Well, I guess I've been avoiding blogging recently because I've had a lot of personal things going on with me. Things I had originally decided I wasn't going to talk about with anyone. Maybe I've changed my mind on that thought though. It's more difficult now because I know that some people I know personally now read my blog and now I have to wonder about what they think. There's an anonimity I miss.
So where have I gone. That seems to be the question. I found out I was pregnant. Don't get too excited though, this does not have a happy ending.
I suppose I could lie and say that I miscarried the baby, that would be the chicken-shit easy way out. But that's not what happened. I terminated the pregnancy at 8 weeks.
I just couldn't have this baby right now. My family is barely making it right now, not on my pay. Neither car is registered, or insured for that matter. I'm two months behind on my car payment and the only reason they haven't taken the car is that they don't know where it is. My rent costs more than one paycheck so even though I get paid twice a month it only feels like once.
But there's so much more than that. I can't survive this year while being pregnant. I know that deep down in the core of who I am. I would either fall into a deep depression that I may not recover from or I would just become some one I never want to be. I don't want to regret my children, or regret my marriage. As bitter and sad as some believe that I am, I still know that underneath it all is the girl who likes to sing into her hairbrush and dance naked after a shower. I don't want to lose her. I see people I used to know who have lost themselves in this profession. It's so sad, I wish I didn't know them anymore. I miss them. And I wonder if they miss themselves. I don't know if they'll ever be the same.
And then there's the difficulty of being pregnant. Before I had my baby I didn't think it was that hard to be pregnant. So your a little fat... man up. Then I got pregnant. I threw up ever day for almost the first six months. It didn't matter what I ate. I lost weight . I picked partially digested salad out of my teeth so many times that I still can't eat lettuce. Have you ever tried to preform chest compressions at eight and I half months. They had to but two step stools underneath my feet so I could get my belly over the patient. I was sweating buckets. My pregnancy didn't go smoothly either. At 22 weeks I had an ultrasound that showed a problem. The baby had bilateral kidney defects and a heart defect. I was advised to have a late term, 2nd trimester abortion because they thought she had a genetic anomally. I couldn't do it though. She already had a name, I could feel her moving inside of me. She would have been a D&E, the so called partial birth abortion. So for once in my life I had a little faith and things turned out okay. Not perfect, but okay. After she came out and she wasn't deformed my husband and I just cried and cried. We didn't realize we had essentially been holding our breath for 4 months. I can't do that again. I'm just not ready to go back there yet.
So where have I gone, I've gone where most people who terminate a pregnancy go. Into hiding. Sure, I'm allowed to make the choice I made but that doesn't mean I don't feel ashamed or judged. Part of me says fuck everyone, they don't know me. But its hard watching my daughter playing and knowing that there would be another one of her if not for my choice. I regret it. Make no mistake about it, I'd do it again if I got pregnant again. But I still regret having to make the choice. I think the pro life and the pro choice side get so caught up trying to make the issue black and white that they forget that life is grey. I'm just trying to do the best for me and my family and it in this case the best choice was to not have this baby.
So now you know. Say what you will, think what you must. Turn me into a sinner or a saint. At least I didn't lie about it. At least you know where I've been
Saturday, December 30, 2006
Friday, November 17, 2006
Moving On
Wow, I got a lot of responses for my previous blog and it was well appreciated. I 've just started Neurology and I'm feeling a bit ambivalent about it. I don't enjoy the brain. I don't really care what it does, or how facinating most people think it is. It's just a pile of pink jello as far as I'm concerned, or at least that's they way it looks splattered on a gurney.
I suppose I dislike the brain because it's like a very fragile toy, once you break it you generally can't fix it. How boring is that. Some people get a kick out of seeing the neuro problem and trying to figure out where the problem is. I'm not one of those people. I'm not even distantly related to one of those people.
Most of my patients can generally be seperated into two groups. Old people with strokes and young people with brain tumors. It sucks for the young people. There's just no getting around the fact that it's over for them before it even started. Down in the ED you watch their scans come up and we all say" Dammmnn" as you watch this huge mass appear where normal brain should be. There's just not a whole lot you can do about it. Take the trip you always wanted, forget studying for college exams, you will not grow old with someone. You will never grow old. And the old people don't get much of a break either. This is it for them. Today you find out what will kill you. Now it may not be the stroke that kills you but you have now begun the decline that will only end in your death.
I suppose it must be weird knowing what your going to die from. I have no idea what's going to get me. Most people don't until the last minute. I wonder if that's one of the last things that goes through your brain after you get shot or in a car crash. This is how I die. Weird. Anyway....moving on.
I suppose I dislike the brain because it's like a very fragile toy, once you break it you generally can't fix it. How boring is that. Some people get a kick out of seeing the neuro problem and trying to figure out where the problem is. I'm not one of those people. I'm not even distantly related to one of those people.
Most of my patients can generally be seperated into two groups. Old people with strokes and young people with brain tumors. It sucks for the young people. There's just no getting around the fact that it's over for them before it even started. Down in the ED you watch their scans come up and we all say" Dammmnn" as you watch this huge mass appear where normal brain should be. There's just not a whole lot you can do about it. Take the trip you always wanted, forget studying for college exams, you will not grow old with someone. You will never grow old. And the old people don't get much of a break either. This is it for them. Today you find out what will kill you. Now it may not be the stroke that kills you but you have now begun the decline that will only end in your death.
I suppose it must be weird knowing what your going to die from. I have no idea what's going to get me. Most people don't until the last minute. I wonder if that's one of the last things that goes through your brain after you get shot or in a car crash. This is how I die. Weird. Anyway....moving on.
Thursday, October 26, 2006
"It"
I'm half asleep in the Peds ED, the only thing that has stood between me and blissful sleep is a 12 y/o with abdominal pain. I was set to send her home until her WBC count clocked in over 15,000 and she bought herself a CT scan. One more rule out appy for my last shift before vacation.
"Do you guys have an attending in here yet" asks one of the residents from the adult ED. We do not in fact have an attending on, not until 8:00am. It is just me the intern and a second year pediatrics resident running a level 1 trauma center. "Call the NICU then, you have a premie comming in".
I start to wake the resident when the firemen walk through the safety doors carrying a towel. They are sweating profusely as they walk quietly to the rescusitation room. The women has her fingers delicatly positioned over the middle of the towel as her index finger softly pumps, one two, three, four.... Her partner is holding an oxygen mask over the towel completly obstructing my view. The nurses with vastly more knowledge and experience than me have already rolled over the warmer and turned it on. The fireman sets the towel down.
It's bright red, about the size of my hand. It eyelids are fused, and it's skin is so transparent I can see it's lung moving beneath impossibly small ribs. The frantic movement I see beneath the sternum I can only surmise is its heart. It is not even clearly human, it insteads looks like some shrunken alien crash landed on this planet. It's head is smaller than a lime, its mouth opens less than the width of a pea. It can't possibly be alive. And then it breathes. So hard that I can watch all the muscles between its ribs retract with every tiny breath. We all stop, the seasoned nurses, the naive intern. The ER is usually one big traffic accident and most of us have long since stopped rubbernecking but everyone comes to see this. And from each one you can here the same audible gasp.
Peter, the NICU resident arrives on the scene and states what I know we all understand in our hearts. "It's not viable, we don't have a tube that runs that small. We just have to get the weight and we can be done" The rule in neonatal recussitation is firmly drawn at 500 grams. Anything bigger we go all out, do everything, even though most will die or be permanently neurologically disabled. Anything less and we do nothing. Like it never even existed. Whether you live or dies depends on whether you can outweigh a Coke can.
It weighs in at 177 grams. According to the report from mom, she thinks she was 18 weeks pregnant. That's less than 5 months.
We rewrap it in the towel, turn off the warmer. Peter goes over to ask the mom if she wants to hold it, say goodbye. She does. I go back to my desk to see what the hold up is on my appy kid. The ED is eerily silent and I can here the nurses in the lounge talking about what has happened, decompressing, trying to forget. A half an hour passes and Peter returns to the Peds ED with the towel.
"OB is going to take Mom upstairs to check her out. I already talked to my fellow and she says that protocol is to put it in a specimen jar and send it to pathology." "Alright, " I say half paying attention, " thanks for all yor help". I hear him sigh and then slowly start to speak again. "the thing is, it's still breathing. " The world grinds to a halt as I turn to face him, to take in what he is trying to tell me. "I have all the paperwork for path, I even have the jar. But it's still breathing. I can't put it in the jar like this. We can't take it to the NICU if were not going to do anything. I didn't think it would still be alive." None of us did.
We agree to keep it downstairs with us. It doesn't have any where else to go. Technically it not alive, but it's still breathing so I can't really say it's dead either. We find an empty room, Peter and I are now co-conspirators of some horrific crime that up until tonight I had no idea existed. We lay it back down on the warmer but we don't turn the warmer on. " Don't wrap it up," he says as I begin to swaddle it. Looking at it breathing, I can't help but think of my daughter when she was a newborn. I want to hold it, to tell it that its okay, to comfort it. Does it feel pain? I don't know. But I do. It must feel something. To go from the comfort of being warm and snug suurounded by amniotic fluid with it's life finely tuned to the rhythmic beating of it's mother's heart. The world now cold and chaotic. We are as foriegn to it as it is foreign to us. " If you expose it then it will go faster."
And so we wait, while it continues to breathe and defy us. We wait as another intern on a different rotation stops by to see how my night went. I bring her in to see it. It is colder now, breathing more slowly. A bloom of bright red covers it's chest. Trauma from the fireman's CPR has ruptured its fragile blood vessels. And so we wait. My appy kid does not have an appy, just some kid with run of the mill abdominal pain. So we wait. Time has slowed to an unbelievable crawl as we wait for death to claim a life that never was. I come in to check on it. It is cold to the touch, it has stopped moving. I pick it up, ready to finally put it in the jar.
Then it breathes.
And so we wait. The nurses change shift and the waiting room fills with patients that have no idea what is happening in room 6. I wait for it to die, to be done. The attending comes in and I tell her about the cordened off room, the squiggly line on the board with no name and no chief complaint. We wait, in truth it is just me who is waiting. Everyone else seems content to forget about it but I keep returning to the room every half hour. To let it know that it has not been forgotten even though I will do nothing for it. I wait.
Four hours after it first appeared in the ED, one of the senior nurses comes in the doctor's area with a towel. There is no doubt what is inside. She gets the jar. I don't even know if it was actually dead when she put it in the jar. I didn't ask to see it, to see for myself that it was over. Who knows maybe she just has more nerve than me. All I know is that it is over. Or it least it should be.
But I am still waiting. Waiting for forgiveness though I my head knows I did nothing wrong. Waiting to stop seeing it breathe in my dreams. Waiting for it to give up on life even though it never knew what life was. Waiting to stop seeing it in my dreams. To stop seeing it in my daughter's eyes when she laughs. Waiting to stop being mad at myself for not holding it and giving it comfort while it died. To give it the gift of humanity that is all our birthrights, when it had, in fact, been born. It had lived though it will have no funeral, no name, no birthday. Just "it". I am waiting. I am still waiting. I wil always be waiting.
"Do you guys have an attending in here yet" asks one of the residents from the adult ED. We do not in fact have an attending on, not until 8:00am. It is just me the intern and a second year pediatrics resident running a level 1 trauma center. "Call the NICU then, you have a premie comming in".
I start to wake the resident when the firemen walk through the safety doors carrying a towel. They are sweating profusely as they walk quietly to the rescusitation room. The women has her fingers delicatly positioned over the middle of the towel as her index finger softly pumps, one two, three, four.... Her partner is holding an oxygen mask over the towel completly obstructing my view. The nurses with vastly more knowledge and experience than me have already rolled over the warmer and turned it on. The fireman sets the towel down.
It's bright red, about the size of my hand. It eyelids are fused, and it's skin is so transparent I can see it's lung moving beneath impossibly small ribs. The frantic movement I see beneath the sternum I can only surmise is its heart. It is not even clearly human, it insteads looks like some shrunken alien crash landed on this planet. It's head is smaller than a lime, its mouth opens less than the width of a pea. It can't possibly be alive. And then it breathes. So hard that I can watch all the muscles between its ribs retract with every tiny breath. We all stop, the seasoned nurses, the naive intern. The ER is usually one big traffic accident and most of us have long since stopped rubbernecking but everyone comes to see this. And from each one you can here the same audible gasp.
Peter, the NICU resident arrives on the scene and states what I know we all understand in our hearts. "It's not viable, we don't have a tube that runs that small. We just have to get the weight and we can be done" The rule in neonatal recussitation is firmly drawn at 500 grams. Anything bigger we go all out, do everything, even though most will die or be permanently neurologically disabled. Anything less and we do nothing. Like it never even existed. Whether you live or dies depends on whether you can outweigh a Coke can.
It weighs in at 177 grams. According to the report from mom, she thinks she was 18 weeks pregnant. That's less than 5 months.
We rewrap it in the towel, turn off the warmer. Peter goes over to ask the mom if she wants to hold it, say goodbye. She does. I go back to my desk to see what the hold up is on my appy kid. The ED is eerily silent and I can here the nurses in the lounge talking about what has happened, decompressing, trying to forget. A half an hour passes and Peter returns to the Peds ED with the towel.
"OB is going to take Mom upstairs to check her out. I already talked to my fellow and she says that protocol is to put it in a specimen jar and send it to pathology." "Alright, " I say half paying attention, " thanks for all yor help". I hear him sigh and then slowly start to speak again. "the thing is, it's still breathing. " The world grinds to a halt as I turn to face him, to take in what he is trying to tell me. "I have all the paperwork for path, I even have the jar. But it's still breathing. I can't put it in the jar like this. We can't take it to the NICU if were not going to do anything. I didn't think it would still be alive." None of us did.
We agree to keep it downstairs with us. It doesn't have any where else to go. Technically it not alive, but it's still breathing so I can't really say it's dead either. We find an empty room, Peter and I are now co-conspirators of some horrific crime that up until tonight I had no idea existed. We lay it back down on the warmer but we don't turn the warmer on. " Don't wrap it up," he says as I begin to swaddle it. Looking at it breathing, I can't help but think of my daughter when she was a newborn. I want to hold it, to tell it that its okay, to comfort it. Does it feel pain? I don't know. But I do. It must feel something. To go from the comfort of being warm and snug suurounded by amniotic fluid with it's life finely tuned to the rhythmic beating of it's mother's heart. The world now cold and chaotic. We are as foriegn to it as it is foreign to us. " If you expose it then it will go faster."
And so we wait, while it continues to breathe and defy us. We wait as another intern on a different rotation stops by to see how my night went. I bring her in to see it. It is colder now, breathing more slowly. A bloom of bright red covers it's chest. Trauma from the fireman's CPR has ruptured its fragile blood vessels. And so we wait. My appy kid does not have an appy, just some kid with run of the mill abdominal pain. So we wait. Time has slowed to an unbelievable crawl as we wait for death to claim a life that never was. I come in to check on it. It is cold to the touch, it has stopped moving. I pick it up, ready to finally put it in the jar.
Then it breathes.
And so we wait. The nurses change shift and the waiting room fills with patients that have no idea what is happening in room 6. I wait for it to die, to be done. The attending comes in and I tell her about the cordened off room, the squiggly line on the board with no name and no chief complaint. We wait, in truth it is just me who is waiting. Everyone else seems content to forget about it but I keep returning to the room every half hour. To let it know that it has not been forgotten even though I will do nothing for it. I wait.
Four hours after it first appeared in the ED, one of the senior nurses comes in the doctor's area with a towel. There is no doubt what is inside. She gets the jar. I don't even know if it was actually dead when she put it in the jar. I didn't ask to see it, to see for myself that it was over. Who knows maybe she just has more nerve than me. All I know is that it is over. Or it least it should be.
But I am still waiting. Waiting for forgiveness though I my head knows I did nothing wrong. Waiting to stop seeing it breathe in my dreams. Waiting for it to give up on life even though it never knew what life was. Waiting to stop seeing it in my dreams. To stop seeing it in my daughter's eyes when she laughs. Waiting to stop being mad at myself for not holding it and giving it comfort while it died. To give it the gift of humanity that is all our birthrights, when it had, in fact, been born. It had lived though it will have no funeral, no name, no birthday. Just "it". I am waiting. I am still waiting. I wil always be waiting.
Wednesday, October 11, 2006
It's been awhile
Well, I am finally begining to recover from the Hell that was my month on Orthopedic surgery and I'm pretty sure I didn't learn a damned thing. Oh well, at least it's over. Intern year on the whole has not been that bad. It's certainly a lot of work, there's no getting around that. I'm back in the ED again so I'm pretty happy about that.
It's so weird when your on a tough rotation how much you lose touch with the outside world. It gets to the point where your never quite sure what day of the week it is because the standard reminders like TV shows and weekend are lost to you. The only thing that holds any reference is whether your on call, post call, or pre-call. That's pretty much the only thing that has any effect on you. Then when the rotation is over it's almost like the sun comming out after a long winter and you remember what it's like to go outside again. I have a fairly rough stretch comming up over the holidays. Three straight months of call to screw up my Thanksgiving, Christmas, and New Year. Oh well, I just have to remember that once this year is over I'm done with call.
Today is my daughter's first birthday. Technically I have the day off but I get off today at 8:30 in the morning so it's going to be a struggle to stay awake all day. It's hard not to be selfish about these things. She won't remember that I missed any of these events, she has no idea what it means to have a birthday or Christmas. But I know-and I know that I'm missing them. I missed my daughter's first steps and I cried when my husband told me on the phone at work. I know its better for her that she won't remember any of this but I wish that it was easier on me. I guess I'm just selfish.
It's so weird when your on a tough rotation how much you lose touch with the outside world. It gets to the point where your never quite sure what day of the week it is because the standard reminders like TV shows and weekend are lost to you. The only thing that holds any reference is whether your on call, post call, or pre-call. That's pretty much the only thing that has any effect on you. Then when the rotation is over it's almost like the sun comming out after a long winter and you remember what it's like to go outside again. I have a fairly rough stretch comming up over the holidays. Three straight months of call to screw up my Thanksgiving, Christmas, and New Year. Oh well, I just have to remember that once this year is over I'm done with call.
Today is my daughter's first birthday. Technically I have the day off but I get off today at 8:30 in the morning so it's going to be a struggle to stay awake all day. It's hard not to be selfish about these things. She won't remember that I missed any of these events, she has no idea what it means to have a birthday or Christmas. But I know-and I know that I'm missing them. I missed my daughter's first steps and I cried when my husband told me on the phone at work. I know its better for her that she won't remember any of this but I wish that it was easier on me. I guess I'm just selfish.
Wednesday, September 13, 2006
Grumble, grumble, grumble
Have I told you yet that I hate ORTHO. Ugghh. First off I'm Q2 this week. For those not in the know that means that I am on call from 6 am Monday until noon on Tuesday then 5:30 am on Wednesday until noon on Thursday. I have no life outside of the hospital. Just a mind numbing blur between sleep and the hospital. And if I'm real lucky, sleep in the hospital. Except I find that trauma has a distinct prediliction for happening late at night when normal people are sleeping. This is not to say that some idiot can't get drunk and run you over at eight in the morning, it's just that if I was a betting woman I would definitly bet on midnight.
Add to that I have sent my family away this week so they can spend time with people who will actually be awake and interactive. My eleven month old daughter and my husband went to visit the grandparents and though I thought it would be no problem I find that I miss them terribly. They remind me that there is a world out there aside from the hospital. One where I am loved and needed. So aside from the cats, it's all me this week. Sighhhhh.
I hate medicine somedays, mostly because I don't feel like I'm actually doing medicine right now. My day goes something like this. " Yes sir, it's broken. Your going to need surgery", or "Yes it's broken, you need a cast.", or "No its not broken, you'll be fine". Exciting isn't it.
Grumble, grumble, grumble.
Add to that I have sent my family away this week so they can spend time with people who will actually be awake and interactive. My eleven month old daughter and my husband went to visit the grandparents and though I thought it would be no problem I find that I miss them terribly. They remind me that there is a world out there aside from the hospital. One where I am loved and needed. So aside from the cats, it's all me this week. Sighhhhh.
I hate medicine somedays, mostly because I don't feel like I'm actually doing medicine right now. My day goes something like this. " Yes sir, it's broken. Your going to need surgery", or "Yes it's broken, you need a cast.", or "No its not broken, you'll be fine". Exciting isn't it.
Grumble, grumble, grumble.
Sunday, September 03, 2006
Ortho Hell
Well, I'm on Ortho now and am in the seventh circle of intern hell. Nothing I ever do is right and for the most part my goal at the end of the day is to try and psych myself up for yet another shitty day.This rotation is just re-enforcing what I've always known. I hate surgery. It's not just the actually surgery itself ( oh let's see how long we can stand on our feet without eating and peeing), it the whole lifestyle of surgery. The hours are such that I haven't seen daylight in at least a week. That and I have two weeks worth of laundry piled to the sky in my room. Thank god for the Costco sized pack of underwear I picked up recently. Plus, Surgeons are among the most arrogant people on the face of the earth. It's like living in a medical version of Hell's Kitchen with Simon Cowell playing my chief resident. Seriously, I am just not as facinated as they are with their own greatness. And I have yet to learn anything remotely related to orthopedics.
There are only a few ways to actually survive this rotation.
1. Hide out on the pediatrics floor. Although I am accessible by pager for the most part the seniors find it too much work to call me.
2. Be completley incompetent. "Oh, you were serious when you said no food before surgery"
3. Pretend that I have been wisked away to a prison work camp. Spend any free time planning my escape.
For the most part am I trying option number one and I am now considered the fourth Peds intern. At least it beats being on Ortho
There are only a few ways to actually survive this rotation.
1. Hide out on the pediatrics floor. Although I am accessible by pager for the most part the seniors find it too much work to call me.
2. Be completley incompetent. "Oh, you were serious when you said no food before surgery"
3. Pretend that I have been wisked away to a prison work camp. Spend any free time planning my escape.
For the most part am I trying option number one and I am now considered the fourth Peds intern. At least it beats being on Ortho
Monday, August 14, 2006
The long wait
I know it's comming and there's nothing I can do about. There are two empty beds in the MICU and this can only mean one thing. I will not sleep tonight. There are comming. The Code Blue down the hall, the ER patient with urosepsis. All conspiring to seperate me from the necessity of sleep.
Only in medicine is it considered a badge of honor to go thirty something hours without sleep. Every other profession from piliots to the military accept that the human body has needs. That we are not mearly cogs in some great machine. Every one except medicine. And this is one of our greatest mistakes. There is nothing noble in what we do. Our patients are certainly not the better for it. Studies bear that out. Patients would be better treated by a drunk resident than one that has been up overnight. I've certainly made mistakes, and at any one time there is a least one patient here because of a medical mishap.
This notion of not sleeping is just a giant pissing contest that pre-dates modern medicine.
And yet it just won't go away. After high profile deaths efforts are always made to limit hours, to bring some semblence of normalcy to a residents life. And each time it is met with resistence from our attendings, our peers, sometimes ourselves.
So here I am tonight, sleepy as all hell, but not sleeping. Because I know as soon as my head hits the pillow I will get my new admit. So I wait for them to come.
Maybe then I can get some sleep.
Only in medicine is it considered a badge of honor to go thirty something hours without sleep. Every other profession from piliots to the military accept that the human body has needs. That we are not mearly cogs in some great machine. Every one except medicine. And this is one of our greatest mistakes. There is nothing noble in what we do. Our patients are certainly not the better for it. Studies bear that out. Patients would be better treated by a drunk resident than one that has been up overnight. I've certainly made mistakes, and at any one time there is a least one patient here because of a medical mishap.
This notion of not sleeping is just a giant pissing contest that pre-dates modern medicine.
And yet it just won't go away. After high profile deaths efforts are always made to limit hours, to bring some semblence of normalcy to a residents life. And each time it is met with resistence from our attendings, our peers, sometimes ourselves.
So here I am tonight, sleepy as all hell, but not sleeping. Because I know as soon as my head hits the pillow I will get my new admit. So I wait for them to come.
Maybe then I can get some sleep.
Sunday, August 06, 2006
The First
Everyone dreads there first night on call and I 'm certainly not cool enough to pretend that I wasn't scared. For those not in the know, call means that you start work in the morning, stay overnight in the hospital and round again in the morning. It's about a thirty hour shift. The scary thing about being on call is that most of the people who know what the hell there doing leave around six, and then it's all you. The attendings make a big deal about the fact that you can call them at home so technically were not really alone. But if you believe that then I'll order you a psych consult.
Lay people also fool themselves into thinking " Hey, your doctors. What's the problem" Seriously though, we graduate as med students on a Friday and start work on a Monday. There's no great infusion of knowledge over that weekend, so one day we can't order an asprin without a co-signer and the next day were left overnight with critical patients. I highly advise you never to enter a teaching hospital in June or July. The monkeys are running the asylum. But I digress.
So I'm on call in the ICU and I have known my patients for about four hours. Just long enough for me to figure out there names and ventilator settings but not long enough to get used to the incessant beeping of alarms that is the background music in any ICU. My resident, whose job it is to orient me and make sure I don't accidentely kill any one, has clinic and will be gone for the afternoon. Ummm, I'm not really sure this a good idea. And sure enough out comes the nurse from Bed 8 " Mr Alberto has a pulse of 180, blood pressure is 70 over 40 and he's sating (O2 saturation) at 73%. What do you want to do?" What do I want to do: RUN. I don't know what the fuck to do, are you kidding me. I've never felt that inadequate in my life. I walk in the room and sure enough, things are as bad as the nurse says they are. "Page the resident" I order with some semblence of authority in my voice. Vague recollections of orientation are comming back to me, but I can only remember the drugs we give when the heart stops or slows. Not exactly the case I'm facing now. And then I remember that I can give a beta-blocker, a wonderous drug that slows the heart rate and is generally not all that dangerous. So I push my drug waiting for it to fix things and nothing is happening. My patient still has the heart rate of a coked-up hummingbird. My resident calls back and as calmly as I can fake I explain that things have promptly gone to hell upstairs. "Well did you give Metoprolol" he says. "Of course I did" I answer, like how dare he think I don't know what I'm doing. "And it didn't work" Umm, no. "I think you should come up here" Now he's pissed. That whole discussion of how we can call for help when we need it-total bullshit.
My resident heads back to the ICU, walks in and says "This isn't good". Yeah, I'm pretty sure I had already made that determination. Can we move on to the 'How to fix it' portion of the conversation. Out comes a whole arsonal of drugs that I clearly have no idea how to use. We push dig, we give dilt, nothing works. Then the Cardiology team comes wandering in and announces to the world that we need to break this rhythm. I'm going to file that under the "Duh" category. We tell them what we've tried and that nothing has worked and they offer a simulataneously exciting and terrifying option:Cardioversion. Cardioversion is shocking the heart and hoping that when it restarts it decides to beat like its supposed to. It freaks us out because in rare instances you can shock it and it doesn't restart. As the new intern I get to be the one who cardioverts. "Charging 100. Charged. Clear" Blam 100 joules hits the guy and he jumps of the bed. We all stare at the moniter and see the most wonderous sight. Normal sinus rhythm at a rate of 83 beats per minute.
This is that part in the movie where we all walk away and congratulate ourselves for a job well done, but I'm an call. There is no walking away. I'm going to be taking care of this man all night long, by myself, and he could probably do this again and again and again. And next time my resident will be gone and Cardiology won't be in house. I started my call night scared. And that's where I stayed all night long. White knuckling it until the cavelry arrived the next morning. In spite of how hard I can try I will never be able to properly articulate what momments like these do to the soul. Its easy to say well everything worked out, and it did. But looking back I can laugh and joke, but that night was so terrifying. Our only goal is to keep the patients alive until the morning, and you can't fail at that. You can't fail as a doctor. This year is going to be so painful, because I will fail, and people will die. And I will never forget that feeling of just wanting to run and knowing that I couldn't. I cried the entire way home from the hospital.
I'm on call again in three days.
Lay people also fool themselves into thinking " Hey, your doctors. What's the problem" Seriously though, we graduate as med students on a Friday and start work on a Monday. There's no great infusion of knowledge over that weekend, so one day we can't order an asprin without a co-signer and the next day were left overnight with critical patients. I highly advise you never to enter a teaching hospital in June or July. The monkeys are running the asylum. But I digress.
So I'm on call in the ICU and I have known my patients for about four hours. Just long enough for me to figure out there names and ventilator settings but not long enough to get used to the incessant beeping of alarms that is the background music in any ICU. My resident, whose job it is to orient me and make sure I don't accidentely kill any one, has clinic and will be gone for the afternoon. Ummm, I'm not really sure this a good idea. And sure enough out comes the nurse from Bed 8 " Mr Alberto has a pulse of 180, blood pressure is 70 over 40 and he's sating (O2 saturation) at 73%. What do you want to do?" What do I want to do: RUN. I don't know what the fuck to do, are you kidding me. I've never felt that inadequate in my life. I walk in the room and sure enough, things are as bad as the nurse says they are. "Page the resident" I order with some semblence of authority in my voice. Vague recollections of orientation are comming back to me, but I can only remember the drugs we give when the heart stops or slows. Not exactly the case I'm facing now. And then I remember that I can give a beta-blocker, a wonderous drug that slows the heart rate and is generally not all that dangerous. So I push my drug waiting for it to fix things and nothing is happening. My patient still has the heart rate of a coked-up hummingbird. My resident calls back and as calmly as I can fake I explain that things have promptly gone to hell upstairs. "Well did you give Metoprolol" he says. "Of course I did" I answer, like how dare he think I don't know what I'm doing. "And it didn't work" Umm, no. "I think you should come up here" Now he's pissed. That whole discussion of how we can call for help when we need it-total bullshit.
My resident heads back to the ICU, walks in and says "This isn't good". Yeah, I'm pretty sure I had already made that determination. Can we move on to the 'How to fix it' portion of the conversation. Out comes a whole arsonal of drugs that I clearly have no idea how to use. We push dig, we give dilt, nothing works. Then the Cardiology team comes wandering in and announces to the world that we need to break this rhythm. I'm going to file that under the "Duh" category. We tell them what we've tried and that nothing has worked and they offer a simulataneously exciting and terrifying option:Cardioversion. Cardioversion is shocking the heart and hoping that when it restarts it decides to beat like its supposed to. It freaks us out because in rare instances you can shock it and it doesn't restart. As the new intern I get to be the one who cardioverts. "Charging 100. Charged. Clear" Blam 100 joules hits the guy and he jumps of the bed. We all stare at the moniter and see the most wonderous sight. Normal sinus rhythm at a rate of 83 beats per minute.
This is that part in the movie where we all walk away and congratulate ourselves for a job well done, but I'm an call. There is no walking away. I'm going to be taking care of this man all night long, by myself, and he could probably do this again and again and again. And next time my resident will be gone and Cardiology won't be in house. I started my call night scared. And that's where I stayed all night long. White knuckling it until the cavelry arrived the next morning. In spite of how hard I can try I will never be able to properly articulate what momments like these do to the soul. Its easy to say well everything worked out, and it did. But looking back I can laugh and joke, but that night was so terrifying. Our only goal is to keep the patients alive until the morning, and you can't fail at that. You can't fail as a doctor. This year is going to be so painful, because I will fail, and people will die. And I will never forget that feeling of just wanting to run and knowing that I couldn't. I cried the entire way home from the hospital.
I'm on call again in three days.
Monday, July 31, 2006
Round and Round
Much to my dismay I'm out of the ER now. I only get two months in the ED my first year and it's halfway over. I'm on medicine right now, and I hate medicine. Everyone picks their specialty for different reasons but most of us in the ED say the same thing about medicine: we can't stand rounding.
Rounding is the art of doing and saying absolutely nothing for hours on end while standing up and pretending to be interested. Each patients every past and present medical complaint must be examined and discussed ad nauseum. They could be here for pneumonia or DKA but we still have to talk about that time when they were twelve and they got an ear infection. Why? What the hell does that have to do with why their here now. And do I really have to miss breakfast because Mr. Smith's INR is not exactly two and a half. Is 2.4 really that unacceptable. Ever little lab abnormality must be worked up to the fullest. Maybe he has hypercalcemia because he had too many TUMS for dinner. Maybe it's a lab error. But I really don't think we need to talk about it for ten minutes and start a work up for multiple myeloma. Even completly normal people are allowed to have abnormal labs from time to time. If someone invented a machine that could give out a minute by minute Chem-7 the internist would strangle themselves with their stethoscopes. This of course would make rounding infinitly more interesting.
It's not like we only round once a day either. No the entire process has to be repeated in the afternoon. The same patients, with their same problems, get the exact same discussion not just once but twice. That's a real good use of my time. "What? We only spent a half an hour this morning discussing whether Mr Johnson should be on the renal diet for his kidneys or the cardiac diet for his heart. Let's do it again please, pretty please, with sugar on top. Let's not go home at a reasonable hour and spend time with our actually families or better yet get some sleep. This is critical life and death stuff".
Thank God it's only for a month.
Rounding is the art of doing and saying absolutely nothing for hours on end while standing up and pretending to be interested. Each patients every past and present medical complaint must be examined and discussed ad nauseum. They could be here for pneumonia or DKA but we still have to talk about that time when they were twelve and they got an ear infection. Why? What the hell does that have to do with why their here now. And do I really have to miss breakfast because Mr. Smith's INR is not exactly two and a half. Is 2.4 really that unacceptable. Ever little lab abnormality must be worked up to the fullest. Maybe he has hypercalcemia because he had too many TUMS for dinner. Maybe it's a lab error. But I really don't think we need to talk about it for ten minutes and start a work up for multiple myeloma. Even completly normal people are allowed to have abnormal labs from time to time. If someone invented a machine that could give out a minute by minute Chem-7 the internist would strangle themselves with their stethoscopes. This of course would make rounding infinitly more interesting.
It's not like we only round once a day either. No the entire process has to be repeated in the afternoon. The same patients, with their same problems, get the exact same discussion not just once but twice. That's a real good use of my time. "What? We only spent a half an hour this morning discussing whether Mr Johnson should be on the renal diet for his kidneys or the cardiac diet for his heart. Let's do it again please, pretty please, with sugar on top. Let's not go home at a reasonable hour and spend time with our actually families or better yet get some sleep. This is critical life and death stuff".
Thank God it's only for a month.
Saturday, July 22, 2006
Something new
Now I haven't been an ER doc for too long, but you get used to the usual stuff pretty damn quickly. Under thirty with chest pain-either panic attack or cocaine. Big lady with abdominal pain- gallstones. So it was kinda nice the other day to get a suprise. I was hanging out in the trauma bay with the typical MVA when the security gaurd comes running in. "we've got a situation out in the ambulance bay" So I run to grab gloves and run out the doors to see what's up, and by the way, unlike what you see on TV we never go outside. Only in "ER" do the doctors meet the ambulances, it drives me nuts. In runs a nurse with a bloody bundle, and sure enoug it's a newborn baby.
We all run around trying to grab the warmer from whatever dusty corner it's been relegated to and shove the baby inside. With a new baby you have one mission in life. Warm, dry, stimulate. That's it, that is the magic of life. God needs no other help then that. After a heart stopping second the trauma bay is alive with the sound of a brand new human being. It was one of those moments that brings every one, the nurses and the attendings, over for a seconds as we all looked at her. It was kinda neat, we don't get to see pure happiness too much. People die all the time in the trauma suite. I still remember what it was like the first time I called out the time of death of a patient. But it was really cool to see a new baby, a new life. And sure enough she went upstairs to the NICU to get checked out, and the ED once again belonged to the tragedy unstead of the ecstacy. But it was still one of the moments that I'll always remember.
We all run around trying to grab the warmer from whatever dusty corner it's been relegated to and shove the baby inside. With a new baby you have one mission in life. Warm, dry, stimulate. That's it, that is the magic of life. God needs no other help then that. After a heart stopping second the trauma bay is alive with the sound of a brand new human being. It was one of those moments that brings every one, the nurses and the attendings, over for a seconds as we all looked at her. It was kinda neat, we don't get to see pure happiness too much. People die all the time in the trauma suite. I still remember what it was like the first time I called out the time of death of a patient. But it was really cool to see a new baby, a new life. And sure enough she went upstairs to the NICU to get checked out, and the ED once again belonged to the tragedy unstead of the ecstacy. But it was still one of the moments that I'll always remember.
Friday, July 14, 2006
Constipation in the ED
I hate when the board isn't moving. No one is going upstairs, no one is comming back from triage and everybody starts getting bitchy. The board is the center of activity in the ED. As the patients come back from the waiting room they get a spot on the board, but not necessarily a bed in the ED. It lists their age, complaint, which MD is seeing them and there final dispositon. People essentially either go home or head upstairs. But the board isn't moving today because we have NO beds upstairs. Nada. No ICU beds, no PCU beds, no ward beds. At least half of the board is filled with patients who have been admitted to the hospital but have no place to go. So they sit in the ED, taking up space. And the board doesn't move.
So now we start the delicate dance of walking the waiting room, trying to figure out which patients can afford to wait another twelve hours to get on the board and who really needs to go back now. Every year at least a couple people die in the waiting room because we couldn't see them in time. Usually in our department it takes 12-15 hours to from registration to getting back and on the board. The total time it takes to figure out what's wrong with you is usually another 4-8 hours ( blame radiology and lab for this). Then it can take another day or so to get a bed upstairs. It's a scary thought that in our country people can literally be 24 hours plus to see a doctor.
Just because we have no beds and the waiting room is beyond capacity doesn't mean the ambulance runs stop. We are officially closed to trauma today but the paramedics can use their "clinical judgement" to decide if they need to come to us. So from time to time we are running traumas in the middle of the ER. Almost all of our traumas are sick enough that they need to be admitted, but we have no beds, so they stay downstairs with us-backing up the ED. Right now there's a line of ambulance gurneys with patients that have no bed in the ED. In the ED there is a board full of patients that need to go upstairs. And upstairs there is a hospital full of patients who are too sick to go home. And I only have nine hours left on my shift.
So now we start the delicate dance of walking the waiting room, trying to figure out which patients can afford to wait another twelve hours to get on the board and who really needs to go back now. Every year at least a couple people die in the waiting room because we couldn't see them in time. Usually in our department it takes 12-15 hours to from registration to getting back and on the board. The total time it takes to figure out what's wrong with you is usually another 4-8 hours ( blame radiology and lab for this). Then it can take another day or so to get a bed upstairs. It's a scary thought that in our country people can literally be 24 hours plus to see a doctor.
Just because we have no beds and the waiting room is beyond capacity doesn't mean the ambulance runs stop. We are officially closed to trauma today but the paramedics can use their "clinical judgement" to decide if they need to come to us. So from time to time we are running traumas in the middle of the ER. Almost all of our traumas are sick enough that they need to be admitted, but we have no beds, so they stay downstairs with us-backing up the ED. Right now there's a line of ambulance gurneys with patients that have no bed in the ED. In the ED there is a board full of patients that need to go upstairs. And upstairs there is a hospital full of patients who are too sick to go home. And I only have nine hours left on my shift.
Friday, April 14, 2006
Show me the money
I'm broke. You wouldn't think you'd hear that from a doctor to be, but we are the poorest humans on the face of the planet. I already owe close to 250,000 and currently have -1000 in the bank right now. So I'm searching for yet another loan. I'm not a total jackass with money, inspite of my debt load. I never owed any money before medical school, didn't even own a credit card. But financial aid in medical school is a complete joke. It doesn't matter how old you are, whether or not your married or even if you have kids, your still considered dependant on mommy and daddy for fin aid purposes. Are you kidding me. I moved out of my parents house almost ten years ago and I have to ask them for their tax information and assets. I feel like I'm trying to see what's in their will and there not even dead yet. So that's how I ended up in so much debt. But with all that money I must be living it up right? People buy houses for less so why am I still broke. Well most of that money went for tuition and the rest for rent and food. Were not exactly supposed to work in medical school. Can you imagine my job interview."Yea, I'm just staying in medical school untill I get promoted at In and Out Burger"
It doesn't help that we get all our money in a lump sum and are expected to portion it out just right. When you got ten thousand in the bank what's a couple hundred on groceries. But when your down to your last fifty bucks your just trying to figure out how much Top Ramon you can eat without hurling. So where else did all the money go? Oh yea, that's right, I had a kid this year. No, there not expensive at all. You would think fin aid would let me take out some more money but noooo, adding another human being to your family is not grounds for needing more cash. "Student loans are for students not students families"-thanks alot to my financial aid counselor. Way to be helpful.
But wait I have a job in June. I'll be a doctor that's when they money starts flowing. My salary for my first year is $37,000. That will support me, my husband and my kid-right? That's it boy and girls that's what I spent 10 years in college for. Oh and did I mention that I won't get my first paycheck until August 30. Fuck, won't somebody give me another loan.
It doesn't help that we get all our money in a lump sum and are expected to portion it out just right. When you got ten thousand in the bank what's a couple hundred on groceries. But when your down to your last fifty bucks your just trying to figure out how much Top Ramon you can eat without hurling. So where else did all the money go? Oh yea, that's right, I had a kid this year. No, there not expensive at all. You would think fin aid would let me take out some more money but noooo, adding another human being to your family is not grounds for needing more cash. "Student loans are for students not students families"-thanks alot to my financial aid counselor. Way to be helpful.
But wait I have a job in June. I'll be a doctor that's when they money starts flowing. My salary for my first year is $37,000. That will support me, my husband and my kid-right? That's it boy and girls that's what I spent 10 years in college for. Oh and did I mention that I won't get my first paycheck until August 30. Fuck, won't somebody give me another loan.
Friday, April 07, 2006
Is there a Doctor in the house?
So congratulations to me. I'm going to be a doctor, and I'm so excited about it I could just die. Or at least kill my younger self who decided this would be a good idea. Like at least 50% of my classmates I don't want to be a doctor anymore. But were all fucked because we owe so much money that there's no backing out now. It's less painful to pay back the mob then pay back medical school debt. At least the mob is willing to kill you and put you out of your misery. I graduate from medical school in two months and I'm already burned out. Oh yea, this is going to be a great year for me.
I'm starting internship soon. Also known as the worst year of my life. I get to have all the compassion and empathy squeezed out of me while enduring 30 hour shifts every three days, not sleeping for months on end and never seeing my family. Internship is supposed to mold you into this great all knowing doctor, or completly break your spirit - whatever comes first. So I thought I would let the civilians into the mind of what doctors are really thinking this first year. This won't hurt a bit.
I'm starting internship soon. Also known as the worst year of my life. I get to have all the compassion and empathy squeezed out of me while enduring 30 hour shifts every three days, not sleeping for months on end and never seeing my family. Internship is supposed to mold you into this great all knowing doctor, or completly break your spirit - whatever comes first. So I thought I would let the civilians into the mind of what doctors are really thinking this first year. This won't hurt a bit.
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