"Did you ever just get so tired of your job that you just didn't even want to go in the next morning?" my wife asked me one night.
Laughing, I responded, "yeah, be very, very wary of that feeling. It drove me to the insanity of med school."
October 31, 2012
October 29, 2012
red presents
They would come wrapped up in a red biohazard bag. Grimly dubbed "red presents" they contained the remains of amputated limbs. 99 times out of a 100, they were from a diabetic who just never got their blood sugars under control. Infection would set in and the surgeons would begin to earn their nickname of sawbones. In other words, completely preventable. The worst was when it was a repeat amputation. A stumpectomy, if you will. The patient had an amputation just above the ankle. But still the infection continued to ascend up the leg so the surgeons removed more. It seemed utterly futile to me. I'm sure that patient probably would be dead within a year. If the infection didn't get them, failing kidneys, a heart attack, or a stroke would claim them. They were a victim of an abusive and viscious process that had raged out of control for decades. I wanted to take a picture of the grisly pile of flesh to show my future recalcitrant diabetic patients so I could say to them, "THIS is what is in your future if you don't get your diet under control."
October 25, 2012
raison d'etre
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.
I did not speak her language. And as a med student, I was mostly in the way of both the more senior doctors as well as the nurses. They had a protocol to follow and were carrying it out with the efficient habit of one who is able to do it in their sleep, which as it turns out was useful as it was three in the morning. The flurry of activity ceased and suddenly the patient was stable but alone. Despite the fact that the contractions were coming every 2 to 3 minutes, she was still hours from delivering. Pregnant, confused, in pain, alone. That last one I could at least do something about. A contraction started coming and she writhed in bed as her body tensed involuntarily. I approached her bedside and held out my hand. She quickly grabbed it and began to squeeze my hand in an effort to alleviate her physical pain. The contraction passed and her grip eased as her hand slipped away. "Gracias," she muttered. Three short minutes later she again reached out for my hand and squeezed. I had no words of comfort and only my hand to offer. I have no idea how many times this pattern went on but I stayed with her until she could be admitted to the hospital and her husband could join her in the room. She did not deliver while I was on and after a 28 hour shift, I wasn't about to wait around any longer. We all have our limits. I will never see that patient again. I don't even remember her name. I doubt she will remember anything about me, as well. I will never receive a good grade for my actions. But it reinforced the reason I want to be a doctor and that was enough.
I did not speak her language. And as a med student, I was mostly in the way of both the more senior doctors as well as the nurses. They had a protocol to follow and were carrying it out with the efficient habit of one who is able to do it in their sleep, which as it turns out was useful as it was three in the morning. The flurry of activity ceased and suddenly the patient was stable but alone. Despite the fact that the contractions were coming every 2 to 3 minutes, she was still hours from delivering. Pregnant, confused, in pain, alone. That last one I could at least do something about. A contraction started coming and she writhed in bed as her body tensed involuntarily. I approached her bedside and held out my hand. She quickly grabbed it and began to squeeze my hand in an effort to alleviate her physical pain. The contraction passed and her grip eased as her hand slipped away. "Gracias," she muttered. Three short minutes later she again reached out for my hand and squeezed. I had no words of comfort and only my hand to offer. I have no idea how many times this pattern went on but I stayed with her until she could be admitted to the hospital and her husband could join her in the room. She did not deliver while I was on and after a 28 hour shift, I wasn't about to wait around any longer. We all have our limits. I will never see that patient again. I don't even remember her name. I doubt she will remember anything about me, as well. I will never receive a good grade for my actions. But it reinforced the reason I want to be a doctor and that was enough.
October 22, 2012
memories can be too much to carry
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.
As a student doctor, I usually have more time to spend with the patients so I often would receive either the new patients (a veritable pandora's box of possible health problems) or the hospital follow ups. This one was a hospital follow up. As I quickly scanned through her chart, I wondered, "what in the hell is she doing HERE?" She had terminal cancer and judging by the ER doc's notes, she was not long meant for this world. What was she doing at family practice?
Tattoos, a gruff voice, and a face carved with lines of a hard life, she was an independent woman who was not too keen on doctors. She would be more at home on a Harley than in a doctor's clinic. This was the last place she wanted to be. The interview quickly became disjointed and scattered. Twenty different bottles of pills, a patient who is confused, and an accompanying friend who was clearly concerned. After getting the gist of the history which ranged from her coughing and vomitting up blood to "I think my blood pressures have been running too high doc", I decided her history of hypertension was really quite irrelevant. I sensed that she wanted someone to be blunt and give it to her straight so I asked her, "What is your understanding of hospice?" She had no idea what it meant. Wow. The previous doc had recommended hospice and hadn't even really bothered to outline what that meant to the patient. We then began one of the most honest and open conversations I've ever had with a patient in my short career. It started with me saying, "You are facing the hardest thing anyone has to face and that is your death," and ended with me telling her about my own personal experience with hospice. Somewhere in the middle I told her, "ask yourself, how would you like to die?" I finished up and then went to tell the attending.
The attending came in and did his thing. As we walked out of the door, I felt a tug on my sleeve. The friend whispered, "She wants to ask you something without the doctor here."
The patient sat looking at me for a moment and asked, "How long did your brother live?"
"From diagnosis to death? Fifteen months. And he died at home with his family all around him." She looked me squarely in the eye and held my returned gaze for a span of time which was unmeasurable. There were no more words left to say. She continued to look me right in the eye, shook my hand firmly, and said with a voice beginning to crack with emotion, "thanks, doc...thanks." That was the most heartfelt gratitude I've ever heard from a patient.
As a student doctor, I usually have more time to spend with the patients so I often would receive either the new patients (a veritable pandora's box of possible health problems) or the hospital follow ups. This one was a hospital follow up. As I quickly scanned through her chart, I wondered, "what in the hell is she doing HERE?" She had terminal cancer and judging by the ER doc's notes, she was not long meant for this world. What was she doing at family practice?
Tattoos, a gruff voice, and a face carved with lines of a hard life, she was an independent woman who was not too keen on doctors. She would be more at home on a Harley than in a doctor's clinic. This was the last place she wanted to be. The interview quickly became disjointed and scattered. Twenty different bottles of pills, a patient who is confused, and an accompanying friend who was clearly concerned. After getting the gist of the history which ranged from her coughing and vomitting up blood to "I think my blood pressures have been running too high doc", I decided her history of hypertension was really quite irrelevant. I sensed that she wanted someone to be blunt and give it to her straight so I asked her, "What is your understanding of hospice?" She had no idea what it meant. Wow. The previous doc had recommended hospice and hadn't even really bothered to outline what that meant to the patient. We then began one of the most honest and open conversations I've ever had with a patient in my short career. It started with me saying, "You are facing the hardest thing anyone has to face and that is your death," and ended with me telling her about my own personal experience with hospice. Somewhere in the middle I told her, "ask yourself, how would you like to die?" I finished up and then went to tell the attending.
The attending came in and did his thing. As we walked out of the door, I felt a tug on my sleeve. The friend whispered, "She wants to ask you something without the doctor here."
The patient sat looking at me for a moment and asked, "How long did your brother live?"
"From diagnosis to death? Fifteen months. And he died at home with his family all around him." She looked me squarely in the eye and held my returned gaze for a span of time which was unmeasurable. There were no more words left to say. She continued to look me right in the eye, shook my hand firmly, and said with a voice beginning to crack with emotion, "thanks, doc...thanks." That was the most heartfelt gratitude I've ever heard from a patient.
October 18, 2012
Decisions
One of the good things about the third year is that I get to see what a field is like from a real world perspective, at least in an academic teaching hospital. The day to day grind details are a big part of my equation in selecting my specialty. At one point obstetrics was on my list simply by virtue of how surreal and amazing it was watching my son being born. Obviously, there's more to the field than that and after having seen it, I'm comfortable scratching it from list. It's a cool field and I can definitely see its appeal, but it's just not for me.
October 14, 2012
what's in a name
As I stumble through hour number 20 of my 24 hour shift in a sleep deprived state, I suddenly realized how family medicine got its name. It is not that you treat families. It is that you actually get to see your family.
October 7, 2012
dark
My blog has been dark of late, mostly because I am either at the hospital or asleep. I suppose there is some lesson to be learned or moral to be gleaned from waking up at 3:45 in the morning but I'll be damned if I know what it is. All it tells me is that OB/GYN is not in my long term plans.
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