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
Thursday, October 25, 2012
Sunday, October 21, 2012
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
Newbie Doc
Saturday, October 13, 2012
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
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
Tuesday, October 2, 2012
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
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
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
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