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
