March 27, 2015

dr death

     It seemed a befitting end to my medical school career.  The patient was dying.  Late 70s, history of Stage IV cancer, now with sepsis and respiratory failure.  All attempts at weaning the patient from the ventilator failed.  The patient's heart failure worsened the situation as fluid backed up into the already damaged lungs.  Then the kidneys began to fail which was the tipping point.  As I said, the patient was dying.  The family had been presented with end of life care on multiple occasions.  They refused.  They wished to keep going.  It was clear that the patient was in pain - groaning, writhing, restless, high heart rate.  But everytime we sedated them more, the respiratory condition got worse. 

     So on my last morning rounds of medical school, I stood tall, my voice loud so the entire group could hear and began, "just because the family wishes to keep fighting does not mean we lose sight of the obligation to the patient, who happens to be in pain from bone metastases.  It is clear that with multiple failures at weaning her from the ventilation, her respiratory failure is not improving.  In fact, it's getting worse judging by her compromised heart function, chest x-ray, the blood gasses, and her worsening acidosis compounded by renal failure.  What's the harm in keeping the patient comfortable?  She is dying either way.  She might as die without pain."  The attending nodded at me and told the nurse to bump up the fentanyl.

March 17, 2015

match explained

For those of you confused by The Match, join the club. I don't pretend to like it, understand it or defend it. Here's the official explanation, though. Wikipedia is pretty good, too. As the number of medical students has increased relative to residency positions, I'm not sure if the "logic" would still hold today. All I know, this is just one of MANY hoops to jump through. You stop questioning them pretty quickly to retain your sanity and to not lose sight of the real goal - to become a good doc. At least I did. But having come from the private sector first, I MUCH prefer the model of having job offers to consider and weigh against each other than this rolling of the bones.

March 12, 2015

writer's block

     I could say that my lack of writing was due to the Match process.  I did not wish to write anything that could drop me to the bottom of a program's list.  In part, this is true insomuch as it is a rationalization.  It is what I told myself when confronted with the fact that so much emotion has poured out through my fingers these past years and now my fingers desired a break.  In truth, I wished for nothing worth writing about.  Like an old photograph negative, my life has consisted of sharp contrasts in dark and light.  Though artistically interesting, it is a difficult environment in which to survive, much less thrive.  I am a doctor.  Though there were fewer people to watch me walk across the stage than were there to watch me start.  I have made great strides in being able to connect with patients at the deepest of levels and yet each step has cost me dearly.  Such is the nature of my life.  I am still attempting to search for a new life to build among the surreal rubble of boulders heaved down on me from upon high.  I've had enough of rolling boulders up hills to only watch them go down again.  I could stand some more moss.

March 1, 2015


    If you can make one heap of all your winnings 
    And risk it on one turn of pitch-and-toss, 
And lose, and start again at your beginnings 
    And never breathe a word about your loss; 
If you can force your heart and nerve and sinew 
    To serve your turn long after they are gone,   
And so hold on when there is nothing in you 
    Except the Will which says to them: ‘Hold on!’
- except for Rudyard Kipling's If

My ranking of the residency programs are in. Where am I going? I do not know. Things are out of my hands and now I wait.