Hiding from my patient
On my last day of my inpatient peds rotation, we got some imaging from one of my patients. This patient had been in my care for a long time. He was, technically, was an adult but was being treated in peds anyway. Which meant I had a pissed off adolescent teenager who was pretty unreasonable.
Yeah, I said it. Unreasonable. Being sick sucks. I got it. Grow up, life isn't fair. He had a diagnosis that had a long recovery ahead after surgery - scheduled a week away - that my service fought very hard to get approved. He lived in total denial of what was happening to him and had a freak out my last day over the size of scar he will have with screaming and crying that he wouldn't have the surgery. I so much wanted to reach out and shake him, 'if you don't have the surgery you will die and no one will care how nice of a corpse you look!' His ever-present parents were very aware of how bad his prognosis was without surgery.
Before you judge me too harshly, this is not his first freak out. This is like his 20th. I spent alot of time keeping his nurses spirits up, whom he treated pretty badly. His diagnosis wasn't cancer (since I was on a non-cancer service) so it's not like I'm talking about a kid that had been sick for years. This 'kid' can fight for his country, he can vote, he can drive, and he is allowed to make healthcare decisions for himself.
So moving past that part of the situation. We sent him down for some additional imaging. We saw something we didn't expect to see, and it was BAD news. My last rotation in surgery tells me that what we saw changed everything. It was very likely that we weren't talking about a surgery next week with a hopeful discharge for his graduation. We were probably talking about a surgery as soon as they could get the team assembled.
However, without the official word, we could tell the patient nothing. In fact, my house staff specifically told me not to re-enter the room for any reason. We did not have an official read of the results and we did not have a plan of action. The plan was up to the surgeons, and all we would do is upset the family and screw up the care of the patient by not having solid answers.
Thus I hid. It was my last day, but under no circumstances was I coming back to say good-bye to the family. I know myself. They would ask me about the test results, and I would have trouble saying 'no official read yet' without betraying our suspected BAD BAD news. It sucks to say this, but in medicine, until you have an official attending backing you up, you aren't allowed to say what you think.
I was sent home before the surgery team even found out the news. Yes, it is an unsatisfying climax to a story, but that is how medicine can be.
Labels: bad news, hiding, medicine, pediatrics, surgery
Surgery - I just don't get it
We all know I love the TV show Grey's Anatomy. I watch it religiously and will endlessly talk about it if given the opportunity. However, there is no way that I would
EVER become a surgeon after my past rotation and now being on peds. The surgery rotation is made to crush your spirit and is practically a waste of time on account of its overwhelming ineffieciency. Worse, the cracks in the foundation are extremely obvious and it's maddening that everyone has to pretend how wonderful it is. While I now respect the surgeons more, I think that anyone who tolerates this is insane.
So I wanted to make a comment on some of my pet peeves about the surgery rotation. (I am writing this 2 months after I finished it, and I still feel just as strongly)
1)Why am I here at 4:30am? Honestly, I don't really know because the nurses haven't even draw the labs. It doesn't make sense for me to get here this early because WITHOUT labs no notes are complete and pre rounding can't even be done. Most days the labs aren't up until 7am, and you can't finish notes or round without labs. And without rounding, no resident can scrub into the cases.
2)Why can't the attendings round by themselves? My service had six attendings last month. Yes, six. No one could go home until we had rounded as a team with all six attendings. It was even worse when one attending would be very late and decide he wanted to teach. Most fo these attendings rounded on their patients in the am and the pm. They get impatient and pissed off if the team isn't waiting for them to round - perhaps it is because we are rounding w/another attending. Heaven forbid you round by yourself in the am and then communicate to the chief what 3 new orders you put it. Did all of us need to be there to see you replaced Ms. K's potassium?
3)Why can't you use your manpower effectively - aka - why am I even here? The first two weeks on my service were horrible b/c the chief resident insisted on doing things in a 'his way' format that was inefficient and worthless. He was gone for a week and didn't realize we went to a moderately more efficient set up which involved the med students seeing a section of the hospital w/o the residents. When he came back he accused us of skipping out on work and refused to talk to us for a few hours before he asked us what we had done all morning. Heaven forbid we put some organization into our day.
4)What 80-hour work week? As with many other specialties, it is still a joke. The residents are lying about their hours. I don't need another talk about how the 80 hour work week is the worst thing that happened to medicine from someone who has been brainwashed into believing this is good. I can't believe how some absolutely brilliant people can buy into a rhetoric that denies them basic sleep deliberately. I think surgery was certainly the worst of the group with OB and medicine coming in close second and third.
You know, I could go on for a long time about what is wrong with surgery and how we train for it, but it is like yelling at the rain. You can't change the wet, but you can get an umbrella.
Labels: 80 hour work week, residency, rounds, surgery
Excessive talking helps
You never know how much making random friends will help you out. Here's an excellent example yesterday. Or maybe it just showed how weird med student life is.
So I woke up Tuesday morning not feeling so hot. I ate breakfast, headed to the hospital, and then found out the first 2 surgeries were canceled so we had a few hours to kill. My stomach had felt sort of upset, but I ate my animal crackers and diet sprite anyway. Then I started puking. I reached the point where it was pretty much just dry heaves. After 4 hours of this, I was the color of paper, woozy, passing out in the restroom, and propping myself up on various walls.
Fortunately I had struck up conversations with one of the anesthesia residents at earlier visits. After establishing that I was so dehydrated it was tough to even find a vein (opps, too much studying and not enough drinking), I got my very own liter of Lactated Ringer's running into my arm. We ran that baby in so fast that we almost blew my vein and I ended up with quite the bruise afterward. The resident also made sure that I informed my attending who sent me home since there were no actual surgeries that day.
Good thing too. I had a 100+ temperature and wasn't at all appropriate to be around patients, even if I didn't look like death warmed over.
Moral of the story: be nice to everyone, even those not on your rotation. You never know when you'll be so dehydrated that someone needs to put an IV in you. Just make sure you have the anesthesia resident, not the PMR resident.
Labels: dehydration, IVs, residents, sick, surgery
Glass half sideways
On the day of a spinal surgery scheduled to last forever, I was sent this from '
black belt blue gi' for some inspiration.
His message:
"The pessimist looks at how many people are in front of him in line. The optimist looks at all the people behind him - they would count themselves lucky to have his spot."
My response:
"The realist stands in her 15 pound lead apron for 8 hours during spine surgery and realizes the resident is beside her, the attending across from her, and those lucky nurses behind her don't have to worry about contaminating the sterile operating field."
The lead apron you wear to protect you from the x-ray is heavier than you think it is. All of the weight just crushes you - though the other option looks like
this though it is possible that they were joking.
Labels: back pain, lead, protection, spine, surgery, x-ray
Surgery Week IV
The last week on that horrible rotation.
Sunday 0 hours first day off in 2 weeks
Monday 8am-7:30pm 11.5 hours
Tuesday 5:30am-6:30pm 13 hours
Wednesday 5:30am-5pm 11.5 hours
Thursday 6am-7pm 13 hours
Friday 6am-3pm 9 hours
Saturday - off
A mere 58 hours in five days and that included that I got off a few hours early on Friday for an organized medicine meeting. My a$$hole chief resident came back on Monday, but all the surgery residents had a conference on Tuesday so they weren't around. I was really happy on Wednesday when our pissed of intern sent us to a conference that didn't exist and the chief threw a total fit b/c he thought the med students were skipping out on work. He treated us like crap for 2 hours before finally asking and realizing we had been there since 5:30 and had covered 12 patients he hadn't even seen.
So lets look at the bill. In the eyes of the hospital, I was a staff member for 26 days and worked a total of 285.25 hours. That averaged out to about 11 hours a day. I had two days off the ENTIRE month. I know I got off pretty lightly with the meeting and the doctors appointment. The residents, I'd estimate, worked at least an hour more than me per day.
Thank goodness my next service is super laid back and lots of outpatient clinic - ortho surgery.
Labels: hours, surgery
Impulsive - so sue me
Now that I am moving onto to my surgery rotation - which scares me alot - I'm taking a moment to slap down my true personality and assume the proper respectful Med 3 position: meek. I'm going to be at a big outside hospital that sees alot of trauma and charity cases. That puts me in line to see alot of 'poor outcomes' (aka, people are going to die on the table.) It sounds bad, but I haven't seen someone die for the past few months.
I just spent a month on neuro and psych, neither of which were my cup of tea. They are two different breeds of people. The truth is, they were WAY too laid back for me. I'm intense. It doesn't make me an intense studier necessarily, but I'm just intense. If I'm doing something, it doesn't matter what it is, I'm doing it all out.
Sometimes this leads me to doing said thing RIGHT NOW. Yeah, I'm impulsive, but I don't regret that. It makes me the intense person I am. I'm dedicated and it makes sense to do it this very second. (Greetings from a future ER physician.)
Which leads me to a pet peeve: people who say they are going to do something and then don't. If I say I'm going to do something, I do it. If I don't do it, I'm sure as heck trying to do it or contacting the appropriate place and telling them why I'm not doing it. It doesn't matter what is going on elsewhere in my life; I'll probably still do it. Heck, I returned phone calls on Thanksgiving with my family in the car.
However, I have a strong suspicion that I'm going to have to clamp that off during surgery. It's going to be hard for me to because I am who I am - and you should probably not leave me alone with the patient and the scalpels when you aren't scrubbed in yet. I probably can't do the entire operation myself, but I have a pretty good idea how to start - yep, another budding ER doc. :)
Labels: impulses, personality, relationships, surgery
