Monday, May 3, 2010

Take Home Points: Vol 2

There are times when I feel that I haven't learned anything during my intern year. It's been ten months, and I still find myself wondering what I've learned. Most of the year was spent trying to keep my head above water. I spent my time floundering about in an awkward dog-paddle instead of immersing myself in scholarly study.

Then, I rotated through the surgical intensive care unit for the second time. I should have realized that the fact I didn't throw up on the way to work the day of my first call day meant that I had learned something. The first night I was on call, back in September, when my colleagues signed out their patients at the end of the day and left for the night, I was so scared, I wanted to throw myself at them, hang onto their leg and scream, "Don't leave me." I just managed in suppressing this urge.

It took me last month to realize I had actually learned something. It took me 24 hours in the Neonatal Intensive Care Unit (NICU) (my place of residence during the lovely month of May) to realize that I had learned how to learn.

Sometimes, it is all I can do to not share everything I've learned with pretty much anyone who will listen. I do realize that, while important, most things learned during an intern year do not make for good conversation topics. For example...Transfusion parameters in critically ill patients. Fluid resuscitation guidelines in sepsis. Antibiotic prophylaxis for neurosurgical patients. Symptom-based benzodiazepine dosing for alcohol withdrawal symptoms. Methods of maintaining cerebral perfusion pressure. It is dinner topics such as these that have lead to a significant shortage of dinner guests. Although, if you're interested, just let me know. I'll send the articles your way.

But I have learned other things. Things you might call "life lessons." Take home points. A way to summarize a month's worth of experience. Things that may possibly be interesting to the general public. Or those reading this. That's yet to be seen.

It started with trauma service in December. These stood out to me more than others.

But every service has its lessons.

So, here are my take home points for the last several months.


January: Radiology

Don't smoke.

I'm not saying this in a preachy or judgemental way. I've heard the spiel that smokers are starting to feel like social outcasts or discriminated against. But seriously, Don't Smoke. Radiology showed me what can grow in the lungs, the necks, the mouths, the noses, the throats of people who smoke. And even if it isn't a giant cancer that carves out of home in the right upper lobe of the lung, it's the emphysema. The chronic bronchitis. The turning of beautiful, clear lungs into hazy, blebby air sacs.

Don't smoke.

February: Internal Medicine

1. Don't smoke.

It's not just the lungs. It's the vessels. People who have lost circulation to their feet. People who are more prone to strokes and heart attacks. People, where it doesn't matter how healthy they eat, how much they exercise (if they are able), what vitamins they take. None of this matters, because it is overshadowed by the damage done by the cigarette in their hand.

2. Take your medicine.

I know. This also sounds preachy. It isn't' meant to. If it makes you feel better, I'm going into a field where the chance I ever write a prescription for anyone is next to none. However, if you've taken the time to go see a doctor, and the doctor thinks that you should take a medicine, you probably should. I know that you say you'll manage your diabetes through diet and exercise, that you will get your cholesterol and blood pressure down the same way. I know that you don't want to finish that course of antibiotics. I'm sure it's a inconvenience to take pills for your heart/kidney/lungs/...etc, etc. But we're not handing out medications because we think it's fun. It's because you probably need them. Half the people I took care of where admitted due to issues regarding "non-compliance." Blood pressures out of control, diabetic complications, recurrent infections. Please, just take your medications.

March: Anesthesiology

Wow, I love my job.

April: SICU

This is probably the most important lesson of all.

Take the time to talk to your loved ones about your wishes for the end of your life. Talk to your parents about what they want. Talk to your spouse about what you want. Does your mother or father want aggressive management? Or do they feel that, should the worst happen, they would rather limit their time in a hospital, on a ventilator, or undergoing procedures. I'm not going to say which is best. It depends on the person, the disease process, and the situation. But talk about it. Let your family know.

There is nothing worse than a disagreement between family members about how to proceed with treatment. Bedside arguments about withdrawing care or continuing shouldn't happen. It's already such a horrible situation. The worst thing imaginable has happened to these families. They should be able to be there for each other, a source of comfort and support. Don't be the next Terri Schiavo. Even if you are young and healthy, even if your parents are young and healthy. Talk about it.


Okay, I'll admit. None of these make really great party conversations either. But at least it's better than discussing the indications for selecting a vasopressor. Although, skimming through this, I'm starting to get a better grasp of my social awkwardness.

I've also learned that eating fried food at 11:30 pm will keep you up all night with heartburn.


  1. So I think I get this a little better than some. Cam is taking anatomy right now and to pass that class you really have to own the vernacular. He walks around saying things about ventricles and mandibular joints all the time. His life has to be emerged in those health things as well for his other classes. If he tell his family about osteoporosis one more time I think they will run the other way. I know the things he is learning are really valuable but, to try to share those in mixed company- not always appropriate. I had to laugh at this post because it reminds me of my hubby...

  2. My dad's mother died of pneumonia, which was because she had emphysema caused by decades of smoking. I don't understand why anyone would do that to themselves.

    I try to be good about taking my medicine, but sometimes I just don't wanna!

    I'm really glad you loved anesthesiology so much. Sounds like you really did pick the right discipline!

  3. I wonder what you'll think about your intern experience 20 years from now, when you're an old pro. "I wish I knew then what I know now."

    You're last point about talking with loved ones re end-of-life decisions is so true! We're currently working this out with my mother-in-law (not that she's anywhere close to dying, but she is elderly). It's not an easy conversation, but so important to know what she wants and honor her wishes as best we can.

  4. Great post!

    I totally agree with the not smoking. Why would you do that? It will kill you.

    End of life talks are so important too. It is so hard to talk to your love ones about things like that though. So hard.

  5. You've learned so very much. You have increased things like composure, tact, compassion, reflection, perspective, balance, self control, patience, tolerance, acceptance, presence, wisdom, etc, etc. in addition to the life saving things you do all day, every day. You are still amazing and your take home points are excellent.