My Fears

8/20/2013 Recently, I was on a lovely 24-hour work binge and early during the evening I got a consult for a little old lady (LOL) with a bowel obstruction. She came in with abdominal pain, nausea, and vomitting. The CT scan showed that her bowels had gotten into some pretzel-forming shenanigans so bad that you could actually palpate the knot of bowel in her abdomen on physical exam. It almost felt like a tumor. She needed an operation. STAT. DR. TINYCAT! (please see picture at the bottom) :) The problem was that she was over 90 and demented. And unfortunately, the surgeon I had to work with does not have the best reputation. Now, I had to tell the husband that she needed an operation as soon as possible, because her bowel was at risk of dying since it was so twisted it was going to cut off its own blood supply. This risk was greater given the fact that I wasn't called about the consult for 12 hours while the patient just sat in the ER. If we held off on the surgery, her bowel would become ischemic, die off and bring her along with it. But she was very old with other health problems, and the surgery itself could kill her. The look on his face... I guess that's what distraught would look like. He kept asking if we could hold off on the surgery cause he thought it would kill her. But I had to keep insisting that even though she looks okay and isn't in pain, the risk of her dying without surgery was greater. He stuttered a bit and finally agreed. You got to do what you have to to save her. We go to holding and the husband is nervous as he shuffles around with his walker. I engage in a similar conversation with multiple staff members: "You ever operate with this surgeon?" "No, this is my first time." "Oooh... well, good luck." "Yeah, I know." Even the scrub nurse, out right whispered to me, "This doctor is going to kill her. I really don't want to be here for that. Worst surgeon I've ever worked with." Oh Baby Jesus, in your little onsie, please help. But, what touched me, was this moment: The patient gets wheeled from her spot in the holding area to the doors that enter the operating suite. The husband having had his back turned while taking to someone notices she's bein wheeled away. He so nervously starts rushing forward in his walker with fear in his voicing saying "Please, let me give her a kiss goodbye." Everyone stops the anesthesiologist from taking the patient away and the husband caresses his wife's face and kisses her forehead. He tells her he loves her and that he'll be waiting till she gets back. Everyone reassures him she'll be fine.... I feel myself lying to him when I say she's going to be okay. He smiled and just shook as he stood grasping his walker, watching the love of his life be strolled away. The woman he'd been married to for 70 years, we found out. LUCKILY, the case went well, and she's okay! But it got me thinking of how scared the husband was knowing he could lose his wife that night. She wasn't healthy healthy, but she was in a good state, doing well. He brought her in because he was worried about this abdominal pain and to suddenly find out she needed life-saving surgery that could potentially kill her. He wasn't mentally or emotionally prepared for this. No one could be. And within 2 hours of meeting him, I had given him his wife's diagnosis and was wheeling her away to surgery. All a whirlwind in his mind I'm sure.And I don't know, it made me think of things I'm scared of. How I haven't been afraid to lose something or someone like that. Someone whom you built your life with. At the time I was afraid of losing someone (as in the relationship would end, not her life) who I had been dating for a couple of months. I didn't want to lose the relationship and companionship that had developed. But the moment I saw the husband kiss his wife goodbye, it made everything seem so insignificant. Most of the time, our interactions with other people can be so petty and inconsequential, yet because it is personal, they tend to be exaggerated in its importance. She was on my mind and whatever would happen, we'd remain friends. In the end no big deal. Especially compared to this couple who might have just said bye for the last time. Seeing how scared the husband was made me just think about what I'm afraid of in this life. I'm afraid that as a surgeon I won't have insight into my ability. I hate to say it, but some surgeons are not good. They shouldn't be operating. They put people's lives at risk. No one should be operating for more than 12 hours, 10, even 8 hours, ever! Unless you're some plastics guy reconstructing a person from scratch, and by scratch I mean play-doh). I don't want the residents and nursing staff to express the same opinions about me as they did about the surgeon that night. It's not that they aren't smart, or know the steps, or care about the patient. I just feel like either they either can't accept that they fail as a surgeon, or they really just have no inisght and think "Well, that was tough and anybody would've had the same problem." If that ever happens to me, I ask my collagues to just break my hand so I can't operate (but not enough that I wouldn't be able to play videogames). I'm afraid that I may not be the person I should have been. Or could be. I sometimes look at my shortcomings and think they probably just extend from my lack of committment. I love to try and do so many things but I don't finish it. Its something I've been trying to work on, but with work it interferes. I want to write stories and be published. I want to make beer and maybe have a personal recipe. I want to continue making origami. I want to start playing the flute again on a consistent basis. I want to be able to do well in my career and become a safe surgeon. I want to finish the books I bought 6 months ago. Too much... but I want to change that. I cancelled my cable so I'm less distracted! So, baby steps! I'm afraid of things with many legs, like millipeds. Why, why so many legs?!! I only need two, why do you have so many??? Trypophobia. Enough said. http://www.buzzfeed.com/daves4/trypophobia-is-a-real-terrifying-thing-and-you-definitely-ha I'm afraid that I've hurt people I cared about enough that they don't want to see or talk to me again. And not because they don't want to talk to me, but because I made someone feel that bad that they had to cut me off. I'm afraid that my mother's adoration may be underserved. That perhaps any admiration from anyone in anything may be. That I'm not living up to expectations of others, or even of myself. Like I could be some kind of fraud. I'm afraid that the world may run out of bacon... or shrimp. I'm afraid of getting old. I see so many patients that have dementia and it's scary. Losing who you are completely. No memories. No emotions are stirred when you look at loved ones. No inside jokes when you chat with friends. Or becoming so frail and weak that you become a drain of your family and friends. You end up getting stuck in a nursing home, passed out in your wheelchair along with the other gomers. I'm afraid she'll walk away. I'm afraid of killing a patient. What if I forget to order something, or follow up on something? What if I forget an important step in a procedure? What if... anything?! It happens to everyone. It'll happen to me. I just hope I don't cry too much afterwards. I'm afraid I won't get to see the Northern Lights. I don't know why, but I feel like I have to go. I'm afraid that if this life is all we get, it gets wasted away with nonsense... crappy TV (which i now cancelled), mundane paperwork, irritating interactions, sleeping, staring into space, pooping, traffic, etc. I have a huge fear of missing out, and it's annoying because, sometimes I'm not really missing out on anything. Not every night out is epic. Not ever happy hour is epic. Not every party is epic. Some times, they suck. And they are a waste of money. And a waste of time. Time I could have been using to make origami, reading a book, or making a new delicious dish since I'm a chunky monkey. And to be sappy, I'm afraid I won't know when I've found the love I'm supposed to fight for. But if some of my degenerate friends are married, I can't fuck that up too bad. I'm sure I'm afraid of other things like the kraken, veggie burgers, or mermaids not being real.

Year in Review: My Bad News

8/20/2013 As much as being a resident sucks with the shitty schedule, nothing drains the happiness out of my bacon-flavored soul like delivering bad news. Yeah, I get upset when I have to miss out on seeing friends, going out, or what have you, but I'm over it quickly. With this, it's like you have to recover from it. I'm not sure if there is another job-related activity out there that even comes close. Not only do you have to deal with whatever reaction the patient or their families go through, but you have to deal with yourself. If we were robots, then it would be a piece of cake, but we're not. Our own emotional and psychological fortitude, if I may, is just as important in survive this conversations. There's two conversations that come to mind that relate to this. The first was a gentleman who presented with lower abdominal pain and lack of bowel function for about 3 days. He came into the ER and got a CT scan which showed an obstructing lesion in his colon. Yup. Cancer. So, I get called from the ER to see the patient and and I diligently gather all my information before meeting him. He was a very nice guy with an equally nice wife. After talking and examining him, I asked him what his understanding of the situation was. He tells me that was just told that "there was something with his colon and surgery had to be consulted." Now something that vague turns people into nervous wrecks. Unfortunately, this seems to happen a lot in some hospitals. Whatever doctor saw the patient first just decides to pawn off any responsibility of actually talking to the patient and explaining their condition whoever they consult. I'm sure it's happen to people who read this. Why? Probably because they themselves are not comfortable with these conversations. And yes, they may be attendings who have been practicing for years and still won't bring themselves to it. So guess what? It falls on me. At least I'm awesome and can handle it. I explain to the patient that he has a mass in his colon of which I cannot say is cancer with absolute certainty, but it's very likely. And, it took me a little bit to use the word cancer, because I was uncomfortable doing so. I don't want to bring distress, pain, or worry to my patients. Words like cancer and death shock someone. Thier mind locks up and focuses on that one word. They don't listen to anything else you have to say, because to them, their life was just given an end point. I don't want to be the cause of that, but I have to be honest. I owe it to them. I'm not going to pawn off that responsibility to someone else. I don't think anyone ever gets comfortable with this situation. In time, we deal with it better, but it is tough. Imagine the awkwardness and hesitation you have when you want to break up with someone. Not fun, huh? And as technology has gotten better, we went from breaking up in person, to over the phone, to email, to text message. Sometimes we kind of just avoid the person until whatever relation fizzles out. Though, probably guys do this more than girls. We try to distance ourselves as much as we can from the other person so we don't have to face their reaction and the consequence of our decision. We want to avoid feeling bad when we see the pain we cause the other person. And that truthfully makes us selfish as hell. But now imagine that same feeling but multiplied with the fact that instead of ending a relationship with someone who will eventually move on, you are talking about a life ending. And you can't do it through texts. I don't think they've come up with the right emoticon for it. So with this guy, the positive was he was a surgical candidate. The mass could be resected and he could undergro whatever treatment he had to. After going through the barrage of questions from his and his wife, I feel like I was able to help them understand the situation and give light to the fact that there is something we can do. It was hopeful. I was on service during his stay and it was always nice when they would specifically say hello or bye to me when we rounded as a group. For whatever it was worth, however I led that conversation, I did it in a way that they felt they could trust me and felt a connection with me. And that's invaluable. The second conversation was actually with a patient's family member. The patient was an unfortunate soul who fell and suffered such severe brain trauma that he had to be given CPR out in the field. By the time he got to me in the ICU, he had no neurologic function. Brain dead... though not confirmed so we did what we could to prevent further injury. I was the chosen one who had to call the sister. What I wasn't aware of, was that I would be the first person to talk to her. She had no idea her brother was in the hospital. She was shocked, of course, and confused as the story didn't make the most sense. At first, I tried to cushion the news of her brother's situation, but I quickly realized it wasn't right. She was under the impression he would be waking up and getting out of the ICU in a few days. So I had to just say that it was extremely unlikely he would ever wake up. The metaphorical bus hit her. Her voice cracked and I could amost hear the tears start pouring out. Her words stammered non-stop. The tone of worry in her voice was replaced with fear, dread, and panic. I had caused that. She was going about her day until she got the call from me. I tried to comfort her as much as I could but a person can only do so much, a person can only take so much. Her last words were, "I'm sorry I have to go, I'm about to throw up." I felt like crap. And it's not like when you break up with someone, you feel relief. A weight has been lifted. Freedom tastes so nice. On to the next conquest. No. Instead, you carry it, and it's on to the next dying patient. I don't imagine doctors carry all the bad conversations, deaths, and mistakes they've had, but I'm sure its a lot of them. I'm sure they can remember patients right down to their full names, ages, and hobbies. All that weight on our backs keep us grounded, focused, and attentive--wary of the pitfalls and mistakes of the past. And that's good, but it can destroy us. Having reminders of those lives lost is like having dementors slowly draining us of a will to keep going. It is what it is. And luckily for every patient I have to say good-bye too, there's many more who will take my hand and thank me for whatever small part I played in their recovery. And that's invaluable. “I guess I came over here to tell you how proud of you I am. Not because you did the best you could for those patients... but because after 20 years of being a doctor, when things go badly, you still take it this hard. And I gotta tell you man, I mean, that’s the kind of doctor I want to be.”— J.D.

Year in Review: My Forgetfulness

7/7/2013 Looking back, being in residency is kind of out of this world. Everyone outside the medical profession wants to know what it's like. They don't even understand what residency is. Are you still in school? Do you get paid? You're training? Is it only for a year? Are you really doing surgeries? It's easy to forget that this world is completely foreign to laypeeps (Not lay-springtime-delicious-treats, but laypeople). Working as a resident means being in a 3-???-year paid training program. We are overworked and underpaid. We are yelled at by angry patients. We are reprimanded by angry attendings. We get at least 15 different human bodily fluids spilled onto our already stained scrubs, yet we can't make a face lest we upset the patient. We sometimes get thanks. We sometimes get to eat. We sometimes get to sleep. We miss going out and having fun. We miss laying on a couch and doing nothing without worry. We miss being with friends and family. We do good. We make mistakes. Unfortunately, those mistakes can cost lives. And when we go home, we're kept awake knowing the hospital doesn't sleep, and the shitstorm will be waiting for us in the morning. Yet for all the crap, we get paid to save lives. Life would be grand with another career. A 9-5 job where work stays at work, weekends are off, and you can take vacation days and sick days. It's just not for us, I guess. I know I couldn't stand sitting at an office desk. My day is random and lovely: running around the hospital, flirting with nurses, seeing patients, operating, and shuffling down hallways. It's all chaotic, busy, tiring, unexpected, and exciting even if frustrating. Yet as it all becomes commonplace after a year, I had to stop and wonder that my life after all isn't the shitty one--it's the patient's. I forget that the patient is not just A patient. He is a father. A son. A muggle. She is a wife. A fancy CEO. A unicorn breeder. They had lives before meeting me and hopefully after we say goodbye. Their days weren't filled with concerns of being sick, getting better, or dying. Their worried about providing for themsevles and their families, and doing well at their job. When they get sick, they want to make sure they are okay. Chances are they will be. I've never been an inpatient. I've been to the ER a few times but only for a few hours, no biggie for gp. I can empathize patients, but only to a certain degree. I forget that when I introduce myself as a surgical resident (and 2-time winner of best mushroom haircut in highschool), the patient immediatlely tenses up and is afraid of me. Why is surgery involved? Am I being operated on? Am I going to live? My first job is to calm them down and explain the situation to them (You have a bowel obstruction and a surgeon is most apt in managing this, though most of the time it is treated non-surgically. You have free air under the diaphragm which means there is a perforation somewhere in your intestine and will need surgery). I forget the patient with abdominal pain is hoping it's just a stomach bug, but that hearing the word surgery is scary. Probably only second to hearing the word cancer. I forget that the patient is dressed in an ugly, standard, oversized gown that only covers half their body. I forget that people aren't used to being half-naked, even if home alone. I forget people aren't used to being confined to a room, or half a room and a bed. I forget they get nervous when a team of residents come in to round at 5 am. I forget they get nervous and scared when they are meetting multiple physicians and consultants and aren't getting straight answers. I forget they aren't used to having IVs and drains and tubes in them. I see patients with drains coming out of every orifice and skin surface, all day. They never had a nasogastric tube inserted into their nose all the way to their stomach to clear it out. They never had a foley catheter in their peepee to drain urine. They never had a grenade-looking (Jackson-Pratt) drain sticking out of their abdomen after an operation or a chest tube between their ribs. They NEVER had an OSTOMY! Imagine waking up from an operation to see a bag sticking out of your abdomen only to realize that it's there to collect stool because part of your intestine is now opening through your skin. Just.... imagine that. Look down at your perfectly intact flabby belly, filled with beer and bacon yet protecting washboard abs from the sun, and imagine this weird pink, bulging tissue with a hole in the middle. Then, realize that you are looking into your intestine and that hole is where stool will come out of. And if you can't properly take care of it, you will literally shit yourself. I can't. I know I see it on other patients. The first time I had to change someone's ostomy bag, stool come out and soiled the patient, his bed, and, fortunately, my gloved hand. He was very apologetic and embarassed. Anyone would be, but I had to calm him and reassure him it was just an accident and that it happens all the time. Plus, I was getting paid so i wouldn't have felt right if my job was too easy. But seeing an ostomy on myself? I'd freak the fuck out if I didn't know I was going to wake up with that. We consent patients and explain it to them, but it's not like we're pulling out Google Images to show them what it's going to look like. For the patients who we can't consent because they are intubated or unconscious, fuck. Or, maybe not even an ostomy but an open wound. It can range from a small one of about 5 inches after an open appendectomy because the appendix perforated, to one that travels the entirety of your abdomen requiring a wound VAC to close it. I once had a patient cry in the ER as we were packing the wound because she could no longer take the reality and broke down. A young pretty girl, in the midst of summer, now had a decent sized open wound in her abdomen that was not going to close for weeks. I forget how devastating it can be for a person. And you think, it's just a scar! I saved your life!The patient doesn't see it that way. They only see the finished product. Yes, they are alive and they are grateful, but now they have to carry this reminder on their body for the rest of their life. I'm sure they'd like for it to at least look nice. The patient comes first. They need to feel comfortable and safe. They need to know they are being taken care of and how. Their questions need to be answered (no matter how many times). Their fears quieted and their hopes lifted (if appropriate). We shouldn't take things personally, because as bad as our day is, theirs is worse, because sometimes we know that that patient on our service who can be a jerk and is ungrateful to everyone... sometimes, we already know they won't make it out of the hospital alive. I wish I wouldn't forget these sentiments, but chances are, I will. I'll be swept away by the chaotic routine of the day. NGT here, foley here, digitizing an ostomy here, etc, etc.... until a patient starts crying. And then I start crying. And then after a few moments, I ask, "Wait, why are we crying? Is Finding Nemo on? Did Marlin leave Dory?!" And she tells me that she can't deal with what's going on. She can't deal with having an ostomy. She can't deal with an amputated leg. That she needs to talk to someone. Honestly, I don't know how we don't have everyone talking to "someone" be it a chaplain, psychiatrist, or a friendly neighborhood Jan Itor, without his knife-wrench, of course. But, like I said, I'll forget. We all do. We might have to, in fact, once in awhile. Or else, we probably wouldn't survive. *If you read all of this... here's a prize: http://themetapicture.com/media/funny-T-Rex-toilet-paper.jpg

Year in Review: My Gratitude

7/1/13 At 8am I left Jersey Shore hospital after working my last shift as an intern. *happy dance* It's a great feeling to know I'm not the littlest monkey on the totem pole anymore. Though, if the intern is out then I'll be reverted back to my younger days and be forced to hold the damn pager (No other sound will ever instill as much irritation, panic, sadness, and anger as that ring... we even have nightmares on call where we think it went off and didn't answer it). Actually, every resident will still cover the pager if needed, but as long as you're not the intern, you can pass it off to a junior person as soon as possible (so much so, that you can throw it at the junior the minute you see them down the hall.... I mean, it's a curse. Why would you hold on to it?). And what does it all mean? It means I won't have to do these annoying months of alternating between day shifts and night float on a weekly basis, but instead will actually take real "call" and be at the hospital for 24 hours (which means I get a post call day, and get to sleep and be productive in my personal life). I'll get to operate more. I'll get some more days off a month. And as scary as it sounds (which is really scary), I'll be the most senior resident at the outside hospitals during the night when on call... but more on this later. Things are better for a second year (for most people), and that's exciting. Intern year was not the worst.... I had a great time, overall. I've formed some great friendships, made some great memories, and have done/seen some pretty cool shit. I mean, do you get to put in chest tubes to help re-inflate someone's collapsed lung? Amputate some toes? Use sweet instruments to take out an appendix or gallbladder? Or a wedge of a lung? Or delicately suture an artery to a vein? Probably not. So, yeah, as much as the long work hours, co-resident tension, ER frustration, and the more than ocassional grumpy, unappreciative patient annoy me, surgical residents do some awesome shit to save lives, and you can be jealous while you sit at a desk excelling. But, our social lives are sub-par, so there's a decent trade off, but we make the most of it. And, I'll still drink you under the table. But for what it's worth, I've decided to reflect on my past year, and before doing so, I wanted to start off by showing my appreciation and gratitude to those that have made this year what it is. However, this isn't to thank friends and family. (But, very quickly, I love my family and my friends. I thank them for always showing support. I also really thank everyone who keep inviting me out and understand that chances are I won't be able to make it, but they don't forget about me. So for that, I am very grateful. It's very easy to become a hermit in a job where you are working 80 hours a week, 6 days a week, day or night, and when you get home, all you want to do is sleep.) No, this is to thank the rest of the supporing players, and they are mostly at work. NURSES I would not do your job. NOPE. I'm not sure you need 3-4 days off a week, but I suppose it's well-deserved... at least to the good nurses. (By good nurses, I mean the ones who aren't lazy and work hard. I'm not a fan of a nurse who questions a proper order to replete a patient's potassium through an IV because "that'll take all day." I'm here all day, so are you, and the patient isn't going anywhere, so hang up the damn bags) I don't know if the ladies and gents currently in the profession would agree, but I think it's glamorized to the outside world. You have beautiful nurses who assist sexy doctors in treating good-looking patients... and then they start haveing sex with each other on the patient's bed... oh no, wait, that's porn. No, wait, it's not. But, I think it's true. You don't see the truth of what it is to be a nurse until you are hands deep in someone's shit trying to clean them up for the 3rd time on your shift. Their day is full of charting everything that happens, following orders from doctors (and sometimes, astutely, catching errors and potentially saving lives), cleaning up patients, holding their hand, talking with them and trying to answer their questions and comfort them and at increasingly frustratingly times, get a damn doctor to see them. They are the ones taking care care of patients. I would say we manage their care, but I'm definitely not the one giving medications (orally, intravenously, or rectally) or doing most of the aforementioned. I will most certainly talk to patients and try to comfort them or make them laugh, and of course put in orders and operate, but for the other 20 hours of the day, the nurses are the front line. When I first started, exactly a year ago, I would mentally piss my scrubs everytime the pager went off. I was responsible to call back and respond to the nurse. I had to make a medical decision, no matter how small. A great piece of advice when starting off was, "Just ask what the nurse would do." And by golly, I did. Of course, this is only appropriate in certain situations. But, the nurses have been around for years and they've seen a lot of this before and know what's usually done. And, especially for that first month, thank God they do. Can you imagine having to deal with interns as a nurse each year? Here you are working at a hospital for at least 10-15 years, and in comes some sexy, cocky yet self-deprecating, nerdy surgeon straight out of medical school who hesistates at whether to put in a foley or straight cath a patient, and you have to call HIM for orders and answers? Right there I'd want to kill myself. Is that patience? Understanding? I don't even know. And that's another thing. Nurses can't do much without an order from doctors. I guess in an era of malpractice and lawsuits, everyone has to cover their asses. Honestly, I would feel so constrained not being able to take care of things without an order. Can you put an order for tylenol for a headache? Can you put an order to flush the foley? Can you put an order saying it's okay for the the patient to shower! Of course the patient can fucking shower, I don't want to smell him at 4 am in the morning when I'm rounding! (It's a him, because girls only smell like roses... and they don't fart or poop. So much the superior race.) Yet for everything they have to deal with, most nurses love their job and their patients, I think. And I'm sure they have the best stories at parties. If you're going to be a nurse, you have to be truly altruistic. You have to deal with a lot as much as we may complain about their attitudes, and work habits, and what have you, patient care wouldn't be provided. There'd just be orders in a computer... (they're in the computer?!) So for all that, I thank you. PLUS, some of you are attractive... or funny. Or both! I thank you for that, too. NURSE TECHS You help out the nurses and that is invaluable. Thank you. PHARMACISTS An invaluable resource. Many times, especially when starting out did they help me with medications and doses and antibiotics. And I love it when they teach why an order should be changed and then volunteer to fix it (I mean, I'm already busy putting in an Okay to Shower order). The pharmacists at RWJ are great and extremely helpful, and I love them for gladly adjusting and re-ordering TPN for my patients. It's a slap to the face when I'm at the outside hospitals and they are not as helpful or generous. So for that, I thank you. ORDERLIES Thank you for wheeling my patients where they need to go. Surgeons need pictures, and pictures are taken down in the basement at radiology. Patients need to get there. Thanks, Wheelman. Your stretcher-handling skills, I will write home about. JANITORIAL ENGINEERS A hospital has to be clean. Everyone plays their part in making it run. And, for the 89 year old man who still cleans our call rooms, you are an inspiration. Thank you, gramps. CAFETERIA PEOPLE Thank you to the people who don't charge me a nickel for a cup of water. Shit adds up. OPERATOR How do you know the know the numbers to any office/department I ask for so quickly!? How do you know everything!??! Thank you and your witchcraft. PATIENTS Thank you for letting me stick a knife or needle in you. Most fun.

My Sun and Moon

We share this one moon no matter the distance And though I can't run across the ocean to you, I can sing from the dying sun to the blue moon. The crashing waves on the coast carry the beat As the twinkling stars above shine every note And I blow a gentle breeze to let you know that This song is from me to you. We watch this one moon Feeling at peace, as one. But there, the green flash of a new day And the feeling is gone. For the sun with all its warmth and light Feels too large and busy As if owed to all those awake Working, struggling, worrying. It's not the quiet moon With its soft glow That brightens dark corners And uplifts lonely hearts By reflecting the love of the Sun Even when they are apart ... draft, not finished yet. it's 430 am. its late. wompity womp 11/27/2012

My First Month

And it has begun. I officially started residency a month ago, on July 2nd, and it has been awesome.....ly tiring. Hospital-wide orientation began on a Friday... a day so hot I decided to wear a polo and shorts, because if all the other guys wore shirt and tie, the polo wouldn't make me stand out too much. Most of them did. I reveled in my comfort. The day preceded with a bunch of useless lectures, including one on how to avoid lawsuits and all, which was presented in a much better tone than Ted Buckleys. After the day ended for most people, we went on to the surgery department orientation which is when we first received our white coats. Obviously, we threw them on immediately and felt impowered.... a feeling that would quickly dissipate in a few days. After the weekend, we started our first day. Luckily I knew how things worked at the hospital because I was there as a student, but it took me time to realize that nothing happens in a hospital without an order.DAMN ORDERS. It's what I spend most of my time doing when I'm at a computer. Putting in orders for patients. Medications, foleys, nap time, imaging, lab work, and tickling sessions. Even though they know more of how to manage a patient from their experience, nurses really aren't allowed to do much without an order from a doctor. A doctor.A term that still feels unearned. For the most part, I introduce myself to doctors and usually nurses by my first name. I feel unworthy of it. I may have grown 1% more comfortable with being referred to as a doctor, but it's still weird, because when I'm addressed that way, it is because I have to make a decision. I have to give an order. And when I started out a month ago, that was overwhelming. But, going back to the first few days. I stumbled around a bit trying to remember that I have to put in orders for things to happen. Nurses would call me to put in orders. I would get paged cause I put in the wrong order.... "Doctor (there it goes again), the patient is NPO (nil per os, nothing by mouth) so they can't take pills, can you change it to IV?" (What? Are you not accepting my challenge?) "Oh, yeah, sorry. Changing it as we speak! Thanks." Obviously, the best part of doing this whole thing is the ability to operate. http://www.youtube.com/watch?v=2wZlqsw-VyY And as Dr. Turk Turkleton once said, "This morning, I had my hands inside of a guy's chest. I couldn't even see them! I should not be allowed to do stuff like that." As an intern, I'm not doing big crazy cases (though I did get to do a laprascopic appendectomy and cholecystectomy [take out appendix and gallbladder using small incisions and a camera]), but normally doing hernia repairs. It was a great feeling to have the attending tell the scrub nurse (who gives us the tools in the OR) to pass me the knife to make the first incision, and I realize that though I am learning I am going to be doin most of the operation, which I do. Just recently I had to take a cancerous mole (melanoma) from a patient's cheek, and I didn't think I'd be doing that incision, but the attending passed me the knife and said becareful around the eye. AH! Oh, and I did get to amputate a toe. That little piggy ain't going NOWHERE! I do love operating. It may get repetitive, but that's how you learn. This isn't easy stuff. That's why training is 5 years just for general surgery plus a fellowship to specialize... and even then you're not gonna be at your peak. And each human body is different. Each case is different. And then, when you think you have nothing else to do, you can always be at a teaching hospital and train students and other residents. Plus, we're not only doing stuff in the operating room. On my second week, I put in a chest tube to help decompress a patients lung. And guess what, it worked beautifully. http://s1.e-monsite.com/2009/01/19/10/40556091pneumothorax-gif.gif (This is an example, notice how there are no lung markings on the left, it's completely dark... that's a collapsed lung). Also on my second night, I get consulted as I'm covering urology to put in foleys (the small tubes that go into the urethra to help you pee) for patients because older medical residents are uncomfortable. I literally strolled up to one of them and said: "I talked to the urologist and he said there shouldn't be a problem putting in a foley, he's not at risk for bleeding, so you can do it." "No, I'm not comfortable, but he really needs one, he's very distended" "Alright, fine. I'll do it." And on the 3rd day, GP said, LET THERE BE PEE! True factoid. The patient was so distended and had to urinate so bad that he could not lay still. He was calling out for help and writhing around. The moment the foley went in and about a liter of urine poured out, the patient passed out. But I'm not putting in foleys into pensis all day, all night! Sometimes, I'll find myself in the ER or some hospital room cutting into peoples abscess to let the pus drain out. That's what we do as surgeons, we take care of bizniz. We can take care of our patients operatively and nonoperatively. We can prescribe the medications and all that, but when it comes down to it, we can do all these procedures as well. But unfortunately, compared to more senior residents, I won't be operating as much. I'll get to a decent amount, but I'm an intern. I have to learn how to cover the floor, manage the patients, and answer the pager...... The.... Pager.... The source of all my anger. The pager is not so bad. It helps nurses get in contact with us when they need an order. I was terrified my first morning to get my first page. Why? Not because I wouldn't know what order to put in or how to answer a question. I knew that was gonna happen regardless. I was nervous for the page that would be like "Doctor (Stop calling me that!) your patient is coding!" which is code for dying... NOW! The heart rhythm is all out of wack, their breathing might be gone, they may not have a pulse. It calls for CPR, fast medications, and even defibrillating them like you see on TV.... CLEAR! BZZZ! My first page like that.... I was on night float. My pager went off a few times in a row which is common at night. I can literally sit at a phone for an hour just answering pages because as the intern, we are covering all the other surgical patients which I would say is close to a 100. That can get extremely overwhelming and frustrating, especially when you already have a tone of other work to follow up on from the day team, new consults to see, and emergencies to take care of. But anyway.... my pager goes off a few times, but I'm in the middle of seeing a patient so I dont rush to answer it. When I look at my pager I see ithe callback number is from a room. I start to dial back when I panic... the overhead system says "Doctor Vidal (Whose playing this joke on me?!), please call 8 Tower!" WTF IS HAPPENING? They answer my call on the other side. "Is this Doctor Vidal?!" "Yes" "Your patient in room 69 is bleeding out, come here quick!" I start running. I'm not even sure the fastest way to that building because as hospitals grow they tend to build buildings into complicated mazes with hallways that don't line up, and floors that are not in alignment. But I'm running and thinking to myself what the hell am I gonna do. Luckily, my senior calls me at that very moment while I have the phone in my hand to call her. I tell her about the patient. By the time I get there, thankfully she was closer, she had already applied pressure to the wound to help stop the bleeding. There was blood all over the patient, the floor, and somehow the door about 20 feet away. It was an arterial bleed and so it was gushing like... almost kind of like in the movies when they fake chop off someone's arm. In the end, everything turned out ok. But... that's what I was most afraid of when holding the pager. I still am. More so when I'm on Nights because the whole team is not there. My first time taking call like that was working Fourth of July. I know I know things. I did graduate school. But being new and not understanding protocols and how things work is frustrating. It felt like I was boxed in, but in an open box, yet I was afraid to step out of it. That holiday, there was a patient who was very distended because he could not urinate. He needed a foley, but the nurse had asked if I should straight cath him (just stick in the foley for a second, drain the urine and pull it out, rather than leaving it in) or just put in the foley. I couldn't decide. I kept thinking, would my senior get mad if I make the decision without her? Would I make the wrong one? When exactly do you choose one or the other? Why am I getting so nervous about this? Neither decision will kill my patient, and that's my one goal: Don't kill patient. They tend to frown upon that. The nurse had to stop me and tell me to put the foley in. She said, he needs it just do it. It will be okay.I'm grateful for that. She told me she understood because I don't have confidence at all. I'm pretty sure I had so little confidence I probably owed some back to the general pool of confidence. Ze Lago de Confidencia. All the nurses int he station and I had a good laugh about it, and they all agreed that it comes with time and they understand. I think that gave me a little more confidence to realize that if I know a decision won't kill a patient then it's not the worst thing if I handle it myself. The days and nights have gone better. I feel myself becoming more comfortable at the hospital, but I'm still nervous. I play it off cause I'm awesome, but sometimes I just feel like a glorified student. I'm not ready to feel like a doctor. I know that will come with time. That's why I'm training for a long time. But regardless of all that, this is all about the patients. They are the ones who have to get better. They are the ones in a bed sick, suffering, dying. The crap I go through is nothing to what they experience. I haven't undergone major surgery. I don't have tubes and drains and IVs sticking out of every arm and part of my body. I'm not confined to a bed and room that's not mine. I don't have deep-seated fear that maybe I'll never make it back home. I can suck up being tired, being hungry, and being yelled at... I gotta learn my lesson, turn around, and just keep swimming. (FINDING NEMO IN 3D COMING SOON!) And I do love talking with the patients. Most of them are great, and most of them are very appreciative. You can see it in their faces when they are getting better, when they are ready to leave. We once had a patient say, "Alright guys. I really appreciate you coming in to see me, but it's 5 oclcok so you guys should get out of here and go to happy hour!" Awesome. And so yes, I'm working a lot... 80 hours a week. I'm there 6 days a week. The hopsital doesn't shut down, because the patients don't shut down.... well, not all of them. It's always there. My mind is now 20% always there. I am at a baseline of tiredness... I get hungry often but that's cause I love food... I have to sacrifice a good chunk of a social life to do what I have to do, because it is a responsibility that I took upon myself. And so I will.... and recently I think it has been sinking in more. And I have to say I'm more glad now that I had great early 20 years to look back fondly on, but it is hard not to miss not seeing all my friends, especially now that it is summer. Maybe facebook exacerbates that. I don't know what other things I will have to give up. Somethin happened last week that made me thinkin about all this and is it worth it. And I hope so, I enjoy it now and I'm not going to stop. But it's tough. But I'm not the first person to do this. There have been many a surgeons who have gone on to have families (or had families in residency, had other careers, etc), have great friends, travel the world, etc. They just need the support of people who love them, and are patient, and dedicated. Who are understanding.... that hey, maybe I can't see you every week. But I don't think any of this would be possible without having worked so far with great residents cause I'm no superman. We have a lot of laughs. Pulled off a few prank calls to nurses and other interns. Joke around about things. Everyone loves it when my phone goes off and it's Your Love by the Outfield. It's so far been a great experience and I'm having fun.But I have to be honest... I would like to sleep a little more.... see my friends a little more... dance a little more... http://www.youtube.com/watch?v=bhh7qzurMZY

I Belong to You

I Belong to You 4/2/12 I stare at the moon to believe Your touch is the breeze on my face. Miles apart, our bodies grieve But your soul I can lightly trace. Our dreams bring love to light A place to feel a warm touch, kiss Where this distance is slight And we no longer need to miss. The rising dawn begins the day Bringing new beauty to my life Filled with hope for a way To embrace you as my wife. For our bond began long ago When our eyes met, and smiles grew. One soul in us, it began to show And I knew it was always you. So with my eyes skyward, I hear The music made by a hearts dove That brings those apart close and near Just as it does you to me, beloved.