Just a quick post. I'm coming up on my black Saturday and I'm utterly out of energy. It's like when you are on call and you are exhausted and you look at your watch and it's only 8:30 pm and you realize as you count the hours that you aren't even half done yet. Yesterday I was on call and I started to fall asleep while writing a note, I wrote 2 sentences before I came to. I wrote something about bleeding and a patient needing a transfusion...the patient in question was in for irretractable migraines...scary...I went down stares and chugged two energy drinks...big ones (and then finished the day as fast as I could). I did a friend a favor today and stayed a little later. As a reward I got the most horrible admit a pediatrician has ever seen, I stayed an extra 3 hours on top of what I was already there for...seriously this kid has 20+ medications and his problem list is bigger than a geriatrics patient. People were apologizing that I was there that long, I don't complain to them, especially when it's something like that...I hate seeing other people do that - sometimes you get screwed, there isn't anyway around it, just deal with it and move on...when other people complain about their bad luck during work it just demoralizes me...but honestly I'd be lying if I told you staying way late and getting crazy patients like that doesn't effect me. I stay up late these days playing video games, surfing the net, and blogging (occasionally) mainly because I'm procrastinating...I really don't want to go back to work...at least not so soon. My wife and I feel like we get home, eat, sleep, and go back to work...I think in the back of my mind all this staying up is me trying to infuse a little "non-medicine" between the work-sleep-work part of things (not exactly a bright idea). We're both really starting to feel it. She complains that we never see each other anymore, but we really see each other as much as we can. I try to be the "bright side" of things and tell her it's just a blink away from over...I don't really feel like that either, but I feel like admitting to it would make it that much worse for both of us :P
Maybe that's why I really hate complainers at work...what makes it worse is that the ones that complain about work are also the ones that do the least amount of it. I like that country song - that says when you're going through hell, don't stop in it, just keep on going...don't pause to remark on the scenery just get on through it...on that note maybe I should stop messing around and get to sleep so I can get this rotation over with. Goodnight everybody. I hope you all are doing great and things are looking up : ) I'm out.
Newbie Doc
Thursday, September 23, 2010
Monday, September 20, 2010
The Clouds Break
So a continuation of my last post, "Doing The Right Thing". I arrived today surprised to see that the mother of the little boy who couldn't stand had decided not to leave AMA after all. The ultrasound studies that we had ordered over the day I was gone had come back as normal, but we had ordered a bone scan today which I REALLY felt would show us something. (A bone scan shows where the "activity" is in the bone - whether normal or abnormal - it's similar to the difference between taking a picture of a car engine running -MRI- or taking a video of a car engine running -Bone Scan-).
Well what followed was a massive effort to navigate the bureaucracy of medicine. We had ordered a bone scan for today...but my attending over the weekend didn't think it was necessary at the time and took it off the schedule until Monday. Putting it back on the schedule last minute was a massive effort requiring me to call and smooze 5 different schedulers, 2 different doctors, and bribe 2 nurses with chocolate...which actually works way better than I ever would have believed (I'll never forget the power of chocolate after today) ;P...seriously though. It took an act of God to get it done...and then another act to get the thing read by a radiologist today...but it was a big payoff as we were able to figure out what was wrong with this little guy.
DISKITIS!!!! It's awesome, because 1) it was on my differential of suspected causes 2) it had gone undiagnosed at two other different hospitals 3) I had to fight tooth and nail to get this bone scan which ended up being the one test that we really needed and most importantly 4) this is a treatable disease (not cancer thank God!). Anyway it's a big win for my team and for my patient...I had to stay 4 hours longer than normal, but I would do that day in and day out if everyday were like today.
It seems as a resident sometimes you are lost in a sea of "wrongs", you don't know down from up, north from south and all you really have is your faith that you'll get to where you are going, but every once in awhile when you are feeling lost in the storm, the clouds will break for what may be only an instant, and with a sudden shining beam of light, you'll see a bright blue sky with a radiant warm sun - a stark reminder of where you're going and who you want to be.
Newbie Doc
Well what followed was a massive effort to navigate the bureaucracy of medicine. We had ordered a bone scan for today...but my attending over the weekend didn't think it was necessary at the time and took it off the schedule until Monday. Putting it back on the schedule last minute was a massive effort requiring me to call and smooze 5 different schedulers, 2 different doctors, and bribe 2 nurses with chocolate...which actually works way better than I ever would have believed (I'll never forget the power of chocolate after today) ;P...seriously though. It took an act of God to get it done...and then another act to get the thing read by a radiologist today...but it was a big payoff as we were able to figure out what was wrong with this little guy.
DISKITIS!!!! It's awesome, because 1) it was on my differential of suspected causes 2) it had gone undiagnosed at two other different hospitals 3) I had to fight tooth and nail to get this bone scan which ended up being the one test that we really needed and most importantly 4) this is a treatable disease (not cancer thank God!). Anyway it's a big win for my team and for my patient...I had to stay 4 hours longer than normal, but I would do that day in and day out if everyday were like today.
It seems as a resident sometimes you are lost in a sea of "wrongs", you don't know down from up, north from south and all you really have is your faith that you'll get to where you are going, but every once in awhile when you are feeling lost in the storm, the clouds will break for what may be only an instant, and with a sudden shining beam of light, you'll see a bright blue sky with a radiant warm sun - a stark reminder of where you're going and who you want to be.
Newbie Doc
Sunday, September 19, 2010
Doing The "Right" Thing
Ahhhhhh. I'm on break today - I was reading my last post and I don't think I gave my wife enough credit, her rotation IS harder than mine - I do have the 30 hour calls every 4 days but she works from 5am till 7pm every day and she'll do it straight through for a month - no days off (she did take a half day off a week ago...that was nice...turns out she miss read the schedule and wasn't supposed to though).
Anyway I thought I'd take a second to talk about crazy people. Beings how hospitals are places for sick people, it stands to reason that we tend to attract all kinds of nuts...I'm not just talking about the doctors and nurses ;P Occasionally, you run into someone that you just can't understand - there is no logic in there action and none of what they do makes sense...in adult medicine it's a lot less painful to watch these people make poor decisions that effect their health...it is after all their life and their choice...but what happens when one of these people is a parent, and the poor decision their making doesn't effect the adult but instead is effecting their innocent child?
It was late evening two days ago now, I was on call. I got paged to a new admit. It was a small little boy named Alex. He was a pretty cute little guy - just over a year, he had been previously health...until he stopped walking or even sitting up. For the last 2-3 weeks he has been laying on the ground and would not get up. If you try to make him stand or sit he will scream out in pain. This mother has taken Alex to several different hospitals, each doing their best to figure out whats going on. What I get is all the records of previous testing for this little boy. So far despite other hospitals best efforts the best we can say from the massive amount of testing ran is that there is something causing a major inflammatory response in his body. This is one of those things that is causing such a response, we know that we WILL find it...it's not one of those things that goes undiagnosed and then disappears...this will likely continue to become more and more of a problem as time goes on.
Alex's problem is two fold though, not only does he have a serious problem already effecting him, but also he has a mother who has really poor coping skills. As I admitted Alex, I thought I caught a hint of it here or there in the way the I gathered the history...for instance you ask a concerned parent, "Did the vomit have blood in it or green bile?" and the parent responds (instead of a quick "no" or "yes"), "uhhhhhhh...I...don't know....".
Why wouldn't you know facts like that about your child. Anyway as time went on it became increasingly apparent that Alex wasn't at the top of her priorities list...the mother's excuse list was a mile long...never ending and it was impossible to get to the bottom of it and figure out what was really bothering her, it just seemed like she HAD to get out of the hospital as fast as possible and she would make up any excuse necessary to do it...none of which were very good. Throughout the rest of the morning I was intermittently called back to her room to argue for the child's benefit - someone needs to find out what is wrong with Alex and it's not going to get done if she keeps leaving hospitals AMA (against medical advice) which is what she has done with the last two hospitals (and what she is planning on doing with us). She is demanding, she is unreasonable, and she is shows a general lack of concern for her child! I had my "mask" on like it was my face, I honestly have never been so two faced in my life. Talking to her all the while with compassion and faked understanding, trying to remain calm, as she slowly brought up reason after pathetic reason for her to take her child out of the hospital.
"I have school on monday." -- "I'm not doing well in school." -- "My kids are at home with my grandmother." -- "I don't like hospitals." -- "People will think I'm a bad mother, if I leave my kid alone in the hospital."
We discussed that she didn't have to be here all the time. Her husband even said he could be here for some of the time and we are a children's hospital - set up for really sick kids and parents that can't always stay 100% of the time with their children. We have social workers that can help her school understand what she is going through and cut her some slack.
Every issue she had (there are many more than I listed - all equally small concerns compared to your child) we addressed. However, it would only be another hour or two until she would call again wanting to leave. She would have the same exact concerns - no different than before. We would speak with her regarding those concerns (basically saying the same thing as before). This happened four times before I left. On the fourth time, we had had enough and simply told her unless she had something new to say, she knew that she could leave if she chose to - however we recommended against it for her child's sake. I went off post call that afternoon...something tells me she's left by now.
I've seldom felt so much frustration and rage, wanted so desperately to direct it at one person, and been unable to. Instead I had to play the doctor role...her kid is really sick and she cared more for her own comfort than her child...I wanted to punch her in the face...but I didn't, I remained cool and collected...and I did the "right" thing.
Newbie Doc
What I wrote right there makes me feel really immature and emotional, but it's how I felt, right or wrong...it's how I still feel.
Anyway I thought I'd take a second to talk about crazy people. Beings how hospitals are places for sick people, it stands to reason that we tend to attract all kinds of nuts...I'm not just talking about the doctors and nurses ;P Occasionally, you run into someone that you just can't understand - there is no logic in there action and none of what they do makes sense...in adult medicine it's a lot less painful to watch these people make poor decisions that effect their health...it is after all their life and their choice...but what happens when one of these people is a parent, and the poor decision their making doesn't effect the adult but instead is effecting their innocent child?
It was late evening two days ago now, I was on call. I got paged to a new admit. It was a small little boy named Alex. He was a pretty cute little guy - just over a year, he had been previously health...until he stopped walking or even sitting up. For the last 2-3 weeks he has been laying on the ground and would not get up. If you try to make him stand or sit he will scream out in pain. This mother has taken Alex to several different hospitals, each doing their best to figure out whats going on. What I get is all the records of previous testing for this little boy. So far despite other hospitals best efforts the best we can say from the massive amount of testing ran is that there is something causing a major inflammatory response in his body. This is one of those things that is causing such a response, we know that we WILL find it...it's not one of those things that goes undiagnosed and then disappears...this will likely continue to become more and more of a problem as time goes on.
Alex's problem is two fold though, not only does he have a serious problem already effecting him, but also he has a mother who has really poor coping skills. As I admitted Alex, I thought I caught a hint of it here or there in the way the I gathered the history...for instance you ask a concerned parent, "Did the vomit have blood in it or green bile?" and the parent responds (instead of a quick "no" or "yes"), "uhhhhhhh...I...don't know....".
Why wouldn't you know facts like that about your child. Anyway as time went on it became increasingly apparent that Alex wasn't at the top of her priorities list...the mother's excuse list was a mile long...never ending and it was impossible to get to the bottom of it and figure out what was really bothering her, it just seemed like she HAD to get out of the hospital as fast as possible and she would make up any excuse necessary to do it...none of which were very good. Throughout the rest of the morning I was intermittently called back to her room to argue for the child's benefit - someone needs to find out what is wrong with Alex and it's not going to get done if she keeps leaving hospitals AMA (against medical advice) which is what she has done with the last two hospitals (and what she is planning on doing with us). She is demanding, she is unreasonable, and she is shows a general lack of concern for her child! I had my "mask" on like it was my face, I honestly have never been so two faced in my life. Talking to her all the while with compassion and faked understanding, trying to remain calm, as she slowly brought up reason after pathetic reason for her to take her child out of the hospital.
"I have school on monday." -- "I'm not doing well in school." -- "My kids are at home with my grandmother." -- "I don't like hospitals." -- "People will think I'm a bad mother, if I leave my kid alone in the hospital."
We discussed that she didn't have to be here all the time. Her husband even said he could be here for some of the time and we are a children's hospital - set up for really sick kids and parents that can't always stay 100% of the time with their children. We have social workers that can help her school understand what she is going through and cut her some slack.
Every issue she had (there are many more than I listed - all equally small concerns compared to your child) we addressed. However, it would only be another hour or two until she would call again wanting to leave. She would have the same exact concerns - no different than before. We would speak with her regarding those concerns (basically saying the same thing as before). This happened four times before I left. On the fourth time, we had had enough and simply told her unless she had something new to say, she knew that she could leave if she chose to - however we recommended against it for her child's sake. I went off post call that afternoon...something tells me she's left by now.
I've seldom felt so much frustration and rage, wanted so desperately to direct it at one person, and been unable to. Instead I had to play the doctor role...her kid is really sick and she cared more for her own comfort than her child...I wanted to punch her in the face...but I didn't, I remained cool and collected...and I did the "right" thing.
Newbie Doc
What I wrote right there makes me feel really immature and emotional, but it's how I felt, right or wrong...it's how I still feel.
Friday, September 17, 2010
Getting By
I'm looking at my calendar and I've only got 16 more days of Wards...I can't wait till this is over. I'm getting much better at managing it, however, between Wards and OB (what my wife is on - which may actually be even harder especially since she is pregnant) our house is falling apart. My wife and I come home exhausted, we plop down on the couch and eat whatever we can scrounge from the fridge or freezer, we watch a 30 minute episode of TV, and we go to bed...we wake up (her at 4am and me at 5) and we repeat the cycle. We do the bare minimum around the house, so unless you need scrubs or a bowl for food you really don't do either (if you can help it) and errands/chores just pile up...and they will keep piling up until this little horror of a month is over for us...I really don't mind when it's just one of us on a hard month, but when we both get "hit" it really throws us for a loop...you basically just crawl along, slowly getting toward your goal - you do only what absolutely needs done in your "life" and you try to make it to that better schedule in the sky.
Cursed
One thing you come across regardless of the area of medicine that you are in is the "chronic" family. While we all have our diseases that run in the family or problems that occur infrequently (sometimes tragically), for these rare few tragedy, pain, and suffering is the norm. If you saw them walking down the street a dark cloud might be following in their wake. I'm almost apprehensive in writing about this because I feel I may jinx my own family as God has blessed us with relatively good health. Today I came across one such family and having a little extra time than I'm usually accustomed, I spent some of it getting to know them after I checked on how their son was doing. This is a family with a genetic disease. The father carries the gene, which although not tested, is probably the most severe form of the disorder. They, throughout their life, develop tumors all over their body, these tumors develop as early as 18 years of age and effect everyone who inherits the gene. The tumors themselves are usually not malignant (the kind that spreads all over the body), but the size and frequency of these masses are problem enough as they develop behind eyes, block arteries, and even compress brain tissue...basically they spend more time in and recovering from surgery than you or I could imagine in the darkest corners of hell...and yet the most amazing part of it (for me) is that they somehow manage it and find a way to move on. I suppose I could find inspiration in a group of people like this and to some extent I do - I am amazed at what the human body and spirit can endure, but from a scientific point of view I find myself slightly angered by their choices.
While the field of genetics has only really blossomed recently, the idea of inheritable diseases has been around for a very long time. Why did these people keep reproducing?!?!? It seems selfish to me to knowingly put a child through this type of medical horror day in and day out...really for any argument I can come up with to justify it...it still seems ridiculously selfish.
I can see the argument for wanting your "own" child. I realize there is an argument for the family that is so used to it, having tumors pop up all over your body isn't abnormal to them. I know that some will argue for God's will. I spoke with this family for a good little while, but I never got up the guts or got comfortable enough with them to find out what their argument or reasoning was for bringing children into a world to be tortured.
The patient I am seeing, is here for a stomach flu (gastroenteritis), something totally unrelated...to be totally understated...he is just REALLY unlucky. As of right now he is completely healthy and hasn't shown any signs of the tumor growth, but, as he has been tested, he very likely will start developing them sometime in high school. Looking at the father, who is in his late 30's, I can see how difficult this life will be for the child. The father is missing an eye, walks with a limp, and (as I found out from speaking with them) has had most of his bowel removed. His face is scarred and areas of it are hollowed out from various tumors that have been removed....although chronologically this man is only a decade older than I, the life he has lived has advanced his age far beyond his years.
I see the father and the older sister who is similarly effected and I wonder why you would do this to someone you love? why you would put them through this, bring them into this world? I don't have an answer or a clever thought to end my post, I don't know why and I know it's beyond me to judge them...but I can't help but do it a little anyway...I think I'm judgemental because I don't understand them and maybe the closed-off, relatively "good" reality I live in doesn't want to understand them...I think deep down it's really that this cowardly doctor hopes and prays he never can relate to or understand such a horrible thing.
Newbie Doc
While the field of genetics has only really blossomed recently, the idea of inheritable diseases has been around for a very long time. Why did these people keep reproducing?!?!? It seems selfish to me to knowingly put a child through this type of medical horror day in and day out...really for any argument I can come up with to justify it...it still seems ridiculously selfish.
I can see the argument for wanting your "own" child. I realize there is an argument for the family that is so used to it, having tumors pop up all over your body isn't abnormal to them. I know that some will argue for God's will. I spoke with this family for a good little while, but I never got up the guts or got comfortable enough with them to find out what their argument or reasoning was for bringing children into a world to be tortured.
The patient I am seeing, is here for a stomach flu (gastroenteritis), something totally unrelated...to be totally understated...he is just REALLY unlucky. As of right now he is completely healthy and hasn't shown any signs of the tumor growth, but, as he has been tested, he very likely will start developing them sometime in high school. Looking at the father, who is in his late 30's, I can see how difficult this life will be for the child. The father is missing an eye, walks with a limp, and (as I found out from speaking with them) has had most of his bowel removed. His face is scarred and areas of it are hollowed out from various tumors that have been removed....although chronologically this man is only a decade older than I, the life he has lived has advanced his age far beyond his years.
I see the father and the older sister who is similarly effected and I wonder why you would do this to someone you love? why you would put them through this, bring them into this world? I don't have an answer or a clever thought to end my post, I don't know why and I know it's beyond me to judge them...but I can't help but do it a little anyway...I think I'm judgemental because I don't understand them and maybe the closed-off, relatively "good" reality I live in doesn't want to understand them...I think deep down it's really that this cowardly doctor hopes and prays he never can relate to or understand such a horrible thing.
Newbie Doc
Tuesday, September 14, 2010
Worn Out
I'm so worn out. Yesterday was my fourth 30 hour call...I'm counting em down like Xmas...or days of detention. I'm not even half way yet. I had a long night, but I was able to manage my patients without any screw ups and even had a couple of good "catches" on some patients (ie I recognized a drug reaction no one had considered). All in all a brutal day, I didn't sleep a wink of it and I seriously went from one admit to another. There wasn't a single "easy" admit, the one admit they told me was "easy" ended up being the most complex kid of the bunch (he had a major heart defect, born premature, poor weight gain, and now with new sudden episodes of turning blue - cyanosis...where did they get "easy" from). Much to my surprise I weathered it all and lived to tell about it...I'm now having trouble going to sleep. I've only had about 1-2 hours of it in this 48 hour time period...but if I go back to sleep that means I'll soon wake up and do it all over again...I don't know if I'm ready for that - but I guess I better do it anyway :P
Here Goes Nothing.
A Very Exhausted Newbie-Doc
Here Goes Nothing.
A Very Exhausted Newbie-Doc
Monsters
Person: "What do you do for a living?"
Me: "I'm a pediatrician."
Person: "Wow, I couldn't do it dealing with all that sad stuff."
They are right...in medicine there is alot of sad stuff and in pediatrics it's the sad stuff that can really jump up and grab you. You will see countless adults in medicine that have made poor choices and now they are at the end of the line, honestly it's easy to get over that - they had thier choice now they are living with the consequences, you do your best to help them and the sadness of their situation (cold as it may seem saying this) washes over you...because you don't know them and you can tell yourself that. In pediatrics, that statement is never made or even thought about. No kid deserves to be sick. I think that's why I'm in pediatrics, every day my patients actually DESERVE help...it drives me nuts working with a 40 year old diabetic who doesn't listen to my advice or take my prescribed medication. Ussually if there is any frustration in caring for my patients it is derived from the parents. The parents are often the source of the child not taking the medication or the child being sick...and none of these undeserved problems is more frustrating and sickening than child abuse.
The typical case you'll see on TV is where suddenly they see a child with abdominal pain and the doctor walks in while the parent is hitting the child. Suddenly the doctor slams the parent against the wall and screams for the police, its all very draumatic and leaves you with this rewarding feeling that "good" has been done. That's not typically how these cases go. In real life the child comes in with some injury...something just slightly conspicuous (ie the child rolled off the table and got a skull fracture). At first it doesn't seem all that concerning...you want to believe in this beautiful and perfect world...the mother is going to tell the truth about her little girl...you will believe her...and that's that. However, when you speak to the father...his story doesn't quite match up. As you begin thinking about it, how many children fall 3-4 feet onto the floor and get a serious skull fracture (very few - there have been studies). As you involve child forensics and the cross examination begins of the parents and the family, this perfectly optimistic world you live in develops "cracks". After multiple tellings of the story from the parents, the mother finally collapses in tears, snapping under the stress of trying to hide that her mother is the cause. Suddenly it's as if this magic bubble of a world you believe in shatters...suddenly you wake up in the real world...a world where monsters really do exist.
There isn't always this black and white answer to the abuse or accident. Sometimes it's nobodies fault, sometimes it's everybodies. One thing is for certain, at the end of the day you don't feel like somebody's hero and you don't feel like your TV episode is rolling with credits, playing a happy song. You feel like the world is "darker" than it once was and as you walk out the door of your hospital...maybe even before you go to sleep that night, you'll be thinking about how your patients don't deserve this...and that's why, no matter how tough it gets, you'll walk back through the doors in the morning.
Newbie Doc
Me: "I'm a pediatrician."
Person: "Wow, I couldn't do it dealing with all that sad stuff."
They are right...in medicine there is alot of sad stuff and in pediatrics it's the sad stuff that can really jump up and grab you. You will see countless adults in medicine that have made poor choices and now they are at the end of the line, honestly it's easy to get over that - they had thier choice now they are living with the consequences, you do your best to help them and the sadness of their situation (cold as it may seem saying this) washes over you...because you don't know them and you can tell yourself that. In pediatrics, that statement is never made or even thought about. No kid deserves to be sick. I think that's why I'm in pediatrics, every day my patients actually DESERVE help...it drives me nuts working with a 40 year old diabetic who doesn't listen to my advice or take my prescribed medication. Ussually if there is any frustration in caring for my patients it is derived from the parents. The parents are often the source of the child not taking the medication or the child being sick...and none of these undeserved problems is more frustrating and sickening than child abuse.
The typical case you'll see on TV is where suddenly they see a child with abdominal pain and the doctor walks in while the parent is hitting the child. Suddenly the doctor slams the parent against the wall and screams for the police, its all very draumatic and leaves you with this rewarding feeling that "good" has been done. That's not typically how these cases go. In real life the child comes in with some injury...something just slightly conspicuous (ie the child rolled off the table and got a skull fracture). At first it doesn't seem all that concerning...you want to believe in this beautiful and perfect world...the mother is going to tell the truth about her little girl...you will believe her...and that's that. However, when you speak to the father...his story doesn't quite match up. As you begin thinking about it, how many children fall 3-4 feet onto the floor and get a serious skull fracture (very few - there have been studies). As you involve child forensics and the cross examination begins of the parents and the family, this perfectly optimistic world you live in develops "cracks". After multiple tellings of the story from the parents, the mother finally collapses in tears, snapping under the stress of trying to hide that her mother is the cause. Suddenly it's as if this magic bubble of a world you believe in shatters...suddenly you wake up in the real world...a world where monsters really do exist.
There isn't always this black and white answer to the abuse or accident. Sometimes it's nobodies fault, sometimes it's everybodies. One thing is for certain, at the end of the day you don't feel like somebody's hero and you don't feel like your TV episode is rolling with credits, playing a happy song. You feel like the world is "darker" than it once was and as you walk out the door of your hospital...maybe even before you go to sleep that night, you'll be thinking about how your patients don't deserve this...and that's why, no matter how tough it gets, you'll walk back through the doors in the morning.
Newbie Doc
Monday, September 13, 2010
Chinese Torture Chamber
I really never had an opinion before on torture. When all the water boarding controversy was in the media I knew about it but didn't really give it much thought. I guess it was because I didn't have any background information on it and didn't really expect it to happen to me anytime soon. I'd also never been around anyone that had been tortured or that had tortured anybody. Well......maybe that's a little white lie 'cause I do have some brothers. But since I started on wards I know without a doubt that I am against it. It's inhumane and it screws with your mind and by the time you've been tortured for 30 hours straight who knows if the information your spitting out is truth, lies or a dream. When you're on call on wards you take care of your regular patients and you take care of other doctor's patients and somewhere among the chaos you try to eat, sleep and go to the bathroom. You expect to be overworked, overtired and at times overwrought by the challenging decisions you have to make. But one thing you don't expect is to be tortured....not by water, but by the pager. The nurses on the other end of the pager don't have a clue that you're in the bathroom, or eating or drifting off into desperately needed sleep, and they don't care. What they do care about is their patient, but that means if there are 40 different patients then there are 40 different nurses (they come and go over 8 to 12 hour shifts) that want orders, updates and an occasional pat on the back. Between their coming and going they sleep, eat and visit with their family. For the most part they arrive at their job refreshed and ready to start the day and sometimes forget that hour number 1 of their shift might be hour number 19 of mine. So to all you nurses out there reading my blog (like nurses would want to read my blog) here are some tips. Please read through all the recent and prn orders before you page me; it just might be that the last shift had the very same problem you are having and has already called me about it. Please get a current and accurate set of vital signs and know the patient's intake and output for the last 12 to 24 hours. Peruse the lab work and see if there is anything new or pertinent that I might need to know. Ask your co-workers if they have any questions for me about their patients so I can take care of several problems with only one page. And last but not least try to solve non-life threatening problems yourself and if you are a new nurse ask a seasoned nurse first what she would do and if she thinks your patient's problem is worth paging the doctor. Please remember that we are a team and for some unknown reason I was picked to quarterback and I am trying my best to win.....not just for us or notoriety or that next paycheck.....but for all the kids that are counting on me. I can't do that if I'm walking around like a drooling idiot who has only had a total of 1 hour of sleep in a 30 hour period.
Thanks for letting me vent....if only I had a bullhorn instead of a blog I might actually feel better.
Newbie Doc
Thanks for letting me vent....if only I had a bullhorn instead of a blog I might actually feel better.
Newbie Doc
Thursday, September 9, 2010
Shotgunning
It's my third call and I'm anxious. The first call was so horrible and the second was so much improved that I have no idea what to expect...but I do know that it's with anxiousness and trepidation that I accepted that little red pager this morning (the call pager). I only have 3 patients so I am wide open for getting crushed by admissions...here we go.
So this little girl we have here presented to us with swelling of her legs below the hips and a rash that looks like it may have little tiny bleeds in it (petichiae - probably misspelled). This kid was getting better and much improved from the history so I ran a few preliminary labs that would check generally for any worsening (blood count, inflamatory markers, and a couple common infectious diseases that present like this around here). The next day I come in with a new attending who, without looking at this little girl, FREAKS OUT. I'm inexperienced so maybe she had a right too and I just don't know any better. Instead of conservatively ordering labs, she puts everything under the sun in her differential diagnosis (what could be causing this), even if it was VERY unlikely, she consults three different teams, and starts "shotgunning" labs.
Shotgunning labs is where you get labs like you are shooting a shot gun at a diagnosis. You don't try to narrow down or aim your labs...you just order thousands of dollars in time consuming mostly pointless labs and hope that you hit your target.
As expected it didn't work. The reason we didn't get alot of labs is that the kid had recieved steroids and a host of different antibiotics before coming to us. That's why we checked the "general" labs as well as a few likely culprits and decided to observe. The reason for this is it's unlikely we will ever know what caused it. The peripheral smear (where you actually look at all the cells in the blood) looked like a leukemoid reaction (where your WBC's can "over react" to a stressor/infection) and his white blood cell count and inflamatory markers kept getting better, so why torture this kid.
I honestly don't know if I'm inexperienced and stupid for doing this or if my attending is the one who doesn't know what she is doing...my experience would be that it's me...but watching her order 10,000$+ in lab tests before even seeing the patient was sickening (not to say I would have been bothered had I considered it necessary).
Anyways, she's getting better and better and will likely go home today...after we have done nothing at all...but cost tax payers alot of money.
I don't want to totally come down on my attending. There are different ways of doing medicine. She is a liberal and I'm a conservative, in other circumstances her reaction would have been more acceptable...in this one I'm not sure it was the "most" acceptable, but all her labs she ordered were appropriate and would hold up in court should they ask her, "Why did you order this?"...it's a safer way to practice I guess, but I feel it's lacking in common sense.
Newbie Doc
So this little girl we have here presented to us with swelling of her legs below the hips and a rash that looks like it may have little tiny bleeds in it (petichiae - probably misspelled). This kid was getting better and much improved from the history so I ran a few preliminary labs that would check generally for any worsening (blood count, inflamatory markers, and a couple common infectious diseases that present like this around here). The next day I come in with a new attending who, without looking at this little girl, FREAKS OUT. I'm inexperienced so maybe she had a right too and I just don't know any better. Instead of conservatively ordering labs, she puts everything under the sun in her differential diagnosis (what could be causing this), even if it was VERY unlikely, she consults three different teams, and starts "shotgunning" labs.
Shotgunning labs is where you get labs like you are shooting a shot gun at a diagnosis. You don't try to narrow down or aim your labs...you just order thousands of dollars in time consuming mostly pointless labs and hope that you hit your target.
As expected it didn't work. The reason we didn't get alot of labs is that the kid had recieved steroids and a host of different antibiotics before coming to us. That's why we checked the "general" labs as well as a few likely culprits and decided to observe. The reason for this is it's unlikely we will ever know what caused it. The peripheral smear (where you actually look at all the cells in the blood) looked like a leukemoid reaction (where your WBC's can "over react" to a stressor/infection) and his white blood cell count and inflamatory markers kept getting better, so why torture this kid.
I honestly don't know if I'm inexperienced and stupid for doing this or if my attending is the one who doesn't know what she is doing...my experience would be that it's me...but watching her order 10,000$+ in lab tests before even seeing the patient was sickening (not to say I would have been bothered had I considered it necessary).
Anyways, she's getting better and better and will likely go home today...after we have done nothing at all...but cost tax payers alot of money.
I don't want to totally come down on my attending. There are different ways of doing medicine. She is a liberal and I'm a conservative, in other circumstances her reaction would have been more acceptable...in this one I'm not sure it was the "most" acceptable, but all her labs she ordered were appropriate and would hold up in court should they ask her, "Why did you order this?"...it's a safer way to practice I guess, but I feel it's lacking in common sense.
Newbie Doc
Wednesday, September 8, 2010
Note
I can't believe my last post was the 2nd. I feel like that was five seconds ago. Time passes so fast when you are busy like this. Sorry guys - I'll do a better job of keeping up on the blog.
Newbie Doc
Newbie Doc
Keep On Keeping On
So I've been crazy busy since talking to you last. I've felt really guilty about not blogging and I finally had to post something in between patient care and rounding, because it was bothering me. My second call went much better, the little "blinking lights" weren't as frequent and there wasn't as many medical problems requiring my intervention...I was also alot better about ignoring the stupid questions and the unimportant ones. I got 1 hour of sleep that night, which I'm told is very good for the usual...but I also admitted way more than I did the night before 5 patients versus 3 patients.
Currently I have a kid in that is a big question mark. She has bilateral lower extremity weakness, pain, swelling and a rash...it's looking like it was either a resolving infection...or less likely leukemia (which you need a very painful bone marrow biopsy to confirm)...clinically though he is getting better, although his labs are either negative or the ones that are positive for wierdness :P are standing still (not getting better). I'll write more on her in my next post. There is also my other patient who is a lesson in medical communication - three teams manage her care and each team has a different idea for her care...I'm stuck in the middle trying to manage ego's and poor communicators, it's rediculous - I just want to put them in a room and toss in a knife.."Fight to the Death!!!".
Other than that the baby and my wife are doing well...as well as can be expected. I get up early but she gets up EARLY...like 3:45am every day and works till 6 or 7. She says she's fine but I don't know anybody who would work that and not feel overworked, she's a cute little trooper...oh yeah and I forgot, she will work this for another two weeks straight (that's 3 weeks without a single day off!).
I really can't complain with her having a schedule like that, but I'm very busy too, it seems like things around the house never get done and my "to do" list is stagnent - I can't check emails because I don't have the time and now I think I'm not checking emails because I'm scared of how much crap there is to do in them...not a good coping strategy. Sounds like I'm panicing but really it gets like this in medicine alot...you'll either have a psycotic breakdown or you'll blow a fuse and quit caring so much. I'm more of the latter, I resign myself with doing the best I can for my wife, my patients, and finally me...I console myself by saying "Just put one foot in front of the other and you'll be through before you know it." I'm on the low part of my "wave" right now, but I get through it because I know for a low point to exist, there has to be a high one...and it's coming...hopefully soon :P
Newbie Doc
Wards is very, very, very busy.
Currently I have a kid in that is a big question mark. She has bilateral lower extremity weakness, pain, swelling and a rash...it's looking like it was either a resolving infection...or less likely leukemia (which you need a very painful bone marrow biopsy to confirm)...clinically though he is getting better, although his labs are either negative or the ones that are positive for wierdness :P are standing still (not getting better). I'll write more on her in my next post. There is also my other patient who is a lesson in medical communication - three teams manage her care and each team has a different idea for her care...I'm stuck in the middle trying to manage ego's and poor communicators, it's rediculous - I just want to put them in a room and toss in a knife.."Fight to the Death!!!".
Other than that the baby and my wife are doing well...as well as can be expected. I get up early but she gets up EARLY...like 3:45am every day and works till 6 or 7. She says she's fine but I don't know anybody who would work that and not feel overworked, she's a cute little trooper...oh yeah and I forgot, she will work this for another two weeks straight (that's 3 weeks without a single day off!).
I really can't complain with her having a schedule like that, but I'm very busy too, it seems like things around the house never get done and my "to do" list is stagnent - I can't check emails because I don't have the time and now I think I'm not checking emails because I'm scared of how much crap there is to do in them...not a good coping strategy. Sounds like I'm panicing but really it gets like this in medicine alot...you'll either have a psycotic breakdown or you'll blow a fuse and quit caring so much. I'm more of the latter, I resign myself with doing the best I can for my wife, my patients, and finally me...I console myself by saying "Just put one foot in front of the other and you'll be through before you know it." I'm on the low part of my "wave" right now, but I get through it because I know for a low point to exist, there has to be a high one...and it's coming...hopefully soon :P
Newbie Doc
Wards is very, very, very busy.
Thursday, September 2, 2010
Know Thyself
I finished my first call in Wards at noon today...it was hell on earth...the single worst call I've ever had in my career. I'd been told it was bad, but I was arrogant and believed I wouldn't be phased. They handed me a second pager, the call pager...I now HATE that pager.
I'd compare it to a giant wall of tiny buttons. When a button lights up you simply press it down and it turns off...some are harder to press down than others, but it starts out slow...these tiny jobs popping up all over. You prioritize and one by one press the buttons down. But as the day goes on the number of lights popping up increases and you continue to work at the same rate...or less because now you are starting to get tired. This goes on for 30 hours, without sleep or rest of any kind...any rest you take, you are likely inconveniencing someone else...or letting a patient suffer. This continues until finally at the end of it all there are lights blinking, waiting to be pushed, all over and what started as an easy task of simply pushing the button down with your mental muscles has worn you down until even the simplest "button press" is ridiculously hard.
That's what happened to me last night. I treated myself as if I could take any job. I told myself I could handle it and when others asked me if I was alright or needed help, I was to proud to take them up on it. 99% of those little blinking lights were pressed by the end of the night...but there was one at the end of the night, one job, I decided that I could do...that I didn't get "pressed". I took a new patient, a small child with a UTI (urinary tract infection), which is a pretty simple medical case. I knew it wasn't really my responsibility, but in offering to take it, I would be help ease my co-workers load. I thought it was a really easy case, seemed like it was open and shut...It wasn't until I was sitting there presenting the case and my medical decisions to my senior that I realized that although I had walked up to that "button" and "pressed it" I had lacked the mental strength at that point in the night to actually complete my task...it was embarrassing how incomplete my medical history, physical, assessment, and plan were of this poor little girl. Luckily, that is what seniors are for...they realized that I was "out of it" and sent me to get some sleep and fixed all of my mistakes...that was embarrassing and really painful to sit there and take, but I knew that I could only hurt the team by continuing to work as I was, so I took a 1 hour nap. I, afterwords, some what rectified the situation by going up stairs and fleshing out my exam and history of this patient, I console myself in that trying to correct my mistake I actually found somethings out in the history that will help us treat her better later on in her hospital stay, however, even though no harm was done, all mistakes were fixed, and she's now doing great it's still a BIG lesson to me...to know my limits. To know when to ask for help.
Part of me really wants to be that "perfect" resident that knows everything and helps everyone. The resident that everyone can look to, to get the job done. I still want to be that resident, but not at the cost of hiding my limits and acting "unphasable" to my peers, not anymore. I realize now that in medicine, being honest with yourself and others isn't just the "grown up" thing to do...it's the thing that you do so your friends aren't stuck cleaning up your messes and your patients are hurt by your mistakes.
This really sucks to write about. I did a lot of things really "right" yesterday, but somehow this and mistakes like it are what I will remember with such clarity. I'm going to take a sleeping pill so I can quit thinking about it, get some much needed rest. Hopefully I'll be able to wake up tomorrow, well rested, and do a better job than I did the day before.
A Much Humbler Newbie Doc
I'd compare it to a giant wall of tiny buttons. When a button lights up you simply press it down and it turns off...some are harder to press down than others, but it starts out slow...these tiny jobs popping up all over. You prioritize and one by one press the buttons down. But as the day goes on the number of lights popping up increases and you continue to work at the same rate...or less because now you are starting to get tired. This goes on for 30 hours, without sleep or rest of any kind...any rest you take, you are likely inconveniencing someone else...or letting a patient suffer. This continues until finally at the end of it all there are lights blinking, waiting to be pushed, all over and what started as an easy task of simply pushing the button down with your mental muscles has worn you down until even the simplest "button press" is ridiculously hard.
That's what happened to me last night. I treated myself as if I could take any job. I told myself I could handle it and when others asked me if I was alright or needed help, I was to proud to take them up on it. 99% of those little blinking lights were pressed by the end of the night...but there was one at the end of the night, one job, I decided that I could do...that I didn't get "pressed". I took a new patient, a small child with a UTI (urinary tract infection), which is a pretty simple medical case. I knew it wasn't really my responsibility, but in offering to take it, I would be help ease my co-workers load. I thought it was a really easy case, seemed like it was open and shut...It wasn't until I was sitting there presenting the case and my medical decisions to my senior that I realized that although I had walked up to that "button" and "pressed it" I had lacked the mental strength at that point in the night to actually complete my task...it was embarrassing how incomplete my medical history, physical, assessment, and plan were of this poor little girl. Luckily, that is what seniors are for...they realized that I was "out of it" and sent me to get some sleep and fixed all of my mistakes...that was embarrassing and really painful to sit there and take, but I knew that I could only hurt the team by continuing to work as I was, so I took a 1 hour nap. I, afterwords, some what rectified the situation by going up stairs and fleshing out my exam and history of this patient, I console myself in that trying to correct my mistake I actually found somethings out in the history that will help us treat her better later on in her hospital stay, however, even though no harm was done, all mistakes were fixed, and she's now doing great it's still a BIG lesson to me...to know my limits. To know when to ask for help.
Part of me really wants to be that "perfect" resident that knows everything and helps everyone. The resident that everyone can look to, to get the job done. I still want to be that resident, but not at the cost of hiding my limits and acting "unphasable" to my peers, not anymore. I realize now that in medicine, being honest with yourself and others isn't just the "grown up" thing to do...it's the thing that you do so your friends aren't stuck cleaning up your messes and your patients are hurt by your mistakes.
This really sucks to write about. I did a lot of things really "right" yesterday, but somehow this and mistakes like it are what I will remember with such clarity. I'm going to take a sleeping pill so I can quit thinking about it, get some much needed rest. Hopefully I'll be able to wake up tomorrow, well rested, and do a better job than I did the day before.
A Much Humbler Newbie Doc
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