The clock always runs forward
I'm taking my shelf board tomorrow and getting a break. That also means I'm rotating out of the ER. Without a doubt I will miss it, but I know I need a little time to process what I'm going through against what I've seen.
Last week I was two miscarriages in one day, which is the same number of miscarriages I was part of during OB in six weeks. While I have my suspicions about how the MOBs (mother of baby) felt about the 'demise,' the most distrubing thing I saw came from some random OB resident. One of the miscarriages happened at 18 weeks and the completition of the miscarriage needed to be helped. The resident was extremely unsympathetic and said 'oh, I stopped by and pulled 'it' out.' I thought back to my previous experiences, when the nurses wouldn't let the students into those rooms on L&D. How does the woman who experienced that loss feel about the 5 white coats standing in her room right now pretending we don't see the POC (products of conception) on the floor?
No
mourning. No acknowledgement. Just go grab the ultrasound and move on with your day.
In my last two shifts, two patients died. I didn't have anything to do with their deaths, but it's sobering all the same. One was a GSW that nicked a critical blood vessel, and the other was a hemorrhage. I was the person standing in CT scanner when the head CT came back white. I was the first person to see the death sentence. At least my attending on that one cared because the wasn't any holding back on the 'god d@mn it.'
While I'm sure this is what I want to do, I need a little distance to accept all of this. I don't want to be that resident who didn't exhibit a shred of humanity. Only I still don't know how I think that I can walk home after everything and return the phone message from that cute boy, like none of this happened.
All I need is a little time. Especially since it is always running forward on everyone.
ER Office Christmas Party
It was a long week in the ER, at least for me. It's been a bit of an endurance trial some days. However, I am absolutely in love with the rotation so at least that works.
I did end up going to the first office party of my life with the ER staff. I forced myself into last year's formal dress (in which I can neither bend or breathe), let down my hair, and took someone else's fiancee to the event. In the past, I used to curl my hair and people wouldn't know who I was. In the ER, I put my hair down and no one knew who I was. The 4-5 inch heels I wore might also have made me a little more disorienting too, but there were lots of double taking from people on this rotation.
The evening was dedicated to looking at other people's clothing and schmoozing. (big points to man in red leather pants) It is what everyone does at an office party. I didn't become significantly intoxicated, which meant nothing embaressing was said, and I feel I circulated well. Some things were said to me that made me feel better about myself. For example, an intern told me I was a good student and asked where I was interviewing. She was pretty surprised to find out I was still a Med 3. One of my attendings introduced me to one of the unit clerks as a natural ER resident-to-be.
The party itself was a bit tame, but since we left at 10 that might have been the issue. I think it would have been out of control if it had been open bar instead of cash bar. A different attending I have to say was certainly the life of the party . . . It was interesting to see who brought whom to the party, pretty much a glimpse into the personal lives of people you see professionally. Which can be scary and brings up it's own set of unaskable and unanswerable questions.
But I guess that is the true purpose of the Office Christmas Party.
Graveyard in the ER
Quality night in the ER, hour by hour.
11pm: Arrival and picking up my first patient. My mentor is there signing off, but I check in with the chief resident like I am should. I pick what I thought was straightforward ToothExtraction. TE turns out to be more complicated due to uncontrolled diabetes and blood sugars in the 600s. And TE had a bleeding tooth, one of multiple tooth extractions if my tooth numbering is anything to go by. There isn't any signs of fever, which is good with TE is allergic to penicillin.
Midnight: With TE getting DKA ruled out and a consult to dentistry, time for a new patient. Lucky for me around 1 am, ItchyHives roles in. IH woke up this morning with hives that have spread to the face and starting down the legs and arms. IH also has 'strep' which was treated with amoxicillin. Mono and strep have similar presentations so I get permission to call the lab and find out how long it takes for an EBV test for mono to get back.
1am: Dentistry says we should just pack TE's tooth and recommend follow up with the dentist that pulled the tooth. Oh yeah, and deal with TE's blood sugar medically because they don't know what to do. IH wants the hives to stop itching and will consent to the mono test. That patient will get some anti-histamines, steroids, and the door as soon as we can get the paperwork through.
2am: TE has stopped bleeding and the CBC/chem 7 show blood sugar in the 300s, but no DKA. Hopefully soon as some fluids get in TE and the paperwork finished, TE will be out the door. I use my mentors 'paperwork makes the world go round' line to tell TE it could be a while. I pick up BackPain who has been transfered from an outside hospital. After spending some time with BP, it appears the 'pain' is supratentorial in nature due to a very inconsistent physical exam. BP claims 'numbness' over a non-existent dermatone and a paralyzed leg which is 'unparalyzed' when BP turns over to let me do my lung exam.
3am: The bars are closed on this Friday night so everyone comes in with their drunk related traumas - namely DrunkGuys 1-5, mostly cuts. A few traumas come in but they are claimed by surgery (hi other medstudents doing trauma call!) IH has been sent home. BP is getting scanned, and TE is still waiting on paperwork. I head off with one of the interns to stitch up DG1 who is accompanied by his uninjured friend DG1a. The intern leaves to go get something, and I get stuck with DG1 and DG1a hitting on me because they must have seen too many episodes of Grey's Anatomy. I try to ignore them as I wait for my intern to come back and rescue me. It takes a long time.
4am: Still sewing up DG1, while my resident takes care of DG2 and DG3. There is a really nasty FaceCut that plastic surgery is coming down to sew up. There is no hurry and DG4 who is pretty altered (aka stuporous drunk) needs his skull lac stapled. With the 3am rush of patients finished, triage is empty and the board is emptying. BP's scans are clean and it is time for the discharge to be repaired. BP is very needy and wants attention, but none of it is the ERs problem. We just can't fix BP's martial problems and depression here.
5am: Nothing new on the board. DG1 and DG1a with their HotFriend leave. DG4 is so out of it, he doesn't really do much when I put 3 staples in the back of his head. TE's paperwork is finally finished and out the door at last. I hang out with the residents and try to do some of my family practice reading.
6am:BP is being discharged but still wants attention . . . and more pain meds. I can't solve BP's problems. I go to check out FC and happen to be in there while 2 docs from plastics are checking out the injury. Note to self: never get in a bar fight with glass involved. Plastics leaves to go fill out some paperwork and will come back later. I only have a few minutes left in my shift and am not picking up the new patient RotatorCuff. Trauma arrives and in come the surgeons and their trauma med students. Note to self: sharp objects are pointy and dangerous. HotSurgeon that I knew from internal med is in charge, but since someone is bleeding, he doesn't see me. I'm fine with that.
7am: BP has finally left and I'm getting ready to leave too. Then plastics comes back and recruits me to watch them suture FC. I know this is a learning experience, but I want to go home. I'm smart enough to not say that because unless you are an ER doc, no one understands 'my shift is over and I want to go home.' The two surgeons try to sell surgery to me. I'm smart enough to plead undecided because I don't want to be pimped or piss them off. We discuss safer topics like Grey's Anatomy and Nip/Tuck as FC sleeps through the entire procedure.
8am: FC is all sewn up with 30-40 stitches. I'm free to go. I check in with my program director for further plans this week. He thought I went home an hour earlier. We rearrange my schedule a little bit for the week. I'm going to spend a long time putting in IV's on Wednesday. I bundle back up and walk out of work into a bright bright sunshiny day. I'm totally going to bed. I'm asleep by 8:30 am.
Hours Part I
I've been a med 3 for almost 6 months now, but I still don't understand how to 'fix' my sleep cycle when on call or late shifts. They both have different issues, but today I will address the much friendlier topic of trying to work the 11pm-7am shift.
Let me start with a short story about my previous life as a nurses aide at an assisted living home. During my last month in college, all of the 11-7 workers were fired and I was asked, as a part time aid, to fill in. So I found myself with a schedule that looked something like
11-7am - work 8am-12noon - class 12noon-4 - sleep 4-7 - track practice/dinner 7-10 - sleep
Up until med 3, that was probably the longest month of my life because I had no schedule to regulate my sleep cycle. I was constantly falling asleep all over the place because I was still trying to maintain a daytime existence. It was less dangerous than the time I did 11-7am without sleep and fell asleep while driving multiple times, but it still wasn't fun.
So three years later, I'm still trying find a way to convince my body that it needs to be awake for that night shift. While not the supreme test of endurance of call, it is still pretty difficult to achieve. The anticipation of the night is much harder on you then the actual event - i.e. - trying to sleep for the second time during the day so your body thinks it is the middle of the day at night. I find I'm most functional if I make an effort to sleep about noon-five.
Yeah, that post was not all hospital related. The next one will be.
Talking about the dead
Now that I know what I want, I've been thinking alot more about what it means to be a doctor. I don't mean the play doctor that everyone was in Med 1 and 2, but the real thing. Even now as a med 3, I'm still in the safe bubble of not making the decisions. Right now I stand on the sideline and encourage the intern who is making a decision. Sometimes I feel superior because I'm sure on my course of action and can see that it doesn't really matter which beta-blocker we pick from the hospital formulary. To the intern, it is much more 'what if the beta blocker I pick has side effect X and I just killed another human being?'
I would say in the past month and a half, I have been more profoundly affected by the ER and woundcare patients than I would have been before on my other rotations. I think it is because I have a little more time to think, whereas IM and OB kept you so busy you never processed the people ill/dying around you. I've had alot more time to see abuse and neglect now, and it makes me wonder what the rest of my life is going to be like.
With all the HIPPA regulations, I feel like I can't even talk about some of the things I have seen to anyone who is not a peer or an official med representative. Even when you do, it feels like some type of evaluation of your character. There is still this feeling that outsiders aren't supposed to see the dark side of the physician's soul. Or insiders for that matter. That may sound dark and twisty, but it's true. My patient is dying of X and no one on my service will use the word 'die' in a conversation about his/her care? We can say the treatment fails or the patient expires, but the mere word die cannot be spoken.
Honestly, how does anyone go home and talk about this stuff? Is there a normal well-adjusted way to say 'today we shocked a guy back to life . . . but he's sort of brain dead so he won't enjoy it . . . he's in the ICU and I might check up to see if I did anything wrong . . . he was a really cool case.' Did I refer to the death of a human as a cool case?
Or what do you say on that crappy day when you didn't shock him to life? Can you tell your mom about getting the couple to sign the death certificate for their 18 week gestation baby that did not 'live' in the eyes of the state? It scares me that I can be affected by all of this, and that there is a question of who I am when it stops affecting me.
And then I worry about what that will eventually mean to whomever I eventually end up with, and partially makes me wonder why I even bother. No one understands what it is like to be a physician like another physician/nurse and so forth. It also helps that you spend most of your time around other health professionals, so it makes sense to date them. Except that part where its a bad idea to date people you work with, especially if you eventually can be their superior (Grey's Anatomy isn't completely untrue). Which leads back to dating outside of that realm. Not that I have time to meet anyone outside, or, even if I did, explain to them how my life is going to work; let alone welcome them into my world of 'so-and-so died today.'
If, at that point, I can even use the word 'die.'
It's been an interesting month
I have officially been twenty five for a month. It has been a very interesting month. When it rains it pours, but you just can't tell if the downpour is going to last. There were some good choices, there were some bad choices, and there were choices that I didn't make that were made for me. It happens, but even more, I'm not upset about any of it.
I think it might have something to do with my rotation. I am the first Med 3 in a few years to get an ER rotation, and they are still in the process of figuring out what to do with me. This puts me in this strange nowhere between the shadowing of Med 1 and 2 and the responsibility of Med 4.
But I wouldn't change it for the world. It's been pretty amazing so far and has basically solidified what appears to be more and more of the reality of me wanting to be an ER doctor. Honestly, this is the most I want to study, well, in ever.
