coming down here?" The question was lined in carefully concealed panic. V. Tach (ventricular tachycardia) is a rather ominous rhythm for your heart to be going in, and can lead to several bad places, one of which is six feet under.
"Sure...have you paged the cardiologist about this?"
"Yes, he's on his way in from home as we speak, but if you could come until he gets here, that would be really great."
"I'll be right down," I said as I reached for my white coat and clogs. In my head I was thinking about how much I needed the cardiologist's help in this particular situation--well, how much the patient needed the cardiologist's help, and how the nurse knew that too. But the fact that I was coming down until he got there was going to make everyone feel better until he arrived. That's the magic of the white coat. Luckily, he arrived shortly after I did.
The patient looked remarkably well for someone whose heart could peter out at any moment. She was alert and talking. Pleasant, even. We gave her several boluses of a drug that should/could help her heart to convert back into a normal rhythm. No such luck. We waited and tried again. Waited and try again. Ultimately, there's only so much time you can spend waiting and trying again before you have to manhandle the heart. We needed to deliver a shock.
In addition to pulling in the crash cart, we called the anesthesiolgist to help sedate the patient. Despite what you've seen on ER or Grey's Anatomy, a good number of shocks are actually delivered to alert patients who might really hate you if they were cognizant for the electric parade you're sending their way.
The cardiologist turned to me. "Would you like to deliver the shock?" "Sure!" He said it in a voice that indicated he felt like this was the least he could give me for my trouble. i.e., 'this poor resident has been up since 6 am yesterday...we can at least let her do the fun part.' I appreciated it.
We put the pads on the womans chest and back, waited for the sedative drugs to kick in, and charged up the machine.
"Everybody Clear," I said in a voice that lacked that unmistakable televised-like drama.
And then I pressed the button. With my thumb. Apparently, that's unusual.
The patient's chest arched up off the bed as the rest of her body went rigid, and then she fell back onto her pilllow. We all looked at the monitor. A beautiful, sinus rhythm was there as a reward for our efforts. The anesthesiologist woke the patient up, and she was happy to learn that the problem had apparently been resolved. We put our equipment away, and I headed back to my call room.
The next morning around 11 am, I was just finishing up some of my chart work on some patients, hoping to get out of there soon. The same, very kind cardiologist from the night before was walking by. "Hey, OCM...do you want to shock someone else? I'm just on my way there now." "Uh, sure!" It might have been the end of a long shift, but it's not really the kind of thing you say 'no' to. Maybe he figured my thumb was on a roll.
This time the patient was a gentleman who had come in for a planned cardioversion. He was in an abnormal rhythm that, while not great, wasn't imminently dangerous. So I went in, and ran through the same routine as above, albeit with even less of an edge. It can all seem so ordinary until you stop to think about it. "Hi, nice to meet you. I'm Dr. *, I'll be the one electrifying you." Ha ha ha. I have to admit that you feel like some kind of mad scientist when you push a button and then watch somebody's body convulse up off the bed in response. You know you're doing something beneficial, but it feels a little sadistic.
Well, I'm off to bed. May you all have very un-shocking evenings. :)
Things are busy around here. Busy, but good. I'm taking Step 3 of my boards in a little over 2 weeks. Yikes! Studying for the first two sets was hard enough when I had an entire month off to prepare. Now, in addition to working 80 hours weeks, I'm supposed to use my, uh, spare time, to study for a test. It is so much fun. Anyhoo, it will be over soon. And the more exciting piece of news is that I only have two--TWO--call nights left in my intern year!! In June I'll be working in the ER, which means that while I'll work some odd hours, it will never be more than 10 or 12 hours per shift. None of this 30 hour business that I've somehow become accustomed to. Plus, a vacation coming up. Plus, two family weddings coming up. Plus, Mary's baby will be born soon. With so many fun things on the horizon, it's hard to feel to stressed about boards. And maybe that's why I'm a little worried about it. :)
So, a few calls nights ago, I headed back to my call room in the wee hours to lay down. My pager interrupted my not-so-beauty sleep about an hour later. It was the PCCU (post cardiac care unit) callling. I knew which nurse would be at the other end of the line when I called back, and which patient it would be about, because she had called me several times earlier in the evening with various issues. I had hoped that the patient would somehow stay stable and well until at least 6 am, but as tends to happen, 4 o'clock proved to be the bewitching hour.
"Dr. *, this patient is in sustained V. Tach. Would you mind coming down here?" The question was lined in carefully concealed panic. V. Tach (ventricular tachycardia) is a rather ominous rhythm for your heart to be going in, and can lead to several bad places, one of which is six feet under.
"Sure...have you paged the cardiologist about this?"
"Yes, he's on his way in from home as we speak, but if you could come until he gets here, that would be really great."
"I'll be right down," I said as I reached for my white coat and clogs. In my head I was thinking about how much I needed the cardiologist's help in this particular situation--well, how much the patient needed the cardiologist's help, and how the nurse knew that too. But the fact that I was coming down until he got there was going to make everyone feel better until he arrived. That's the magic of the white coat. Luckily, he arrived shortly after I did.
The patient looked remarkably well for someone whose heart could peter out at any moment. She was alert and talking. Pleasant, even. We gave her several boluses of a drug that should/could help her heart to convert back into a normal rhythm. No such luck. We waited and tried again. Waited and try again. Ultimately, there's only so much time you can spend waiting and trying again before you have to manhandle the heart. We needed to deliver a shock.
In addition to pulling in the crash cart, we called the anesthesiolgist to help sedate the patient. Despite what you've seen on ER or Grey's Anatomy, a good number of shocks are actually delivered to alert patients who might really hate you if they were cognizant for the electric parade you're sending their way.
The cardiologist turned to me. "Would you like to deliver the shock?" "Sure!" He said it in a voice that indicated he felt like this was the least he could give me for my trouble. i.e., 'this poor resident has been up since 6 am yesterday...we can at least let her do the fun part.' I appreciated it.
We put the pads on the womans chest and back, waited for the sedative drugs to kick in, and charged up the machine.
"Everybody Clear," I said in a voice that lacked that unmistakable televised-like drama.
And then I pressed the button. With my thumb. Apparently, that's unusual.
The patient's chest arched up off the bed as the rest of her body went rigid, and then she fell back onto her pilllow. We all looked at the monitor. A beautiful, sinus rhythm was there as a reward for our efforts. The anesthesiologist woke the patient up, and she was happy to learn that the problem had apparently been resolved. We put our equipment away, and I headed back to my call room.
The next morning around 11 am, I was just finishing up some of my chart work on some patients, hoping to get out of there soon. The same, very kind cardiologist from the night before was walking by. "Hey, OCM...do you want to shock someone else? I'm just on my way there now." "Uh, sure!" It might have been the end of a long shift, but it's not really the kind of thing you say 'no' to. Maybe he figured my thumb was on a roll.
This time the patient was a gentleman who had come in for a planned cardioversion. He was in an abnormal rhythm that, while not great, wasn't imminently dangerous. So I went in, and ran through the same routine as above, albeit with even less of an edge. It can all seem so ordinary until you stop to think about it. "Hi, nice to meet you. I'm Dr. *, I'll be the one electrifying you." Ha ha ha. I have to admit that you feel like some kind of mad scientist when you push a button and then watch somebody's body convulse up off the bed in response. You know you're doing something beneficial, but it feels a little sadistic.
Well, I'm off to bed. May you all have very un-shocking evenings. :)
Archives: Call Night
April Intern Year:
***Today we were down in the ER, talking to one of the hospitalists. He gave us the brief run-down on one of his patients who he was admitting, that included the following tidbit:
She is a chronically sick lady who, because of throat cancer ("no reason not to keep smoking!"), has had to have a feeding tube placed through her abdominal wall and into her stomach. See above picture. She is allowed nothing by mouth. We always ask an alcohol history, but with someone who can't swallow, you might think this a moot point. Not so! Patient X mixes oranje juice with vodka and pours it directly into her G-tube. We can take away many things, apparently, but not her ability to get drunk!!
***Last week, I got called down to the ER first thing in the morning to admit a gentleman in respiratory failure who had already been intubated. I was admitting him with one of my favorite Critical Care Attendings, Dr. Lee (alias).
If you've ever been a patient in a hospital or ER, you've probably had a peripheral IV placed. This is where a nurse or doctor pokes a needle into a small vein in either your arms or legs and then puts a small catheter over it that will stay put, so we can give our medicines through it. In the ICU, peripheral IV's often don't cut it. The meds that we use are so heavy-duty that if they come into close contact with the skin, you can end up with serious irritation or burns. Hence, in the Units most patient's require what we call a Central Line. This is essentially a much larger and longer catheter that gets threaded into a much larger and more central vein, so that the meds have more direct access.
There are three veins that we usually put them in (in ascending order of 'makes me nervous' factor):femoral vein (groin), subclavian line (under the clavicle), and the Internal Jugular (the side of the neck). I have put in femoral lines and subclavian lines, but had never done an IJ. All central lines have their risks because these bigger veins run in closer proximity to other vital structures. Like, say, the lungs. It is not entirely rare for a patient to get part of their lung punctured when having a subclavian placed, for example.
So that morning, Dr. Lee said, "Let's put in an IJ. Wanna do it?" "Sure." Inside I'm thinking, "Please, oh, please, do not let me hit the carotid!" The carotid artery--you know, that big pulsating artery in your neck that allows you to feel your pulse--runs right over the jugular.
We gowned up, sterilized the patient, and got our kit out. I felt my landmarks about a million times to make sure I knew exactly where I was aiming (please, please, please no carotid) and then stuck my needle in. The pulse always seems to migrate right when you are sure that you know where you need to hit. Also, the skin on older people's necks is a little leathery, so you have to push with enough force to break the skin, but with enough restraint to avoid running right through things. ;)
I advanced my needle and pulled back on the syringe, waiting for a flashblack of blood to let me know I'd hit gold. It can take a while to find the vein, so I slowly came back and forth looking for my goal.
"I think you need to go closer to the carotid," Dr. Lee said.
"And if I hit it?"
He smiled. "We'll just hold pressure until he stops bleeding.It's happened to me loads of times." Simple Enough. Right.
I took out my needle, repositioned closer to the carotid, and advanced again. Bingo! Gosh, it feels so good to see venous blood return...brisk, but not pulsating in the way it would if you'd hit the artery. From there, I threaded in a wire through the needle that would coarse through the veins creating a path. Then I took a blade to make the skin incision a little bigger. Next, I withdrew the needle over the wire, careful not to let go of the wire and lose it inside the vessel. That would be bad. Next I threaded a plasticky type catheter over the wire, and then removed the wire from within. Lastly, I took a needle and thread and sewed the end of the catheter into the skin. You don't want to risk it slipping out after all that work. And done!
I stepped back, evaluated my handiwork, and exhaled.
"Right now," I thought, "I feel like a doctor."
***Today we were down in the ER, talking to one of the hospitalists. He gave us the brief run-down on one of his patients who he was admitting, that included the following tidbit:
She is a chronically sick lady who, because of throat cancer ("no reason not to keep smoking!"), has had to have a feeding tube placed through her abdominal wall and into her stomach. See above picture. She is allowed nothing by mouth. We always ask an alcohol history, but with someone who can't swallow, you might think this a moot point. Not so! Patient X mixes oranje juice with vodka and pours it directly into her G-tube. We can take away many things, apparently, but not her ability to get drunk!!
***Last week, I got called down to the ER first thing in the morning to admit a gentleman in respiratory failure who had already been intubated. I was admitting him with one of my favorite Critical Care Attendings, Dr. Lee (alias).
If you've ever been a patient in a hospital or ER, you've probably had a peripheral IV placed. This is where a nurse or doctor pokes a needle into a small vein in either your arms or legs and then puts a small catheter over it that will stay put, so we can give our medicines through it. In the ICU, peripheral IV's often don't cut it. The meds that we use are so heavy-duty that if they come into close contact with the skin, you can end up with serious irritation or burns. Hence, in the Units most patient's require what we call a Central Line. This is essentially a much larger and longer catheter that gets threaded into a much larger and more central vein, so that the meds have more direct access.
There are three veins that we usually put them in (in ascending order of 'makes me nervous' factor):femoral vein (groin), subclavian line (under the clavicle), and the Internal Jugular (the side of the neck). I have put in femoral lines and subclavian lines, but had never done an IJ. All central lines have their risks because these bigger veins run in closer proximity to other vital structures. Like, say, the lungs. It is not entirely rare for a patient to get part of their lung punctured when having a subclavian placed, for example.
So that morning, Dr. Lee said, "Let's put in an IJ. Wanna do it?" "Sure." Inside I'm thinking, "Please, oh, please, do not let me hit the carotid!" The carotid artery--you know, that big pulsating artery in your neck that allows you to feel your pulse--runs right over the jugular.
We gowned up, sterilized the patient, and got our kit out. I felt my landmarks about a million times to make sure I knew exactly where I was aiming (please, please, please no carotid) and then stuck my needle in. The pulse always seems to migrate right when you are sure that you know where you need to hit. Also, the skin on older people's necks is a little leathery, so you have to push with enough force to break the skin, but with enough restraint to avoid running right through things. ;)
I advanced my needle and pulled back on the syringe, waiting for a flashblack of blood to let me know I'd hit gold. It can take a while to find the vein, so I slowly came back and forth looking for my goal.
"I think you need to go closer to the carotid," Dr. Lee said.
"And if I hit it?"
He smiled. "We'll just hold pressure until he stops bleeding.It's happened to me loads of times." Simple Enough. Right.
I took out my needle, repositioned closer to the carotid, and advanced again. Bingo! Gosh, it feels so good to see venous blood return...brisk, but not pulsating in the way it would if you'd hit the artery. From there, I threaded in a wire through the needle that would coarse through the veins creating a path. Then I took a blade to make the skin incision a little bigger. Next, I withdrew the needle over the wire, careful not to let go of the wire and lose it inside the vessel. That would be bad. Next I threaded a plasticky type catheter over the wire, and then removed the wire from within. Lastly, I took a needle and thread and sewed the end of the catheter into the skin. You don't want to risk it slipping out after all that work. And done!
I stepped back, evaluated my handiwork, and exhaled.
"Right now," I thought, "I feel like a doctor."
Archives: 35 mm Joy
January Intern Year:
I'm now two weeks into my OB-GYN rotation.
When I was helping with my first delivery of this rotation, I realized that I hadn't been in a birth since the beginning of third year of med school. So as I stood and watched a sweet, young Hispanic woman labor through incredible pain, and then produce a lovely (albeit slightly grey and wrinkled) baby, I was unprepared for the tears that would well up while watching she and her mother cry. It was such a powerful moment when that baby was delivered and took its first breath. Now, after many more deliveries, some of that initial awe and wonder has diminished. I wish I could get it back, because as I stood there and witnessed that birth, I could feel holiness in the process.
Most of the patients that we deliver are 'clinic patients'. As in, 'free clinic' patients. These are patients who are: often young, mostly hispanic, and thrilled to be in a hospital at all. Many of the mothers are unmarried, but there are a significant number who have supportive boyfriends or husbands with them during their births. Some of these couples are so precious, I want to squeeze their little cheeks.
The men/boys who are present, are generally very anxious about their partner's wellfare. "Is she okay? Is she okay?" they ask over and over. Then, when the baby is born, the smile that breaks out over their faces is one of child-like joy and excitement. They look as though NOTHING could ever be as exciting as this moment! They stay with their wife for a little while and then rush over to the baby in the warmer like a kid on Christmas Day. An old 35 mm camera is pulled out from their back pocket and they start taking pictures of the baby incessantly. Their cameras look so archaic to my 'newest tech toy' trained eye, that the sweetness of it touches a cord. They turn and smile broadly back at their loved one before rounding again to take portraits of the tiny one. It is such a beautiful sight.
I want to take that young 19 year old boyfriend who looks thrilled to be a father and say, "I really, really hope this all works out. I hope you still look at your girlfriend this way in 10 years, and 10 more after that. I hope that the realities of dirty diapers, and bills, and obligations don't make you forget this moment and how happy you were to be this little family." I wish there were a prescription I could write for that.
In the meantime, I'll just soak up the happiness that seems to radiate from these births, and pray that it sticks to their hearts forever the way it sticks to mine while I'm there.
I'm now two weeks into my OB-GYN rotation.
When I was helping with my first delivery of this rotation, I realized that I hadn't been in a birth since the beginning of third year of med school. So as I stood and watched a sweet, young Hispanic woman labor through incredible pain, and then produce a lovely (albeit slightly grey and wrinkled) baby, I was unprepared for the tears that would well up while watching she and her mother cry. It was such a powerful moment when that baby was delivered and took its first breath. Now, after many more deliveries, some of that initial awe and wonder has diminished. I wish I could get it back, because as I stood there and witnessed that birth, I could feel holiness in the process.
Most of the patients that we deliver are 'clinic patients'. As in, 'free clinic' patients. These are patients who are: often young, mostly hispanic, and thrilled to be in a hospital at all. Many of the mothers are unmarried, but there are a significant number who have supportive boyfriends or husbands with them during their births. Some of these couples are so precious, I want to squeeze their little cheeks.
The men/boys who are present, are generally very anxious about their partner's wellfare. "Is she okay? Is she okay?" they ask over and over. Then, when the baby is born, the smile that breaks out over their faces is one of child-like joy and excitement. They look as though NOTHING could ever be as exciting as this moment! They stay with their wife for a little while and then rush over to the baby in the warmer like a kid on Christmas Day. An old 35 mm camera is pulled out from their back pocket and they start taking pictures of the baby incessantly. Their cameras look so archaic to my 'newest tech toy' trained eye, that the sweetness of it touches a cord. They turn and smile broadly back at their loved one before rounding again to take portraits of the tiny one. It is such a beautiful sight.
I want to take that young 19 year old boyfriend who looks thrilled to be a father and say, "I really, really hope this all works out. I hope you still look at your girlfriend this way in 10 years, and 10 more after that. I hope that the realities of dirty diapers, and bills, and obligations don't make you forget this moment and how happy you were to be this little family." I wish there were a prescription I could write for that.
In the meantime, I'll just soak up the happiness that seems to radiate from these births, and pray that it sticks to their hearts forever the way it sticks to mine while I'm there.
Archives: Reasons Why You Might Think I'm Crazy
December Intern Year:
Every once in a while, when the effects of cumulative sleep deprivation start to rear their ugly head, I might give people cause to wonder if I am one burger short of a happy meal. I'm so sure that I'm not (ha ha ha), that I'm willing to share three of said experiences from the last month:
1) I got off from work today at noon, post-call, and was asleep in bed by 1:30 pm. And oh what a very deep sleep it was. I had set my alarm for around 7:00 so that I could wake up to meet my uncle for dinner, but at around 6:40, the following scenario took place.
"Brrrring!! Brrrring!"
Alarm? Phone? Hmmm...not sure....very, very sleepy.
"Brriiiing!! Brrring!" I brush the covers off my head and look through the darkness at my nightstand. Phone. Definitely, Phone. I make a few fumbles to grasp at it, while trying to get a few facts straight, "What day is it? Is it a weekend? Do I have to get up and go to work?" I see that it's my sister-in-law, Caitlin, who it's always a pleasure to hear from. "Not a weekend," I decide, "but morning...I think I have to go to work. Which means that it's around 6:30 am here...making it around 4:30 am in Utah...shoot! Something must be wrong or she wouldn't be calling at 4:30!!"
I answer the phone.
"Hello? Caitlin?" "Hi, OCM, how are you?" "Good, is everything okay?" "Yeah, fine, why, what are you doing?" "Sleeping, but, uh, it's so early there." All of a sudden I realize that if it's 6:30 am my time, then I have monumentally overslept, and I sit up with a start. "Oh my gosh," I gasp, "I'm late for work!" "What? You have to go to the hospital?" Now she's starting to sound worried. Finally the light of understanding starts to dawn, and I think that she sounds oddly unlike someone who is making a call at 4:30 am. My brain gels together enough for me to ask, "What day is it?" "Monday." Then I notice two helpful little letters next to the 6:30 on my clock: P.M.
So now that we have that straight.
Wow...strong performance, OCM. :)
2) I was taking care of a very adorable, and very sick little boy last week who I'll call Will. Will, 2 years old and cute as a button, came in with meningitis and significant mental confusion. He was very lethargic and had a tendency to stare into space for long periods of time. A little freaky. Because I hated to wake him when he was sleeping, but needed to regularly assess his mental status, I asked mom to have the nurse page me the next time Will was awake. One afternoon I got a page that he was awake, so I headed over to the room. When I walked in, I was shocked to see Will out of bed, and kneeling by a chair at his bedside, playing with a little hand-held video game! Wow...he looked like he'd made a complete turnaround. I knelt down next to him and said, "Hey there buddy...how's it going?" "Good!" We chatted for a few minutes, and the whole time I'm thinking how he seemed like a new kid. After I was satisfied that he was looking about ten million times better, I stood up and turned to his parents. "Is he still having staring spells? He looks so much better!" Mom looked back at me with a very confused stare. "Actually," she said haltingly, still looking at me like I'd grown another head, "It's Will that I'm worried about...not Nathan."
My head whipped around to the bed, and there tucked underneath the covers, and nearly swallowed up by the big bed (I swear !), was Will, looking identical to, but much sicker than, his 4 year old brother Nathan (I swear !) who I had just thoroughly examined.
Ha ha ha...try explaining that one. "Apparently I can't quite differentiate your children from one another, but I swear we're taking good care of you." Actually, the parents were really nice about it, and I think I played it off fairly well. After all, those boys could practically pass as twins (I swear !)
3)About a month ago, Rockstar and I were planning on going to see the new Bond movie after work one day with Nancy and Robert. Nancy had mentioned that maybe she could pick up discount movie tickets from Costco, when I remembered that I'd heard that the hospital sells them as well. I figured that would be easier than her trying to make it to Costco in time, so I made a quick U-turn and headed back to the hospital.
As I walked in the doors, all I could remember was that I'd been told the tickets were sold in the Office of Decedent affairs. Apparently, so I'd been told, they offer all kinds of random services there, like detailing of your care and laundry. Who knew? I knew I'd seen the signs for the office over by the student call rooms and the Morgue, so I headed down to the basement and found my way there. I knocked on the door and heard a tiny voice call out, "Come in!'
I opened the door and saw a small, brown-haired woman sitting behind a non-descript desk, with nary but one or two filing cabinets filling up the mostly empty room. 'What an odd place to be selling movie tickets and doing laundry,' I thought.
"Can I help you?"
"Uh, yeah...I heard that you sold discount movie tickets here?"
She looked taken aback. "Movie tickets?? Here? "
All of a sudden it did seem rather ridiculous for a hospital to be selling movie tickets, and I felt a little bashful. "Uh, yeah...I thought I was told that."
"Honey, I think you are in the wrong office." I was actually a little relieved, then, because her comment seemed to indicate that in fact the hospital did sell them, but I had just wound up in the wrong office. "I think you are looking for Campus Corner," she continued, "which is downstairs. It can be a little hard to find, so why don't I walk you there."
"Great," I replied, relaxing a little.
She led me out of the office and we made small talk as we headed towards the elevator.
"Do you work here?" she asked me.
"Yeah, I'm one of the residents," I admitted, a little embarrassed that despite working there 80+ hours a week, I couldn't find my way to the movie ticket office.
We chatted a bit more and then the elevator arrived.
"By the way," I asked before she walked away, "What do you do in the office of Decedent Affairs?"
"Oh, we take care of all the dead bodies. We take them from the morgue and place them in the various funeral homes around the area. This is a pretty busy season for us."
My smile froze in place the way it does when you realize that you can't hide from the 'idiot' sign flashing away on your forehead.
"Thanks again!" I choked. She smiled a knowing smile, and turned to walk away.
Later, I turned to Webster's to see how a little etymology could have prevented the whole affair.
decedent |diˈsēdnt| noun Law a person who has died : to make sure the decedent's property passes to his children. ORIGIN late 16th cent.: from Latin decedent- ‘dying,’ from the verb decedere (see decease ).
Like I said, a few burgers short of a happy meal. But only on occassion. ;)
Every once in a while, when the effects of cumulative sleep deprivation start to rear their ugly head, I might give people cause to wonder if I am one burger short of a happy meal. I'm so sure that I'm not (ha ha ha), that I'm willing to share three of said experiences from the last month:
1) I got off from work today at noon, post-call, and was asleep in bed by 1:30 pm. And oh what a very deep sleep it was. I had set my alarm for around 7:00 so that I could wake up to meet my uncle for dinner, but at around 6:40, the following scenario took place.
"Brrrring!! Brrrring!"
Alarm? Phone? Hmmm...not sure....very, very sleepy.
"Brriiiing!! Brrring!" I brush the covers off my head and look through the darkness at my nightstand. Phone. Definitely, Phone. I make a few fumbles to grasp at it, while trying to get a few facts straight, "What day is it? Is it a weekend? Do I have to get up and go to work?" I see that it's my sister-in-law, Caitlin, who it's always a pleasure to hear from. "Not a weekend," I decide, "but morning...I think I have to go to work. Which means that it's around 6:30 am here...making it around 4:30 am in Utah...shoot! Something must be wrong or she wouldn't be calling at 4:30!!"
I answer the phone.
"Hello? Caitlin?" "Hi, OCM, how are you?" "Good, is everything okay?" "Yeah, fine, why, what are you doing?" "Sleeping, but, uh, it's so early there." All of a sudden I realize that if it's 6:30 am my time, then I have monumentally overslept, and I sit up with a start. "Oh my gosh," I gasp, "I'm late for work!" "What? You have to go to the hospital?" Now she's starting to sound worried. Finally the light of understanding starts to dawn, and I think that she sounds oddly unlike someone who is making a call at 4:30 am. My brain gels together enough for me to ask, "What day is it?" "Monday." Then I notice two helpful little letters next to the 6:30 on my clock: P.M.
So now that we have that straight.
Wow...strong performance, OCM. :)
2) I was taking care of a very adorable, and very sick little boy last week who I'll call Will. Will, 2 years old and cute as a button, came in with meningitis and significant mental confusion. He was very lethargic and had a tendency to stare into space for long periods of time. A little freaky. Because I hated to wake him when he was sleeping, but needed to regularly assess his mental status, I asked mom to have the nurse page me the next time Will was awake. One afternoon I got a page that he was awake, so I headed over to the room. When I walked in, I was shocked to see Will out of bed, and kneeling by a chair at his bedside, playing with a little hand-held video game! Wow...he looked like he'd made a complete turnaround. I knelt down next to him and said, "Hey there buddy...how's it going?" "Good!" We chatted for a few minutes, and the whole time I'm thinking how he seemed like a new kid. After I was satisfied that he was looking about ten million times better, I stood up and turned to his parents. "Is he still having staring spells? He looks so much better!" Mom looked back at me with a very confused stare. "Actually," she said haltingly, still looking at me like I'd grown another head, "It's Will that I'm worried about...not Nathan."
My head whipped around to the bed, and there tucked underneath the covers, and nearly swallowed up by the big bed (I swear !), was Will, looking identical to, but much sicker than, his 4 year old brother Nathan (I swear !) who I had just thoroughly examined.
Ha ha ha...try explaining that one. "Apparently I can't quite differentiate your children from one another, but I swear we're taking good care of you." Actually, the parents were really nice about it, and I think I played it off fairly well. After all, those boys could practically pass as twins (I swear !)
3)About a month ago, Rockstar and I were planning on going to see the new Bond movie after work one day with Nancy and Robert. Nancy had mentioned that maybe she could pick up discount movie tickets from Costco, when I remembered that I'd heard that the hospital sells them as well. I figured that would be easier than her trying to make it to Costco in time, so I made a quick U-turn and headed back to the hospital.
As I walked in the doors, all I could remember was that I'd been told the tickets were sold in the Office of Decedent affairs. Apparently, so I'd been told, they offer all kinds of random services there, like detailing of your care and laundry. Who knew? I knew I'd seen the signs for the office over by the student call rooms and the Morgue, so I headed down to the basement and found my way there. I knocked on the door and heard a tiny voice call out, "Come in!'
I opened the door and saw a small, brown-haired woman sitting behind a non-descript desk, with nary but one or two filing cabinets filling up the mostly empty room. 'What an odd place to be selling movie tickets and doing laundry,' I thought.
"Can I help you?"
"Uh, yeah...I heard that you sold discount movie tickets here?"
She looked taken aback. "Movie tickets?? Here? "
All of a sudden it did seem rather ridiculous for a hospital to be selling movie tickets, and I felt a little bashful. "Uh, yeah...I thought I was told that."
"Honey, I think you are in the wrong office." I was actually a little relieved, then, because her comment seemed to indicate that in fact the hospital did sell them, but I had just wound up in the wrong office. "I think you are looking for Campus Corner," she continued, "which is downstairs. It can be a little hard to find, so why don't I walk you there."
"Great," I replied, relaxing a little.
She led me out of the office and we made small talk as we headed towards the elevator.
"Do you work here?" she asked me.
"Yeah, I'm one of the residents," I admitted, a little embarrassed that despite working there 80+ hours a week, I couldn't find my way to the movie ticket office.
We chatted a bit more and then the elevator arrived.
"By the way," I asked before she walked away, "What do you do in the office of Decedent Affairs?"
"Oh, we take care of all the dead bodies. We take them from the morgue and place them in the various funeral homes around the area. This is a pretty busy season for us."
My smile froze in place the way it does when you realize that you can't hide from the 'idiot' sign flashing away on your forehead.
"Thanks again!" I choked. She smiled a knowing smile, and turned to walk away.
Later, I turned to Webster's to see how a little etymology could have prevented the whole affair.
decedent |diˈsēdnt| noun Law a person who has died : to make sure the decedent's property passes to his children. ORIGIN late 16th cent.: from Latin decedent- ‘dying,’ from the verb decedere (see decease ).
Like I said, a few burgers short of a happy meal. But only on occassion. ;)
Archives: This Might Save Your Life
Intern Year:
Today is my last day on my family practice rotation. I've become so accustomed to spending my evenings wrapped in the coziness of my apartment and in the company of my dear hubby, that it seems unreal that I will again be spending every 4th night at the hospital from now until June. That's life, and it's what I signed up for, but it was amazing how quickly I got used to living the life of mere mortal and not that of an overworked intern. At 6:00 am tomorrow, the gun will sound and off I'll go on a four week race through the surgical world. Based on what I've heard from the intern just finishing her surgical rotation, my new mantras are, "It's just four weeks." and "You choose your feelings." More on that as the month progresses.
Mom tells me that many God-fearing Doctors write about how they often feel like they are an instrument in God's hands, and that He is the true healer. I had my first experience like that this week.
I was seeing Mr. Fernandez (an exciting alias, to be sure) for some abdominal issues that he'd been having. In his 50's, he was pretty healthy, except for that whole hospitalization thing. He was on the upswing and stable. In other words, he was one of those patients that you have a low suspicion that something else will go wrong. In the brief physical exam that we do on patients each morning, we often give a cursory glance at their calves to make sure they aren't swollen, tender or warm. Often it becomes something more like 'reach under the sheets and give each calf a squeeze while saying, "does that hurt"? What we're looking for are blood clots, and redness, asymmetrical swelling, warmth, and pain upon palpation are red-flag signs. Having a blood clot in your legs can be tricky because if it breaks off and heads to your lungs, you could be dead in less than a minute.
So one morning I was in seeing Mr. Fernandez. He looked great and I reached down to quickly examine his legs. I squeezed each, he had no pain, and I was about to leave. But then I thought, "hmmm...was that left calf just a touch more swollen than the other one?" I almost brushed the thought off, but it persisted, so I said, "Can I just take one more look at your calf?" He re-iterated that it didn't hurt a bit, and I saw that there was no redness at all. But, when I looked more carefully, I saw that the left leg was indeed slightly bigger than the right one. After comparing the two legs a few times, I also felt that the left one was a few degrees warmer. Probably nothing, but it was noticeable enough that I thought we should have an ultrasound done to make sure.
I mentioned the finding to my attending, and he initially brushed me off. He probably thought, "overzealous intern." But then he went to examine the patient to follow-up on my findings, and agreed that there was a subtle difference. He wanted to hold off on the ultrasound, though, and see how it looked the next day.
All night I prayed: Please don't let anything happen to Mr. Fernandez overnight, Heavenly Father. If he has a clot, please let it stay put until we can run this test and start treatment.
The next day the swelling was still there and my attending consented to order the test. We left for the day. I didn't get to see Mr. Fernandez the next day, or his test results, because I was helping with newborn nursery. When I walked into lunch at the office, my attending stopped me. "Did you hear about Mr. Fernandez's test results?" "No." "He had several large clots in his left leg. Good catch." I couldn't believe it. It was such a tiny thing. So easily missed. But there was that voice in my head...that little nagging impression that 'shouldn't I just make sure that leg wasn't a little more swollen?'
I felt so humbled. I could easily have missed that, and there could easily have been consequences for that patient. I'm so grateful to know that God can guide my hand, sharpen my eyes, and inform my intuition to pick up things I might otherwise not. He is the healer.
Today is my last day on my family practice rotation. I've become so accustomed to spending my evenings wrapped in the coziness of my apartment and in the company of my dear hubby, that it seems unreal that I will again be spending every 4th night at the hospital from now until June. That's life, and it's what I signed up for, but it was amazing how quickly I got used to living the life of mere mortal and not that of an overworked intern. At 6:00 am tomorrow, the gun will sound and off I'll go on a four week race through the surgical world. Based on what I've heard from the intern just finishing her surgical rotation, my new mantras are, "It's just four weeks." and "You choose your feelings." More on that as the month progresses.
Mom tells me that many God-fearing Doctors write about how they often feel like they are an instrument in God's hands, and that He is the true healer. I had my first experience like that this week.
I was seeing Mr. Fernandez (an exciting alias, to be sure) for some abdominal issues that he'd been having. In his 50's, he was pretty healthy, except for that whole hospitalization thing. He was on the upswing and stable. In other words, he was one of those patients that you have a low suspicion that something else will go wrong. In the brief physical exam that we do on patients each morning, we often give a cursory glance at their calves to make sure they aren't swollen, tender or warm. Often it becomes something more like 'reach under the sheets and give each calf a squeeze while saying, "does that hurt"? What we're looking for are blood clots, and redness, asymmetrical swelling, warmth, and pain upon palpation are red-flag signs. Having a blood clot in your legs can be tricky because if it breaks off and heads to your lungs, you could be dead in less than a minute.
So one morning I was in seeing Mr. Fernandez. He looked great and I reached down to quickly examine his legs. I squeezed each, he had no pain, and I was about to leave. But then I thought, "hmmm...was that left calf just a touch more swollen than the other one?" I almost brushed the thought off, but it persisted, so I said, "Can I just take one more look at your calf?" He re-iterated that it didn't hurt a bit, and I saw that there was no redness at all. But, when I looked more carefully, I saw that the left leg was indeed slightly bigger than the right one. After comparing the two legs a few times, I also felt that the left one was a few degrees warmer. Probably nothing, but it was noticeable enough that I thought we should have an ultrasound done to make sure.
I mentioned the finding to my attending, and he initially brushed me off. He probably thought, "overzealous intern." But then he went to examine the patient to follow-up on my findings, and agreed that there was a subtle difference. He wanted to hold off on the ultrasound, though, and see how it looked the next day.
All night I prayed: Please don't let anything happen to Mr. Fernandez overnight, Heavenly Father. If he has a clot, please let it stay put until we can run this test and start treatment.
The next day the swelling was still there and my attending consented to order the test. We left for the day. I didn't get to see Mr. Fernandez the next day, or his test results, because I was helping with newborn nursery. When I walked into lunch at the office, my attending stopped me. "Did you hear about Mr. Fernandez's test results?" "No." "He had several large clots in his left leg. Good catch." I couldn't believe it. It was such a tiny thing. So easily missed. But there was that voice in my head...that little nagging impression that 'shouldn't I just make sure that leg wasn't a little more swollen?'
I felt so humbled. I could easily have missed that, and there could easily have been consequences for that patient. I'm so grateful to know that God can guide my hand, sharpen my eyes, and inform my intuition to pick up things I might otherwise not. He is the healer.
Archives: Two Weeks In
Intern Year:
So I'm two weeks into my CCU rotation and it has definitely been a roller coaster ride. On the whole, it's been a positive experience. I have a good team (consisting of two residents and two other interns) and the work has been satisfying. A few highlights and lowpoints:
Two of my patients died in the first week I was on service. This has never happened to me before. I've had patients die right after I rotated off a service and I've seen bodies of people I've never taken care of, but never before has someone died while I was there caring for them. The strange thing about both of them was that they looked pretty okay when they came in. Most people in an ICU look like they could die, but not these two. I remember wondering aloud why they had been sent to our unit. And both times I left the night before saying goodbye to them and having them talk back, and returnd the next morning to find that they had crumped overnight. Unbelievable, and mostly unexplainable. The first was a gentleman in his early 60's. His family had been notified of his tenuous stataus before I arrived in the morning, so I didn't see the initial impact of the news on them. The family gathered in his room, shut the curtains, and played soothing music on a CD player while life support was withdrawn. We gave them their privacy, but the wife came out after he had passed to thank us for our help. I remember her smiling sadly at us to say thank you.
The second death was the one that really broke my heart. She was in her late 70's and was being admitted for what seemed to be a small pneumonia. Her husband was adorable, adoring, and full of, "whatever you need to do to make her better!" and "I've been in and out of this hospital so many times...I'm the sick one. She'll be fine!". He mentioned to me that her mother had lived until her mid-90's, and he was sure she would do the same. What he didn't know was that her chest x-ray from that day was awfully suspicious for lung cancer. But we weren't going to pursue that until she was stabilized. When I left that night, they were both in good spirits and the husband was leaving to get some rest.
When I returned the next morning I was told that around 3 am she had unexpectedly coded, and while they had revived her, she was now brain dead. I was in shock. Her husband would be arriving momentarily. All he had been told was that he needed to come quickly because it was critical. I saw him walk in the double doors, looking helpless the way people do to me when they don't yet have the information that's going to change their lives forever. Already my tears were at the surface and I didn't know if I had the composure to talk to him. Luckily the other intern who had been on call when she coded said that she could talk to him. We went in together and she explained to him that while his wife looked like she was still alive, she was only being kept alive because of all the pressors, etc., and that she was brain dead. He crumpled before my eyes. Literally. He just folded to the floor and then picked himself up to the chair, sobbing. That's what I wanted to do as well. I could barely keep myself together and the tears were starting to come out. We each gave him a hug and said that we'd give him some time alone with her to think. We also went to call their primary doctor so that he could talk to them about the situation. I walk-ran out of their and straight to the bathroom where I proceeded to bawl my eyes out. It's not the dying patients that get to me, I realized, but their families who are left behind. Have you ever watched someone get that kind of news? It devastates. I could hear the other intern through the wall, crying in the call room. Our first heartbreak of intern year.
The husband decided later that day to withdraw life support and we were able to be with him and comfort him. When she passed, my resident asked me to come with him to 'pronounce' her officially dead. There's actually a science to it--a checklist of things you have to do to verify that they are really dead. He said, "I know it's hard to learn it like this, but you'll need to know." He was right. The very next day I was on call when I got a page. It was a nurse from one of the upstairs surgical units that I don't work in. "Can you pronounce people," she said? "Yes." "Would you mind coming up here? One of our patients just died and the surgeon is stuck in traffic. We need someone to come up here and pronounce him." "Sure, I'll be up." I walked upstairs and found an elegant African-American man laying on his bed like he was just taking an afternoon nap. His open-eyed, glazed over stare was the only thing that spoke to the contrary. Well, that and his flat-lining monitor. The nurse told me that he was a physician himself, a soccer player, and had been stable as far as everyone could tell until early that morning. I was beginning to think that it might actually be better to look sick, as those patients seem to end up coming round. I went through my check list of things and pronounced a man I had never met, dead. Another nurse came in and said that she'd just spoken with the wife. The wife had been driving so the nurse had been reluctant to tell her anything but that she needed to come in immediately. The wife pressed the nurse for more information until she finally told her that he was dead. The wife just started screaming. I'm telling you...it's the families. The first nurse who had called me up walked over to the patient's pillow, lifted up a corner of it, and pulled out a well-worn bible. She looked at me. "This must be the fun part of your job."
So I'm two weeks into my CCU rotation and it has definitely been a roller coaster ride. On the whole, it's been a positive experience. I have a good team (consisting of two residents and two other interns) and the work has been satisfying. A few highlights and lowpoints:
Two of my patients died in the first week I was on service. This has never happened to me before. I've had patients die right after I rotated off a service and I've seen bodies of people I've never taken care of, but never before has someone died while I was there caring for them. The strange thing about both of them was that they looked pretty okay when they came in. Most people in an ICU look like they could die, but not these two. I remember wondering aloud why they had been sent to our unit. And both times I left the night before saying goodbye to them and having them talk back, and returnd the next morning to find that they had crumped overnight. Unbelievable, and mostly unexplainable. The first was a gentleman in his early 60's. His family had been notified of his tenuous stataus before I arrived in the morning, so I didn't see the initial impact of the news on them. The family gathered in his room, shut the curtains, and played soothing music on a CD player while life support was withdrawn. We gave them their privacy, but the wife came out after he had passed to thank us for our help. I remember her smiling sadly at us to say thank you.
The second death was the one that really broke my heart. She was in her late 70's and was being admitted for what seemed to be a small pneumonia. Her husband was adorable, adoring, and full of, "whatever you need to do to make her better!" and "I've been in and out of this hospital so many times...I'm the sick one. She'll be fine!". He mentioned to me that her mother had lived until her mid-90's, and he was sure she would do the same. What he didn't know was that her chest x-ray from that day was awfully suspicious for lung cancer. But we weren't going to pursue that until she was stabilized. When I left that night, they were both in good spirits and the husband was leaving to get some rest.
When I returned the next morning I was told that around 3 am she had unexpectedly coded, and while they had revived her, she was now brain dead. I was in shock. Her husband would be arriving momentarily. All he had been told was that he needed to come quickly because it was critical. I saw him walk in the double doors, looking helpless the way people do to me when they don't yet have the information that's going to change their lives forever. Already my tears were at the surface and I didn't know if I had the composure to talk to him. Luckily the other intern who had been on call when she coded said that she could talk to him. We went in together and she explained to him that while his wife looked like she was still alive, she was only being kept alive because of all the pressors, etc., and that she was brain dead. He crumpled before my eyes. Literally. He just folded to the floor and then picked himself up to the chair, sobbing. That's what I wanted to do as well. I could barely keep myself together and the tears were starting to come out. We each gave him a hug and said that we'd give him some time alone with her to think. We also went to call their primary doctor so that he could talk to them about the situation. I walk-ran out of their and straight to the bathroom where I proceeded to bawl my eyes out. It's not the dying patients that get to me, I realized, but their families who are left behind. Have you ever watched someone get that kind of news? It devastates. I could hear the other intern through the wall, crying in the call room. Our first heartbreak of intern year.
The husband decided later that day to withdraw life support and we were able to be with him and comfort him. When she passed, my resident asked me to come with him to 'pronounce' her officially dead. There's actually a science to it--a checklist of things you have to do to verify that they are really dead. He said, "I know it's hard to learn it like this, but you'll need to know." He was right. The very next day I was on call when I got a page. It was a nurse from one of the upstairs surgical units that I don't work in. "Can you pronounce people," she said? "Yes." "Would you mind coming up here? One of our patients just died and the surgeon is stuck in traffic. We need someone to come up here and pronounce him." "Sure, I'll be up." I walked upstairs and found an elegant African-American man laying on his bed like he was just taking an afternoon nap. His open-eyed, glazed over stare was the only thing that spoke to the contrary. Well, that and his flat-lining monitor. The nurse told me that he was a physician himself, a soccer player, and had been stable as far as everyone could tell until early that morning. I was beginning to think that it might actually be better to look sick, as those patients seem to end up coming round. I went through my check list of things and pronounced a man I had never met, dead. Another nurse came in and said that she'd just spoken with the wife. The wife had been driving so the nurse had been reluctant to tell her anything but that she needed to come in immediately. The wife pressed the nurse for more information until she finally told her that he was dead. The wife just started screaming. I'm telling you...it's the families. The first nurse who had called me up walked over to the patient's pillow, lifted up a corner of it, and pulled out a well-worn bible. She looked at me. "This must be the fun part of your job."
Archives: It's Called Fear
Intern Year:
So yesterday was my last day of orientation, and Monday is the day of reckoning. I've got my long white coat, I've been given my hospital tour and computer logins, I've been told 'good luck' at least a dozen times, and now it's just me and the enormous workload that lies ahead. I think I've been in a denial phase for the last little while. Going in, I was so determined not to be scared. "I'm well trained, I've done this kind of work before....I won't let it get to me." And yet here I am, feeling like I want to throw-up or quit or just take a very, very long nap.
I think part of it is that I now have to take more responsibility for any ignorance that will be uncovered. Gone are the days of, "I'm just a medical student," and here are the days of medical students looking to me for answers. Doctors obviously aren't supposed to know everything, but sometimes we put that pressure on ourselves. Or maybe it's everyone else who does that. :)
Another thing: now when my pager goes off to alert me that a patient is coding, I am supposed to be a first responder. Excuse me, what? I know. I'm supposed to run the code. I know it's all information that I've learned, but reading it in a book is much different from barking orders like, "You! Call the Code! You! Start Chest Compressions!"
I'm starting in the Cardiac Intensive Care Unit, which is definitely more intimidating. Patients are sick, sick, sick, and the learning curve is steeper.
I left orientation on Friday with a headache. Probably because I have a pretty good idea of what's ahead. I know what it feels like to wake up early and realize it's a race against time to get all your patients seen and notes written before it's time to round with your team. I know what it feels like to be on your 24th hour of a 30 hour shift and feel like you don't know how you'll make it through. I know what it feels like to cry out of pure frustration at the system, or sadness for a patient or embarrassment at having made a mistake. So it's easy to get a little tired thinking of it.
Luckily, I also know how incredible it can be to sit by a patients bed and explain what we're going to do to help them, and see them smile back at me. I know how it feels to be part of a team of other students and doctors and to laugh hysterically at things that no one else would ever think funny. I know how it feels to work yourself to the bone, but be confident that it was worth something.
All of which means, I'll probably still be here to tell the tale a year from now at my own 'intern' graduation.
Cross your fingers.
So yesterday was my last day of orientation, and Monday is the day of reckoning. I've got my long white coat, I've been given my hospital tour and computer logins, I've been told 'good luck' at least a dozen times, and now it's just me and the enormous workload that lies ahead. I think I've been in a denial phase for the last little while. Going in, I was so determined not to be scared. "I'm well trained, I've done this kind of work before....I won't let it get to me." And yet here I am, feeling like I want to throw-up or quit or just take a very, very long nap.
I think part of it is that I now have to take more responsibility for any ignorance that will be uncovered. Gone are the days of, "I'm just a medical student," and here are the days of medical students looking to me for answers. Doctors obviously aren't supposed to know everything, but sometimes we put that pressure on ourselves. Or maybe it's everyone else who does that. :)
Another thing: now when my pager goes off to alert me that a patient is coding, I am supposed to be a first responder. Excuse me, what? I know. I'm supposed to run the code. I know it's all information that I've learned, but reading it in a book is much different from barking orders like, "You! Call the Code! You! Start Chest Compressions!"
I'm starting in the Cardiac Intensive Care Unit, which is definitely more intimidating. Patients are sick, sick, sick, and the learning curve is steeper.
I left orientation on Friday with a headache. Probably because I have a pretty good idea of what's ahead. I know what it feels like to wake up early and realize it's a race against time to get all your patients seen and notes written before it's time to round with your team. I know what it feels like to be on your 24th hour of a 30 hour shift and feel like you don't know how you'll make it through. I know what it feels like to cry out of pure frustration at the system, or sadness for a patient or embarrassment at having made a mistake. So it's easy to get a little tired thinking of it.
Luckily, I also know how incredible it can be to sit by a patients bed and explain what we're going to do to help them, and see them smile back at me. I know how it feels to be part of a team of other students and doctors and to laugh hysterically at things that no one else would ever think funny. I know how it feels to work yourself to the bone, but be confident that it was worth something.
All of which means, I'll probably still be here to tell the tale a year from now at my own 'intern' graduation.
Cross your fingers.
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