For Keeps

I am really not ready to start 2007, but it is becoming apparent that I don't have much of a choice. If I keep dating things 2006, people will just look at me funny like the morning last week when I timed and dated one of my notes April 1993. Oops.

Many times people start looking to a new year all goal-oriented and stuff, but I have kind of already set lofty goals for myself, so I am going to ask you a tougher question:

What do you like about yourself that you want to keep this year?

For me, I suppose that would have to be my sense of humor and my compassion for other people. Lately, work seems to be full of war metaphors. In terms of healthcare, sometimes it seems like an "us vs. them" scenario in which the patient is the enemy. (Boy, I sound like our hospital lawyer's worst nightmare.) It is too easy to become cynical. While I agree that when taking care of others, one needs to be able to separate themselves emotionally from their patients, I don't want to get to the point where I have to be reminded about the patient's feelings. And I am guilty of it to an extent, in that I keep a very close eye on the clock. My day is pretty much built up around leaving and getting everything ready to leave on time. Maybe I have been approaching burnout, but I should still be checking and rechecking my patients, rather than their labs and their orders.

So to keep my compassion and sense of humor, I plan on taking better care of myself. Slowing down more in my free time. Less to-do lists, and more time for myself. Letting the voicemail pick up if I don't feel like talking. More saying "no" if I don't want to go out.

Happy New Year!

Typhoid Gary?

Today, I was in the cafeteria dumping salt on my scrambled eggs and about to go hide in the resident lounge when one of the aides from the floor asked if he could join me. He sat down and started talking about his career aspirations and how his dreams of becoming a chef were ruined halfway through culinary school when the heptitis outbreaks started. Then he asked me if I had any kids. That's when I shoved all my remaining bacon down my throat and said I'd better get back up to the floor before they noticed I was missing.

I really need to figure out how to page myself at opportune times.

Half Full Glass

It appears that I have caught a nasty upper respiratory infection over the past week. Yesterday I am pretty sure I was swaying during rounds as I felt feverish and weak. Today I feel better, but I'm kind of raspy and my nose has been running constantly. I think I've lost about 3 lbs in mucus! I definitely cleaned out five or six of those tiny, wimpy hospital boxes of kleenex that were lying around the units. My hands are chapped too, as every time I sneeze or blow my nose, I reach for a pump of alcohol gel.

I feel bad as I am around a lot of really sick people right now. The last thing they need is a nasty cold. At the same time, if I go home, there's no one to come in for me. There are too many notes to write and orders to take care of for one intern to do by herself. No one's said anything to me about it, but I'm pretty sure it's obvious to everyone on the team and they're easing up on me. The attending has been picking only on the other intern... then again, maybe that's because I'm about 6 inches taller than him!

On the plus side, my sinus headache has completely disappeared.

Home for the Holidays

Yesterday after work, I came home and opened the packages that I have been eyeballing for the past week or so. One of them contained cookies baked by my mother. I suppose that Springerle cookies are one of the few reflections of my German heritage. They are a crunchy shortbread-type cookie with a slight anise flavor. I remember opening packages from my grandparents as a child and there was always an old coffee can containing the cookies wrapped in wax paper. Admittedly, they weren't my favorite as they were very hard and the design on the top of them that is made with a special rolling pin always reminded me of bugs. Now, being a coffee drinker, I have a new appreciation for the cookies.

After taking a mid-evening nap, I woke up and drove a few miles out for a candlelight service at one of the local churches. I don't think that I've really mentioned this here, but I haven't found a church community here where I feel like I fit in. There's so much history and tradition in this part of the country. However, that same chronicity also seems to have served as a dividing line. For example, there are over a dozen congregations of the same small sect of Protestantism that I belong to. I don't really even know what the differences are between many of these groups. I have floated around when my work schedule has allowed, and have found most of the churches that I have visited here to be pretty empty. It's not that it needs to be a large social club, but it would be nice to have some friends outside of work with similar beliefs.

Anyhow, the church I visited last night was full. The hymns were reassuring as was hearing the passages. Although I didn't go to the earlier family service, I was reminded of many Christmas programs that I had participated in as a child. Even after all this time, I couldn't help but snicker as we sang the second verse of "What Child is This":

Why lies He in such mean estate,
Where ox and ass are feeding?
Good Christian, fear: for sinners here
The silent Word is pleading.

I can still remember wearing a long-sleeved red velvet dress and having to sing with the other 8 year-olds in front of the church. My buddies Jay and Chad helped to increase the volume on the word "ass" and pointed at each other for the words "sinners here". I think that in the following years that the adult choir took over that song.

The service ended with the traditional lighting of candles from person to person. Just like always, the drip shields weren't quite adequate and I ended up with hot wax on my fingers during the last verse of "Silent Night". There are times when I question what exactly I am doing here as I frequently feel out of place, but last night's service was a reassurance that I am home.

Party Pooper

Last night was our intern holiday get-together. One of our chief residents had a party at her apartment earlier in the week. The department cocktail party was just a little while back. I think I'm officially partied out. For the most part, I'm a social person, but I think I do much better with individual interactions. I just feel so awkward and forced in large groups. I'm not very good at mixing, and I often feel like I have nothing to say or just am kind of observing conversations rather than participating. Then again, when it's the same people over and over, what more is there to say?

After sleeping in this morning, I dragged myself to the gym. I have been reading a book that one of the other interns loaned me about running. I haven't been all that impressed because I think that reading about running is like looking at magazine photos to take a vacation. It just doesn't translate well. The one thing that I have taken from it is that I was overdoing it with working out almost daily. This author recommends running 3 times/week at the most and using walk breaks to increase your mileage and prevent injuries. This has been a little bit unnatural for me as my method before was to pretty much just run until I was exhausted. However, today I ran for just under 4.5 miles! It took me an hour because I'm so slow and I was walking 2 minutes for every 6 minutes of running.

Other than that, it has just been a day of returning phone calls, doing laundry, and watching DVDs. I am working late on Christmas Eve, and partial days (hopefully) on Christmas Day and New Year's Day. I kind of have been anticipating working holidays this year. With my immediate family being so far away, I figured there was no way I would get the 3 days or so off that I'd need for travel. Happy holidays if you are celebrating!

Vacancy

The hospital census has been extremely low this week. Last week we were overflowing with patients, with many checking in for quick tune-ups. Now, with Christmas and New Year's Day approaching, people are impatient and insistent upon leaving. Many more are foregoing their own health and staying at home, ignoring signs and symptoms in order to be with their loved ones. And then there is a small subset of lonely types who want to be hospitalized so that they will have some sort of human contact over the holidays. It's strange-- one would think that heart attacks and pneumonias would come on random days, but then when emotions and human will are factored in, the patterns all get out of whack. I imagine next Tuesday will be crazy.

One of These Things is Not Like the Others...

This afternoon we admitted a patient for elective cardioversion. He has an arrhythmia, and rather than taking medications to control his heart rate and rhythm the rest of his life, he'd rather us just shock him back into a regular rhythm. He had this done successfully back in 2002, and basically just wants a repeat performance.

While I was belaboring over a beautifully eloquent admission note (yeah, right!) it occurred to me how fine the line of the law is. For instance, why can this dude choose and schedule to have voltage sent through his heart when execution via the electric chair raises so much protest? How bad can it be if this guy's doing it again? Granted, his voltage will be considerably less, but similar concept, no? Why can't we just sedate our inmates and then zap 'em? It seems a lot less painful than what poor Gram and Gramps go through when their pacemaker starts malfunctioning and zapping them erratically.

A similar comparison could be made for lethal injection. When someone comes in with an extremely rapid heart rate, we slam them with a medication that stops their heart. The effects last for just a few seconds, but this is sometimes done without any premedication, and I've been told it hurts like Hell. Why is this behavior kosher, while lethal injection is being labeled as inhumane?

I suppose when one analyzes it further, what makes it "good" or "bad" is the intent behind the action and whether or not it's agreeable to the recipient. If Mr. X stands to benefit from the treatment, and our specialists aren't acting outside of their "scope of practice", then it's all aboard for electricity and antiarrhythmics. What if death row inmates got to choose from a variety of options? Would that make it more humane?

I don't believe that the death penalty is a deterrent for crime, but I think it's silly to house anyone for the entirety of their life. It just seems like such a waste of space and resources to me. I've heard arguments that life sentences are a greater punishment, but if we're really looking to punish people as severely as possible, then I think you have to forget about the whole humane argument.

And now that I have probably offended my handful of loyal readers, let the silence begin...

Brilliant

I was on "short call" tonight. That means getting to work at 6:30 am and staying until 8 pm. It's team call, but I don't really feel very involved with this particular team. They kind of overexert themselves and write orders on my patients while I sit back and wait for the staff to call me if there's a problem. I can check labs just fine from the safety of the resident lounge with CNN on in the background and my latte in my left hand. There's no reason to pace back and forth across the floor, asking poor nurses and secretaries why your orders haven't been carried out. That's just crazy. Besides, if the other intern in her desire to become a cardiologist and impress our attending wants to do every admission note and not only manage her patients but invade my space, who am I to stop her? I am quite content to breakfast, caffeinate, lunch, and recaffeinate all while compulsively checking my personal email over and over. I mean, one should pick their battles, right?

I'll always remember shedding many tears after receiving my first "C" ever during my first semester in college. It was in general chemistry. I should seriously thank that professor. Although at the time I was devastated, I think that was the beginning of the end of my perfectionism. The older I get, the more willing I am to let go.

So tonight, instead of leaving at 8, I asked to be excused at 7:15 to attend an interview with resident applicants at one of the pubs downtown. My "teammate" was almost gleeful to run the entire floor by herself for almost an hour. So rather than getting home by 8:30, I got home at almost 10 pm. Brilliant. Rounds tomorrow will come awfully early, and I have no one else to blame for my own tiredness, but I think getting out did improve my mood somewhat.

Trouble

One of my English teachers in junior high used to call me "Trouble". I think that perhaps I should tattoo my forehead to warn off men. BDG keeps calling, despite my "I don't have time to talk to you every day," and the more classic, "Oh, I forgot to call you back," subtleties. I guess I would rather just be by myself than have that kind of drain on my time right now. Maybe if there was some actual chemistry between us, I would feel differently.

Last week, one of the other residents asked me if I was dating one of the other interns. I've been hanging out with him quite a bit, apparently too much. He's got a great sense of humor, but it would be really horrible to date and break up with someone in the program. Too much contact and all that stuff.

On the other hand, I have had a medical student on my team the past week, and he's been really sweet about helping with all of my more mundane tasks like writing prescriptions. He's done with our service after this week, though. I've been showing him little tricks here and there... like what medications are more effective at making people poop. Maybe young and naive is a better route for me than older and wiser?

The Happiest Place on Earth

Lately, I resemble a woman from an Excedrin commercial, touching her temple and wincing with pain. I talk about work entirely too much here, but it just seems like I'm getting pulled in all different angles at once.

It is one thing to get paged and questioned at the same time. It is quite another to get paged and questioned while being bumped into, brushed up against, having your chair stolen repeatedly, and having people pile crap on your stuff and misplace your paperwork... all with a background noise level equivalent to an industrial vaccuum cleaner. Perhaps it is partly the sinus headache I seem to have had for the past THREE weeks, but I just have so little patience lately. One of my patients even looked at me the other day, and said "What's wrong? You usually are much more perky!"

My own personal mascot has become that little pink starfish from "Finding Nemo" who freaks out and wails, "Find a happy place, find a happy place!"

Somewhere Out There

Somewhere a woman in her 30's lies comatose, the victim of a catastrophic heart attack. She was programmed that way, familial heart disease. Her five small children visit every day with their father, hoping and praying. Today her toe twitched. Her husband has renewed hope, but the neurologist says there is none.

Somewhere a woman sits alone in a nursing home. No one has visited her in weeks. She has no idea that she wasn't supposed to make it, that her family had decided on a "terminal wean" from the ventilator. They were actually disappointed when she kept breathing on her own. Who's going to take on care of mother now?

Somewhere a woman sits in a rocker in an empty nursery. The twins should have been born last month. She knew something was wrong when she hadn't felt them move that last day. The ultrasound revealed what she already feared: no heartbeats. What she hadn't expected was the news that her unborn babies were captured on ultrasound holding hands.

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Life is not fair. Many of us are told that as children by our parents, but it's a lifelong struggle to be comfortable with the concept. People get angry, and look for justice when really there is no way to equilibrate their losses. I've heard it said over and over that people don't believe in God because this or that happened, and that a "just God" wouldn't allow such things to occur.

In the end, it all comes down to faith. I don't understand why bad things happen to seemingly good people, or why miscreants seem to get chance after chance. I suppose that in a fair world, there wouldn't be much learning. After all, one can't learn to walk without first falling down a few hundred times. The best I can do is believe that all of this unfairness has a greater purpose.

I don't really have much to write about. Here's something from my past:

I remember standing on the cool metal at the top of the slide of our backyard swingset. It was tall enough that I could look out over the top of our house and see for miles... the few skyscrapers that were downtown, a small levee and overgrown trees to the south.

In the distance, men rode on tractors lighting the fields on fire behind them. Huge billows of black smoke trailed behind them, rising and diluting in the blue sky. The flames burned hot and fast, but extinguished almost immediately, after reducing the dry stalks. Small, black ashes drifted in the currents of the wind and I tried to clasp my hands around them. The burnt remnants curled and flaked in my fingertips and left behind a smoky reminder of their presence.

The smell of a wood fire today still reminds me of the end of sugarcane season.

Agua

Pictures from the other weekend:




The roaring water made me want to build a trans-national pipeline and fill this in:


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I finished with baby delivering on Saturday. It was fun, but at times exhausting. Now I'm back at my hospital again, which is nice because I run into familiar faces here and there.

More Merriment

The workplace Holiday Drinkathon was last night. Open bar, chocolate fountain, assorted fried appetizers, the usual things. I think this one was restricted to residents, attendings, and their families. Afterwards, we went to a bar, and after that to Denny's. I can't remember the last time I stayed out until 2 am. Only a few unpleasant remarks were exchanged here and there, hopefully soothed by alcohol. McNeedy was making unintelligable statements to the higher-ups and my buddy and I tried to steer her away, but perhaps weren't quick enough. Oddly enough, she wasn't drinking at the time.

I'm not really sure what the logic is behind getting a large group of coworkers together and supplying them with alcohol. I know that these parties happen all across America, but unlimited amounts of alcohol with one's coworkers just seems like a recipe for trouble. It seems like a bad formula to me, but the drinks were tasty!

Haiku This

My friend, Ru, is quite the poet. I envy her as I can't manage more than a silly haiku every now and then.

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Holiday Lights

Twinkle, twinkle, lit-
Crap! I slipped off the ladder!
Stupid broken neck.

Cliche

One of my high school English teachers used to circle cliches angrily in red on our papers. If she found one, you were sure to instantly lose points. I often daydreamed of writing in nothing but cliches, hoping to create a product so soaked in red ink that her pen ran out. Ah, teenage rebellion...

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I feel like my writing here has been stagnant of late. Same $%*#, different day. Last night I worked another 24-hour shift. Like a fool, I put all of my eggs in one basket. I went to bed late the night before, thinking I would certainly be able to sneak in a nap somewhere during the day. It was nonstop action from 6:30 am - 1:30 am.

There was no calm before the storm.

I was up a creek without a paddle.

The staff (myself included) was running around like a bunch of chickens with their heads cut off.

There were many women around with buns in the oven.

I felt like a deer, caught in the headlights.

This morning, after being there for 26 hours, someone "accidentally" signaled a cardiac arrest on the Labor & Delivery floor. I was terrified it was someone I had admitted last night and hadn't heard anything about since. I sprinted down the hallway to find that it was actually the scheduled c-section patient I hadn't even met. When I arrived breathless, with my heart racing in the OR, a trail of residents scrambling in my wake, I found that not only had the patient not arrested, but she was awake and lying on the table talking to the anesthesiologist! They had simply wanted another obstetrician present for the section as the baby was starting to look distressed and had paged out a cardiac arrest by mistake... clearly when it comes to that staffer's brains, the wheel was turning, but the hamster was dead.

To talk more of this would be beating a dead horse.

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BDG was here this past weekend. He's a nice guy and we had fun hanging out, but he's clearly not Mr. Right, or even Mr. Right Now. I thought I had eloquently explained this to him on Sunday when we talked about how there could be no "us", and that we both have other things to worry about. I even told him that if he meets someone back home he should go for it. However, he's called several times over the past few days. It was fun having someone to do things with, and we did a bit or wandering around, but I really don't like having someone around all the time. I'm sure the calls will taper off eventually.

I also saw McNeedy today. Fortunately, she was smart enough to not ask about my weekend.

Ahem

So yeah, apparently I'm not exactly a great communicator. About 10 minutes after my last post, "needy co-worker" called me up complaining that she's fat when she's about 3 sizes smaller than me. How rude do I have to be? I guess at least I'm learning how to be more confrontational.

Right now I'm ticking away minutes in the call room. I really just want to go to bed, but I'm stuck waiting on some lab results so that I can send someone home. Labs and pagers, these are the enemies of an intern.

Think Happy Thoughts

I'm ok, but I almost completely lost it with a co-worker tonight who won't stay out of my business. I have told her over and over that I keep my personal life personal, but she just keeps prying and trying to guilt me about not opening up to her. I told her off, but I think I was pretty diplomatic about it. I really just want her to leave me alone. Someone with common sense would, but then I'm not exactly dealing with that here.

The plan is to just relax when I have time off and avoid all contact... perhaps with everyone. Kind of like mini-hibernating. Maybe I'll take a day trip somewhere this weekend and get out of town. No phones, no internet, no pagers. It sounds lovely already.

Eat, Drink, and Be Merry

I think I accomplished all three of the above over this weekend, and even risked four hours of shopping on Friday. I even managed to find a cocktail dress for the upcoming department party! It actually wasn't all that bad, but I still have quite a bit of shopping to do. With having relocated this year, unfortunately most of my gifts will require shipping. Argh. The goal is to be done with it by next week.

My body took advantage of having three days off in a row by completely shutting down yesterday and going into full-on exhaustion mode. I guess I had it coming.

Today I'm back for another 24-hour day at the hospital, which will end with my semi-annual evaluation with my program director tomorrow morning. Yuck. I like the guy well enough, and I actually have some entertaining tales to tell him from "medicine" last month-- let's just hope I'm not completely delirius. Wish me luck!

Seriously?

24-hour call, again.

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My head hurts.

I just got paged by a local pharmacist wanting to know how much Robitussin with codeine to give to my pregnant patient. I wrote "1 bottle". You would think this would translate to whatever standard cough syrup-sized bottle is on the shelf. You would think wrong.

This guy tells me, "We carry this stuff in bulk, I can give her as much as you want."

I'm thinking: that's great dude, give my pregnant patient everything you've got, give her so much cough syrup with a narcotic in it that she can't carry it out the door. Let's see what happens. Perhaps she can score some sweet cash on the street for that stuff. Instead, I say: "How much did I say she could have?"

"You wrote for 1 teaspoon every 4 hours." (1 teaspoon = 5 mL)

"Good, let's give her enough to last her just a few days."

"Um, so how much should I give her? We carry it in bulk. I've got TONS of this stuff."

"Just give her a small supply, she's going to see her real doctor soon."

"Ok, how about 500 mL?"

Seriously? Seriously? Did you really just say that to me? This is a controlled substance, and my DEA number is technically not even real. "Um, let's go with SIXTY."

"Ok, we can do 60. Just so you know, I have this stuff in bulk."

"Great, thanks. You might want to save some of that stuff for someone else." Click.

And yes, I am being a little stingy with the supply on this one. My attending approved the dose, but I still don't like giving it, and the patient said she really didn't want to take it anyway.

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My head hurts.

Just prior to that I got a call from the nurses' station. Apparently, one of them is vacationing in Chicago with her mom, and wanted to know if her mom's antibiotic eye drops could be causing the rash on her face.

1. It's 10 pm. I have been here since 6:30 am.

2. I'm an intern.

3. I'm an intern on the "Obstetrics Service".

4. I don't even know this nurse.

So what do I do? I get out of bed(!), walk down there, punch the drug into my PDA and say, "Nope, don't think so. She probably doesn't need to go to the ER unless she can't breathe or her mouth/throat starts swelling up. Glad her eye looks better. Happy Thanksgiving."

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My head hurts.

I currently have an "induction of labor" cooking. Only instead of putting in a cervical-ripening agent that lasts for 12-hours, my attending went with the one that lasts for 4. This means that I have to check the patient and place another tab at 11 pm, 3 am, and 7 am. Perhaps he hates me? I don't know, I think perhaps he just didn't think about it as he also ordered her a sleeping pill. How is she supposed to sleep for 8 hours if I'm supposed to check her cervix several times overnight? Then, in the morning, after she's had a crappy night's sleep we'll start the pitocin drip, which will make her uterus start contracting and she'll really feel awful. Great technique, eh?

Just a few more minutes, and hopefully we can get her next dose going and I can grab a few hours of sleep.