Residency graduation happened a little while ago.
Granted, I'm not actually done with residency. I still am making up each day I missed for maternity leave. But, as I tell Duck on a near daily basis, it was still a good idea.
Graduation for residency is much less than other graduations. There are no gowns and caps. There is no "Pomp and Circumstance" playing. It's a quiet lunch where small certificates are handed out. A certificate that is apparently supposed to represent all the sacrifices and heart ache and sleep deprivation and hard work and moments when you lost your faith in humanity, in God, and yourself, and the moments when that faith was restored.
For four years, I looked forward to the day when I would receive that small piece of paper. I eagerly counted down the days, thinking of how grand and glorious life would be on the other side of that handshake with my residency direction and departmental chair.
Because residency is a weird thing. We stay awake 30 hours at a time, asked to make life and death decisions while doing so. We hold lives and futures in our hands. Outside the hospital, we are adults, with children and mortgages and ailing parents and crumbling relationships. And then we come into the hospital and we are yelled at, belittled, talked down to, humiliated. We have all our weaknesses laid bare for the examination of strangers. We are expected to deliver bad news. We are expected to know, always know. We see blood, and nudity, and death. We are expected to care, always care.
If I could get through residency, I could get through anything. That is what I've been telling myself for four years.
And here I am. Through it.
And the predominating emotion? It isn't the elation I thought I would feel. It isn't the weight off my shoulders I thought I would feel. It isn't the fall to my knees in pure relief I thought I would feel.
Mostly, I just feel lonely.
Because residency is a weird thing. While we are going through everything, we have our fellow residents beside us, going through the same things.We are in it together. We develop friendships, friendships forged by fatigue and saving lives together. Of facing the same self doubt and overcoming. Of being surrounded only by people who have 8-15 years post high school education. These are some of the tightest connections formed. I often spent more time with my fellow residents than my own family.
And now it's over. Residency ends and everyone leaves. Now is the time, 12 years later than our friends from high school, hundreds of thousands of dollars in debt, disillusioned, tired, now, finally, is the time to start our lives.
And just like that, everyone is gone.
I wouldn't ever wish to do this again. Even in the loneliness, there is still the elation and the relief. That we have made it through this.
Because no matter what else is out there, we can do it, we can make it through. Because after all, we survived residency.
And we have a piece of paper proving it.
Showing posts with label Residency Road. Show all posts
Showing posts with label Residency Road. Show all posts
Tuesday, July 23, 2013
Friday, June 14, 2013
Last Night
I can think of at least a dozen things I should be doing instead of sitting in front of my computer, clacking away at the keyboard. My dirty house, my stack of board review cares, the appt I need to leave for in 20 minutes, and my bed are all loudly calling to me.
But sometimes, you just gotta write.
Last night was my very last call night of residency.
While there are still quite a few more days in front of me before the end of residency, they are mild and benign compared to what lies behind me.
Nights are the worst time to be a doctor. It is when people get the sickest, the decisions have to be made the fastest, and you feel the most alone. During the day, surrounded by colleagues and consult services and social workers and interns, everything feels safe and manageable and yes-I-can-do-this-I-am-okay. But then night comes and the bustling crowds teaming around each patient bed are gone. The fatigue sets in. The hour counting starts (20 hours awake, 21 hours awake, 22...) And things just happen. It feels like night is when hearts choose to stop and strokes choose to start and metabolic derangements choose to declare themselves. Insecurity and doubt and sleep deprivation and loneliness press in from every side.
Yet decisions are still made, vent settings are changes, medications are started and stopped and labs values are corrected and pagers beep and are answered and I find that I can do this.
Morning arrives and fresh, rested faces appear back in the hospital and all the patients from overnight are just fine.
In the pre-dawn bustle, I head to the hospital cafeteria. I, the soon-to-be anesthesiologist, stand in line between the soon-to-be neurosurgeons, orthopedic surgeons, trauma surgeons, and obstetricians. We are all bleary eyed and pale, ordering our scrambled eggs and breakfast sandwiches and coffee.
There is camaraderie between us as residents, wearing our fatigue as war medals beneath our eyes.
I wonder to myself, now that the last night is over, I wonder will I miss this?
And that's when I realize how tired I am. Because no. From now on, every night will be spent in my bed. I will come home every evening. I will not count how long past 24 hours I've kept my eyes propped open and flogged my brain to decide, work, choose.
The last night is finally done. And all I can feel is gratefulness to have survived yet another thing. To be done with another thing.
But sometimes, you just gotta write.
Last night was my very last call night of residency.
While there are still quite a few more days in front of me before the end of residency, they are mild and benign compared to what lies behind me.
Nights are the worst time to be a doctor. It is when people get the sickest, the decisions have to be made the fastest, and you feel the most alone. During the day, surrounded by colleagues and consult services and social workers and interns, everything feels safe and manageable and yes-I-can-do-this-I-am-okay. But then night comes and the bustling crowds teaming around each patient bed are gone. The fatigue sets in. The hour counting starts (20 hours awake, 21 hours awake, 22...) And things just happen. It feels like night is when hearts choose to stop and strokes choose to start and metabolic derangements choose to declare themselves. Insecurity and doubt and sleep deprivation and loneliness press in from every side.
Yet decisions are still made, vent settings are changes, medications are started and stopped and labs values are corrected and pagers beep and are answered and I find that I can do this.
Morning arrives and fresh, rested faces appear back in the hospital and all the patients from overnight are just fine.
In the pre-dawn bustle, I head to the hospital cafeteria. I, the soon-to-be anesthesiologist, stand in line between the soon-to-be neurosurgeons, orthopedic surgeons, trauma surgeons, and obstetricians. We are all bleary eyed and pale, ordering our scrambled eggs and breakfast sandwiches and coffee.
There is camaraderie between us as residents, wearing our fatigue as war medals beneath our eyes.
I wonder to myself, now that the last night is over, I wonder will I miss this?
And that's when I realize how tired I am. Because no. From now on, every night will be spent in my bed. I will come home every evening. I will not count how long past 24 hours I've kept my eyes propped open and flogged my brain to decide, work, choose.
The last night is finally done. And all I can feel is gratefulness to have survived yet another thing. To be done with another thing.
Sunday, May 19, 2013
Hanging On
That's what I've been doing lately. Just hanging on.
Hanging on until spring came. And amazingly enough, just like every other year, it came. Despite freezing temperatures and snow falls in March and bare branches and brown, dead lawns and gardens in April it came.
Hanging on until residency is over. I'm still waiting for that one, but it's coming, in a very slow, dragged out way, but it's coming.
Hanging on until Duck, and by natural extension, me, starts sleeping through the night again.
I keep thinking that I'm on top of things, that I can make time for everything. For all the dishes and laundry and school activities and family time and studying and home projects and putting away the winter clothes and movie night and research projects and the over all big picture. But I can't do it all.
I think I'm on top of it, and then there is a huge family crisis that has me rushing back to Utah to be with family.
I think I'm on top of it, and then I realize that there are just a couple months until boards and I'm spending every last second studying. Listening to lectures while I drive. Flipping through questions while in line at the grocery store. Rushing to get the boys to bed so I can pull out the books and study until I fall asleep at the kitchen table surrounded by highlighters and flashcards.
I think I'm on top of it, and then I find myself doing 24 hour calls every third night and working 85 hour weeks and 15 straight days. And I'm just so tired and overwhelmed that I can't even fake a smile.
I think I'm on top of it until I realize that I'm busy and tired and overwhelmed and my boys are rapidly growing up around me and I feel a blind panic that I'm missing every thing important.
I know this is just a temporary phase.
Boards and residency will be over in July. There will be no more 24 hour or weekend shifts. Eventually the piles of laundry and the faint smell of unwashed dishes will be taken care of.
Until then, I'm hanging on.
Hanging on until spring came. And amazingly enough, just like every other year, it came. Despite freezing temperatures and snow falls in March and bare branches and brown, dead lawns and gardens in April it came.
Hanging on until residency is over. I'm still waiting for that one, but it's coming, in a very slow, dragged out way, but it's coming.
Hanging on until Duck, and by natural extension, me, starts sleeping through the night again.
I keep thinking that I'm on top of things, that I can make time for everything. For all the dishes and laundry and school activities and family time and studying and home projects and putting away the winter clothes and movie night and research projects and the over all big picture. But I can't do it all.
I think I'm on top of it, and then there is a huge family crisis that has me rushing back to Utah to be with family.
I think I'm on top of it, and then I realize that there are just a couple months until boards and I'm spending every last second studying. Listening to lectures while I drive. Flipping through questions while in line at the grocery store. Rushing to get the boys to bed so I can pull out the books and study until I fall asleep at the kitchen table surrounded by highlighters and flashcards.
I think I'm on top of it, and then I find myself doing 24 hour calls every third night and working 85 hour weeks and 15 straight days. And I'm just so tired and overwhelmed that I can't even fake a smile.
I think I'm on top of it until I realize that I'm busy and tired and overwhelmed and my boys are rapidly growing up around me and I feel a blind panic that I'm missing every thing important.
I know this is just a temporary phase.
Boards and residency will be over in July. There will be no more 24 hour or weekend shifts. Eventually the piles of laundry and the faint smell of unwashed dishes will be taken care of.
Until then, I'm hanging on.
Monday, March 4, 2013
Grief, Revisited
In my line of work, it's inevitable that there is illness, disease, and yes, even death. There is hardly a day that goes by where I don't come in contact with this, where I don't play a minor role in all these sad stories.
How I'm affected by these stories vary. Most of the time, I'm learning to not be as affected. I'm learning to recognize the things I can change, the things I can't, the inevitable from the preventable. It's not easy, but an essential part to maintaining my sanity.
However, there are still events that knock me out of my comfort level, that rattle me to my core. Things I see that leave me hollow, sad, and waking up from bad dreams in the middle of the night.
That's what this last week has been. There was one patient that I can't get out of my mind. A patient that I desperately wanted to save, a patient that I desperately wanted to return, whole and healed, to their family. But that was not the case. Yes, against all odds, we worked as a team and were able to get the patient out of the OR. But that's where the good news ended. The patient was too ill, too broken, and didn't survive the week.
I cried in the car on the way home. I cried at home to Hubster. I woke up from bad dreams crying.
I recognized that some of my grief stems from my inability to not project my own situation on what had happened. What if it was my loved one? How would I feel if I had to go home, and my own family member was suddenly not there?
I met the family several times. I saw grief etched in every aspect of their expressions, their posture. Witnessing their grief, it felt that my own sadness was selfish. Despite all my attempts at empathy, how could I even image what they were going through? How dare I even pretend that my tears compared in some way to theirs?
I had thought I was past this, that I had built enough emotional distance from all the sad stories. Despite how emotionally draining, how acutely horrific this last week has been, a small part of me is actually relieved to find that this is not the case.
How I'm affected by these stories vary. Most of the time, I'm learning to not be as affected. I'm learning to recognize the things I can change, the things I can't, the inevitable from the preventable. It's not easy, but an essential part to maintaining my sanity.
However, there are still events that knock me out of my comfort level, that rattle me to my core. Things I see that leave me hollow, sad, and waking up from bad dreams in the middle of the night.
That's what this last week has been. There was one patient that I can't get out of my mind. A patient that I desperately wanted to save, a patient that I desperately wanted to return, whole and healed, to their family. But that was not the case. Yes, against all odds, we worked as a team and were able to get the patient out of the OR. But that's where the good news ended. The patient was too ill, too broken, and didn't survive the week.
I cried in the car on the way home. I cried at home to Hubster. I woke up from bad dreams crying.
I recognized that some of my grief stems from my inability to not project my own situation on what had happened. What if it was my loved one? How would I feel if I had to go home, and my own family member was suddenly not there?
I met the family several times. I saw grief etched in every aspect of their expressions, their posture. Witnessing their grief, it felt that my own sadness was selfish. Despite all my attempts at empathy, how could I even image what they were going through? How dare I even pretend that my tears compared in some way to theirs?
I had thought I was past this, that I had built enough emotional distance from all the sad stories. Despite how emotionally draining, how acutely horrific this last week has been, a small part of me is actually relieved to find that this is not the case.
Monday, March 5, 2012
Typical Day
It's been a long time since I've described a typical day around here. Mostly because there are no typical days. Even when the days are blurring into one heavy load that sometimes crushes me into exhaustion, I cannot choose one day that accurately portrays my life.
But today was about as routine as they come. So I'll start with today...
4:50 am: Alarm goes off. I push snooze. I always give myself 5 minutes of snooze. It feels like such a luxury.
4:55 am: Alarm goes off again. No more luxury. Time to get out of bed. I've started getting up a few minutes early to do a few exercises and stretches. Because I'm losing a war with my scale. And with my pants. And so ultimately, with myself. I do crunches, push-ups, and stretches. I check to see if I can still reach my toes. Success.
5:00 am: Enough exercise. 5 minutes is enough. Head to the bathroom. I weigh myself. Okay, 5 minutes isn't enough. I wash my face, put in my contacts, brush my teeth, pretend to do my hair and make-up. Even though my eyes is all that people will see of my face most of the day at work.
5:15 am: Get dressed. Put on deodorant.
5:20 am: Downstairs to make coffee while I put on my compression stockings (don't judge, I stand a lot at my job.) I pack a quick lunch. I'm tempted to grab the delicious leftover broccoli-cheese soup, but I remember that vindictive scale upstairs and pack a grapefruit instead. I also put on my boots, because we got a lot of snow yesterday.
5:25 am: Back upstairs. Kiss a sleeping Hubster, Bug, and Monkey good-bye for the day. Monkey wakes up and wants a hug as well. I hug him tight and hush him back to sleep.
5:27 am: Grab my keys, bag, phone, and coat. Back the car down the driveway. And leave. Everyday I hate the leaving part.
5:37 am: Arrive at the commuter parking lot. Check the weather while I wait for the bus. It says it's cold outside. Yep, already knew that.
5:40 am: Get on the bus. Three of my fellow residents are on the same bus. We talk about what cases we are doing that day.
5:50 am: Arrive the hospital. Walk across the frigid parking garage to the side door I always take. Ride the elevator up.
5:55 am: Change into scrubs. Grab my pager, my stethoscope, my scrub hat, my name badge. Fill my pockets with my phone, several pens, and a marker. Drop my bag off in the resident lounge, put my depressing lunch in the fridge, grab my clipboard with my schedule, and head down to the operating rooms.
6:00 am: Grab supplies from the anesthesia work room. An IV set-up, an extra LMA. Stop by the pharmacy window and check of the drugs for my first patient. Head to my OR.
6:05 am: Get my OR ready. I have a mnemonic I follow every day to make sure I don't miss a thing. Everything I need for airway management is prepared. All the drugs I need are drawn up in labeled syringes. I'm incredibly OCD about my labels. Actually, maybe about everything.
6:30 am: Head upstairs for lecture. Today's lecture is a refresher on obstetric anesthesia.
7:15 am: Lecture is over. I meet with the resident who is rotating through anesthesia right now. We head back down to the ORs. I set up a few more things.
7:30 am: I go to see my first patient, a 40 something female, undergoing a procedure for kidney stones. She's unusual, in the fact that she's otherwise healthy. I don't have many patients this healthy. I introduce myself, talk about the plan for anesthesia, the risks of anesthesia. I answer her questions. I start her IV.
8:00 am: Arrive in the OR with the patient. The nurses ask her a few more questions. I help her move over to the OR bed. I put all the monitors on her. The rotating resident helps. My supervising staff arrives. I give her oxygen while he gives her drugs to drift her off to sleep. Once she's asleep, I place an LMA. We work with the surgical team to position her for her procedure.
8:30 am: The procedure has started. I do some charting. I do my little OCD thing and organize everything, throw away all trash, get everything pretty and clean. I talk to the rotating resident about LMAs: how to use them, their benefits, limitations, indications. I do some more charting. I check the weather. It's still cold.
10:30 am: This first procedure is over. My staff comes to the room. We wake the patient up and take her to recovery (or PACU). I give report to the recovery nurse, write a post-op note. I stop by the pharmacy window to drop of the drugs I didn't use and to check out drugs for my next patient.
10:40 am: Stop by the anesthesia work-room again for a spinal kit for the next patient. Head back to my OR to get everything ready for the next case.
10:50 am: Go see the next patient. This patient is over 90 years old and has a two page long problem list. He is at increased risk of adverse outcomes. We discuss spinal anesthesia and how it would be safer for him, given his lung disease. He stopped his blood thinning medication a week ago and the lab I ordered for him shows that his blood clotting time is at a level safe enough to do a spinal. He agrees.
11 am: Arrive in the OR again with this patient. Put on all the monitors, position the patient for the spinal. The spinal goes smoothly. The patient doesn't feel anything during his procedure and we avoided general anesthesia for him. I sent the rotating resident to lunch and then home for the day.
12:15 pm: This procedure went faster than expected. Take the patient to recovery. He is still numb from the waist down and is requiring some medication to keep his blood pressure up. Give report the to the recovery nurse, put in the order for the blood pressure medication, write a post-op note. Stop by pharmacy again.
12:35 pm: See the next patient. He already has an IV. Talk about the plan, the risks. I say the exact same thing every time. I try to be genuine and personable, but it's just the same speech every day. If I say it out of order, I forget things.
12:45 pm: Arrive in the OR with patient number 3. I offered him a spinal, but he didn't want to be awake. My staff and I drift him to sleep, "induction." Another airway is placed. I do some charting. My staff sends me to lunch.
1:15 pm: Grab a cup of ice water. Arrive in the resident lounge for lunch. Most of the residents have already eaten, but there is usually always someone here. We talk about how our days are going. We complain about how tired we are. We complain about the new scrubs. We share stories, trying to make each other laugh. I eat my grapefruit. I look at my cases for the next day. Two oral surgery cases. My favorite kind. Tomorrow is going to be a good day.
1:45 pm: Time to head back to the OR. The case is finishing up.
2:15 pm: Wake this patient up and take him to recovery. Report, note, pharmacy, OR. Rinse and repeat.
2:30 pm: Meet the last patient for the day. Say the same things. Do the same things.
2:45 pm: Arrive with last patient in the OR. Say the same things. Do the same things. Notice how cold it is in the OR. Check the weather. It hasn't changed. Check my e-mail. My schedule for the rest of residency is done. This excites, scares, overwhelms, and depresses me. I don't know why it does any of those things. Keeping one eye on the patient and the monitors, I play a round of Words with Friends. I'm losing. I do some study questions. This OR is freezing.
4:oo pm: This case feels like it's taking forever. Luckily, the patient has been very stable throughout the entire procedure.
4:15 pm: The surgeon announces suddenly that they are done with the case. Page my staff. Wake the patient up. Go to recovery. Report, note, pharmacy.
4:30 pm: Go back to the resident lounge. Do a happy dance as I enter because originally my cases were scheduled to go until 6 pm and we finished early. This never happens. I call the staff I'm working with tomorrow to discuss the two patients we have tomorrow. I'm excited for the cases.
4:50 pm: Go to the locker room, change out of scrubs and into normal clothes.
5:00 pm: Catch the bus back to the commuter lot. It is light outside and this is deliciously refreshing after not arriving home until after 7 for the last 5 work days. I call my mom and my sister, but don't get hold of anyone.
5:10 pm: Arrive in the commuter lot. Plug in my iPod to listen to happy music on the way home. Get stuck in small-town Iowa version of traffic.
5:30 pm: Arrive home. Do another happy dance for being home so early. I hug Monkey, Bug, and Hubster. Hubster is still in his scrubs from dental school; he only got home 10 minutes before I did.
5:45 pm: Make dinner. Tonight is corn and tofu lettuce wraps. I debate on lying to the boys about the tofu. But it's already written on the menu, so they'd know.
6:15 pm: Finally get everyone up to the table for dinner. Monkey has to get down three times: once for a straw, once for a napkin, and once to give me a hug. It's hard to get mad at that. I ask everyone about their day. Sometimes, this is like pulling teeth. But today, they excited about a game they played in P.E.
6:40 pm: The "how many bites" bargaining begins. I usually win by setting the first bid ridiculously high. Tonight is more successful than most. The boys have already eaten most their food. Hubster disappears upstairs to start studying. He has a test tomorrow.
6:45 pm: Encourage the boys to do their chores. Get Bug to practice his violin and do his spelling. We sing silly songs for each of his spelling words.
7:oo pm: Do dishes. Rinse out coffee mug so it's ready for tomorrow morning. Sit on the couch and just feel tired. Get sucked into the internet while the boys chase each other in circles. I read e-mail, Facebook, news, Pinterest, blogs. I shouldn't, but I do.
7:45 pm: The boys' game of tag has turned into a pillow fight. Send the boys to get in their pajamas and brush their teeth. For some reason, this is the longest part of the day. They don't want to get in their pajamas, since it's interrupting their play. But finally, Bug sets the good example and Monkey soon follows. They come downstairs for story time.
8:15 pm: Start reading. I say two stories, but like every other night, it ends up being three. You win some, you lose some. And if this is the one I lose, I'm fine with it. We read Dr. Seuss, a story of a monster, and a story about shadows.
8:40 pm: It's already past bedtime. Monkey is starting to get cranky. He goes upstairs to bother Hubster, who is still studying. I'm starting to feel really tired, but I have to read to Bug. He looks forward to this so much. I read to Bug, with him cuddled next to me, laughing at the funny parts. We are reading a novel about Ancient Egypt. We Google parts of the book we don't know. It's history lesson and reading all in one.
9:05 pm: I give Bug a piggy back ride upstairs to his room. I collect Monkey from next to Hubster and tuck him in bed. As Hubster comes in to their room to join us for bedtime prayer, Monkey starts sharing the fact he can now do subtraction. Which sets Bug off on the probability he is learning in math. We have to shush them for prayer. The last thing I say is, "We are not discussing negative numbers at this time of night."
9:15 pm: Finally, we have prayer. I kiss them both goodnight. Hubster stays and sings to Monkey. This is their thing together.
9:20 pm: Wash my face, take out my contacts, brush my teeth, change into some sweats.
9:25 pm: Sit with my laptop and two anesthesia text books in front of the TV. I blog. I haven't blogged in a while. It feels good. I watch a show from the DVR. I read a section from my anesthesia book. I talked a while ago that I was going to stop all this multi-tasking. It isn't possible. I have to do all these things at once, or I don't get to do them at all.
10:30 pm: Head upstairs. Kiss my sleeping boys good night. Every night, I make sure the last thing I do before getting into bed is kiss them. Even though Bug is so far over against the far side of his top bunk, that his kiss is delivered from my fingertips to his cheek.
10:32 pm: Hubster is still studying. He offers to move his books out of the bedroom and study in the office. But we don't get much time together, so I'm happy to have him nearby, even if the light is on and he's studying instead of snuggling. I should go straight to sleep, but I play a round of Words with Friends. I read part of a chapter in my book.
10:50 pm: Fall asleep. 6 hours before it all starts again.
As far as days go, this was a great day. I was home in time to cook dinner. I had down time. I got to read with my boys. I didn't fall asleep during dinner. My cases at work went very well.
I had planned on writing about last Thursday or Friday. Those were bad days and part of me wants to share my bad days, wear them like military stripes of what I survived. But I don't want to keep reliving the bad days. When I look back and read this again, I'm hoping that I can remember my days being like this perfectly typical day. Story time with my boys. Talking about math at bedtime. Dinner all together. There will be days that will be better and days that will be worse. And hopefully, there will be more of these typical days.
But today was about as routine as they come. So I'll start with today...
4:50 am: Alarm goes off. I push snooze. I always give myself 5 minutes of snooze. It feels like such a luxury.
4:55 am: Alarm goes off again. No more luxury. Time to get out of bed. I've started getting up a few minutes early to do a few exercises and stretches. Because I'm losing a war with my scale. And with my pants. And so ultimately, with myself. I do crunches, push-ups, and stretches. I check to see if I can still reach my toes. Success.
5:00 am: Enough exercise. 5 minutes is enough. Head to the bathroom. I weigh myself. Okay, 5 minutes isn't enough. I wash my face, put in my contacts, brush my teeth, pretend to do my hair and make-up. Even though my eyes is all that people will see of my face most of the day at work.
5:15 am: Get dressed. Put on deodorant.
5:20 am: Downstairs to make coffee while I put on my compression stockings (don't judge, I stand a lot at my job.) I pack a quick lunch. I'm tempted to grab the delicious leftover broccoli-cheese soup, but I remember that vindictive scale upstairs and pack a grapefruit instead. I also put on my boots, because we got a lot of snow yesterday.
5:25 am: Back upstairs. Kiss a sleeping Hubster, Bug, and Monkey good-bye for the day. Monkey wakes up and wants a hug as well. I hug him tight and hush him back to sleep.
5:27 am: Grab my keys, bag, phone, and coat. Back the car down the driveway. And leave. Everyday I hate the leaving part.
5:37 am: Arrive at the commuter parking lot. Check the weather while I wait for the bus. It says it's cold outside. Yep, already knew that.
5:40 am: Get on the bus. Three of my fellow residents are on the same bus. We talk about what cases we are doing that day.
5:50 am: Arrive the hospital. Walk across the frigid parking garage to the side door I always take. Ride the elevator up.
5:55 am: Change into scrubs. Grab my pager, my stethoscope, my scrub hat, my name badge. Fill my pockets with my phone, several pens, and a marker. Drop my bag off in the resident lounge, put my depressing lunch in the fridge, grab my clipboard with my schedule, and head down to the operating rooms.
6:00 am: Grab supplies from the anesthesia work room. An IV set-up, an extra LMA. Stop by the pharmacy window and check of the drugs for my first patient. Head to my OR.
6:05 am: Get my OR ready. I have a mnemonic I follow every day to make sure I don't miss a thing. Everything I need for airway management is prepared. All the drugs I need are drawn up in labeled syringes. I'm incredibly OCD about my labels. Actually, maybe about everything.
6:30 am: Head upstairs for lecture. Today's lecture is a refresher on obstetric anesthesia.
7:15 am: Lecture is over. I meet with the resident who is rotating through anesthesia right now. We head back down to the ORs. I set up a few more things.
7:30 am: I go to see my first patient, a 40 something female, undergoing a procedure for kidney stones. She's unusual, in the fact that she's otherwise healthy. I don't have many patients this healthy. I introduce myself, talk about the plan for anesthesia, the risks of anesthesia. I answer her questions. I start her IV.
8:00 am: Arrive in the OR with the patient. The nurses ask her a few more questions. I help her move over to the OR bed. I put all the monitors on her. The rotating resident helps. My supervising staff arrives. I give her oxygen while he gives her drugs to drift her off to sleep. Once she's asleep, I place an LMA. We work with the surgical team to position her for her procedure.
8:30 am: The procedure has started. I do some charting. I do my little OCD thing and organize everything, throw away all trash, get everything pretty and clean. I talk to the rotating resident about LMAs: how to use them, their benefits, limitations, indications. I do some more charting. I check the weather. It's still cold.
10:30 am: This first procedure is over. My staff comes to the room. We wake the patient up and take her to recovery (or PACU). I give report to the recovery nurse, write a post-op note. I stop by the pharmacy window to drop of the drugs I didn't use and to check out drugs for my next patient.
10:40 am: Stop by the anesthesia work-room again for a spinal kit for the next patient. Head back to my OR to get everything ready for the next case.
10:50 am: Go see the next patient. This patient is over 90 years old and has a two page long problem list. He is at increased risk of adverse outcomes. We discuss spinal anesthesia and how it would be safer for him, given his lung disease. He stopped his blood thinning medication a week ago and the lab I ordered for him shows that his blood clotting time is at a level safe enough to do a spinal. He agrees.
11 am: Arrive in the OR again with this patient. Put on all the monitors, position the patient for the spinal. The spinal goes smoothly. The patient doesn't feel anything during his procedure and we avoided general anesthesia for him. I sent the rotating resident to lunch and then home for the day.
12:15 pm: This procedure went faster than expected. Take the patient to recovery. He is still numb from the waist down and is requiring some medication to keep his blood pressure up. Give report the to the recovery nurse, put in the order for the blood pressure medication, write a post-op note. Stop by pharmacy again.
12:35 pm: See the next patient. He already has an IV. Talk about the plan, the risks. I say the exact same thing every time. I try to be genuine and personable, but it's just the same speech every day. If I say it out of order, I forget things.
12:45 pm: Arrive in the OR with patient number 3. I offered him a spinal, but he didn't want to be awake. My staff and I drift him to sleep, "induction." Another airway is placed. I do some charting. My staff sends me to lunch.
1:15 pm: Grab a cup of ice water. Arrive in the resident lounge for lunch. Most of the residents have already eaten, but there is usually always someone here. We talk about how our days are going. We complain about how tired we are. We complain about the new scrubs. We share stories, trying to make each other laugh. I eat my grapefruit. I look at my cases for the next day. Two oral surgery cases. My favorite kind. Tomorrow is going to be a good day.
1:45 pm: Time to head back to the OR. The case is finishing up.
2:15 pm: Wake this patient up and take him to recovery. Report, note, pharmacy, OR. Rinse and repeat.
2:30 pm: Meet the last patient for the day. Say the same things. Do the same things.
2:45 pm: Arrive with last patient in the OR. Say the same things. Do the same things. Notice how cold it is in the OR. Check the weather. It hasn't changed. Check my e-mail. My schedule for the rest of residency is done. This excites, scares, overwhelms, and depresses me. I don't know why it does any of those things. Keeping one eye on the patient and the monitors, I play a round of Words with Friends. I'm losing. I do some study questions. This OR is freezing.
4:oo pm: This case feels like it's taking forever. Luckily, the patient has been very stable throughout the entire procedure.
4:15 pm: The surgeon announces suddenly that they are done with the case. Page my staff. Wake the patient up. Go to recovery. Report, note, pharmacy.
4:30 pm: Go back to the resident lounge. Do a happy dance as I enter because originally my cases were scheduled to go until 6 pm and we finished early. This never happens. I call the staff I'm working with tomorrow to discuss the two patients we have tomorrow. I'm excited for the cases.
4:50 pm: Go to the locker room, change out of scrubs and into normal clothes.
5:00 pm: Catch the bus back to the commuter lot. It is light outside and this is deliciously refreshing after not arriving home until after 7 for the last 5 work days. I call my mom and my sister, but don't get hold of anyone.
5:10 pm: Arrive in the commuter lot. Plug in my iPod to listen to happy music on the way home. Get stuck in small-town Iowa version of traffic.
5:30 pm: Arrive home. Do another happy dance for being home so early. I hug Monkey, Bug, and Hubster. Hubster is still in his scrubs from dental school; he only got home 10 minutes before I did.
5:45 pm: Make dinner. Tonight is corn and tofu lettuce wraps. I debate on lying to the boys about the tofu. But it's already written on the menu, so they'd know.
6:15 pm: Finally get everyone up to the table for dinner. Monkey has to get down three times: once for a straw, once for a napkin, and once to give me a hug. It's hard to get mad at that. I ask everyone about their day. Sometimes, this is like pulling teeth. But today, they excited about a game they played in P.E.
6:40 pm: The "how many bites" bargaining begins. I usually win by setting the first bid ridiculously high. Tonight is more successful than most. The boys have already eaten most their food. Hubster disappears upstairs to start studying. He has a test tomorrow.
6:45 pm: Encourage the boys to do their chores. Get Bug to practice his violin and do his spelling. We sing silly songs for each of his spelling words.
7:oo pm: Do dishes. Rinse out coffee mug so it's ready for tomorrow morning. Sit on the couch and just feel tired. Get sucked into the internet while the boys chase each other in circles. I read e-mail, Facebook, news, Pinterest, blogs. I shouldn't, but I do.
7:45 pm: The boys' game of tag has turned into a pillow fight. Send the boys to get in their pajamas and brush their teeth. For some reason, this is the longest part of the day. They don't want to get in their pajamas, since it's interrupting their play. But finally, Bug sets the good example and Monkey soon follows. They come downstairs for story time.
8:15 pm: Start reading. I say two stories, but like every other night, it ends up being three. You win some, you lose some. And if this is the one I lose, I'm fine with it. We read Dr. Seuss, a story of a monster, and a story about shadows.
8:40 pm: It's already past bedtime. Monkey is starting to get cranky. He goes upstairs to bother Hubster, who is still studying. I'm starting to feel really tired, but I have to read to Bug. He looks forward to this so much. I read to Bug, with him cuddled next to me, laughing at the funny parts. We are reading a novel about Ancient Egypt. We Google parts of the book we don't know. It's history lesson and reading all in one.
9:05 pm: I give Bug a piggy back ride upstairs to his room. I collect Monkey from next to Hubster and tuck him in bed. As Hubster comes in to their room to join us for bedtime prayer, Monkey starts sharing the fact he can now do subtraction. Which sets Bug off on the probability he is learning in math. We have to shush them for prayer. The last thing I say is, "We are not discussing negative numbers at this time of night."
9:15 pm: Finally, we have prayer. I kiss them both goodnight. Hubster stays and sings to Monkey. This is their thing together.
9:20 pm: Wash my face, take out my contacts, brush my teeth, change into some sweats.
9:25 pm: Sit with my laptop and two anesthesia text books in front of the TV. I blog. I haven't blogged in a while. It feels good. I watch a show from the DVR. I read a section from my anesthesia book. I talked a while ago that I was going to stop all this multi-tasking. It isn't possible. I have to do all these things at once, or I don't get to do them at all.
10:30 pm: Head upstairs. Kiss my sleeping boys good night. Every night, I make sure the last thing I do before getting into bed is kiss them. Even though Bug is so far over against the far side of his top bunk, that his kiss is delivered from my fingertips to his cheek.
10:32 pm: Hubster is still studying. He offers to move his books out of the bedroom and study in the office. But we don't get much time together, so I'm happy to have him nearby, even if the light is on and he's studying instead of snuggling. I should go straight to sleep, but I play a round of Words with Friends. I read part of a chapter in my book.
10:50 pm: Fall asleep. 6 hours before it all starts again.
As far as days go, this was a great day. I was home in time to cook dinner. I had down time. I got to read with my boys. I didn't fall asleep during dinner. My cases at work went very well.
I had planned on writing about last Thursday or Friday. Those were bad days and part of me wants to share my bad days, wear them like military stripes of what I survived. But I don't want to keep reliving the bad days. When I look back and read this again, I'm hoping that I can remember my days being like this perfectly typical day. Story time with my boys. Talking about math at bedtime. Dinner all together. There will be days that will be better and days that will be worse. And hopefully, there will be more of these typical days.
Wednesday, November 23, 2011
Holiday Blues
I'm having a hard time getting in the holiday mood. I'm not procrastinating anything. In fact, everything is ready for Thanksgiving tomorrow. Christmas cards are done and (mostly) addressed. Almost all the Christmas presents are bought. But I feel like I'm just going through the motions.
The days have flown by, so I'm in denial that it is actually November, let alone nearly the end of November. And since I can barely register the fact that it is the end of fall, it feels that there is no way it can be Thanksgiving tomorrow.
I'm also just to-my-bone-marrow tired. I've been working some of my longest hours in a long time, working 80-90 hours a week for the last several weeks. I'm also on a night shift currently, which just makes me feel cantankerous. And being on nights means that I work 6 days a week, regardless of holidays.
So that means I will be working Thanksgiving day. Actually twice. I get home at 7:30 am on Thanksgiving morning, and have to head back to work at 5:30 pm. I feel that if I have to hear about everyone's 4-5 day weekend, and about all the family and friends they will be seeing, I might have a meltdown. There will be no holiday weekend. There will be no gathering of extending family and friends. There will just be us and a very tired me.
So that's my little pity party for one.
However...this does provide us with good opportunities. We are still planning on a full traditional Thanksgiving dinner. Which means for the first time ever, we have to cook a turkey. I am scared to death of this, but Hubster and I are doing this together. Our turkey is currently being brined, and I'm so excited about it. Tomorrow it will be injected with broth and butter and stuffed with onions and apples.
Given my schedule, there won't be down time after the dinner. But Hubster is planning on bringing our pies to the hospital, so that we can have dessert in the evening, and share it with the other residents that are also away from their families on the holiday.
I'm planning on being over my negativity by the time I wake up this afternoon. I'm planning on cooking with my family and make holiday memories together. I'm planning on forgoing some sleep to make sure that happens. Even if there is no large family gathering, or days off, and even if dinner is eaten around a hospital table instead of the dinner table, I'm planning on celebrating.
Update: I have made two realizations. First, every time I open my mouth (or my laptop) to complain, I have a moment when I realize how pathetic and whiny I sound. Second, I really shouldn't talk (or write) when I am tired. I've slept. And guess what? I'm not really that upset. I'm okay (ish) that I'm working Thanksgiving. It means that someone else won't be. I'm going to have time with my family, and I love them so much. The turkey, despite how afraid I am of it, is going to be awesome. The pies are already done. This is going to be an awesome holiday. Happy Thanksgiving, everyone.
The days have flown by, so I'm in denial that it is actually November, let alone nearly the end of November. And since I can barely register the fact that it is the end of fall, it feels that there is no way it can be Thanksgiving tomorrow.
I'm also just to-my-bone-marrow tired. I've been working some of my longest hours in a long time, working 80-90 hours a week for the last several weeks. I'm also on a night shift currently, which just makes me feel cantankerous. And being on nights means that I work 6 days a week, regardless of holidays.
So that means I will be working Thanksgiving day. Actually twice. I get home at 7:30 am on Thanksgiving morning, and have to head back to work at 5:30 pm. I feel that if I have to hear about everyone's 4-5 day weekend, and about all the family and friends they will be seeing, I might have a meltdown. There will be no holiday weekend. There will be no gathering of extending family and friends. There will just be us and a very tired me.
So that's my little pity party for one.
However...this does provide us with good opportunities. We are still planning on a full traditional Thanksgiving dinner. Which means for the first time ever, we have to cook a turkey. I am scared to death of this, but Hubster and I are doing this together. Our turkey is currently being brined, and I'm so excited about it. Tomorrow it will be injected with broth and butter and stuffed with onions and apples.
Given my schedule, there won't be down time after the dinner. But Hubster is planning on bringing our pies to the hospital, so that we can have dessert in the evening, and share it with the other residents that are also away from their families on the holiday.
I'm planning on being over my negativity by the time I wake up this afternoon. I'm planning on cooking with my family and make holiday memories together. I'm planning on forgoing some sleep to make sure that happens. Even if there is no large family gathering, or days off, and even if dinner is eaten around a hospital table instead of the dinner table, I'm planning on celebrating.
Update: I have made two realizations. First, every time I open my mouth (or my laptop) to complain, I have a moment when I realize how pathetic and whiny I sound. Second, I really shouldn't talk (or write) when I am tired. I've slept. And guess what? I'm not really that upset. I'm okay (ish) that I'm working Thanksgiving. It means that someone else won't be. I'm going to have time with my family, and I love them so much. The turkey, despite how afraid I am of it, is going to be awesome. The pies are already done. This is going to be an awesome holiday. Happy Thanksgiving, everyone.
Tuesday, November 15, 2011
Regrets and Choices
At my work, when people find out that I have children, they are usually surprised. Apparently, I look much too young to have any children, let alone a 9 year old and a 5 year old.
I get asked a lot of questions. How do I do it? How do the kids manage with my work schedule? How do things work with Hubster's schedule?
One of the questions that I have been asked too frequently, especially by other physicians, is whether I regret having children. It's usually phrased differently, such as do I regret having children at such a young age, or do I regret having them so early in my medical career, or do I regret having children that distract me from medicine.
Regardless of how it's phrased, or how tactful the questioner attempts to be (usually failing completely), all they want to know is whether I regret my children.
Balancing medicine and family is difficult.
I find it a little ironic that I never once have been asked the reverse question. Do I regret going in to medicine?
After all, Bug was part of my life before medicine was. So asking me if I would choose medicine over my children is ludicrous.
I've answered both questions to myself, both the one I've been asked multiple times and the one I've only asked myself. I have never once regretted my children. Not once, not even in my worst parenting moments. But I have regretted medicine.
During the application process, I wondered if I was brave enough, outgoing enough. During medical school, I wondered if I was smart enough. During residency, I've wondered I'm dedicated enough. It's been a long process, and I've spent a lot of time, too much time, wondering if I made the right decision all those years ago.
I was driving home yesterday after a 90+ hour week, in tears because I was getting home too late to see my family, the family that I don't regret at all. I've worked so much the last several weeks that I feel I've become a non-entity in my family. I'm tired and frustrated and upset.
But I have come to terms with my choice. Just like my children, medicine was a choice. No one forced me to do this.
I know that I'll continue to be tired. And I'll continue to be questioned about my choices.
But I'm done regretting.
I get asked a lot of questions. How do I do it? How do the kids manage with my work schedule? How do things work with Hubster's schedule?
One of the questions that I have been asked too frequently, especially by other physicians, is whether I regret having children. It's usually phrased differently, such as do I regret having children at such a young age, or do I regret having them so early in my medical career, or do I regret having children that distract me from medicine.
Regardless of how it's phrased, or how tactful the questioner attempts to be (usually failing completely), all they want to know is whether I regret my children.
Balancing medicine and family is difficult.
I find it a little ironic that I never once have been asked the reverse question. Do I regret going in to medicine?
After all, Bug was part of my life before medicine was. So asking me if I would choose medicine over my children is ludicrous.
I've answered both questions to myself, both the one I've been asked multiple times and the one I've only asked myself. I have never once regretted my children. Not once, not even in my worst parenting moments. But I have regretted medicine.
During the application process, I wondered if I was brave enough, outgoing enough. During medical school, I wondered if I was smart enough. During residency, I've wondered I'm dedicated enough. It's been a long process, and I've spent a lot of time, too much time, wondering if I made the right decision all those years ago.
I was driving home yesterday after a 90+ hour week, in tears because I was getting home too late to see my family, the family that I don't regret at all. I've worked so much the last several weeks that I feel I've become a non-entity in my family. I'm tired and frustrated and upset.
But I have come to terms with my choice. Just like my children, medicine was a choice. No one forced me to do this.
I know that I'll continue to be tired. And I'll continue to be questioned about my choices.
But I'm done regretting.
Monday, October 17, 2011
Death on the Table
I had my first patient die in the operating room.
The call came at near the end of a grueling day. There was an emergency case coming from the ICU. I rushed to set up the operating room. Minutes later, the patient arrived, already the color of barely hanging on. We ignored that, and just went to work.
It was all hands on deck. There were three surgeons, and three of us with anesthesia on the other side of the blue drapes. We worked quickly, giving fluids, hanging infusions, pushing boluses of medications. The patient's blood pressure would drop, down, down, down, far enough down that my own heart would skip a beat with fear that this time would be it. But no. We gave medications, we gave more fluid, and the blood pressure would come back up.
Within minutes after incision, the surgeons informed us that things didn't look good. They didn't think the patient's condition was a survivable one. The plan to was close the incision, take that patient back to the ICU, and talk to the family.
That's when it happened. The patient's heart rate went from fast but regular, and degenerated into a dangerous rhythm. We pulled the drapes down to start CPR. But there was no bringing the patient back this time. There was no fighting death, who had been standing at bedside for so long, there was no fighting him off any longer.
There are patients who are too sick for us to save. And I know that. I know that. I know that! But right at the moment this is happening, when the blood pressure is falling to undetectable, and the EKG tracing is a chaotic scribble instead of a pattern, at this moment, I don't believe it. I believe in this medicine. That this medicine is good, and it's strong, and it saves people. Every day, I watch it save people.
And I know that people die. That we can't save everyone. But they don't die on my watch, they don't die on my table.
Except, now, they do.
Whatever it is that I know, right now I don't believe any of it. What I do believe at this moment goes against everything I know.
There are no more beeps of the monitors. I've shut them all off. It's quiet in the OR, a quiet that doesn't sit well, a quiet that turns and pulls at my insides. I stand there for a while, too long, not sure how to leave when my patient is still on table. But there is nothing else for me to do except to leave.
And now I have to go back to being normal. I have to pull off my mask and scrub hat, change out of my scrubs, and go back to my life. Except there is no going back to normal. There is still the buzz in my head from silenced alarms and the weight in my stomach from the failure of what I believed.
The call came at near the end of a grueling day. There was an emergency case coming from the ICU. I rushed to set up the operating room. Minutes later, the patient arrived, already the color of barely hanging on. We ignored that, and just went to work.
It was all hands on deck. There were three surgeons, and three of us with anesthesia on the other side of the blue drapes. We worked quickly, giving fluids, hanging infusions, pushing boluses of medications. The patient's blood pressure would drop, down, down, down, far enough down that my own heart would skip a beat with fear that this time would be it. But no. We gave medications, we gave more fluid, and the blood pressure would come back up.
Within minutes after incision, the surgeons informed us that things didn't look good. They didn't think the patient's condition was a survivable one. The plan to was close the incision, take that patient back to the ICU, and talk to the family.
That's when it happened. The patient's heart rate went from fast but regular, and degenerated into a dangerous rhythm. We pulled the drapes down to start CPR. But there was no bringing the patient back this time. There was no fighting death, who had been standing at bedside for so long, there was no fighting him off any longer.
There are patients who are too sick for us to save. And I know that. I know that. I know that! But right at the moment this is happening, when the blood pressure is falling to undetectable, and the EKG tracing is a chaotic scribble instead of a pattern, at this moment, I don't believe it. I believe in this medicine. That this medicine is good, and it's strong, and it saves people. Every day, I watch it save people.
And I know that people die. That we can't save everyone. But they don't die on my watch, they don't die on my table.
Except, now, they do.
Whatever it is that I know, right now I don't believe any of it. What I do believe at this moment goes against everything I know.
There are no more beeps of the monitors. I've shut them all off. It's quiet in the OR, a quiet that doesn't sit well, a quiet that turns and pulls at my insides. I stand there for a while, too long, not sure how to leave when my patient is still on table. But there is nothing else for me to do except to leave.
And now I have to go back to being normal. I have to pull off my mask and scrub hat, change out of my scrubs, and go back to my life. Except there is no going back to normal. There is still the buzz in my head from silenced alarms and the weight in my stomach from the failure of what I believed.
Monday, September 6, 2010
Fatigue
Before, when things got tough, my approach was to put my head down and push along. As things got harder, I kept at it. I would flog my body and my mind harder to keep up the pace.
Before medical school, I had experienced the usually fatigue. The sleepless nights of a newborn. The occasional all-nighter before a college final. The long road trip. Most of my fatigue was easily managed by a few extra hours of sleep on the weekend or going to bed a little earlier.
And then came medical school. Early classes, late evening labs, and then the studying. The 4-8 hour a day studying. My time to sleep was cut back. From 8 hours to 6 hours, and then to 4-5 hours of sleep a night. Obviously, my ability to stay awake in lecture decreased in direct correlation to my lack of sleep. So, naturally I turned to a cheap legal stimulant. Caffeine. Yes, I was a caffeine consumer before this. I enjoyed my diet Coke, I loved the occasional latte. But now, caffeine wasn't an occasional enjoyment. It was a daily essential. I started drinking Coke after Coke. Then it was coffee after coffee. Enough that Hubster accused me of keeping Starbucks in business.
I was rewarded for flogging myself harder. I got fantastic grades, top marks on exams, flew through boards with amazing scores. Because I had realized early on in medical school that, unlike in undergraduate classes where I was unquestionably the smartest person in the class, in this academic arena, I was only an average smart person. My ego and my view of myself were at risk. I could never out-compete my fellow medical students on sheer brains. I would have to out-compete them with effort. So I studied, beat my body with lack of sleep, beat my brain with caffeine, and succeeded.
And then things got worse. Monkey was born (okay, that's not the "worse" part, that was the joyous part, but still, newborns are hard). I started clinical rotations and started taking overnight call every fourth night. I started working 80-120 hours a week. And still studying. I cut my sleep from 4-5 hours to 3-4 hours. I went every fourth night without sleep. I was a zombie. Coffee, no matter how strong, wasn't cutting it. So I turned to caffeine tablets. 200 mg of caffeine a tab. Multiple tablets a day. So much caffeine in my system that I had horrific withdrawals.
This is where the story could become tragic. I've seen it happen before. I've watched it happen. But I had made Hubster a promise that I would never take anything illegal. That I would never use something that wasn't available at Wal-mart.
This is where I also grew up.
Residency is similar in its demands on my time. There are still plenty of sleepless nights.
But as part of growing up, I'm gentler with myself. Instead of whipping myself to go harder, go faster, do more, I find ways to make my time more efficient, my life less stressful, my schedule more manageable. Yes, a cup of coffee is still necessary occasionally during a bad call night. A diet coke is sometimes still needed to get me through lecture. But when I get tired, I think about how I can change things at home to get more sleep. As a teenager I thought that sleep was such a waste of time. All it did was eat hours of potentially productive time out of my day. Now, I see sleep as healthy, and honestly, enjoyable.
I've also changed my priorities. My family is infinitely more important to me. Yes, I want to be a good doctor. Yes, I want to do well on boards and in-training exams. But I'm not willing to sacrifice my health and sanity for it any more.
I'm perfectly okay being just an average smart person.
Before medical school, I had experienced the usually fatigue. The sleepless nights of a newborn. The occasional all-nighter before a college final. The long road trip. Most of my fatigue was easily managed by a few extra hours of sleep on the weekend or going to bed a little earlier.
And then came medical school. Early classes, late evening labs, and then the studying. The 4-8 hour a day studying. My time to sleep was cut back. From 8 hours to 6 hours, and then to 4-5 hours of sleep a night. Obviously, my ability to stay awake in lecture decreased in direct correlation to my lack of sleep. So, naturally I turned to a cheap legal stimulant. Caffeine. Yes, I was a caffeine consumer before this. I enjoyed my diet Coke, I loved the occasional latte. But now, caffeine wasn't an occasional enjoyment. It was a daily essential. I started drinking Coke after Coke. Then it was coffee after coffee. Enough that Hubster accused me of keeping Starbucks in business.
I was rewarded for flogging myself harder. I got fantastic grades, top marks on exams, flew through boards with amazing scores. Because I had realized early on in medical school that, unlike in undergraduate classes where I was unquestionably the smartest person in the class, in this academic arena, I was only an average smart person. My ego and my view of myself were at risk. I could never out-compete my fellow medical students on sheer brains. I would have to out-compete them with effort. So I studied, beat my body with lack of sleep, beat my brain with caffeine, and succeeded.
And then things got worse. Monkey was born (okay, that's not the "worse" part, that was the joyous part, but still, newborns are hard). I started clinical rotations and started taking overnight call every fourth night. I started working 80-120 hours a week. And still studying. I cut my sleep from 4-5 hours to 3-4 hours. I went every fourth night without sleep. I was a zombie. Coffee, no matter how strong, wasn't cutting it. So I turned to caffeine tablets. 200 mg of caffeine a tab. Multiple tablets a day. So much caffeine in my system that I had horrific withdrawals.
This is where the story could become tragic. I've seen it happen before. I've watched it happen. But I had made Hubster a promise that I would never take anything illegal. That I would never use something that wasn't available at Wal-mart.
This is where I also grew up.
Residency is similar in its demands on my time. There are still plenty of sleepless nights.
But as part of growing up, I'm gentler with myself. Instead of whipping myself to go harder, go faster, do more, I find ways to make my time more efficient, my life less stressful, my schedule more manageable. Yes, a cup of coffee is still necessary occasionally during a bad call night. A diet coke is sometimes still needed to get me through lecture. But when I get tired, I think about how I can change things at home to get more sleep. As a teenager I thought that sleep was such a waste of time. All it did was eat hours of potentially productive time out of my day. Now, I see sleep as healthy, and honestly, enjoyable.
I've also changed my priorities. My family is infinitely more important to me. Yes, I want to be a good doctor. Yes, I want to do well on boards and in-training exams. But I'm not willing to sacrifice my health and sanity for it any more.
I'm perfectly okay being just an average smart person.
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.
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.
Wednesday, April 28, 2010
It's all about the call
I have 8 call days of internship left. 8 more to complete before the end of May. There will be many more over the next three years of anesthesia training, but only 8 more this year (Year in the academic sense. Starting and ending in July.)
Being on call, meaning staying at the hospital over night, really wears on me. Not only does it mean 30 hours shifts and lack of sleep, it means being away from my family for extended periods of time.
Being on call also has it's own language. Such as "float," "mole," "second call," and "third call." And the infamous "q."
As in q3 or q4...or even worse, q2.
Q means every. Q3 means you take call every third night. Q4, every fourth night. So, doesn't q2 just sound fun?
This is how I know that Hubster understands the language and the system. He looked over the SICU call schedule and exclaimed, "I can't believe they have you q3 for most of the month!"
Call can be stressful. Most of the bad things that happen, happen at night. No one seems to have strokes or chest pain in the middle of the day. This problems lurk around the corner in daylight hours and then pounce once it is dark.
The worst of the worst happens at night. This is when patients crash, when surgical complications manifest, when airways are lost, and blood pressures tank. It is at night that intubations are done, central lines are placed, and codes are run.
I've spent many call nights at the bed side, pushing emergency drugs, hand pumping blood and fluids, watching chest compressions being done.
But not every night. While the bad things do seem to cluster in the night hours, most nights are not full of panic and anxiety (and dare I say it...excitement.)
For the most part, call is just really, really, really annoying.
In the ICU, all the beds are open to the central nursing desk, so you can sit at the desk and have a direct line of site to each patient. It's very noisy.
Every time an infusion finishes, or every time an IV tube kinks or clogs, or every time the smallest bubble is in the line, the IV pumps alarm. There are eight patients each separate SICU bay. Each patient has between 2 to 12 IV pumps. They are alarming all the time. Each patient has EKG monitoring, oxygen monitoring, respiratory monitoring, and if they are intubated, ventilator monitors. If this fall off (which they do), or if the patient's heart rate, oxygen saturation, respiratory rate, blood pressure, or any other parameter we happen to be monitoring goes outside the set parameters (even for three seconds), the alarms go off. There are alarms dinging and ringing ALL THE TIME. The majority of these do not need responding to. But we monitor, just in case.
I hear the dinging of the alarms in my head all the time, especially in the quiet of my call room, or as I'm trying to fall asleep post-call at home.
Most things on call are easy to deal with. Orders to be clarified, labs to be followed up, pain medicines to be adjusted.
There are usually quiet moments to escape to the call room. But it is hard to sleep. I lay there, and I just know that my pager is going to go of, at any unpredictable moment. I can't relax, I can't sleep comfortably. I usually just lay there, on the uncomfortably thin mattress with the uncomfortably thin blanket, and wait for my pager to go off.
You can absolutely bet I have my call days marked on the calender and am eagerly crossing them off, one by one.
Being on call, meaning staying at the hospital over night, really wears on me. Not only does it mean 30 hours shifts and lack of sleep, it means being away from my family for extended periods of time.
Being on call also has it's own language. Such as "float," "mole," "second call," and "third call." And the infamous "q."
As in q3 or q4...or even worse, q2.
Q means every. Q3 means you take call every third night. Q4, every fourth night. So, doesn't q2 just sound fun?
This is how I know that Hubster understands the language and the system. He looked over the SICU call schedule and exclaimed, "I can't believe they have you q3 for most of the month!"
Call can be stressful. Most of the bad things that happen, happen at night. No one seems to have strokes or chest pain in the middle of the day. This problems lurk around the corner in daylight hours and then pounce once it is dark.
The worst of the worst happens at night. This is when patients crash, when surgical complications manifest, when airways are lost, and blood pressures tank. It is at night that intubations are done, central lines are placed, and codes are run.
I've spent many call nights at the bed side, pushing emergency drugs, hand pumping blood and fluids, watching chest compressions being done.
But not every night. While the bad things do seem to cluster in the night hours, most nights are not full of panic and anxiety (and dare I say it...excitement.)
For the most part, call is just really, really, really annoying.
In the ICU, all the beds are open to the central nursing desk, so you can sit at the desk and have a direct line of site to each patient. It's very noisy.
Every time an infusion finishes, or every time an IV tube kinks or clogs, or every time the smallest bubble is in the line, the IV pumps alarm. There are eight patients each separate SICU bay. Each patient has between 2 to 12 IV pumps. They are alarming all the time. Each patient has EKG monitoring, oxygen monitoring, respiratory monitoring, and if they are intubated, ventilator monitors. If this fall off (which they do), or if the patient's heart rate, oxygen saturation, respiratory rate, blood pressure, or any other parameter we happen to be monitoring goes outside the set parameters (even for three seconds), the alarms go off. There are alarms dinging and ringing ALL THE TIME. The majority of these do not need responding to. But we monitor, just in case.
I hear the dinging of the alarms in my head all the time, especially in the quiet of my call room, or as I'm trying to fall asleep post-call at home.
Most things on call are easy to deal with. Orders to be clarified, labs to be followed up, pain medicines to be adjusted.
There are usually quiet moments to escape to the call room. But it is hard to sleep. I lay there, and I just know that my pager is going to go of, at any unpredictable moment. I can't relax, I can't sleep comfortably. I usually just lay there, on the uncomfortably thin mattress with the uncomfortably thin blanket, and wait for my pager to go off.
You can absolutely bet I have my call days marked on the calender and am eagerly crossing them off, one by one.
Monday, April 5, 2010
Back to Normal
It's easy to forget how hard it is.
As I get further on in my training, the hours feel a little less demanding, the answers come a little faster, the work feels a little less intimidating.
But confronting sickness and death? That's something that never changes. It's something that never gets a little easier.
In the last 24 hours, I have stood by a bedside as family members watched. I stood, my stethoscope to the patient's chest, listening for the thud of a heartbeat, the whoosh of a breath. I listened for a long time, knowing that I wouldn't hear anything. I looked up at the family, and they know it too.
I left the room to call time of death.
In the last 24 hours, I have stood by a patient's side as they stroked out in front of me. I watched them panic as they lost the ability to talk, and then to move, and then to respond, and then to breathe. I might be able to place breathing tubes and central lines and start medications. But I couldn't stop it from happening.
Despite being busy doing what needed to be done, it felt like I just stood there and watched it all happen.
In the last 24 hours, I have felt powerless, sad, scared, angry, and empty.
Some days, I don't know how to come home and feel normal again.
The hole inside of me feels like it's ready to suck the joy out of my entire life. And take me along with it.
I don't know how to come home. To play games with my boys. To read them stories. To laugh at Hubster's jokes. I sit in the car in the early morning before going inside. Anything normal inside of me has been changed to yucky, dead emptiness.
And at times, I don't want to fight it. I want to give in to the sadness.
And then I see Monkey crack the door just a little and wave excitedly to me. I feel him hug my knees. I feel Hubster's kiss. I hear Bug's welcome.
And I realize that I still feel. That I can recover. That I can go back to normal.
As I get further on in my training, the hours feel a little less demanding, the answers come a little faster, the work feels a little less intimidating.
But confronting sickness and death? That's something that never changes. It's something that never gets a little easier.
In the last 24 hours, I have stood by a bedside as family members watched. I stood, my stethoscope to the patient's chest, listening for the thud of a heartbeat, the whoosh of a breath. I listened for a long time, knowing that I wouldn't hear anything. I looked up at the family, and they know it too.
I left the room to call time of death.
In the last 24 hours, I have stood by a patient's side as they stroked out in front of me. I watched them panic as they lost the ability to talk, and then to move, and then to respond, and then to breathe. I might be able to place breathing tubes and central lines and start medications. But I couldn't stop it from happening.
Despite being busy doing what needed to be done, it felt like I just stood there and watched it all happen.
In the last 24 hours, I have felt powerless, sad, scared, angry, and empty.
Some days, I don't know how to come home and feel normal again.
The hole inside of me feels like it's ready to suck the joy out of my entire life. And take me along with it.
I don't know how to come home. To play games with my boys. To read them stories. To laugh at Hubster's jokes. I sit in the car in the early morning before going inside. Anything normal inside of me has been changed to yucky, dead emptiness.
And at times, I don't want to fight it. I want to give in to the sadness.
And then I see Monkey crack the door just a little and wave excitedly to me. I feel him hug my knees. I feel Hubster's kiss. I hear Bug's welcome.
And I realize that I still feel. That I can recover. That I can go back to normal.
Sunday, March 21, 2010
Today
It's amazing what a year can bring.
Apparently, even when you're not paying that close of attention, a year can bring another birthday.
Today, I'm 28.
Somehow, 28 feels exactly the same as 27. Younger in someways. I've done so much the last 12 months, but only added one year to my age.
I guess the fact that I feel tired most of the time, have found four gray hairs, and can see the start of wrinkles around the corners of my eyes and mouth doesn't exactly make me feel like I'm a twenty something. I don't even want to think about how I'll feel in two years when I'm turning 30. Or maybe 29 again. I still haven't decided.
One year ago, I was celebrating with dozens of friends and family.
Today, I was woken up by three smiling boys, two of which bounced on the bed.
One year ago, we were sharing the news that we had matched into my number one choice anesthesiology residency.
Today, I have completed 9 months of my anesthesiology residency, and am still alive.
One year ago, we broke the news to our family that we were moving to Iowa.
Today, I woke up to a sunny Midwestern morning in our very own home.
One year ago, I thought I had my future all laid out in front of me, like so many dominoes. Iowa, house, residency. Perfectly clear.
Today, the first few dominoes have been pushed, but the path isn't quite as clear. There are so many options and side paths. Third baby? Fellowship? Back to Utah? Hubster in dental school?
One year ago, I was 27.
Today, I'm 28.
Apparently, even when you're not paying that close of attention, a year can bring another birthday.
Today, I'm 28.
Somehow, 28 feels exactly the same as 27. Younger in someways. I've done so much the last 12 months, but only added one year to my age.
I guess the fact that I feel tired most of the time, have found four gray hairs, and can see the start of wrinkles around the corners of my eyes and mouth doesn't exactly make me feel like I'm a twenty something. I don't even want to think about how I'll feel in two years when I'm turning 30. Or maybe 29 again. I still haven't decided.
One year ago, I was celebrating with dozens of friends and family.
Today, I was woken up by three smiling boys, two of which bounced on the bed.
One year ago, we were sharing the news that we had matched into my number one choice anesthesiology residency.
Today, I have completed 9 months of my anesthesiology residency, and am still alive.
One year ago, we broke the news to our family that we were moving to Iowa.
Today, I woke up to a sunny Midwestern morning in our very own home.
One year ago, I thought I had my future all laid out in front of me, like so many dominoes. Iowa, house, residency. Perfectly clear.
Today, the first few dominoes have been pushed, but the path isn't quite as clear. There are so many options and side paths. Third baby? Fellowship? Back to Utah? Hubster in dental school?
One year ago, I was 27.
Today, I'm 28.
Monday, January 25, 2010
Not Me! Monday: Back at Work
Thank goodness for the blogosphere. Otherwise, I would never know what day it was. Even if I did NOT go back to work today after a week of vacation.
I am NOT upset at all about being back at work. I would be completely bored if I stayed home. Right?
And right now, there is NO WAY that I am blogging at work. I am much too professional for that and jump right on my work. I do NOT post-pone reading ICU chest x-rays. I would never. Nope, not me.
I am NOT totally regretting just asking if I could get extra days off for boards instead of using up my vacation studying for and taking them. I am a completely forward, upfront person and always just ask. And I do NOT have a mini panic attack everytime I think about my board scores and whether or not I passed.
I DID NOT gain 3 pounds over the last week. I would NEVER use stress of boards, and then vacation, as an excuse to eat junk food and ice cream. And there is absolutely NO way that, after six months of not eating beef, that I ate a hamburger last night. I would stick to my diet no matter how delicious a portabella and swiss burger sounded.
Bug and I did NOT spend nearly four hours playing Wii together yesterday. I am always good at finding very productive, non-computer/television-based activities for my children to do. And, even if that were true, there is NO way I would do a victory dance when I beat Hubster's Rhythm Kung-Fu score. I am always very classy and a very good sport.
I knew that I had to wake up early this morning, so I DID NOT stay up late watching Revolutionary Road. And since Hubster had no interest in seeing the movie, I would NEVER lure him into the family room with ice cream. I did NOT cry during the movie. I never do things like that.
I am NOT completely dreading February. I do NOT dread overnight call and internal medicine more than anything.
How about you? Anything you DID NOT do this last week? Stop by MckMama to see what everyone else hasn't been doing.
I am NOT upset at all about being back at work. I would be completely bored if I stayed home. Right?
And right now, there is NO WAY that I am blogging at work. I am much too professional for that and jump right on my work. I do NOT post-pone reading ICU chest x-rays. I would never. Nope, not me.
I am NOT totally regretting just asking if I could get extra days off for boards instead of using up my vacation studying for and taking them. I am a completely forward, upfront person and always just ask. And I do NOT have a mini panic attack everytime I think about my board scores and whether or not I passed.
I DID NOT gain 3 pounds over the last week. I would NEVER use stress of boards, and then vacation, as an excuse to eat junk food and ice cream. And there is absolutely NO way that, after six months of not eating beef, that I ate a hamburger last night. I would stick to my diet no matter how delicious a portabella and swiss burger sounded.
Bug and I did NOT spend nearly four hours playing Wii together yesterday. I am always good at finding very productive, non-computer/television-based activities for my children to do. And, even if that were true, there is NO way I would do a victory dance when I beat Hubster's Rhythm Kung-Fu score. I am always very classy and a very good sport.
I knew that I had to wake up early this morning, so I DID NOT stay up late watching Revolutionary Road. And since Hubster had no interest in seeing the movie, I would NEVER lure him into the family room with ice cream. I did NOT cry during the movie. I never do things like that.
I am NOT completely dreading February. I do NOT dread overnight call and internal medicine more than anything.
How about you? Anything you DID NOT do this last week? Stop by MckMama to see what everyone else hasn't been doing.
Sunday, January 10, 2010
Take Home Points
Intern year is strange.
Every month is a brand new job. There are new roles, new responsibilities, new attending, new residents, new expectations.
It takes several weeks just to figure out what I'm supposed to be doing. Right in time for me to finish that rotation and be on to the next.
Even stranger than that is the fact that, for the majority of rotations, I will never do them again. I will never again work in the emergency room, manage cardiology or renal patients, or set foot in the NICU.
It is designed to give us a good foundation for the rest of our training. Which I suppose it does.
Even though I won't be doing radiology or internal medicine again, I do learn a lot from each month. Well, enough to learn some key issues. Take home points, if you will.
I just finished Trauma Surgery last month. I had been dreading this month more than (almost) any other. Both because it feel over Christmas, and because...well, it's trauma. It actually turned out to be one of my favorite months. The people were great. The work was fast paced and interesting. The schedule was predictable. I didn't work Christmas.
It's also the month where the take home points were the most obvious.
First: It is never, never, ever worth it.
The talking on the cell phone when driving. The texting while driving. The speeding. The trying to make the green/yellow/red light. The "it was just a couple drinks." The not taking the keys away from from your drinking friend. The driving sleepy.
All the people I saw in the trauma bay, with all the broken limbs, broken backs, lacerated spleens and livers, head bleeds, and punctured lungs. Yes, some of them were just driving along when things out of their control happened. Sitting at a red light when they got from behind. But the majority of them, that's not their story. Positive alcohol levels, stories of looking down at their cell phones, falling asleep at the wheel.
It is never worth it.
Second: You really should always wear clean underwear.
Every month is a brand new job. There are new roles, new responsibilities, new attending, new residents, new expectations.
It takes several weeks just to figure out what I'm supposed to be doing. Right in time for me to finish that rotation and be on to the next.
Even stranger than that is the fact that, for the majority of rotations, I will never do them again. I will never again work in the emergency room, manage cardiology or renal patients, or set foot in the NICU.
It is designed to give us a good foundation for the rest of our training. Which I suppose it does.
Even though I won't be doing radiology or internal medicine again, I do learn a lot from each month. Well, enough to learn some key issues. Take home points, if you will.
I just finished Trauma Surgery last month. I had been dreading this month more than (almost) any other. Both because it feel over Christmas, and because...well, it's trauma. It actually turned out to be one of my favorite months. The people were great. The work was fast paced and interesting. The schedule was predictable. I didn't work Christmas.
It's also the month where the take home points were the most obvious.
First: It is never, never, ever worth it.
The talking on the cell phone when driving. The texting while driving. The speeding. The trying to make the green/yellow/red light. The "it was just a couple drinks." The not taking the keys away from from your drinking friend. The driving sleepy.
All the people I saw in the trauma bay, with all the broken limbs, broken backs, lacerated spleens and livers, head bleeds, and punctured lungs. Yes, some of them were just driving along when things out of their control happened. Sitting at a red light when they got from behind. But the majority of them, that's not their story. Positive alcohol levels, stories of looking down at their cell phones, falling asleep at the wheel.
It is never worth it.
Second: You really should always wear clean underwear.
Tuesday, December 1, 2009
Over and Gone
It's official.
My vacation is over.
I'm pretty sure those were the fastest 10 days of my entire life. I think they passed even faster because I was so worried about wasting one second of those 10 precious days.
Nothing makes a vacation feel more over than a 13 hours trauma surgery shift. That starts at 5:30 am.
The Thanksgiving leftovers are gone.
The Halloween candy is (finally) gone.
And it's supposed to start snowing any day, so I guess autumn in gone now too.
But it was not without wonderful moments.
Sleeping in until the sun poured through my bedroom window.
Having the time to cook breakfast for my family.
Finishing the Christmas shopping.
Discovering a new park.
Working on our next home project (here's a clue...)
Final project will be revealed, well, when it's done.
I love being home so much it makes me wonder how I can ever go back to work. The very idea of being away from my boys nearly makes me sick. But I wake up, at 4:40 am, and go to work. For them.
My vacation is over.
I'm pretty sure those were the fastest 10 days of my entire life. I think they passed even faster because I was so worried about wasting one second of those 10 precious days.
Nothing makes a vacation feel more over than a 13 hours trauma surgery shift. That starts at 5:30 am.
The Thanksgiving leftovers are gone.
The Halloween candy is (finally) gone.
And it's supposed to start snowing any day, so I guess autumn in gone now too.
But it was not without wonderful moments.
Sleeping in until the sun poured through my bedroom window.
Having the time to cook breakfast for my family.
Finishing the Christmas shopping.
Discovering a new park.
Working on our next home project (here's a clue...)
Final project will be revealed, well, when it's done.I love being home so much it makes me wonder how I can ever go back to work. The very idea of being away from my boys nearly makes me sick. But I wake up, at 4:40 am, and go to work. For them.
Monday, October 19, 2009
Not Me! Monday
I do NOT have moments where I freak out and forget all my medical training when something happens to the boys.
Roman DID NOT swallow a penny and my first thought was NOT to take him straight to the ER for an x-ray. I would realize they would have me watch him, see if it passes, and bring him in at the first sign of abdominal pain.
Blaise DID NOT develop a new rash on his cheeks. My first thought was NOT some horrific illness or rare manistation of swine flu. I DID NOT think about calling his pediatrician. It is a rash, and I've seen hundreds. Once I calmed down, I DID NOT realize it DID NOT look perfectly benign and is most likely a mild flare of his eczema due to the drier conditions in our home now that the furnace is on.
I would never panic and have my first thought be to call a REAL doctor. I DO NOT keep forgetting that I am a real doctor. Nope. I would never do that.
My cardiology rotation is completely NOT terrifying me. I have NOT ONCE badgered Keith to get his 34 year old self into his doctor to get started on a statin for cholesterol. He DOES NOT have a family history of heart disease that scare me to death. I DO NOT think about him everytime I admit another 40-something year old male with a heart attack. I NEVER image myself a widow at an early age. I will NOT keep pestering him until he goes in and does it. And I do NOT bring up the whole daily aspirin thing on a daily basis. I would always wait and let his doctor do proper blood testing and make a decision based on rational and not the terror of ending up alone prematurely. And I don't badger my husband. Nope. Never.
I have NOT been so tired that I have just dumped the last several loads of laundry onto my bedroom floor. My family is NOT looking for their daily clothes in huge piles of laundry. Nope, not me. I always put the laundry away immediately, no matter how bad the call night has been. Just the same way I do the dishes and NEVER set the table using all of Blaise's IKEA plastic utensils because there was not any clean silverware. I would NEVER get let the dishes go that long.
Or would I?
Our house is NOT completely over run with lady bugs. Or Japanese beetles. Or what every you call them. I DID NOT get home from work two hours late to find our living room floor covered in dead ladybugs. Keith would NEVER go on a bug killing spree. And we obviously would have contacted a exterminator a long time before it got this bad. We're on top of things like that.
And after a long weekend of call in the cardiac ICU, I did NOT forget that today was Monday until I read Gina's blog. I did NOT let Roman stay up almost an hour past his bedtime because I DID NOT think that since I have a day off tomorrow, that it was the weekend. I always know what day of the week it is. Don't you?
Join MckMama and the rest of us who HAVE NOT done anything this week.
Monday, August 24, 2009
Not me! Monday: Sugar High
At the fair this weekend, we did NOT eat candy bars dipped in funnel cake batter and then deep fried. And then after that, we absolutely did NOT eat powder sugar covered funnel cakes. And there was NO WAY we also ate cotton candy. I am fanatic about my kids eating healthy and would NEVER fill them up with sugar and let them loose on a barn full of animals. Nope, not me.
While I was showering last week, I was NOT shaving my legs with my feet propped up awkwardly against the shower wall. No, I would have definitely have found a better way to shave my legs. And while I was shaving, my foot DID NOT go through the wall. Tiles did NOT fall down and sheet rock did NOT start crumbling. And I know for sure that I DID NOT calmly finish showering and getting dressed before telling Keith. I love our house and would never try to downplay such an event. And I DID NOT feel terrible that I have created another project.
I did NOT invite three families over this weekend for Blaise's upcoming birthday party. Our house is SO CLOSE to being done and three year old's need big parties. Or NOT.
I absolutely did NOT postpone doing my anesthesia textbook reading because I was trying to finish reading the entire Harry Potter series (again.) No, I would NEVER do that. I always have my priorities straight.
Feeling guilty for something you totally DID NOT do this week? Hop on over to visit MckMama, and see what else everyone has NOT been doing.
Wednesday, July 1, 2009
Day One
I successfully made it through my first day as an intern.
I got to introduce myself as "Doctor" for the first time today.
I wrote orders and they happened. I asked nurses for things, and they got them. I felt, not just like a doctor, but like a grown-up.
And I got paid today. My first real paycheck in, um, a very long time.
I actually had a good day.
Which is very strange for me to say. I almost feel embarrassed to say it. I've spent to much time (and strangely, effort) into being upset about the demands of a medical life, and nervous about residency, that having fun was the last thing I expected.
I actually kind of like being a doctor.
Well, at least today I did.
When I wasn't thinking about how much I missed Roman and Blaise, and wondering how Keith was doing in his new role of stay at home dad. And wishing that I was much more caffeinated.
It was a successful day one. Now I just need to figure if it is all uphill or downhill from this point.
I got to introduce myself as "Doctor" for the first time today.
I wrote orders and they happened. I asked nurses for things, and they got them. I felt, not just like a doctor, but like a grown-up.
And I got paid today. My first real paycheck in, um, a very long time.
I actually had a good day.
Which is very strange for me to say. I almost feel embarrassed to say it. I've spent to much time (and strangely, effort) into being upset about the demands of a medical life, and nervous about residency, that having fun was the last thing I expected.
I actually kind of like being a doctor.
Well, at least today I did.
When I wasn't thinking about how much I missed Roman and Blaise, and wondering how Keith was doing in his new role of stay at home dad. And wishing that I was much more caffeinated.
It was a successful day one. Now I just need to figure if it is all uphill or downhill from this point.
Monday, June 22, 2009
Because dishes DO NOT do themselves
So after a very long time, I've decided to participate in the blog festival that is "Not Me! Mondays" created by MckMama. I've read these posts on many of my favorite blogs, but have never had a reason to participate...
Until now! I can't think of a better way to sum up this week then "NOT ME!"
Things are crazy when you're moving. Everyone knows that. Add a apparently not-so-minor home renovation on top of that, and, well, we've just approached a whole new level of craziness.
But even with that, every girl has her limits.
I DID NOT leave the dishes undone and piling up in the sink. Keith DID NOT feel obliged to mention the insane amount of dishes. Because I am always on top of housework. And Keith doesn't mind a little craziness.
And then, while I was NOT adding a seventh layer of paint to the trim, the dishes DID NOT do themselves. Or did they...?
I DO NOT hate trim. Because painting seven layers of glossy white paint on trim is fun.
I DID NOT cry when we pulled back the carpet in the family room.
Because we DID NOT find mold. We DID NOT find water. Our family room does NOT leak every time it rains. Who would buy a house like that? Not me.
I DID NOT get a massive sunburn on my back and arms and shoulders when we were at the lake. Because everyone knows that I'm obsessive about sunscreen. I still DO NOT think it was a glorious day.
I DID NOT panic when I came home from my lab coat fitting and found this in our master bedroom.
Because I am always very calm. I was perfectly aware that fixing the floor joist was going to be a big project. So I absolutely DID NOT freak out at the size of the hole.
I AM NOT having moments of complete panic about being a resident and all the responsibility that goes along with it. I AM NOT having moments of terror when I think about being in the ER next week. Because I am a calm individual and and completely prepared for residency.
I AM NOT blogging instead of making dinner. I would never do that.
What have you not done this week? Head over to MckMama to see what everyone else hasn't done?
Until now! I can't think of a better way to sum up this week then "NOT ME!"
Things are crazy when you're moving. Everyone knows that. Add a apparently not-so-minor home renovation on top of that, and, well, we've just approached a whole new level of craziness.
But even with that, every girl has her limits.
I DID NOT leave the dishes undone and piling up in the sink. Keith DID NOT feel obliged to mention the insane amount of dishes. Because I am always on top of housework. And Keith doesn't mind a little craziness.
And then, while I was NOT adding a seventh layer of paint to the trim, the dishes DID NOT do themselves. Or did they...?
I DO NOT hate trim. Because painting seven layers of glossy white paint on trim is fun.
I DID NOT cry when we pulled back the carpet in the family room.
Because we DID NOT find mold. We DID NOT find water. Our family room does NOT leak every time it rains. Who would buy a house like that? Not me.
I DID NOT get a massive sunburn on my back and arms and shoulders when we were at the lake. Because everyone knows that I'm obsessive about sunscreen. I still DO NOT think it was a glorious day.
I DID NOT panic when I came home from my lab coat fitting and found this in our master bedroom.
Because I am always very calm. I was perfectly aware that fixing the floor joist was going to be a big project. So I absolutely DID NOT freak out at the size of the hole.
I AM NOT having moments of complete panic about being a resident and all the responsibility that goes along with it. I AM NOT having moments of terror when I think about being in the ER next week. Because I am a calm individual and and completely prepared for residency.
I AM NOT blogging instead of making dinner. I would never do that.
What have you not done this week? Head over to MckMama to see what everyone else hasn't done?
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