Blogging 101

So as you can tell from the number of posts I've had in the last 7 months, I am in fact extra qualified to write a post entitled "Blogging 101." I am not really sure why I abandoned the idea of writing for my blog. I think I just got tired of talking about self reflection and why I should doctor a certain way.  I often find myself thinking about writing down some thoughts about current events, sports, my faith, or even sometimes something about a book I'm reading or new recipe I've tried, but these things just all feel so...already done. Now maybe my faith is one that doesn't feel that way, but that is more of a personal thing that I love sharing, but that is through action and not words, I am just not blessed with the talent to elegantly share that part of me in words on an internet blog. As for the other things I've listed, current events are usually related to political views in some way these days (and trust me, I am DEFINITELY not eloquent enough to have those discussions).  Sports is always a fun one for me, but what can I say that hasn't already been said elsewhere? Anyway, all of this is to say I realize I need to do this more and I plan on doing that. Right now, I think I just want to write a little update about us.

Jordan and I recently had a vacation to Napa. It was unreal. The experience was unlike anything either of us have ever done. It was so cool that it was the first vacation that we both saved up for, planned ourselves, and enjoyed together, just the two of us. We choose an awesome time of year. Napa weather was beautiful (60 degrees most days). The leaves in the vineyards were all changing and were breathtaking. I even discovered I like wine!  Here we are on a deck that overlooks an awesome vineyard while wine tasting:

Other than working and vacationing in wine country, life has been fairly ordinary for us (well as ordinary as it gets for 2 residents). We have a pretty good routine these days. Usually Jordan has to go to work an hour or two before me. We each work throughout the day, randomly texting stories about our day to each other and get home just in time to share dinner, maybe watch a recorded TV show,  catch up on the news (for me the news is actually reading news websites, for Jordan, well let's just say you'd be surprised how up to date you can be kept by Facebook!), and occasionally catch an evening walk. Lately, we've also managed to do some reading for fun. We then get exhausted, head to bed and repeat the next day. This routine is pretty awesome and overall we are bother really happy with it.

Our routine may not seem like much, but I can't tell you how fun it is to look forward to those evenings with Jordan. I do know that in that routine can be time to give more updates. I plan on doing that and will have another one soon. Maybe I'll have the motivation to tell a work-related story, write about some new music I've found or even about a book I've read (your choices however would be limited to The Girl with the Dragon Tattoo, Harrison's Principles of Internal Medicine, or the 4th Harry Potter book). Until then...

~Vaya con dios

My doctoring conundrum

Well, I am back at work doing my regular job at Joe's after a long stretch at other hospitals, clinics, and a stint in nights. The first two weeks were really tough and I just now am feeling like I am getting used to the grind again. With these past two weeks being so tough, an old thought I have had often during this process has made its way back into the forefront of my mind.

I always feel guilty telling a patient or family member I am leaving for the day. I know it's crazy, but as a patient or loved one, do families resent the fact that I am not there to answer every question, or have every update in real time, or know every detail? As a provider, I try to learn as much as I can, as fast as I can, in as much detail as I can, but obviously there is just no way to know it all and be available at any moment's notice. I suspect patients understand this, but then I think about my response if a loved one of mine is in a healthcare setting. I wonder if my expectations change when I am looking through different glasses, when I'm on the other side. I am not really sure if my expectations get too lenient or of I expect more. I know it is unrealistic to feel guilty every time I leave work and think I should just be there. That being said, I do. And on top of that, I have come across patients and families that really do make me feel more guilty for leaving. Of course the best possible care would come from a super-human physician that required no sleep and had no life outside of the hospital that would never need to leave and knew everything in real time about every patient. Sometimes I wonder if that is in some way expected of us. Maybe the fact that I feel this way is a wake up call of sorts to myself to remember while I am re-adjusting to the grind to not lose sight of the important part in all of this.  Learning this trade is secondary. People's lives are affected every day by the many things I do in the hospital. I need to be as available as I can within reason and maintain some semblance of myself and my life so I can be effective for them. I will never be super-doc, but I can strive to be better every day.

~via con dios

Room

It's been a while since I've gotten around to writing anything here. Honestly the past few months have been some of the more challenging months I've ever experienced and I didn't much have the energy or desire to write anything. I have a bunch of great stories from my month in the emergency department last month, but I think those are best served as stories told rather than shared on my blog (I have been dying to go to a coffee shop and just sit and have coffee, so if you want to hear them, then let's go!)

I just finished night float which was another hard month for me. The patient interaction, autonomy, and decision making has been great, but the schedule is just down right hard. Instead of sharing stories about the month I want to share something different. First just a little background, nightfloat is a month with 2 interns splitting the responsibilities and a supervising resident who oversees everything. We each admit 5 patients and cover half of all the resident teams' patients. One of us works from 4p-4a and the other 7p-7a. That means the times where there is only one of us, we are responsible for upwards of 70-80 patients. Typically the 4p-7p time is a little more slow and the same is true from about 3-5. That means I have managed to get some reading done which has been fun and takes me to what I wanted to share...

...Room is the latest book I just finished and it sparked a lot of thought for me. Without giving away too much about the book, it is a story about a young woman who was kidnapped and held in a small room. The story is actually told through her 5 year old son's (Jack's) perspective. Jack was born in the room and his whole entire world is that 11x11 foot room. The entire book has such amazingly tragic perspective and has really got me thinking. Jack knows nothing but what is in his room and what he sees on TV (which to him can't possibly be real). Jack's perspective got me thinking about our isolated world in the hospital. There are many parallels that I thought of while reading the book, but the most significant one for me comes from later in the book (at the risk of giving away too much, just don't keep reading if you don't want absolutely anything about this book given away). Jack and his Ma ultimately make it out of the room and Jack has to learn so much about the world he lives in and didn't have a clue about. He is so overwhelmed with the complexities of our world that he is completely unable to function. His mom is even unable to understand why he can't grasp it. Just as Jack has overwhelming amounts of information to process in this new world, so too do our patients who set foot into the hospital. For us health care workers it is often times difficult to understand why a patient or a family doesn't get why we have to wake them up at 3am to check their blood pressure. What does it mean to have tachypnea? Why can't a loved one drink more than a liter in a day and why are you measuring their pee? These oddities are a part of my every day life and it is easy to forget to explain them.  I have attempted to maintain an understanding about this throughout my training, but I think this book really helped me to grasp that and helped reaffirm at a time where things have become a little less exciting in the day to day and a little more redundant. The book was tragic, difficult to read at times, and amazing. I recommend it, but be warned it deals with some very difficult things.

Well that was fun, but I am getting tired and I have one more night left tonight. I really feel like I have grown a lot in the past few months and I hope to share more soon!

~vaya con dios

How do you answer?

I was thinking about writing a post about my first week in the ED when I decided it's too soon for that. What I did come across was a bit I wrote one night following a really tough day during my first week of oncology. This patient definitely got to me. It's kinda fun to read about the experience a couple of months out. It's also nice to read about a time when I had a little more responsibility (the biggest knock on my current rotation so far). This is from November 1st:

"Today I was faced with a challenge of which I have had on my mind all night. I have been helping to take care of a younger patient who is fighting his SECOND form of cancer in the last 15 years.  This go around has been tough on him. The chemotherapy has caused a lot of pain and a few different infections. He has had a really tough past few days and as a result was experiencing a lot of pain today. I have spent a lot of time with his wife and him discussing the progress he has made each day, the new complications that have ensued, and even just listening to how they are coping. And then today it happened: he straight out asked me, "tell me I am going to make it, please tell me I am not going to die." We are trained to never make promises. We are warned not to make statements promising a patient about an outcome. Yet here I was, wanting so badly to promise him he would make it. I just sat there looking at he and his wife thinking to myself, "How do you answer that?" The truth is, while I was taught what not to do, I don't know if there is a way to teach what to do."

I never finished so it never got posted. The patient ultimately ended up getting a lot better in the coming days. His long term prognosis is still tenuous, but overall, he made it home in time for his 3 year old's birthday and I consider that an enormous success. This job changes people, I just have to make sure it keeps changing me for the best.

~Vaya con Dios