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