October 17, 2014

fruits of labor


     In a hurry, I sat down at a nursing station to grab a computer.  I needed to see if the final read of Mr. Smith's chest CT was up and if the immunology blood work up on Mrs. Jones was completed.  Instead I was interrupted by a nurse.  She stated, "Mrs. Evans in Room 2112 says that you're the best doctor she's ever had.  She says that you were the first one that ever sat down and actually listened to her."

October 10, 2014

a walking meditation

     My last month was spent in the hospital enrolled in the clerkship dubbed "acting intern".  It is essentially supposed to have me perform as an intern, or first year resident, would.  Now I see why so many residents start to become less empathetic towards the patients.  Overworked, too much red tape, sleep deprived, hassles with the EMR, clashes between the rest of the people taking care of the patient, and did I mention overworked?  I began to imagine ways of fighting against this natural pull of the stream.  One method I developed was to check on my patients in the afternoon for just a few minutes (assuming we were not slammed with new admissions).  When prerounding at 0 dark thirty, your time is spent hurriedly trying to figure out how the patient did overnight and whether they responded to the adjustments in treatments implemented the day before.  Then you have to take all that information and type it into a coherent note for the attending before actual rounds.  Then the patient is often overwhelmed by the presence of the entire team when rounding.  Who would want to talk candidly when 5-6 people step into the room looming over you in the hospital bed?  I know I wouldn't.
     But when I stop by in the afternoon, there is no agenda.  I just sit down and briefly talk to them.  That's it.  Mostly I just ask how they're doing?  It doesn't take long but it does take effort, especially if that time could be spent taking a power nap.  But I've been amazed at how that 3-5 minute visit deepens the connection with the patient far beyond what I would have expected.  They trust me more and are far more willing to engage more in their own treatment.  And in return, I am one step further removed from becoming burned out and jaded. 













October 7, 2014

insight

     If you've read my blog at all, you know that I have a keen interest in psychology and psychiatry, despite going into family medicine. As one psychiatrist attending told me, "family med is just psychiatry with procedures."  So I've been meaning to post this for awhile but have been too busy in the hospital. This month is a bit slower, so better late than never. It's comic Mark Maron's comments on the suicide of Robin Williams. You only need to listen to the first 7 minutes to get one of the best descriptions of the suffering of depression I've heard in awhile. If you listen to the rest, well, it is Robin Williams so expect both the profane and profound.

Press here to listen.

October 3, 2014

hard work realized

     Normally I do not check my school email often.  It's mostly announcements from the school about various going ons.  But the past two days, I've started checking it more frequently.  The process for applying to residency has started.  It's a centralized process that is nationwide across multiple specialties.  You apply and then sit and wait to hear back from the programs.  Interviewing usually starts in earnest in November.  And I only had one letter of recommendation uploaded out of the three required.  One got lost somehow.  The other is from a busy faculty member so I figured I'd have to wait a bit longer since I was missing those two letters still.  Only I haven't had to wait that long.  I have three interviews offered for October and one more coming.  After all that has happened in my life, it's hard to imagine moving on to the next step.  It is not that I do not wish to move forward.  Far from it.  Still, it is surreal to be honest.  I wasn't sure this day would come despite all reassurances to the contrary.  There have certainly been far too many opportunities for me to collapse or fall apart.  I have walked along that cliff for what seems a lifetime.  Experientially, I have lived several lives in the past several years.  And yet I am still here.  I cannot say how but yet still the next phase of my journey is beginning nonetheless. 

September 26, 2014

calling

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

     ".....well, we can't all be rich doctors," the patient said smugly.
     Timeout.  I've had it with patients thinking that I'm doing this for the money.  They have no idea the hell I've been through, and continue to go through to do this.  It's time for some patient education.
     "This is not my first career.  I was the primary breadwinner with a respectable salary and a comfortable lifestyle.  I quit and chose to do this because it was my calling."
      "Ah, that's what all the doctor's say until they're driving fancy cars,"  the patient still a skeptic.
      "Let me put into numbers, because I've done the math.  I've given up XXX of a million dollars when I add up lost salary and student loans, never mind the personal sacrifices.  If I'm doing this for the money, I need to rethink my math.  Do you still think I'm doing this for the money?  Or, perhaps is it because it really is my calling?" I respond firmly.
     The patient is caught off guard and to their credit says, "a doctor who actually cares?  They still exist?"
     "Yes, in fact, we do still exist."