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

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