The Farmer and the Fighter

There are different factions of medicine acute versus preventative.  In some ways you can compare them to the navy seals versus the farmers.  You need both, both are essential.  The navy seals, they are what you think of when you watch tv, they are the people on the front lines when death comes to claim your loved ones, the standing commanders running the group actively doing chest compressions, knifing in chest tubes, and shocking your hearts back to life.  Then there are the farmers, depending on your frame of reference, while less glamorous  they are equally or one may argue even more important than the Navy Seals they make movies about.  You can't make very good movies about a group of people that consistently stops problems before they even start, it's not very exciting, yet even a Navy Seal will secomb to starvation.   Once back in the dawn of time, the people who did the fighting and the people who did the farming were the same people. It was less civilized, less specialized, but they got the job done in a place and time when you couldn't have your cake and eat it too.  There are places even today, where that still goes on, where the villager is out plowing the fields and in a second, drops his implement for a spear and goes to war.  Just as you might think, those places are not as safe as your perfect, specialized, urbanized world that most of us have gotten used to.  In the medical world, that holds true too.  Out in the small communities there is still need for a doc that can do a little bit of everything and I'm terrified and honored to say that, if I understand my future job right, I'm joining their ranks.  I could intubate a dieing child in the middle of the night and the next morning be giving shots that prevent illness years from infection.  I hope I'm strong enough, I hope I'm good enough to do both jobs to the standard that I've held myself to for the last three years.  The doctors that I'm joining are "old" docs, born of residency before work hour restrictions, before they started "watering" us down.  They pulled 36 hour shifts every 3 days, sometimes back to back.  It wasn't safe, but those who survived came out medical power houses.  I pulled Q4 30 hour shifts (ie every 4 days I worked 30), "they" have since then deemed even that too hard to work, safely.  In my third year as a resident, I feel confident and strong,  yet I know just as I wasn't and couldn't be prepared for internship as a medical school student, there is no possible way I can be prepared for what I face as an attending of "rural" pediatric medicine, I'll be the farmer plowing day in and day out, but even still my spear has to lay sharp and at the ready in my tent for the lions that approach in the night.  What am I getting myself into?  I'll keep you posted, hopefully with my good results :)

Newbie-Doc

Continue To Do Good

One thing I will never get used to in pediatrics is having to "turn the other cheek" so to speek.  We take care of sick kids and despite saving the childs life, the parents often don't see the big picture, they see, instead, the IV pokes, the shots, and the painful (sometimes debilitating) surgical procedures...to them sometimes we arn't saving the childs life, we are torturing them, and no amount of talking diswades them from this very emotional and primitively ingrained notion.  Sometimes, they get the spotlight and lambast you for your actions, and as a doctor you have to keep your head down and keep silent, you're bound by laws of privacy and by your own conscience to do no harm, even if it's only to a patient's/parent's reputation.  The vast majority of the work we have done for a parent's child will never be known to them.  We continue to work when you sleep, when you leave to take a shower, when you scream at us, when one of our other patients dies, when our own family gets ill, sometimes when the world feels like it's falling apart around us, we are still caring for your children and doing the best we can.  A friend has this on the wall of his office, when I was younger I wondered what bad or distasteful experience posessed him to place it there, as a reminder to never faulter in doing good, now I know, it was his experience in becoming a doctor.

God and You
They may see the good you do as self serving.

Continue to do good.

They may see your generosity as grandstanding.

Continue to be generous.

They may see your warm and caring nature as a weakness.

Continue to be warm and caring.

For you see, in the end, it is between you and God.

It never was between you and them anyway.
~ anon

Not feeling so Newbie these days - Doc

Parents

I wish I could take credit for this.  An attending who was once my senior, was supervising my care of a patient in clinic.  She wasn't allowing us to vaccinate her 2 month old child, an act of supreme idiocy...not in my opinion...in medical fact.  Her reasons, as they always are, are misinformed, ignorant, misguided and often selfish.  After politely arguing with her for 15 minutes, behind my mask I'm a red faced maniac.  I walk out.  My attending discusses this with mother longer and he himself comes out very frustrated.  Guessing the end result of his conversation I say, "Well you can lead a horse to water, but you can't make him drink it."  He looks at me for a second and with frustration in his voice, "But you can light one on fire, and he'll be warm for the rest of his life." Parents are often the hardest part of our job.

Newbie Doc

Dragon Slayer

So this same time of year my first year of residency, I was sitting on the porch drinking a beer.  I was depressed.  I had just found out I had a failing score on my in-training exam.  An in-training exam is a test we take to measure our medical knowledge once every year in anticipation of taking the mother of all tests in my particular career choice.  It's hard enough that people who have been out of residency many years, have still yet to pass it, even though they are full doctors and practice pediatrics daily.  You can be a practicing doctor and even function as pediatrician, but this is the test that says you are not only a doctor, but a doctor with the seal of approval to specialize in caring for kids, you are a licensed pediatrician.  It doesn't come with  a pay increase or anything, for me it's a pride-validation thing. I consider kids the most important patient population out there.  I don't care if I got paid in lolly pops and stickers for my work, it's the only medicine I'd practice. It would be a slap in the face if I wasn't officially counted in the ranks of my peers.  It's honestly not notable that my score was failing, everybody fails it in residency (in a given 3 year crop of residents only 10 residents in our 125 person "school" pass this test before they graduate and this is a very competitive, smart residency), but my score was low enough that I was lumped in the bottom group of all the residents in my residency.  That day was a wake up call that none of this was going to be a cake walk.  I changed some things around and started doing daily study, I started teaching other residents, and really digging into my medicine.

When my beginning of year two score came back I eased up my study a bit, I found myself just above average.  I knew my beginning of year three score wouldn't be any good.  I actually planned for it, cause my goal was to kill the monster that laid in wait at the end of residency.  When I went in to do my test, my plan was to go through it one time only without my testing routine.  I usually finish a test and then run through it two or three more times in a particular patent pending way.  Throughout the years, I've developed a routine for testing, as every veteran test taker does, it's something I HAVE to do if I want to do my best.  I've found it typically boosts my scores about 10-15% from what they would have been, it's not scientific but it's what experience with ALOT of tests has shown me.  My plan was to see what my worse case scenario score was on this test.  I figured this would do several things, it would show where my true weaknesses were (the "routine" gets questions right that I don't actually know), my abysmal score would scare the crap out of me and get me back into a hard core studying routine, it would also likely scare my superiors at the program and get them on my back about studying, there would be little chance that I wouldn't study like a dog this year and consequently be ready for this killer test awaiting me after graduation.

So I went in and for the first time in many years, left my routine at the door.  I took the test and left 2 hours early, as I got up WAY early I'm sure my friends either thought I was being an idiot or was really smart, I didn't care, they didn't know what I knew that I was tieing one hand behind my back to make me stronger, that I would likely fail this test HARD.  That was 4 or 5 months ago, it takes some time to tabulate a score like this and compare it to every pediatrics resident in the nation.  Today I opened the email entitled I.T.E. score.  "Here we go..." I thought, preparing myself for the worst.  I scored so high that I actually passed the exam that I take next year...I passed a whole year early?!?!  I've looked over it several times to make sure I'm not misreading it.

There were those few "super-residents" who managed to do such things, my old seniors Mindy, Kelly, and David they were a couple of the very rare few who could actually pass the in-training, am I really one of them?  Usually people study all third year, read a medically dense 2 inch book two or three times, and take a intensive private study course in isolation for a whole week before slaying that monster test...I literally killed that monster on accident?!?! How in the hell did I do that?  All year long I've been feeling like this teenager living under a parents roof, I don't always agree with my superiors anymore, they don't seem like the supermen that I first envisioned when I entered residency. I have this need to get out of the nest and succeed on my own.  Secretly I felt I was getting to big for my britches, that even though I had this feeling I really wasn't ready.  There is more to medicine and treating people than a test, but this is a very unexpected surprise...maybe I'm not ready yet, but I'll be damn if I'm not starting to fit the part.

Newbie-Doc

Rough Waters

I'm having trouble sleeping these days.  It's a bad cycle I get in, I really deep down know I don't want to go to work.  It's weird that I don't really get sad when kids die on the unit, I can keep it at a distance, but it still effects me somehow. Even though I'm not balling-on-the-floor sad, I'm still depressed, when I examine why I don't want to go into work it's because my kids are dying and I can't do anything to save them (not just me, none of us can).  When did I become a black cloud?  I was talking to my interns the other day and when I told them I was a white cloud they laughed (I really thought I was...but they thought I was being sarcastic)...I see it as a badge of honor, being a guy that always seemed to get it a little easier (at least intern year) I felt bad.  My compatriots that didn't get it so easy, seemed to be better at their job, and I wondered whether it was the chicken or the egg.  Maybe God or Fate or whatever gave the best doctors the hardest patients (I can't explain it, but people definitely attract certain patients) One day I was taking jabs, jokingly, at a friend who is always attracting the shit storms and a much older, wiser doctor standing behind us in the lunch line said, "Rough seas make the good sailors." My friend said, "Ya, if it doesn't kill em."

1. The normal 5 month old girl who fell over and suffocated, brain dead, we withdrew care.  The mother screaming as we told her the child was brain dead and gone, it was like up till that time the child was still alive in here eyes and we killed her.

2. The kid I found seizing for >5 hours straight and went into rhabdomyolysis, muscles working so hard they overheat and die.  Basically a seizure that long does the same thing to your brain.  We withdrew care a day later, till that seizure he was walking and talking.

3. The little girl who was born without half of her spine, no gut innervation, a fatal diagnosis.  She was put on hospice and sent home to die in peace.

4.  The little boy with a heart defect, he was placed on heart and lung bypass, when he got really sick.  Unfortunately his veins clotted severely and he lost all four limbs to gangrene, parents are having a tough time letting him go, but the same clots that destroyed his limbs have pretty much destroyed all the higher brain function (likely).  If they want to do everything for him, he needs a 4 limb amputation, a heart transplant, and a tracheotomy.   The chances he survives all these surgeries are minuscule and the chance of any quality of life are 0.  It's really weird to hope the family lets him die in peace, but sometimes there are worse things than death, he is innocent, does he really deserve this torture?  I see him trying to move his lifeless limbs, sometimes that thought catches me off guard and it gets me a little.

I had to write them down, I was trying to think of the children that have died this month and I couldn't remember all of them at first and that made me feel really uneasy, that maybe I wasn't caring enough or something...I don't know.  I'm really worn out and I still have a week and a half to go.  My last month of PICU doesn't seem to want to go without a fight.

Newbie-Doc

Salvage

These months are painful to my ego.  I enjoy the work, but it's punishing, every day working with people that you feel can smash you with size of their medical intellect, whatever competence you felt you had built up in the last three years is immediately destroyed for the time that you spend in the PICU.  I had a second to sit and talk with one of my attendings and realized in discussing his past leading up to his job here at the PICU that he has been practicing intensive care medicine longer than I have been alive (that is insane), to my surprise, every attending in the ICU has practiced intensive care for my entire life span or more.  Day in day out, feeling stupid and inexperienced next to these guys, suddenly it makes alot of sense...I'm not unlike that younger brother that thinks he should be just as big and capable as his much older siblings.  I've spent 3 months time total in the PICU over 3 years, these guys have been practicing almost every day for 30 plus years.  I can't imagine how deep I would understand the human body after practicing medicine that long.  Suddenly their insight into illness and it's intervention isn't so inexplicable, the ventilator machines they worked with in residency are literally in museums.  There is so much to learn from these docs.  Part of me really wants to be one of them, I could be if I stayed, went into fellowship, took another residency essentially, but I'm worn out...my family is worn out, I'm quiting while I'm ahead...but part of me still wants to push, to be at that level, a paragon of medicine knowledge and human physiology...however, I feel like if I did that I'd be making my life even more medicine that what it already is, and that really wouldn't leave much life in me at all.

Newbie Doc

Mercy Killing

There was this 19 year old mom who took her 5 month old baby girl to her friend's house.  She left her on the futon in the living room and got high in the next room with her friends.  When she came back, the little girl had rolled over onto a blanket and not been able to breath, she found her blue and not breathing.  She was brought by ambulance to my hospital where she was resuscitated for about 45 minutes.  We know as doctors that past 5 minutes of resuscitation there is little hope.  By the time she was stable, we had machines breathing for her, chemicals keeping her heart going, and a cap monitoring her brain function.  She showed none.  She laid in her little crib, looking like a perfectly normal 5 month old girl, cute even, with tubes in almost every orifice, but otherwise she could have been sleeping.

When my attending and I arrived to the scene, the room was filled with family, it seemed like 15 people packed into a tiny room.  The mother was in tears sitting on a chair near her daughters bed, people surrounding her, arms of comfort on her shoulder. Before going in I had offered to my attending, "I don't want to tell her this, but I'll do the talking if you want me to."  I knew what needed said, I knew likely no one had told her this whole time.  He looked surprised, "I'll do it." he said simply.

He and I walked in and knelt next to the mother, introducing ourselves, he asked what she had been told about her daughters condition.  In a quivering voice, "They told me that if she lived she would need a tube in her stomach to eat...bring my daughter back to me!" she finished in a sobbing wail.  In that moment, I saw the opening and knew he would take it.  Her soul and all the hope she had left in her body were sitting in front of us, completely vulnerable.  It was as if she were staring down at a blade he held in his hand, knowing where it would go.  Deep down she knew before we walked in that it would be there, waiting for her.  In that moment his words swiftly buried it deeply in her heart, her hope shattered, her soul destroyed, her daughter in her eyes truly was dead.  A mercy killing.

When a child dies on the unit, you would think it's something out of a movie. People shouting, running, crowds flocking.  More often than not, it's very intimate, very quiet. You walk passed the room the next day and someone else is laying in that bed, as if that little girl, Brianna, had never been there...maybe it was just a bad dream?   No one says much about it, we all try to forget and move on, there is more than enough to do, so we throw ourselves into it and, hopefully, we forget.

Newbie Doc

The Offer

When you do what I do and commit large amounts of your time to something where the reward is far off, you start to wonder if it’s worth it. I’m almost there and so the reward feels much closer, but the sacrifice starts to feel a lot larger too. As you go along, you start to see the trouble it’s caused in your relationships, you start to realize that the time you so easily gave up with your loved ones, you can’t get back. In the back of my mind, I have a fear that I’ll get hit by a car or die suddenly, all of my work and sacrifice suddenly for not, or that I'll lose another loved one and feel the lost time even more. I had an acquaintance in medical school that went off to residency up north, she tried driving after an all-night stint and was killed in the resultant car accident. When I heard that, I was horrified, not only at her death but at the massive unfairness of it. I wonder if she knew about her impending death, would she still do it? Would she still use up these years of her life, in the cocoon waiting to emerge?


Imagine some mysterious man came up to you and made this offer, “If you will disappear for 7 years of your life starting now, when you reappear you’ll gain instant prestige and respect, you’ll be 100 times over wiser than you are now, you’ll be paid well for a job that you would do for free, and everyday you’ll make a huge difference in people’s lives, sometimes even in those of your family and friends. You’ll be so much more than you are now. But for those years you give me, you will be mine, you will be tested in punishing and sometimes horrible ways and you’ll lose some of your friends and family along the way. When you awake you’ll be greatly changed and the world you knew will be in large gone, for better or worse, you will never get that time back or the relationships I will take during your 7 year slumber. ” It sounds mystical, but it’s not far off from the truth of it.

When you are young it’s so easy to sacrifice your future, you have so much of it. You feel as if you will live forever. Now looking back, it should have been a much bigger decision. It’s a gamble, I might die tomorrow…was it worth it? I don’t know…I think it has been thus far, but who knows what the future holds. Would you take that man up on his offer?

Newbie Doc

Stockholm Syndrome

I'm going on to PICU for my last stint of it during residency, considering the job that I'm taking it will actually be my last month of it EVER. I have mixed emotions regarding this. Stockholm syndrome is a phenomenon in which hostages express empathy and have positive feelings towards their captors, sometimes to the point of defending them. I've found time and time again that when placed in an overly "abusive" environment I begin to identify with the "abuser", in this instance it's the PICU, other times it has been Wards. It's odd, but while I know it's a punishing environment I begin to love it a little, to look forward to the intensity. Am I crazy? I think it's a coping stratagy, I do this with attendings who stress me out...typically I find myself trying to emulate them in some way. I think this attitude developed from being picked on in high school, I adapted and “survived” by becoming more similar to the people slinging the shit. Maybe I was born with this behavior in my blood, who knows.
I’m nervous before going into the PICU. It’s not that I’m scared that I will hurt a patient or that they will die, it’s what I’m going to see. The last time I was in the PICU was over a year ago, yet there are patients I still see vividly.
There’s the kid who drowned, but lived enough to be a vegetable on a ventilator. How about the kid who was hit by a car and his brain got infected leaving a huge bucket of puss where his brain should have been. Sadder yet is the kids who look like my sons, there’s the four year old who playing with his brother mildly hit his belly on the couch and started bleeding internally, he was diagnosed here with a very aggressive metastatic tumor of the kidney, I still remember his name and his parents faces. How about the kid who came in with headaches and fever an MRI scan revealed that his brain looked like swiss cheese, a fungus was eating him alive. I could go on and on. It’s a little like going to war I imagine. I’m a little nervous about working there, but much more overwhelming is the dread I feel in the proposition of carrying more of these stories around with me at the end of the month.

Paradoxically, mixed in that fear/dread is a sweat taste of hard work, earning my keep, helping people…somewhere in there is mixed a little love for the PICU…and that makes me wonder if I’m going insane.

Newbie Doc

Beware the Dog Skinners

Remember when you were young and your parents did everything for you?  If you do then you remember when you became independent, when it became annoying as they tried to parent you, you felt grown up.  That's what I'm dealing with more and more now.  When I work with other general pediatricians, I find more and more a growing sense of independence.  More and more I want to get out on my own.  The majority of the time I'm accepted as a peer, especially with the doctors that I have worked with for 3 years, who know and respect that I do good work.  Occasionally, though, I have the displeasure to work with a general pediatrics attending who is substandard, one you find yourself disagreeing with on a regular basis.  You'll find that despite your medical knowledge, despite your knowledge that you are right and they are wrong (I always look it up before assuming), that their experience and their "role" will trump your "role".  Doctors have power and attendings much more so than residents.  If you are smart, you stay political, you stay polite, and you stay quiet, until you are out from under their sphere of influence.  It sounds spineless, but the people I've seen who went the other way always regretted it.  I've seen them given bad evaluations and I've even seen them fired.  It's harder to do than you would think as these doctors are often sooo bad and sooo full of themselves (I find one goes with the other often).

I recently came under the tutelage of a general pediatrics practicioner from the community, 1 day a week.  In 1 month that I've been privey to his ignorance, I've watched this doctor read tests wrong and treat patients inappropriately for it, I've sat by and had him berrate me for giving a correct and evidence based diagnosis (in front of the patient no less), and what drives me crazy is his inability to explain his reasoning when he disagrees with me, which is often.  This guy for whatever reason is fairly skilled in heart murmurs, which I do try and pick his brain on, but I'm having trouble staying with him for that reason only, as the only other thing he shows me consistently is what not to do. My plan is fairly mild in reaction to this, I'm switching to a better clinic where I know there is alot to learn.  I will politely excuse myself from working with him and thank him for his "education", and I might annonymously report him so that other future residents will steer clear of his bad habits/malpractice.  In the time I have seen him I can say that he is not dangerous or I would be obligated to a greater reaction, but he is also not very good.  Seriously, I see this guy for 1 half day a week and when I go home I'm so mad I can't sleep at night. 

In medicine, there are often many ways to skin a cat, many ways to go about solving a medical problem.  If you are halfway worth your salt, it's not hard to spot the wackadoo's who on regular occasion skin dogs.

The Check List

I'm filling out a mountain of paperwork for credentialling in the state where I will work once I graduate residency.  It's all about what I've done, who I've been for the last 11 years of my life.  When I review the documents it's like a detailed account of a very long journey or mountain I've climbed.  Next to my years in medical school it simply says the words, "completed"...not even capitalized.  It doesn't talk about the swings in my life that have happened because of it all.  It doesn't talk about who I've become or what I was, other than I was able to jump through said "hoop".  All of the things that I struggled with, triumphed over, failed at, and worked so hard for seems so perfunctory when I look at this list, like it was just expected to occur, in the moment that certainty is so much harder to find.  When you watch someone "clutch" intubate someone while they are crashing, you don't see that skill as a check box...yet one day if you were to take my path, you'll find yourself checking it off.  This job can be so duplicitous.

Newbie Doc

Moving Mountains

As doctors we get divorced of the human element sometimes, that's the only way we get by is to see the person as a disease instead of a person.  We make a lot of sick dark jokes about it, really what are we supposed to do, cry all the time?  Instead we dehumanize the situation, maybe we dehumanize ourselves a bit too. 

The scary times are when it's someone you know, when you can't step away, when it's still there at the end of the day. It's a sense of dread I don't think I've experienced in medicine before, when the lines between your dearest loved ones blur with the patients you've treated, when you hear them speak in echoes of patients passed.  

So far, it seems like I can always come up with a fix, some new option to try.  But I know the odds are stacked against me, someone I love is going to be in trouble and I'll be powerless to help them.  I wonder if other doctors constantly feel inadequate when faced against what we are faced with.  If they too constantly wish they were smarter, better, more impervious.  

It's like society has pulled regular men and women off the street, dressed them in a superman costume and said, "Ok, now go save everybody." The "suit" and everyone's belief that we, the doctors, will be able to help is just enough that we are crazy enough to try.  In fact, we succeed just enough to keep us pushing, but it's never enough.  Suddenly you realize your nearly 30 years old and standing in front of everyone wearing a superhero outfit, pushing against a mountain which you ridiculously expect will move.

Maybe if I can just move it one inch...one centimeter...come on damn it, I'm so close!

Newbie Doc

One Day

I'm still working nights, it's a long month. My wife has 10 days off at her place of work and has taken the family to visit home.  At first I was thrilled with the prospect of being a bachelor again...that lasted less than a day.  It's good to be reminded of how lonely I was and how happy I am now, that it all isn't a daily grind, and to have it put back in my head what it's all about.  To remember that it isn't the family that stresses me, that it's the family that helps me keep it together.  To come back to the understanding that the job is the stress, the job is where the pain resides if that pain is even real at all.

Newbie Doc

Sleeper Hold

I'm working nights this month.  I was contrasting my service which was relatively quiet over the night to another peer's relatively more active service, he'd said, "my service is full of whiners".  I joked that my service is quiet because by 3 in the morning I've found cause to drug every single one of them.  "I'll Haldol a nurse if I get a chance." I dryly remark.  While I'm overplaying it, this doctor trait is true about me, I solve problems while on service, not always perminantely, but when I set out to deal with a problematic patient, I set out to put an end to whatever wrong is going on perminantely or at least for the night...that being said, if you don't really have something wrong with you, if you are being a "whiner"...I might find cause to give you some IV benadryl or maybe even Ativan.  It sounds harsh, but many a 17 year old something likes the lime light of hospital life, the attention they so despirately seek in non-hospital life is finally given to them and they can't get enough of "Call the doctor, I have a hang nail" type problems.  Much to the anger and embarrassment of a nurse, I've made a "green" one have an experienced "buddy" nurse so she'd quit bothering me with stupid questions.  I have this image in my head of a nurse in my gentle sleeper hold for calling me for a vasaline order at 3 in the morning, me laying her gently down under a corner desk where she won't be noticed till day shift.  This while comical is not far from the truth, when I'm on nights I can be a bit cold and ruthless, so if you are part of the problem, I might deal with you strictly in finding the solution.  Say what you want about my methods it's a quiet and efficient service I run and one that everyone actually benefits from, even if every now and again there is a nurse found sleeping on the job.

"Vasaline order you say?  Oh my gawd! What's that behind you!?!?"

Newbie Doc

Senior-itis

I can't believe less than 12 months are left in my residency.  I wondered going in who I would be and what all would transpire when I came out.  When I got into medical school I had heard that becoming a doctor would change you.  I went in with that and a determination that I wouldn't let it, but you can't help what you experience and your experiences change you for better or for worse.  It's about like I thought, I'm not better or worse for it, just different.  I've found strengths I didn't know I had and sadly weaknesses too.  I'm starting to get anxious to start this next part of my family and I's life. If I think about it too much my head fills with a billion scenarios as to what will happen, as usual it's never any one of the hundreds I concoct, usually a mix of many.  That's something I've learned about myself in the last couple of years, even if it's horrible, if I expect it, I can handle it.  One of my greatest fears/annoyances are the things I can't expect, I compulsively try to expect the unexpected and I think my job has only made me worse in that respect.  Every single day at work as I hand my patients over to the new doctor taking care of the patient I'm trying to handle problems and foresee hangups before they ever occur, I think if you have the slightest tendencies before residency you come out full on OCD.  I'm hitting the sack, as I'm finally tired enough to sleep, these electives depress me, one other thing I've found out about myself, I need real work to burn off energy or something or else I just spin my tires, it's so dumb that on these "easy" months I can't keep it together, but the hard ones I'm straight as an arrow.  It's like those old farmers that finally sell their ground, they're so attached to it in another month you find them six feet under it.

Newbie Doc

Standing Up

There have been times during my life I've tried to stand up.  Where I've tried to lead and failed.  I have to admit I'm not the best orator and I'm not the most charismatic, so getting slapped down is what I've come to expect when I try to make changes.  With the media pumping me full of pessimism, the government showing me what not to do, and the masses showing me how to eat the crap shoveled to them; I've slowly but surely learned to keep my head down and do what's best for me and mine, forget the rest.  But, we are all connected, and despite my pessimism, maybe one person can make a difference, maybe I can make a difference.  I'm scared to try, to stand up among so many and to risk failing so publicly, yet maybe it's this fear that has put us as a nation and a global economy where we are today.  Maybe that fear pushes us to selfishness, then to greed, then to evil.  Maybe when given the choice to put my head down and look after myself, I should hold my head up and look out for everyone else a little more often...even if I fail, even if they laugh.  I was working on inpatient this morning for the first time in months, perusing vital signs I glanced a blood pressures of a patient of mine.  My system was running and it was catching hypertension in my patients.  No one knows it was me that changed that.  Years from now they will be catching patients with kidney and heart problems, where before they might have slipped through the cracks.  As a resident you do what any doctor can do, you don't feel like you're making a difference.  If a kid is dehydrated, give him IV fluids...anyone can figure that kind of stuff out, if I wasn't there to write the order someone else would be.  But, today I did what few in my program have done.  When I leave that hospital, I will still be saving lives there, I will still be making a difference in children who come there.  My effect will outlast me.  I won't get any medal for this, maybe a pat on the back from the people who knew I was working on it, but I gained something greater than that.  It restored my faith that one person really can change the system, that I can change the system, and that I need to keep trying to change the system.  Maybe I can't speak well, but maybe my actions can speak for me. 

Newbie Doc

Tele-Doc

There are alot of things you don't get taught in medical school, things that would have been useful to know. One of those things is dealing with family members as patients. If I got any teaching in it at all it involved the words "don't do it". However, my family and friends base is primarily centered in the rural communities, and that has given me a different take on it all together. One of the things I never really empathized with was the comment that I'd heard espoused from so many doctors whom I respected, (insert rural community)..."could really use a good doctor". As I child I never felt medical care was lacking, that we were treated poorly because of where we were. When I was sick I drove to doctor that was 30 minutes away, hell some drive longer in the city to see a doctor where I work. What was this disparity that everybody I looked up to spoke of. Now I know. I remember the first time I really took the reigns of a patient that wasn't in my perview, my little brother. He lives 20 plus hours away from me. I in no way, shape, or form have a right to treat him medically, but I was forced to. He and my parents came to visit my family, one of the rare times they get to. During that time he got sick. I really didn't pay attention as to what his symptoms were at the time. For me when I'm a doctor, I'm a doctor, and when I'm me there is no part of me that is thinking medically, so I really didn't pay attention. But, I remember calling my mother a week or so later and he was still sick. The person who treated him gave him a 7 day course of augmentin and steroids. Talking on the phone, listening to what they gave him, I finally snapped. This was rediculous, he had at least been given the same treatment 6 or so times that year. I was at a crossroads, do I step in and figure out what is going on or do I continue to let my little brother get 'roided up while this doctor pockets his check. I stepped in. From that moment on I began taking more interest in my friends and family from a medical aspect and everytime I've added another case to bulster my underling reason for this, there is a huge deficit in rural medicine (especially in pediatrics). What I've come to understand is there are two types of doctors working in a rural practice. There is the excellent, intellegent doctor I'm happy to count in my ranks (he is there because he wants to be), and there is the doctor that hides there because he/she couldn't get a job anywhere else (the rural community is desperate for care and counts some care better than no care at all). Were I talking to an aspiring medical professional and they asked my advice, what I would recommend is this. If the friend or family member is willing, take a detailed history and if possible exam. Don't treat or test them if at all possible. Instead use your medical knowledge to search out an appropriate physician or specialist in there area that can see and treat them without bias. Do this and everyone will win. The patient in question gets the best care, you have no pressure to treat or guilt in treating (in certain instances), and the specialist gets good buisness as they should if their reputation has lead you to them. There are times I don't follow my own advice and will treat someone I know, however I would do this everytime if I could get away with it. It's a very important personal lesson to the new doctor, not only for yourself, but for the family and friends that will often suffer needlessly if you don't. Newbie-Doc

Taking Care of the "Kids"

3 interns, 2 seniors, 3 med students. All supposidely smart capable human beings...how did it come that I'm the leader in all of this. The doctor mask/role and the leader mask/role are similar but not mutually exclusive. In this millue I've found that although you may have what it takes to take care of patients, you may lack something that makes you good at taking care of other doctors. What I've had to deal with this senior month is an intern who is lazy and thinks she knows everything, a senior who I personally know to be lazy...but at least doesn't think she knows everything, and a student who knows pretty much nill (though she has had 3 years of school, so she is wayyyy behind). All through this it's been pretty much understood that they are all my responsibility. I'm to manage the other seniors shitty intern, I'm to keep the other senior from emotionally and mentally imploding, and I'm supposed to teach a medical school student what many other teachers have apparently failed at after 3 years of school. I don't relish the task I've had this last week and a half as I found out the state of the other group of doctors on my pediatric wards. Sure I don't "HAVE" to do it, but if I want the poison to stay away from the entire team, if I want the "rot" to leave the patients unaffected...here I am, being the person the other senior can't. In taking up the doctor role and now grasping this leader role even more I'm slowly convinced that it is filling me full of shit, the things that come out of my mouth to these people are things that my authority figures would say...I find myself agreeing with them and it's hard not to get addicted to it and let it change you. Just in becoming a doctor I've found my family/home life manners have suffered, I don't say "please/thank you" as much, "sorry" is something that is rare instead of the common as it was in my pre-doctor world. I promise you I'm being as nice as I can and trying to be as logical as I can to get the effect I'm trying to achieve, which is to keep the group together and make a medical school student a real doctor one day (not the psuedo-doctor other docs laugh/are scared of). That being said, I've had to be an administrator, a jerk. I've had to sit down and make a girl cry. I've had to tell someone that I expect better from them, without threatening, simply imply that I expect that certain changes be made to their personality in order to succeed. In short, I've had to dig into people in ways I find intrussive and slightly tyranical. When I've felt really bad I've told my wife and my attendings, asking them if what I said was appropriate...they've approved. That makes me feel better, that I'm not needlessly mentally torturing people, but deep down I feel like even if what I'm doing is "right" in the end...I'm seeing more and more what people mean by "the means justifying the end" that doing the "right" thing doesn't always mean you get to be the hero, that sometimes you have to worry about the "right" thing turning you into the "wrong" person. It's going to become more and more important to keep my personal life seperate from these masks that I wear, so one day I don't find I've driven away the people I love, with a fake personality that I suppose is my own. I hope what I'm doing is right. Newbie Leader

Big Boy

I don't know how so much went wrong in such little time, but it's put me in a me in a mild state of shock.  I'm on wards and my attending is a guy close to retirement. It's generally known in residency that working with him you are basically the attending, because he doesn't give a damn.  If his license goes then he retires...so he doesn't care.  For the last 3 days I've been attending, really.  It's been an eye opening experience, it's shown me that there are things that I can do that I didn't know I could and things that I still can't.  I'm not experienced enough to hold that responsibility and power without making mistakes and when I made those mistakes I stood in front of the other attending's and took my shalaking as a big boy.  I might be a boy in pull ups taking a punishment meant for an older person, but I made those decisions and I have to stand by them, no one else carried that responsibility, I did.

The last six hours of my day was yelling at me.  I'm having trouble processing what lead to things going that bad.  Considering my job it could have been worse, no one was hurt...they could have been.  What it comes down to is I convinced myself I knew what I really didn't and I did what I prided myself on not doing, I believed my own bullshit and didn't look up the right answer.  I tried to handle it on my own and I failed.  I couldn't even go home when I tried to, I couldn't even feel I was so tired and ground down...even without what happened it was a long day.

I contemplated getting drunk, but I have to pull a 6-9p shift in the same damn place.  I ducked out and went to a movie instead.   As I'm walking out of the movie I'm finally feeling better, digging out of the sludge, but just as I feel better another one of the things that happened today hits me again and I'm down in it.  I have a recipe for surviving days like this (I've had 3 total in my time at residency).  You put your head down and watch your feet place themselves one in front of the next.  You think about what mistakes you made, put something in place that keeps them from happening again and you move on and even if you think it's a lie you tell yourself tomorrow is going to be better.  Last step is to go to sleep, sometimes that's the hardest thing is sleeping with what you've done and what you have to wake up to.

Newbie Doc

Fire and Ice

So on April 29th we had our second son, Blake Wesley. Whoohoo!! This really reinforced for me how inadequate pediatricians are at dealing with children sometimes, little Blakey is the quietest cool of a child you've ever seen.  If I had to contrast him with my first son Brian he is white hot to Blake's chilled persona.  There is no instruction manual for little Brian, any pediatrics advice anyone has ever dealt seems to fail ridiculously with him...I was starting to wonder what it meant for me as a pediatrician if I couldn't raise my son in normal pediatrician fashion...as it turns out it means nothing.  Blake is the child all of my advice will work for, he is the as-advertised-model of the "boy".  Just goes to show you, that you are born with a temperament and personality, which along with your experiences shapes you into the person you're going to be.  It's amazing to me that both boys mimic their namesakes so perfectly (Kate and I's respective brothers, Brian and Wes).  Not that I'm hating on my first son, he has and will continue to be difficult to raise, but his temperament is going to push him into success...not that Blake can't have that to (his uncle is easy proof of that), but when I see Brian's personality its hard to imagine him doing anything that isn't in some shape or form exceptional. We are two very tired, very proud parents.

Newbie Dad

Opinionated Aren't We

Did I ever say that my kids are my greatest teacher in my pediatrics residency? They are simultaneously harder than a medical residency and more educational.  I often tell the interns, I don't require that you have a child to be a pediatrician...but if I could I would.  My biggest professional cringe moment is when I think back about some of the advice I gave parents before I was a parent...pshhh...how did they not reach out and slap me.  There are pediatricians I know that have been at this 25+ years without kids...and they are still spilling that same cringe worthy advice out to parents without a clue to how dumb and unrealistic it can be.  My top lessons my kids and my patients have taught me.

1. Kids are resilient and often survive despite our best efforts to kill them.

2. They are human beings, not Furbies, despite what every author/doctor would like you to believe there is no direction manual for your child...we try to help you figure your little one out.

3. Some people shouldn't be parents, some parents shouldn't have been children

4. Use your eyes not your ears with little ones or every sneeze will send you to the ED

5. It's ok to tell a parent there child is crazy...just explain it really well

6. It's ok to tell a parent they are crazy...no explanation is needed...they likely already know 

7. It's ok to not know everything, to be wrong, and to make mistakes - just be honest and remember who you are here for.

8. Most pediatrics advice is not evidence based (you can't perform tests on kids...ethically anyway), if something your telling a patient seems stupid, either figure out why you don't understand it, or don't tell it to them.

9. Sometimes kids need yelled at...Sometimes kids need spanked...If you don't hate doing it then you should stop doing it.

10. Flattery will get you everywhere.

11. Women ARE smarter than men, but children can in certain instances make them retarded. 

12. Men ARE dumber than women, but children can in certain rare instances make them even stupider. 

13. If you're being politically correct, then you are too worried about what other people think of you.

14. Be yourself, then be professional...people want treated by people...they tried robots, it didn't work.

15. How do you know a teen female is lying...her mouth is open.

16. They actually have a specialized doctor for dealing with teenage women...called a psychiatrist.

17. Stereotyping works, but it'll make you a stereotypical ass every now and then.

18. Recognize your limitations you don't know how to mind control patients...yet.

19. Everybody likes gifts and shiny toys, it works for kids and really works for adults.

20. Give a smile to get a smile with an adult, forget the adult is in the room to get a child to smile.

Newbie Doc

A Million Ways to Die

I can't sleep.  A lot has changed in 2 years...my ever-present sleep disorder is not one of them.  April 29th, my wife and I were blessed with our second son.  He's now 7 days old and just back to birth weight (normal for a breast fed infant). I woke up to tachypnic stridor (fast breathing with a high pitched snore like noise on inspiration).  I woke up as a parent and immediately rushed to his side, wide eyed...he was fine, it was positional (when I changed how he was laying it went away).  He was also not struggling to breath, his skin was warm, pink, and he smiled as he farted on me...a normal happy 7 day old.  I changed his blanket swaddle so he wouldn't make that freaky noise, hovered on him for a couple seconds and then forced myself to walk away, my mantra, what will happen will happen. I think you might convince yourself that I'm a really relaxed parent if you were watching me, that's because in my mind I'm constantly obsessing about how my children will get hurt or die...I can't stop...that's normal probably for a parent...but honestly I've done that for a long time before my kids came along. Before it was my kids, it was my parents, my brothers, my grandparents...my underlying thought is that in predicting and seeing how they die I might forestall it...like God would be like, "Oh damn it, he caught me again...he sees where I'm going with this whole heart attack thing...guess I'm gonna have to change my strategy." It's a stupid childhood thought, but it really belies a underlying monstrous fear of loosing those I love.  I know I don't have any control, so I've made a obsession/ritual thought/whatever to pacify me.  The big thing in all this is I see death and illness as a thing that is out of my control, I see so many ways for my kids to kill themselves that I've had to relax...or risk my head exploding.  My near two year old could fall in the pool, he could get hit by a car as he crosses the road, he could fall down the stairs, he could get sick with an infection, he could get a bad cancer, he could get stung or bitten by the wrong bug/snake, he could get kidnapped, he could choke on food or a balloon, he could pull a TV or something heavy down on his head, he could have a food allergy, he could strangulate himself on curtain strings somehow...and my 7 day old...it's very possible (at least in my mind) he could just fail to keep breathing, he could start having seizures, ...and on and on and on.  In my mind I see a bazillion ways for God to take them from me and I realize no hand sanitizer ritual, no constant hovering while they sleep, nothing I can do can prevent them or anyone I love from God taking them from me.  I could protect them from one thing just for one of them to develop a cancer we can't treat.  I think of all these things...probably more than I think of anything anymore...and then with a deep breath I have to let it go. Of course there are times like tonight where I don't have the luxury of slowly thinking about it and I awake in a panic.  I don't know that I'm any different from any other parent, you obsess about your kids and if its a good day you find the strength to let them outside your nest, so they can live, learn, and grow...and you recite your comforting repetitive mantra or thought, whatever that might be.

Newbie Doc

Being a Teacher

In becoming who I am, I've collected mentors and role models.  My role models were never the ones my friends in gradeschool had.  I had to seperate myself from my brother who had the market cornered on the all-american boy from kansas role, sometimes I wonder if I wouldn't have become something else if I didn't have him to polarize me into a more nerdy persona.  I know that I would have always been prone to it, even he ended up becoming an engineer, a science heavy profession, but to be myself and not a lesser copy of him, I think my rolemodels became Einstein instead of Chamberlain, comic book superheroes instead of Jordan.   There have been others like my father and my mother, my highschool science teacher, the doctor who got me started in all this...all of them have bigger shoes than I ever hope to fill.  But, I'm blessed for them and I know I'm in some way headed in the right direction as I occasionally get letters from people that I've taught, letting me know they are going into pediatrics or science since learning under me.  It's a huge honor when I get them, I save them in a drawer at home...I went into this thinking if I saved one life, the effect would last acrossed generations.  That feeling is muffled in comparison to the sense of accomplishment I get in knowing that, from time to time, I join the ranks or my progenetors and even if for a little while get to be like them, a teacher and a rolemodel.

Newbie Doc

Crying Wolf

Traffic was kind to me this morning and I find myself with plenty of time to catch up on emails and all the to-do's of the day.  What I have to write about is really more of a story than something that I actually experienced and I'll try to keep it brief.

Where I work there are what I call "famous" patients.  Patients who everyone has taken care of, patients who are well known.  Some for good reasons, some for less admirable ones.  This was a famous, like many, who had an actual disease...but the disease consummed him, warped his mind.  The disease for all intents and purposes had been delt with, but as is sometimes the case, the pain can twist your mind if it's gone on long enough and as he was he spent more time in the hospital than at home, for more often than not, no reason at all.  He cried wolf, but as is the state of things, you have to believe a patient even if they've "lied" a thousand times.  Every time a faked complaint, every time an admission and discharge.  One day, it wasn't fake and the mother knowing her son, sat on the complaint for two days.  By the time she took the young man into the hospital it was too late and the young man was finally given a rest from the awful life he was so unfortunate to have grown into.  Those of us who knew him and how annoying he was, we can't help but coldly smile that his "crying wolf" finally got the best of him, at the same time there is an apprehension that we would smile at death and we immediately rebound with a "this is terrible" thought...some of us wonder if what the mother did was on purpose...none of us blame her...we just wonder.

Newbie Doc

Cheating

How many times in politics are you maddened by someone getting elected who was clearly incompetent.  Why are they elected? Deep down you know it's because they have that social "spark", they are just the right amount of attractive, friendly, and conversational that they carry votes despite how stupid they are.  A similar thing happens with doctors, luckily there is a bottleneck of rigourous testing that keeps the truly stupid out of our field, if you are a doctor, it is likely that in some way you are bright...even if it's not the kind that is going to make you a good physician.  It's been my ever present lament, but rarely voiced complaint that I'm one of those doctors.  I wouldn't go so far as to say that I'm an idiot, but in the mass of doctors out there I am average at best.  Over the years, what I've found, to my surprise, is that this massive heap of intellect fails against an average one with superior social skills ...just to be clear, I'm not the popular kid in school...I'm more like the poorly adjusted kid who got stuffed in lockers, but in this heap of geak, I'm a social power house. 

I remember a conversation I had briefly with my attending over a difficult patient that I treated.  I didn't do anything better than he did, didn't do anything better than the resident that saw them before me, but I sat and talked to the patient, and smiled with the patient, and probably (seemed) to listen to the patient better than they did.  He was telling me how they were singing my praises.  My response was, "They have no idea how incompetent I am." (it was my second month as a doctor).  What he said back stuck with me and has haunted me ever since, "It doesn't matter, you're going to do very well for yourself."  Am I a fraud? Do I do well because I can talk to people better than my peers? Over time I've found the answer to be Yes and No.

There's a hundred ways I can describe this, but these are two examples.  The first is that I'm never going to be a cardiothoracic surgeon, in matters of the "heart", I know I am a weakling.  Over time I've been able to accept my place here and when it comes to the heart I know I will likely over refer my patients to cardiologists to check out benign murmurs and passing out episodes...I'm just not comfortable enough.  What I've realized is that in the areas I'm weak I know enough to know I'm out of my depth and in those instances I swallow pride and send them to someone smarter...that's how I cope with my weakness.  Does the patient notice that I'm an idiot and just sent something totally normal to the cardiologist...No...she likely thinks it's great I found that and will thank me for being safe.

The second is this, a patient has chronic pain with a large component being psychological (in the patients head).  Dozens of capable, highly intelegent doctors have come in to help this mothers daughter.  Nothing helps the pain, the mother is in tears and has fired several docs from her care because she feels they arn't worried about the pain her daughter is experiencing.  The daughter continues screaming despite all the drugs they throw at her.  All of us doctors are thinking the same thing, there is no reason for the patient to be in pain, all the signs are pointing to here using the "pain" for attention...but none of the doctors can say it...or want to say it.  The mother bothers the doctors every hour all night long for three nights of her stay.  Finally when I'm called to deal with the crazy, I ask the mother to step out of the room and then I use my ability to talk to slowly break it to her that her daughter is using this to get her attention (this takes 30 minutes to break it right and not offend her).  As I'm listening I'm writing down all her complaints so she can "see" that I care.  As we role onto 45 minutes of talking, I'm addressing every problem.  Most I'm treating with small things, abdominal pain I'm going to put warm packs on, sleep problems I'm going to give melatonin for, none of my "solutions" have any proven medical efficacy, but in suggesting ways to cut out her daughters attention grabbing behavior, in providing miniscule treatments that I confidently explain, her daughter sleeps through the night without further complaint...the other residents are in awe of what I've done.  The mom put's me up for a patient nominated award at the hospital.  The patients behavior continues and I've solved the problem of what was ailing both the doctor's and the mother, the patients unremitting pain. 

Superficially you'd think I was an excellent doctor...wow all the other doctors looked up to me, I got nominated for an award, I fixed the little girls pain...guess what...I see myself as a fraud.  Deep down I know I'm not the guy who found the brain tumor she had, I'm definately not the guy who took it out, I'm just the guy who used "Jedi mind tricks" to take away a girls "pain"...everytime I'm congratulated on patient care, it's like they are saying, "Good job...Faker!"..."Keep up the good work...Fraud!". 

I can tell I'm likely going to be successful with this "skill" of mine, but it's like I'm winning at a game because I'm cheating...and I really wanted to win fairly...

Newbie Doc

Farm Thinking

One of the things I learned on the farm was to think on my own. It's something you don't get taught in a book, how to problem solve. It was taught to me sitting in a field with broken down equipment, waiting for my father to arrive and help me. It was taught every morning as my brothers and I planned out how we were going to get our work done the fastest that day. It was taught watching my Dad do things others pay mechanics thousands of dollars for, he has no formal training in many of the things he's adept in, yet he has a sharp mind and like me, his father taught him to problem solve. It's a characteristic that seperates me from many of my peers, both young and old. I pride myself on solving problems others give up on, problems we weren't schooled on solving, things as simple as finding a way to communicate with a swahili immigrant when we don't have interpreters on hand to figuring out what mysterious ailment is hurting my patient and evading detection.

A couple of months back I was between a rock and a hard place. A patient my team was caring for very likely had a GJ-Tube malfunction (a tube that goes directly from the outside abdomen into the stomach and then courses down into the small bowel). My patient's GJ quit flushing and his abdomen became increasingly distended. Stopping GJ feeds allieviated the distention, but how was my very ill patient going to get food? You can give nutrition many ways, but giving it through the gut is the healthiest and sending him to get it fixed requires that we have diagnosed there is a problem with the tube. This is a catch 22 when there's no in house radiologist to perform the study on the weekend. After some inquiry I found it requires a radiologist in house to inject a XRAY contast material down the tube and then take some "pictures" of the abdomen. When confronted with this problem they suggested I leave my patient on IVF over the weekend and get the study monday (There's so much wrong with that thinking that it would be another blog post entirely). As I sat there pondering the stupidity of the situation, I asked why they needed a radiologist to inject the material, they can easily do the XRAY without him. The tech responds, well it's hospital protocol to that only a doctor do this. 1 hour later we have had the patient rolled down to radiology, I simply push a syringe of yellow stuff into his GJ and we take 3 pictures...was that so hard? Apparently it is to some. The problem now is truly "diagnosed" and the IR doctor (who is in charge of fixing the GJ) begrudgingly agrees to come in to help my patient out. I write about this because the other day I was in cardiology watching them in the cath lab when I heard the IR tech complaining about how the peds residents were now doing these G-tube studies by themselves over the weekend and causing more work for them...I smiled secretly to myself...Thanks Dad!

Newbie Doc

Playing for the Bulls

The last time I held a job I took seriously I was 19 and I was a farmer.  Here I am at 27 years of age and I finally have my first real job offer (it's official) in my chosen career.  Sure residency is a job they pay me for, but it's like driving with your learners permit...they still havn't said your experienced enough to "drive". It's a mind job to have someone accept me as an actual peer, a whole year early no less.  To feel like you are a doctor (if only a young one) is one thing, but to have other doctors older and more experienced than you accept you...the feeling I get is akin to that little kid who looks up to Micheal Jordan who grows up and gets an offer to play for the Bulls, I'm extatic.

Newbie Doc

Get My Posts By Email !!!!

So I don't post very frequently, it becomes a bother to check my site.  I've had several people ask me for this since I post once every blue moon.  Well it's here!!!  New posts sent to your email.

1. Go to the bottom of this page.
2. Type in your email address and click on the black box that says "submit".
3. Type in the security code that appears afterwards.
4. Go to your email (the one you just entered) and click on the provided link that was sent to you by email from "feedburner". 

That's it, now you should get an email whenever I decide I have the time to update my blog...I think it might even come with the post itself. Let me know what you think, if it doesn't work ect.

Thank you all for reading!

Newbie Doc

So Lucky

You know I feel like alot of my posts spiral into depressing thoughts.  It's hard not to go there when writing about medicine, it's a vast ocean of choppy waters, I'm a new doctor learning my way.  Sadly, it's often said "you don't want to be interesting in this place".  When something exciting happens, it's often at the expense of someones health...that's why I think this place is so peculiar, this hospital I work at looks like a child's paradise with the vibrant colors, the smiling faces, the lush parks and playgrounds around it...but for most it's a place where they hurt more than they ever hurt before, for others it's a place where they lost there little boy or girl.  It's hard not to get sucked into that and think about that when I come home, it's easy for me to write about in this blog where I talk about what I see, but I also see patients get better, far more often than not.  It's a place where I run into patients visiting the clinic who I treated that are now doing "much better".  Those kids smile and laugh and go home to play another day. 

What I wanted to post about is this, it's easy to get sucked into negativity, but the truth is that we are living in one of the best countries in the world.  Despite it's faults, we are all insanely lucky to live here.  Yesterday, when I was playing with my little boy, laughing at how much of a goofball he is (like his dad), the words just slipped out of my mouth, like it wasn't my brain that actually said it, "We are so damn lucky."   I know it's all relative, that it's not always great for me and it isn't always great for you, sometimes I work 30 hour days, sometimes I cry at work, sometimes people die, but the truth is each of us should be saying that every day we get, we don't but we should.  Remember that it could all go away in an instant, easier than any of us could possibly imagine, so don't take them for granted.  We are all, in some way, so Lucky.

Newbie Doc

What's the Worst That Could Happen?

It's been awhile since my last post, since that time I've passed my test and now am considered a full doctor of medicine, though I felt that way for some time.  I felt like my true test was in finishing my first month of the PICU.  If you have a cold you go to an out patient clinic, if you have a illness that might kill you if untreated in days you would go to the floor of an inpatient hospital (the "wards"), if you are sick enough that you might die within the hour you will inevitably end up at an ICU...or in a coffin...in some sad cases both.  During that month, I've had time to test my true metal and although I've passed through it's fires and I measure up to their standards I find myself lacking.  Not in any one thing in particular, just in general, it's like my first day as a doctor, realizing how over your head you are...only its worse because this time you thought you actually knew something.  Not to say that the month was a failure, I did well...I wanted to write about the first time I intubated a "crashing" kid while everyone was screaming and in chaos around me...I would have called that blog "clutch" because as soon as the tube was down the kids throat and they were bagging him life saving oxygen, I had this feeling of sinking a winning 3 just as the buzzer sounds in a basketball game (though I've never done the latter- in my head the crowd was going wild).  There were moments like that punctuating the depressing drone of my conscience telling me that I don't know enough yet to soundly treat a truly critical child...I'll get there though.

I'm also going for a job interview in a few days...that's probably what has me writing right now, funny that an interview could make me more nervous than a child dying in front of me, before last month it would have been tough to say, but now its not.

I remember this little girl in the PICU that had a horrible cancer.  We are so good at keeping humans "alive", she died (at least for me) the first week of our rotation, but our science kept her body pumping blood to the brain, kept the lungs oxygenating the muscles and the gut, which we fed with a tube in her stomach.  All this time I watched God or Fate continue to hammer new nails in her coffin, so many unlucky events for her and every time a nail went in (one day she'd develop a pneumothorax, the next an fungal infection, and on and on) I had this nagging voice telling me that some force greater than us must want her dead because of how persistently unlucky she was.  I never had to care for her myself, I'm glad...because I have a different word for the "care" that we do to the ones who have long since passed that we keep alive...I'll say it...torture, of the most sickening kind...the kind you wouldn't wish on your worst enemy...on Hitler or Satan himself.  One day if humanity survives itself and can look back from a better place, we'll look down on the concentration camps and the Tuskegee experiment's and, yes, the "caring" we show to our loved ones in the same manner of trepidation.  I'm not saying I'm in a "better place", I've just gotten to see enough of it, more than the most educated politician espousing how horrible it is to "euthanize" someone or one saying how righteous it is.

Here's what I want.  If I'm on a ventilator or a heart machine for more than a week I want you to take me off of them and give me a nice long morphine induced nap, don't feel sorry for me, not one bit.  There are far worse things than dying...I've seen them.