A hobby from the past.

I finally did it. I knew some parts had to be replaced so I made an order on Amazon after doing a little research. I ordered the parts that I knew were long overdue for replacing and had worn out. That evening when they arrived, I spent 30 minutes adjusting and replacing. And then, I just did it. After 7 years of not formally touching the thing, I played the violin. It felt amazing. I forgot how good it could feel to make music. I never felt myself to be very good, so you can imagine after 7 years it was a little rough around the edges, but as I played a few Christmas tunes for Jordan, I felt more and more come back to me. I think I am going to spend some more time playing in the near future. Ultimately, I would like to get some lessons, but in the mean time, I will keep doing a little research and work on re-learning some basics on my own. I don't anticipate playing the thing more than once or twice a month with my schedule, but someday, I want to make music again!

Here is a sample of what I want to sound like someday:

Ok, so if I sound a quarter as good I'll be happy.

~vaya con dios

I haven't had much to blog about lately. I think that is because I am already tired of writing about work. No matter how hard I try to put my experiences into words, the fact remains I am just not a good enough writer to convey what I have been experiencing. That is a little frustrating to me because the experiences themselves have been life altering to me, and yet, when I go back and read what I have to say it all seems a little...saccharin.  Really, I think what it comes down to is a combination of things.  Writing has never been a strength of mine, first of all. Second of all, it is really easy to complain about how hard life as a resident is. It is easy to fall into the same "my life is so hard" trap every time I sit down to write because, well frankly, this process is hard! There is a reason there are so many books, TV shows, and just anecdotal stories about what life is like in residency. In fact, just before I started writing this I was reading the blog of a really good friend of Jordan and I. She was talking about pushing the limits and working while sick. We all do this and I am pretty sure a lot of people outside of medicine do too. But that raises an interesting question, how sick is too sick? If I were, say, a barista, how sick is too sick to pour coffee? One could argue that perhaps being sick at all should preclude that person from working since they could spread whatever illness they may be experiencing to their unknowing customers. Of course, if we eliminated the contagious argument, then we start to get to the point I am trying to make. I would be fairly comfortable with my barista pouring me coffee if they felt ill, perhaps to the point of feeling, say, 50% of normal (again, assuming they were not contagious). Now let's carry this noncontagious individual over to the medical world. How sick is too sick to be a doctor? Would you want a physician caring for your loved one if he or she felt any less than a 100%? Is it okay for the doctor to be caring for your mother if that doctor were only feeling about 80% of his or her potential? What about 50%? Would the hospital even be able to function if everyone that worked there only worked when they were 100%? I suppose it probably wouldn't.

I don't really have the answers to this, we as health care providers are human and just doing the best we can, but I just wonder if the best we can is good enough. All of this gets me thinking about another strange set of feelings that are pulled out of me as a result of my training.  As a resident in training, a lot of my time is still spent dedicated to learning and education (I suppose that will be true of my entire career in medicine, but that just helps drive this point home, I think).  Never before has my learning and education had a direct impact on the lives of others. If I make a mistake in my learning it doesn't just count towards my grade, instead it directly affects others' lives.  There are times this really scares me, but that is not the point I am trying to make. What I am so poorly conveying is sometimes it is easy to lose site of reality. It seems strange to me how often I have to remind myself that I am working with patients, their families, and their lives. When I tell a patient the results of her echocardiogram show she now has a diagnosis of heart failure on top of the cancer she already knew she had, I am completely altering the course of her life as she knows it. What I am not doing is winning the game of discovering the correct medical problem and then getting bonus points for conveying that information to a patient in a caring way in which they can understand the diagnosis. And yet, I continue to fall into that trap daily. Maybe that's my way of separating myself a little bit emotionally, but at the same time, I really need to be careful to not lose sight that this not a game.

Well, I honestly thought this was going to be a short little blog saying I had nothing really to say, because I don't know how to say it or even what I want to say, but I guess not. If you are reading this, please know that while I have disappeared some, I am thinking about all of my friends and family all of the time. I am working really hard, but I am making a lot of progress. I feel more and more like a doctor every day, and I think this sacrifice will definitely be worth it. I will do my best to try to bring more to this blog in an interesting way so as to keep you up to date on my life, my training, and whatever random thoughts pop into my head on any given day. Thanks for reading, thanks for supporting Jord and I, and most importantly, thanks for loving us!

~vaya con dios

Crossroads

As Jordan and I wrap up our much needed vacation together I find myself reflecting. I decided to jot down a few thoughts to help myself process and the result is this blog entry...

Vacation is a strange thing. I think it is especially strange for the resident physician.  There has to be some sort impact on a person that is used to being occupied the majority of their time working and learning, going to a speed of 0.  For both Jordan and I, this vacation has brought a myriad of emotion. We both have done a ton of reflecting this week and I think that is a byproduct of having time. It is absolutely amazing to me that we are more than 3 months into our training as physicians. It's so amazing to me because I feel overwhelmed by the amount I've learned, overwhelmed by the fact that it feels like I have been doing this a lifetime, and overwhelmed by the fact that I am actually capable of doing this! It's such a crazy feeling!

I have also realized how lucky we are. We had the chance to spend time with some family and friends we hadn't seen in a while. We have been blessed to have such unique support by our families and by our friends in such unique ways that I am sure neither of us would have ever made it this far without them. I miss them like crazy but it is also because of them I am not only doing this, but I am doing this the best way I know how. 

We have also spent some time working on our house a little during this vacation. Can I just say, we love our house! We managed to do some much needed deep cleaning, hung a TV upstairs, worked on organizing our basement some, did laundry (funny how that has become a luxury in our house), and Jordan did some baking!

Jordan was asking why the heck I was pointing my computer at her while she was baking.

So I tried to catch her in the action...

 And here she told me to get some pictures of the house including the whole kitchen little did she know it would end up including her in the picture too of course (Oh and yes that is a spaghetti squash in the picture above in case you were wondering. I know you were!)

 Our living room...

And from a different angle...

 

Well that was a random detour. Don't really know what that was about. Once I find our camera, I will take some real pictures of our house and post them, we have only lived here for 3 and a half months after all!

Anyway, I hope you are well if you are reading this, and if you don't read this then I don't hope wellness on you (ok maybe I do anyway).  I think it is time for me to go to bed, I am goofy! I hope this blog is at least semi funny when I read this tomorrow and not totally embarrassing! 

~vaya con dios

Complications

I know I just finished a blog a couple of days ago but something happened that shook me to the core.  I had a patient my first month as an intern that was incredibly difficult to work with. He was a guy in his 30's who abused IV drugs, was HIV positive, and didn't care if he spread it. His entire persona screamed psychiatric problems to me. One night when he didn't get his way, he threatened suicide. The next morning, he said if I called psych in to see him, he'd leave AMA (against medical advice) and throw water on whoever came into his room. He said he had no plans of hurting himself and he wanted to live. We treated his abscess, talked about staying clean, and acted like we had made a difference. Then last night happened. He came back to the hospital really sick.  He was being treated when he suddenly started getting more and more sick.  The initial thought was that he had a complication of diabetes. They were treating him appropriately and he initially got better.  Then he got sick.  When things didn't add up, people started asking questions. He told the team who admitted him that he had binged on meth for days and missed all of his medications. He didn't want to get sick so he took all his medications at once after the binge.  He wasn't sure what he took but he said he took 60 pills. As he continued to get worse, they moved him to the ICU where he later refused all care and he died.

Now what's so strange to me is how guilty I feel. I had so much animosity towards him before. He had done all of this to himself. He would complain about everything, he abused drugs to the point of nearly killing himself, and worst of all, he knowingly spread HIV. But now, in hindsight...Now...I feel somehow, somewhat responsible. Why didn't I insist on a more thorough psychiatric eval? I know that he would have likely died from full blown AIDS a short time later anyway, but what if all of this was not him doing to himself? Rather, what if this was a psychiatric disease doing this TO him? I know this guilt isn't a burden I have to carry, I am trying my best to take it more as a reminder. I can't ever be too busy. I can't overlook these details that seem too minuscule as compared to their whole medical picture. Psych was a worry I had, but with how sick he was before, it just didn't seem like that big of an issue. His reassurances sufficed for me at the time. But in hindsight? Man, in hindsight I just can't help but wonder...

~vaya con dios

"I have been favored by God, and by those who have a say in what happens to me."

As I am winding down in the last rotation of the first quarter of intern year, I find myself looking forward to my first weekend off since starting. This process has been amazing, hard, exhausting, educational, and life defining. In other words, it's been crazy!

This rotation was a general inpatient month for patients with Kaiser insurance. I went into the rotation not really knowing what to expect. Honestly, I was nervous about the variety of patients I would see. I think I was expecting nothing but privileged individuals that could afford health care and would have the elements of disease seen later in life with well-treated chronic disease previously that reached a point where all the treatments we had would fail. Instead I saw a spectrum of patients ranging from a young woman with severe alcoholic disease to a patient with terribly controlled diabetes who had her life completely changed by a SCRATCH she suffered on her leg that will likely take her life in the next year, and all the way to an old man in his 90's with pneumonia who would transition to hospice (I am beginning to learn why they call it "old man's best friend"). This rotation was actually a really good one for me (even if I am so tired) and I really did see a wide variety of patients and illnesses.

My expectations of those favored enough to have a decent health insurance went out the window almost immediately.  Illness is a horrendously great equalizer.  The uninsured patients get the same diseases that the insured patients get.  I saw beautiful relationships carrying people through their times of illness on all ends of the socioeconomic spectrum.  I saw individuals nearing the end of life alone (and really what does it matter at that point if they had Kaiser insurance or Medicaid).  On a large scale I know how detrimental to a patient it can be to go through a disease process without insurance, but really when it comes down to the day to day, as a physician, I don't want to have to care how they will pay for their treatment. I want to be a hand to hold when they are scared, I want to be a teacher about an illness or treatment, I want to be a bright spot in an otherwise dark time.

Thanks for reading!
~vaya con dios

Fall!

With the unofficial beginning of fall coming tomorrow, the dorkiness that is completing my fantasy football draft yesterday, and the start of college football season, I figured I would change gears from my usual whining and complaining about being tired and think about my favorite time of year; fall! Baseball is winding down and the playoffs are getting ready to start! I still am clinging to the slimmest of slim hopes that the Rockies can hold on and grab a playoff berth (sadly, it's doubtful though). Ubaldo Jimenez had a dream start to the season, but sadly, he had 0 run support. Carlos Gonzales is having an MVP type season, but no one (nationally, anyway) pays any attention to sports in Denver. I am afraid this team was built for success but hit too many speed bumps along the way to make the run I am hoping for. All in all though, tt's been a really fun baseball season.

The Broncos season scares me. I want SO bad to think they are going to be good. I want SO bad to have hopes that they have an awesome season. But honestly, I am the most pessimistic I've been since...ever. Kyle Orton is average at best WITH a huge receiving threat (read: Brandon Marshall). The Denver defense is scary against the pass with the league leader in sacks (read: Elvis Dumerville). The team is being talked about only for having a backup (read: Tim Tebow).  Two of those three guys are gone, and the third is going to sit on the bench. This is why I am so down on their chances. To all this, I still don't care. I am so pumped for football to start, I can hardly stand it!
Anyway, I thought I'd take my shot at writing about something different and I think I failed miserably, just rambling about something most care about one-tenth as much as I do. Sorry about that!

~vaya con dios

A critical point in my intern year

The ICU. If you talk to or read about any new doctor or medical student, you will invariably hear the stories about the fear of that first night on call in the ICU. I too experienced that fear, the patient's are sick and the nerves are endless. Well here I am, 3 call nights shy of finishing my first experience as a doctor in the intensive care unit. This month has been challenging for a number of reasons, but it has also been good for me I think.

The first challenge for me has been a recurring theme; lack of sleep. I have been on call overnight every third night. It makes for long days and a lot of fatigue. I have managed to get anywhere from zero to 2 hours of sleep on those nights. Honestly though, it hasn't completely messed with me the way I was sure it would.

The real challenge has been the emotional aspect. It is tough to feel like I am constantly trying to learn and constantly being pushed to know more than I do, but that isn't the source of the emotional exhaustion for me. I have two stories that come to mind. A word of warning though, they are emotionally exhausting for a reason. Here goes:

The first is my most proud and yet is quite disturbing to me. A lady in her 70's came in for what we call a CHF exacerbation. Her heart was pumping as well as it should. Now, typically when this happens, we look for what set off the event. Sometimes we find a reason and sometimes we don't. That day I got lucky, and the patient got incredibly unlucky. When I went to the emergency room to start the paperwork to get her admitted, I pulled up her EKG. Now keep in mind, reading these things takes years of experience and training and I am by no means good at this, I miss a lot of stuff. But for some reason, I noticed an abnormality. I mentioned it to the cardiologist, but he wasn't convinced. He said he was willing to watch her closely from that standpoint, follow a few lab tests, and repeat an EKG later. Well, lo and behold, 8 hours later my concern for this abnormality being a heart attack held up. Now, in hindsight, the cardiologist told me I was probably right. Huge moral victory, right? Well it turns out it wouldn't have changed anything we did, but the hard thing was she got sick. She was on the brink of death that night. I had to tell her husband that I thought he needed to call family in from out of town because I wasn't sure she would make it. This story ended happy and she got better, but it really left me thinking. I was really happy that I found this abnormality when even the cardiologist hadn't. But how could I have been so excited about something that was so bad for this patient? Perspective can be a funny thing.

And the story that is already haunting me a little. A patient in her 20's came to the ICU one night when I was not on call. She was initially being seen at a rural hospital for abdominal pain. A CT scan at that hospital showed some really strange abnormalities, so she was told they wanted to send her to Denver for better workup. She arrived and looked ok. The CT scan was weird, but she seemed stable. That scan showed a bunch of lesions in her abdomen, the most prominent of which being in her liver. There was an onslaught of discussion about what might be causing all this, ranging from strange infections all the way to cancer. The picture wasn't making sense though. She had a diagnosis of lupus for many years, but was otherwise previously healthy. She was followed closely by her doctor. The mystery was, how could someone with such close medical follow up end up with such widespread abnormalities on her CT scan? Well the answer came in the coming days after a biopsy revealed that dreaded word: it was cancer. Based on the type of cancer, she was going to start aggressive chemo while in the hospital. One afternoon while I was on call (strangely enough it was the same call day as the previous story), I was approached by a nurse asking that I keep a close on the patient because she was worried. Now this request was somewhat strange that day because it was still during the day. The team taking care of her was still there, so typically the nurses would call one of those doctors. It just so happened that the resident on that team was in clinic, the intern responded really poorly (not important for this story), and the medical student taking care of the patient didn't seem to grasp how sick she was (a skill I am still developing). As I was working on our other patient, I decided to check in on this lady. She looked SICK. Her breathing was labored and she looked like she was heading towards respiratory failure. I decided there was no time to contact her regular team, I just acted. I called in the pulmonologist, the attending, and my resident. We decided it was time to put her on a ventilator. She had lots of family around and we gave them a chance to tell her they loved her and then intubated her (thank God we let them do that). Over the next few days she seemed to get more and more sick. Then came the point where we started to turn off the sedation and see if we could get her off the ventilator. She wasn't waking up. It later turned out she had massive bleeding in her brain and it became obvious that we had already lost her. Her primary doctors had to tell this family that never left the hospital, that stayed with her day and night, that 1 week ago didn't have any clue that anything was wrong, that this patient, this 20 something year old woman with two young children, that she would not get better. She died later that day. I keep thinking about her and her family. It is weighing on me a little, but appropriately so I think. If this story didn't bother me, didn't make me incredibly sad, I think I would have to reevaluate my career choice. I thank God that I feel sad about this, that it affects me.
One thing that struck me about this whole situation was how things carried on. The day after she died, I walked past her room. It was cleaned and still empty. The bed was made, the family was gone, but the buzz of the unit carried on just the same. The nurses, therapists, doctors all running around trying to help patients, trying to heal others. The medical world is such a strange place.

I have other stories, but this post is getting really long. I don't intend on being depressing in every post I make, but this last story is an overwhelming microcosm of the roller coaster of emotion I have been experiencing this past month.  Please do not misinterpret, I realized as I was speaking with her family throughout this disastrous time that I am called to do this, and I will continue to answer that call every way I know how.

~vaya con dios