Part of the Deal

Monday, December 21, 2009

When I first saw my intern schedule, one of the first things I saw was December filled with the dreaded words. Trauma Surgery.

That is when I knew. I would not have Christmas off. There would be no way to go home and visit family over the holidays. Yes, clinics shut down for Christmas. Why couldn't I have clinic in December? But trauma? That happens every day of the year. Every single day. Just watch some guy in a Santa suit fall off the roof Christmas Eve.

Over a deparment lunch, I was complaining to a fellow intern that I thought I would work over Christmas. She shrugged, non-chalantly, and replied, "Well, we're doctors. That's what we do."

Her statement made me want to shrink into myself and cry. So this is what I'd signed up for. Holidays, weekends, and birthdays away from family are just part of the deal. They don't put that on the brochure for medical school.

But I started thinking about it. Maybe this is what I signed up for. If I have patients in the hospital over Christmas, it's not as if they want to be there either (except for the homeless drunk we admitted two weeks ago. He's as happy as a clam to be in the hospital for Christmas.) And if my patients are going to be in the hospital over the holidays, they still need lab work and xrays and nursing care and food and medication. And the people who provide all that are working on Christmas. I'm part of a system that doesn't take days off.

It turns out that I don't work Christmas. So all the insight and mental preparation were for nothing, right? Well, probably not. I'm not delusional enough to think I'll go my entire residency (much less my professional career) and not work a major holiday. The fact that I got both Christmas and Thanksgiving off as an intern is nothing short of a Christmas miracle. But I remember watching home videos of Christmases over the years, and realized that many of those Christmases didn't happen on December 25th. Many of the videos had the date Dec 24 or 12/26 on the bottom. My dad often worked Christmas. And we adapted.

But I'll work on the acceptance and coping mechanisms later.

When I got my schedule with December 24 and December 25 as days off, I danced for joy. I actually bounced up and down as my schedule printed out. I hugged everyone in the house. I felt like I could finally start celebrating. I've thrown myself into Christmas. I'm more excited for Christmas this year than I have been since I was 9.

It also helps that my co-intern, who is working Christmas, is Jewish. He got the first weekend of Hannukah off. I get Christmas off. We're both happy.

Yes, there will be Christmases where presents are opened the day before or the day after or late in the afternoon. That's what I've signed up for.

But this year? Christmas morning will find me around the tree with my three boys, wearing pajamas and drinking hot cocoa and enjoying the moment.

A Day In My Life

Thursday, December 17, 2009

Over at Mothers in Medicine, a blog dedicated to exactly that, the most recent topic has been "A Day in the Life of..." These amazing women tell what a typical day is like for them as a mother and a neurosurgeon/cardiologist/obstetrician/pediatrician.

This blog has been a wonderful "support group" for me. It lets me know that there are women who have been through what I have and come out as real people and functional mothers on the other side.

The most recent topic has inspired me to share a typical day for me. The only problem? There is no typical day for an intern. Each month is a new service, a new team, a new job. I can only share what is typical for this month.


A day in the life of an anesthesia intern on trauma surgery...

4:30 am: Alarm goes off. Want to push snooze, but don't.

4:55 am: Toast bagel, pack bag with fruit and snacks to eat later that day.

4:58 am: Run upstairs, kiss sleeping boys and sleeping husband good-bye.

5:00 am: Get in car, drive to work in the dark. Eat bagel while driving.

5:10 am: Catch shuttle in parking lot.

5:15 am: Arrive at hospital.

5:20 am: Get to locker room, hang up coat, put on green hospital scrubs and white coat. Check to make sure I have stethoscope, pager, ID badge, PDA.

5: 30 am: Arrive in SICU for check-out from overnight team. One new admit overnight, 19 year old assault victim, intubated, 2 chest tubes in place. Hemoglobin stable. One of patients on the floor had SVT overnight, beta blocker started.

5:45 am: Pre-round on SICU patients. Neurosurgery taking one patient to OR today; we sign off. Assault victim looks stable, tell SICU team okay to extubate.

6:00 am: Pre-round on floor patients. No further SVT seen on telemetery. Patient reports she had this before, but has been off regular medication. Start home medication back up. See orthopedics team, taking another patient to OR to fix tib/fib fracture. See ENT service, thank them for suturing ear laceration on patient.

6:30 am: Return to team room. Write notes, adjust some orders.

6:45 am: Go with team to cafeteria for breakfast. I don't eat any. I had a bagel when I left home. Sit at table with surgery residents. Can't wait until I'm doing anesthesia. Conversations re-affirm I do not want to be a surgeon.

7:00 am: Head to conference. Topic is interesting: angiography to identify vascular injury in trauma. Still can't stay awake. Doze off in back of auditorium.

8:00 am: Conference is over. Head back to team room to check on chest x-ray for assault victim. No evidence of pneumothorax. Labs back on floor patients. No electrolyte abnormalities on patient with SVT.

8:30 am: Call neurosurgery regarding patient with lumbar spine fracture. Injury non-operable. Order patient back brace.

9:00 am: Meet attending trauma surgeon in SICU to round together. Assault victim has been extubated. Remove one of chest tubes. Put in orders to transfer patient to floor.

9:30 am: Get page to clarify order.

9:35 am: Get page to let me know patient's IV infiltrated. Patient taking good PO. Stop IV fluids.

9:37 am: Get page with update on rehab placement for patient.

9:45 am: Return to team room. Finalize notes, finish orders. Finish discharge summary for patient going to rehab.

10:00 am: Try to read ICU textbook. Read blogs, check Facebook, check e-mail, check weather. Try to read. Check Facebook.

11:34 am: Trauma pager goes off. Activation. Self-inflicted gunshot wound. Go to ER Trauma Bay. Get on lead, gowns, face shields, gloves. Hear helicopter land on roof. Team ready when patient rolls in. Patient intubated. Take report from AirTeam. Listen to mid-level resident call out primary and secondary survey. Enter orders. Call CT. Call Neurosurgery. CT calls back, ready for patient. Neurosurgery comes, says injury is non-survivable. Transfer patient to SICU to wait for family to arrive. Contact social work. Go to SICU to talk to SICU resident. Write trauma note. Feel numb.

12:45 pm: Grab bag from locker room. Eat apple, drink Coke Zero. Wish I could finally lose the weight. Team members eating pizza, hamburgers.

1:00 pm: Answer more pages. Feel exhausted. Day only half over.

1:40 pm: Trauma pager goes off. Alert. Fall from roof. Go to ER Trauma Bay. Get on lead, gowns, gloves. No face shields this time. Ambulance team rolls patient in. Patient awake, talking, groaning from pain. Order fentanyl. Order labs, xrays. Go with patient to CT scanner. Sit in reading room while patient's scan comes up. Lumbar burst fracture. Call Neurosurgery again. Admit patient. Neurosurgery will operate tomorrow.

2:00 pm: Go back to team room. Finish trauma note. Answer more pages.

2:15 pm: Code pager goes off. Code Blue on Neurosurgery Floor. Run up stairs. Think about how I should exercise while I run up stairs. Get to room. Room full, chest compressions already going. Senior resident asks for rhythm check. Monitor shows asystole. Chest compressions restarted. Mid-level resident places femoral line. I do nothing. There are so many people in the room. Feel numb.

2:30 pm: Return to team room. Text Hubster. Feel tired. Try to read. Blog instead. Return a few more pages. Wonder why I can't pull my life together like other people seem to have.

3:00 pm: Go to surgical skills lab. Play MarioCart on Wii. Lose every race. Still have fun. Pause game to answer pages.

5:45 pm: Head to SICU to sign out to night team. Let them know the SICU is going to withdraw care on gunshot patient later tonigh.

6:00 pm: Go to locker room, change out of scrubs, grab coat.

6:15 pm: Catch shuttle back to parking lot. Drive home.

6:30 pm: Pull into garage, door opens. See boys waving and smiling at me. Help with dinner, start laundry. Sit around table as a family every night I am home. Ask about school for boys and Hubster. Feel tired.

7:30 pm: Bath boys. Give them their Advent calander chocolate. They never forget. Help them brush teeth. Hubster studies for test in morning.

8:00 pm: Read to Monkey. Tuck him in bed.

8:30 pm: Read to Bug. Give him piggy back to bed.

9:00 pm: Fold some laundry. Watch whatever is on DVR: The Office, Survivor, Chopped, Mythbusters.

10:30 pm: Turn off Christmas lights. Unplug Christmas tree. Plug in cell phone. Shower. Standing in shower, feel sad for the first time today. Sad for what happened at the hospital. Sad for only seeing my family for 2 hours a day. Sad for missing so much. Sad for myself sometimes.

10:50 pm: Kiss sleeping boys goodnight. Every night I am home I do this.

11:00 pm: Fall into bed exhausted. Asleep before I know it.

This is my everyday. The pager goes off at different times. The traumas are different people, different stories. But one day feels much like the same. Until next month.

Days of the Week

Sunday, December 6, 2009

I don't even know what day of the week it is.

I had Monday off, which made Tuesday my Monday, and so I thought Friday was Thursday. I had most of yesterday off, which made that Saturday, which I'm pretty sure it was. But I'm working today, so it's technically my Monday, which makes tomorrow Tuesday, which it's not.

And I'm tired. Getting up at 4:30 am does not agree with me. Given the complete lack of signs of life at that time of day, I'm pretty sure that time of day disagrees with most people.

I roll (or more like droop or collapse) through the door back home at 6:30 pm.

Bug and Monkey are in bed at 8:30 pm. (or 9, or 9:30. It all depends on my level of alertness and motivation at the time.)

I try to catch up on e-mail, some academic reading, laundry, and dishes for a hour. I fall into a dazed stupor in front of the TV for another hour (At this rate, I will never catch up with my DVR). Then I shower, read a little more, and fall asleep around 11 pm.

Only to wake up in 5 1/2 hours and do it all over again.

I spend 2 out of every 24 hours with my children. I spend just over twice that sleeping. It makes me feel selfish. And those 2 hours are spent trying to get them to sit up at the table and just eat two bites, for the love of all that is holy. And where is the math homework? And I've already asked you five time to put your pajamas on, why are you still running around naked? And I'm pretty sure that is plenty of water for tonight.

And that makes me feel even worse.

The confusing thing for me is how much I like the work that I'm doing right now. I haven't once dreaded going to work. I do dread the alarm clock going off, but that's a completely different thing. Actually, most of the time, when I hear my alarm go off, I think it is mistake, and my brain doesn't comprehend that I actually need to get out of bed in the pitch black night.

Last month, the work I did was mind-numbingly boring. The days were so painfully slow that it was all I could do to pull myself out of the house, into the car, and actually go. I was home a lot more.

This month, I'm home less, but the work itself appeals to me more than anything else I've done so far my intern year (except for emergency medicine. If anesthesiology takes a turn for the worse, that it what I would do instead.)

Right at this moment, writing this between my pager going off every 5 minutes, occasionally twice at once, I am desperately homesick. Each sign of a child in the hospital tugs painfully some place deep in my chest.

I feel like I'm caught in some masochistic catch-22. I can either work that I enjoy and been gone all the time, or I can dread every second of each day of work and be home more.

I would pick the second one, if I was forced to choose.

It makes me wonder why I ever get upset with my children. Why would I ever waste a single breath being mad? (Until I find that Monkey has turned off the fridge. Again. And then I have a memory lapse about not being upset.)

Writing the month may be scarce.

With time being my most precious commodity, I'm trying to spend it on my family and get us out of the slump that the last week has thrown us into. That's what I plan doing on my next Saturday...whatever day of the week that may be.

Plow Ahead

Friday, November 6, 2009

Oh blogesphere, how I've missed you! I've fallen woefully behind, not just in my writing, but also in reading so many of your blogs that I love so much. I've been trying to leave comments, just to let you know I really am still here, but even that has been spotty.

There are times when I really, really don't like my job.

The pre-dawn mornings, the frequent all-nighters, the constant crises, the eating every meal by myself, the potential for true disaster around every corner, the fatigue, the stress.

All of this is part of my job. I know that. I knew it before I ever decidedto go down this path. And there are days when none of it phases me. And then there are days when it overwhelms and crushes me.

Originially, when I was thinking about this post and trying to decide exactly what to say about my feelings, it was going to be a post about choice and having a say in the direction your life took.

But that is not what this post is going to be about.

There are mornings, when I wake up warm and comfortable. The sky is just turning from black to gray outside my east facing bedroom window. Hubster is sleeping next to me. The house is still. All I want to do is stay in bed next to Hubster, get a few more hours of sleep, wait for the boys to wake up and have breakfast with my family. I think to myself that maybe I'll just quit residency.

And then I think about how much I like our house. And if I quit my job, we'd have to live in an apartment again, and Hubster would have to go back to work, and then he might not be able to go to dental school like he so desperately wants to. I think all these things. Fine! I'll go to work, I yell at myself in my mind.

On one of my call nights, I was feeling particularly sorry for myself. I was missing my family a little more than normal that night. It had been a busy night. Finally, at 1 am, I managed to find time to run down to the cafeteria to grab my first food of the day. The hospital was quiet, most of the lights off, all the doors to the clinics shut. All that made me feel even more sorry for myself.

Then, around the corner, I saw a man cleaning the carpet in the deserted hallway. He does it every night.

It wasn't just me working in the middle of the night. It wasn't just me away from my family. Here was a janitor, working in the dead of night, alone.

The cafeteria was staffed at 1 am by people who are also away from home. Some of these people may be working their second or third job and be away from their loved ones more than I am.

Sometimes, you just have to suck it up and plow on. The majority of us who work don't do it purely because we love our job that much. Or because we get so much personal satisfaction for what we do that we can't live without our job.

Okay, maybe some people do. I'm just saying I don't.

We go to work because we have a house and a car. We work because we need food and clothes. We go to work because people depend on us.

My views on work have completely changed since I know that I have three people back home that depend on me. I can't quit, even if it isn't exactly what I want to do (which would be sitting at home, playing with my children, and having time to read a good book.)

To be honest, my job is a pretty great job. Yes, it is exhausting. It is more demanding than many other jobs out there. Seriously, they had to implement laws to make sure residents didn't work more than 80 hours a week or 30 hours on one shift. People can be seriously injured if I have an "off" day.

But it is also a job that can be amazingly satisfying.

As long as I just have to suck it up and plow ahead, which I plan on doing, I'm glad I get to do what I do. People have it worse.

Screaming Inside

Wednesday, September 30, 2009

The last couple days have reminded me why I blog.

My thoughts have been running through my head so fast that I'm being whisked along behind them right onto the express towards crazy. They bounce around against my skull, getting louder and louder that I'm not entirely sure people around me can't hear them.

When Hubster and I were dating, I'd often ask him what he was thinking. Turns out, guys don't like to be asked this. And without fail, he would say "Nothing."

I don't ask he what he is thinking anymore. I can read his mood better than the TV menu. And as our relationship has grown, he shares more and more.

But I always wondered about the "Nothing" response. Is it the same as when someone asks me what's wrong, and I say, "Nothing." Because I don't what you to know. Or is it really "Nothing."

How could anyone be thinking "Nothing" when my mind is constantly going. When I'm not thinking about what's for dinner and did anyone get the clothes out of the dryer, and we still need to get plastic bins for the things in the garage before winter, I'm thinking do I really want to fellowship in Pain Management or should I just stick to general anesthesia, and how long would it take to tile around the fireplace, and does Monkey like his new daycare and why haven't I started saving for retirement, and it's been a long time since I've painted, maybe I should try to work in some time.

It's like this ALL THE TIME.

So I blog. I'm not always to get everything out, but at least a little. A pressure valve. At least to thin out the internal crowd.

----

I'm never sure how much to share about work. Because I work in medicine. I feel that I can't just talk about my feelings and experiences, because I'm "representing my field." Can I talk about depression rates and the horrific grind of residency without you wondering if your doctor is depressed and therefore should they be taking care of you?

If I talk about doubts and mistakes I make in my training, does that make you trust medicine less? If I were to say that I felt 100% my senior was wrong about something, and so I went ahead and did what I thought was right and practically saved a patient, is that good or bad? Interns shouldn't be acting without supervision. What I did would not have hurt the patient, and definitely helped her, while doing nothing may have been devastating. But should I have acted of my own accord? Or should I have listened to my senior? Telling you this, do you trust the system less?

I believe in medicine.

I don't think we always make the right decisions. I know that people are hurt by poor decision making. Bad things happen, both due to unavoidable side effects or due to blatant over sight or negligence. It is one thing when your mail is delivered to the wrong address. It is another thing entirely when medicine is delivered to the wrong patient. Or procedures are done incorrectly.

But I still believe in medicine.

Western medicine doesn't have all the answers. I've seen more patients' pain managed with massage and acupuncture than I have with pain medicine and invasive procedures. I've seen patients defy all odds. I've seen families and patients alike get more benefit from prayer, blessings, meditation, and even withdrawal of care, than they would have from ongoing treatment.

But I still believe in medicine.

I may not agree with my training. I don't prescribe to the old school thinking of complete dedication to the exclusion of the rest of your life. I disagree with the hierarchy that's been created in the system. Training shouldn't involve humiliation, degradation, and exhaustion until mental breakdown.

But I still believe in medicine.

I've seen children walk who shouldn't have, because of surgery. I've seen women hold children they never otherwise would have had, because of medicine. I've seen people get a new lease on life after a heart transplant. I've seen infections cured, pain treated, bones set, and lives saved. Because of medicine.

I believe in medicine.

What I write is my own experience. I have bad days and heart-breaking moments. I battle egos as frequently as I do fevers and low blood pressure. I have been through bitterness, depression, and fatigue.

But none of that will change how I treat you in the hospital, with the best care I can provide.

Grief

Wednesday, September 23, 2009

As a medical student, I never had a patient that I was taking care of die.

Patients I had taken care of died, but I had transferred off service, days, months, before that happened.

This last month has been pushed and pulled at me more than I thought possible. I have had three patients die this month.

Every single time, I could have kept them alive. Their blood pressure had been stabilized, they were breathing easily on the ventilator. But every single time, despite the fact that I had done my best, despite the fact the patient was "stable," despite the fact that my attending, myself, and the rest of the ICU team had gone over every possibility and treatment plan, the patient was not going to get better. They were lying in the ICU bed with tubes and wires snaking off their body, surrounded by monitors with multicolored blips and beeping fluid pumps. They had everything medicine could give them. And it wasn't going to make a difference.

Every single time, the families requested that we withdraw care.

Devastating strokes that happened in the middle of the night. Traumas that left the families angry and confused. A combination of a million little things that left the patient and the family with no way out.

When it is just me, a handful of ICU nurses, and the patient, I'm fine. The patient, a middle age woman with a non-functioning brain stem, or a young man with a traumatic brain injury, is quiet, sedated, breathing rhythmically with the ventilator. I adjust medications, watch clear fluid and dark blood flow through tubing to the patient. I listen to breath sounds, feel pulses, watch as the medications slow the heart rate and raise the blood pressure. It is quiet, the patient is stable, and I am fine.

Then the family comes in.

They must have just talked to the surgeon, or the neurologist, or the trauma physician. They are crying, some loudly, some silently. Occasionally, there is yelling at the bedside and someone is asked to leave. There is more crying down the hall, because patients can only have a few visitors at a time.

It is no longer quiet, and I am no longer fine.

The nurses are talking to the family, to the weeping mother, the pale sister, the blank-faced son, so I slip away to the back hall, between the linen carts.

I did my job, and it doesn't matter. I can't fix the brain, I can't save the kidneys or heart. I can keep breathing for them, but they will never breath on their own again. I am crying. I approach a breakdown of my own. And it isn't my grief. Everyone I know and love is still alive and healthy at home, and I will go home to them when I am done with this terribleness. I will finish my shift and leave their grief behind me. It isn't my grief, but still I am crying.

I can only allow myself seconds for the wave of sadness. I return to the silent patient and the aching family.

They wouldn't want this, everyone tells me. The surgeon says there is nothing more they can do, they say to me. Yes, they told me the same.

Two at a time, they say their goodbyes. It takes a very long time, yet not nearly long enough.

Three times, we have taken the breathing tube out, turned off the monitors, pulled the curtains around the bed.

Three times, I've watched someone die. It is never my grief, but still I am crying.

The High Point

Friday, September 18, 2009

I'm approaching the point in residency I've been dreading.

The point where I'm constantly fatigued. I'm so tired that I can't think about doing dishes, or helping prepare meals, or managing the boys school papers. The point where I'm away from home too much, taking overnight in-hospital call every third night. The point where I feel like I will never know enough, never be able to study enough.

I've known this time was coming. I'm not sure if knowing helps me be more prepared or if it just becomes a self-fulfilling prophecy.

During intern orientation, we are shown a graph of rates of depression during intern year. The rate in June is near zero. By January, the rate is near 75%. Everyone looks at this graph and points to the high point in January. We are then given talks about how to cope during the midpoint of the year, the increasing stress, higher expectations combined with the lack of sunshine.

I am scheduled to be on Trauma service at that point.

Although impressive and terrifying, the peak in January isn't what concerned me most about the graph. The red line we were shown never went back to baseline. The rate of depression, so low among incoming residents, so happy after completing four grueling years of medical school, never returned to zero. The lowest it got was 20%.

The funny thing is that even as I approach that January peak, and boy, can I ever feel myself rushing towards it as my confidence and ability to stay awake while standing are every tried...the funny thing is that this is still better than medical school ever was.

Teflon

Sunday, August 23, 2009

The patient goes into a long train of profanities, hoping to portray the amount of agony he has been endured since his failed back surgery three years ago.

I wish I could say that I learned some new words and phrases. But I've heard everything variation on the theme from other patients.

He suddenly falls silent and looks at me, probably realizing for the first time that I am half his age and female.

"Sorry. I didn't mean to offend you."

I reassure him that he didn't. That I understand how frustrating his condition is and how discouraging it can be to have dealt with it for so long before finally getting a referral to our clinic.

When I come back with my attending to have the patient sign the consent for the procedure we hope will ease his pain, he launches into the same stream of profanity, only to apologize again.

My attending disregards it with a casual wave of his hand.

"Don't worry. We're all Teflon-coated here."

Maybe that's true. And maybe that's the problem.

Our training teaches us to be accepting and empathetic. Yet our training also teaches us that we can't become too involved. I used to think that this was harsh. Of course I want to be involved! my newly trained self would shout. But quickly, we learn that we can't.

I can shrug off a patient's accusations or crudeness or flat out rudeness and act like a professional. I can provide the best possible care without prejudice or criticism. I treat IV drug users and parole violators and moms on meth with the same carefully thought out decision making process I use for university professors and preschool teachers and stay at home parents. I can Teflon-coat myself to be immune to the emotional and, occasionally, moral onslaught that occurs daily.

But like most things in medicine, this non-stick coating is a two edged sword. Yes, we can treat your cancer, but you will be sick and weak and bald. Yes, we can treat your pain but you may end up addicted to the drugs we prescribe. Yes, we can fix your problem but it will take you weeks, maybe months to recover from the surgery and you will always, always, have the scar.

Self-protection is no different.

The rudeness and insults an unhappy drug-seeking patient hurl at me as she storms out of the exam room do not bother me.

But neither does telling a patient that their diabetes had completely ruined their kidneys and we need to start talking about dialysis.

I can stand by the bedside while we, as a team, tell sobbing parents that their teenage son will not wake up again. I don't make a sound as we tell a young mom that her once cooing, crawling, smiling baby has had a stroke and will not do any of those things again.

Let me take that back.

Yes, it bothers me. It all does.

I have hunched on the floor behind the coat rack of the locker room and sobbed. I have escaped to stair wells to break down. I have walked away from yelling patients shaken.

But we must not be involved.

We can be empathetic, yes. I can sit with a patient while they take it all in. I can answer their questions. I can occassional provide answers, and hopefully, comfort and reassurance.

But I can't be involved.

The amount of hurt and grief and anger that spins past me everyday is enough to grab me, take me under and never let me surface again.

But I must surface. I must go home everyday where I am greeted by the sound of little running feet and happy blue eyes.

And so I'll take it. I'll take my Teflon-coating, the good with the bad.

Confidence

Sunday, July 26, 2009

Even after four years of medical school, I feel like I know very little.

And I've forgotten at least half of what I used to know.

That's what residency is for. To re-establish and build up the knowledge base that eventually will become second nature.

But everyday, I feel overwhelmed. I feel that I just don't know enough. I'm not always sure how to approach a patient's problem.

It probably doesn't help that this under current of anxiety is coupled to my personality. I'm not a very outgoing person. When I'm with a group of people and someone else is willing to lead (or even dominate) the conversation, I'm more than willing to let them. I'm not a person who will chime in with a thought or opinion. (Note: this is referring to public settings, not interactions with my family, since in those cases I'm more than willing to blurt out my opinion at any time.)

I'm worried that this combination often comes across as a lack in confidence.

I watch my fellow residents (and as much as I hate to admit it, the medical students working with me.)

Everyone acts so much more confident than I feel. So much more sure to make suggestions or even act on decisions.

However, I know for a fact that most of them do not know more than I do.

When we undergo "pimping" sessions, I am able to answer more questions than most. (For the lay person, to "pimp" has no sexual connotation in the medical field. It refers to attendings or senior residents asking questions with the sole purpose to show a junior resident's or medical student's weaknesses in their medical knowledge. It is a very unpleasant experience.)

I did extremely well in medical school and received very high board scores. I spend a lot of time studying.

So, by my calculations, I know at least as much as most the people around me.

So why does everyone else appear so much more confident? Even the medical student who can't come up with a decent differential diagnosis?

My conclusion...

They're faking it.

Back of my mind

Saturday, July 11, 2009

When I was an undergrad, and then again when I was a medical student, I spent most of my times thinking about my children. Nearly every second was spent wondering if they were okay. How long Monkey continued to cry after he was dropped off at daycare? Were the other kids being nice to Bug? How did Bug's spelling test go? Did Monkey get his nap on time? What time was Hubster able to pick them up? Did they get dinner on time? It's bath night, did Hubster remember? Did they get read to before bed?

I resented every minute that medical school kept me away from my children and my husband.

Even when I took several months off and was home with the boys, I would think about Hubster a great deal. Wondering how his day was going, when he would be home, how that project or meeting went.

Since residency starts (a whole 11 days ago) I found myself realizing that I wasn't thinking of them as much.

I would have a quiet moment to sit down and get a drink of water and work on a patient's note, and suddenly realize that I hadn't thought about Bug or Monkey for several hours. Or nearly my entire shift.

And that realization bothered me.

Hubster and I have talked about this before. I would tell him that I thought about him and the boys practically all day long. And he said that he didn't. It wasn't anything against us or mean that he didn't love us or care about us. He just...didn't think us at work.

He thought about work.

I used to chalk this up as one of the many differences between men and women. That men were able to compartmentalize their lives easier than women were. That women worried more. That women were more attached to the people they loved.

And suddenly, I'm faced with the reality that that might not be true.

I've been trying to figure out why. Why, after I've spent years being angry about being gone and worrying about my children with every passing breath, am I suddenly not constantly fixated on how they are doing.

Hubster and I talked about this as well.

For the first time in my professional career, I'm actually responsible. I'm actually making decisions that can affect patients.

I'm also very busy. I've only had the chance to go eat lunch (or breakfast, depending on the shift) once out of my 10 shifts. I see 6-12 very sick, complicated patients a shift. And then there are the consults to call, the labs to order and review, the prescriptions to order, and the notes to write.

And, for the first time, I am the one responsible for providing financially for our family. It really makes a difference when you know that you are being paid for the time you put in. And not paying for it with student loans. There is a lot less resentment there when you are being reimbursed. (And I know, I know...I signed up to be a medical student, I asked for it, it was what I wanted. But that doesn't mean that it is a very difficult, degrading, humiliating, exhausting process.)

It could be any of those things. Maybe just one of them, maybe all of them.

Hubster agreed. He said that when he was doing his job, that's what he was doing.

But I thought of another thing. In the first time in 6 years, our children are being taken care of, at home, by someone who is truely invested in them.

I think that knowing Hubster is home with Bug and Monkey has taken some of the worry that constantly nagged at the back of my mind. He knows that Bug likes only peanut butter and not jam on his sandwich. That Monkey needs to take a 2 hour nap at 1:30. That Bug has a special shirt he likes to wear on Saturdays. That Monkey needs his stuffed dog to fall asleep.

To know that my children are safe and loved and happy takes a lot of weight off my shoulders. Weight that I didn't even recognize I was carrying until I noticed, suddenly, that it had disappeared sometime over that last 11 days.

I don't think this means I'm a bad mother.

I need to be focused at my job. I need to learn everything I can to be a better physician.

My children may not be in the front of my thoughts constantly like they used to be.

But they are always with me.

The second first day of the rest of my life

Wednesday, July 1, 2009

I had hyped myself up to expect the worst of today.

I had images of being a third year medical student all over again. Lost, confused, intimidated by every other person around me, scared out of my mind, and overwhelmed by the slightest thing.

It wasn't like that.

I did have to ask stupid questions. Questions like, "So, are we really diagnosing her with constipation?" "Um...is that normal?" "How do you print discharge instructions?"

Stupid questions are part of every learning curve.

As far as first days go, today was awesome. I felt on top of my game. I charmed the nurses, impressed my attending, had a patient tell me how wonderful I was. Not bad.

About halfway through my shift, I had a revelation.

I like medicine.

I've been trying to convince myself for years that I hate it. That medical school was the biggest mistake that I had ever made. That it was never going to be worth the sacrifices I had made. I've been depressed. I've been angry.

But today...I was happy.

I enjoyed seeing patients. I got excited over radiology reports and lab results.

For a moment, I was able to forget about the Power Point presentations about depression and suicide and divorce rates among resident physicians. I was able to forget about my bitterness about the things I've given up and missed out on.

Today, I felt like a doctor. And today, it felt like a pretty amazing thing to be.

(Although it will never be better than my real job of raising Bug and Monkey.)

During busyness of the emergency room, I was approached by a medical student who had come down to admit one of my patients to the hospital. She asked, rather timidly, about the patient's history. I started telling her about the patient's cancer, how the diagnosis was made, and about the complications she was currently experiencing.

Suddenly, I recognized all the emotions I experienced yesterday. All the feelings of being scared, overwhelmed, intimidated, lost, and confused were painfully obvious on the wide-eyed medical student in front of me.

"Hold on. What year are you?"

"I'm a third year medical student...And it's my first day." She looked like she was ready to cry. I could already see the signs of stress and sacrifice in her face.

"Okay, come sit down and I'll tell you exactly what your resident needs to know. Here are the patient's outside records. It's going to be okay. It's my first day too. And I'm pretty sure we're feeling the same way."

We talked about the patient. She thanked me. Then she left to report to her senior resident.

I learned two things from that interaction.

First, that I should always take the time to make someone's day a little easier. I sure wish someone had sat me down and said "Okay, this is how you do it." That a welcome smile and a little guidance can make a big difference.

And the second thing...

Wow, I've come a long way.

It Begins

In just a few minutes from now, I am heading off to my first day of intern life.

I start in the ER.

I'm not sure if I feel like "so it begins" all doom like, or "Let it begin! Let it begin" all enthusiastic hamster like.


Right at this moment, I'm more worried about acting more like a medical student than an intern. As in "Don't leave me! You want me to do what?"

I've finally decided that I am excited (and nervous. Horribly nervous.)

But regardless of what I am, it begins...

Now.

Scared Stiff

Thursday, June 25, 2009

In a world where people live and die from decisions people make, where 80 hour work weeks are considered merciful, and you are asked to give up sleep and family time without a blink, we're supposed to be tough.

But I'm feeling anything but.

I am scared. Probably more scared than I have ever been in my whole life.

I realize now that all those other times I thought I was scared, I was just nervous. (Well, except before Bug was born. I was actually scared then. But completely different.)

This time, I'm so scared it is difficult to swallow. I walk around with this strange feeling in my stomach that alternates between a dead weight and a hole. I find myself looking at the ceiling when I thought I was sleeping.

Starting July 1st, I am actually going to be taking care of patients. Not medical student patient care. Not "go see this patient, write a note, tell me what you think, and then I'll take care of the rest" type patient care.

This is the real thing.

Obviously (and probably a huge source of relief to all you reading this) I am supervised. Closely.
There are people very invested, for my sake, their sake, the hospital's sake, and mostly the patient's sake, very invested in making sure I don't screw up.

But for the first time, I can sign my name with an MD behind it. And if I write an order in a patient's chart, it will happen. For the first time in my professional life, I have real responsibility that has real consequences. Never will the transition be so enormous.

As a medical student, we can interject our opinions or thoughts, but in the end, we are not responsible. Now, I carry the title "Intern." And that means I am responsible.

I love patients. I love the feeling that I am in a field where someone, voluntary or not, puts their trust in me to take care of them. To treat them. To ease their pain and their worries.

Only in parenthood do we see that some type of trust.

And the thought that I might hurt someone, unintentionally of course, but still hurt someone none the less, scares me.

During medical school, we study nearly endlessly. We take exam after exam. We sacrifice for that opportunity.

To have the trust of a patient.

And I don't want to do anything to lose it.

Just before the drop

Thursday, June 4, 2009

I love roller coasters.

I wait in line excited, watching the people riding before me envious that they have already made it through the line and onto the ride.

But every time I'm in my seat, harness clicked in place, and moving slowly, slowly up the hill, I start to get a little panicky. I know the ride will be fun, but the slow clanking ride upward makes me nervous. Right at that moment I want off.

I'm getting that feeling now.

We pick up the moving truck in the morning. We hit the road the day after. I don't think I've been this excited about something in a long time.

But tonight has the feel of the chain clanking under my feet as I reach the summit.

And I'm scared.

...

...

I tried to think of a nice tie in to this next part, but couldn't. So here it goes. This is less of a confession and more of a...confidence. I don't know. You read, and then you tell me.

I don't really have any friends.

(Okay, don't sit there reading this and say "Oh, the poor girl." Or "Great. I smell a pity party.")

It's not like I've never had any.

I had a lot of friends during high school. But as high school friends, we lost touch as we went our separate ways.

I was friends with my roommates during undergrad. But I was a science major living with three music majors and we all had such different personalities, I think we were glad to let things slip when we moved out.

Out of my group of childhood friends, I was the only one who went to college. I think that decision put a little distance between us. Not purposefully of course. A few of them talked about going to college.

There was always a lot of talk.

It was medical school that really put the nail in the coffin of many of my childhood friendships. Some of my friends were not that subtle about that fact that they were not interested in continuing our relationship.

At first I just thought it was because between raising two boys and working on my medical degree, my schedule just didn't allow for as much time together as it once had.

But after a few obvious snubs, I began to think it might be more.

I blamed myself mostly. I wasn't there enough. I wasn't trying hard enough. I just wasn't a good friend.

Hubster has always been of a different mindset. He thinks that most of my friends were intimidated by what I was doing. That suddenly all their talk couldn't hold up to my actions.

I had always dismissed this.

Until recently. I read an article that female physicians have a hard time making friends in general. Some of it is self-induced seclusion. But not all. Women have talked about negative reactions they have gotten once other women have found out that they are doctors. Soon, they just stop telling people what they do for a living. They try to avoid conversation about work so they won't be asked the question that will stop all future conversation. Many have guessed at possible reasons. The other women are intimidated by the title. Others don't think they are "worthy" (huh) of physician friends. Whatever the problem is, apparently I'm not alone in it.

Medical school was the most emotionally demanding, physically exhausting thing I have ever done (and that is including surviving two newborn phases of 1 am-3am-4am-6am feedings). However it offered a respite from the loneliness that I had felt before that time. I had the most amazing friends in medical school. People that were working towards the same goal I was. People that were coping with the same challenges. People that weren't offended if you didn't make it to a party, because well, they didn't make it either, because they were home studying for the same exam.

But medical school ended and my friends are scattered across the country. We still talk occasionally. But, obviously, it is not the same.

Blogging has helped. I get to have conversations. I've reconnected with people I hadn't talked to in years. Some have even gotten to see that I haven't turned into the emotionless controlling "stereotypical" doctor. And I've made bloggy friends.

Which I get to take with me regardless of where I live.

I've been asked if I'm sad about moving. Scared? Yes. Sad? Not really. Yes I will miss my mom only being an hour away.

But I'm not really leaving anyone else.

I think being lonely in Iowa will be about the same as being lonely in Utah.

Maybe I shouldn't, but I do

Friday, May 29, 2009

I'll admit it.

I get a lot of inspiration for writing from other people's blogs. I don't think this is cheating by any means. It just that people have ideas that get my mind going light speed, and then I need to write.

I read in several blogs lately about regrets.

Mostly, about how people were claiming that they didn't have any.

Not that they thought their lives were perfect or mistake free. But that they couldn't regret anything because it had made them the person they were today.

What's wrong with me?

I've finally gotten to a place in my life where I'm pretty happy with nearly everything.

But I still have regrets.

I've made it through medical school, and I think that I finally have stopped regretting going in the first place. But I will always regret how difficult I made the process for my family. I spent so much of medical school being completely miserable. And it didn't make it so I had to work less, or that people were nicer to me at work. All it did was make it difficult for my family.

I have a wonderful relationship with my boys. But I regret every time that I've lost my patience with them. There is never really a good excuse for it. And I know it didn't ever make me a better person.

I regret losing so many friends along the way. I could have done a better job keeping in touch, trying to be there for people, or just showing up.

I regret nearly every doughnut I have eaten on call nights and morning rounds. I might not have to work so hard to have something to report on Wednesdays if I had just eaten a few less of those glazed temptations.

I regret being so hard with myself when I was "younger." (It feels stranger to say younger when I'm only 27 and already young, but yeah, you know what I mean.) I beat myself up over how much I studied, about what I looked like, about how much I could get done in a single day. If I had just learned to relax and accept me for me, I would have not lost so much time being unhappy.

Maybe I'm over-reacting. Maybe none of these things are worth regretting. Maybe I need to work on letting go of these regrets and accepting that they have made me the person I am now.

But I don't think that any of those things benefited me. Just made me and those around me miserable.

And the regrets keep my eyes open to how to prevent those mistakes in the future.

Like my goal for residency.

My goal is to just suck it up. Yes it will be horrible. It will be much more miserable than third year or my fourth year sub-I could ever be. Will I want to quit? Yes. Will I probably cry? Yes (no probably about it.)

But I'm going to try to not be miserable. Because I have to do it. And being miserable won't make it so I have to work less, or my senior residents be nicer to me. And it won't make the process easier for my family.

I guess this is just a reiteration of my thoughts on guilt.

I don't dwell on my regrets. But I don't deny that they are there.

Change of mind, not change of heart

Thursday, May 21, 2009

It has come to my attention as we make the round, saying goodbye to friends and family prior to our big move, that many are unaware of the change in my career path.

The majority of people still think (or thought, prior to being corrected) that I am going into pediatrics.

And when I tell them that, no, I'm actually going to be an anesthesiologist, there is the unavoidable explanation.

I'm always met with variations of the same conclusion.

"So, now you hate kids?"

I thought I would take this opportunity to explain why I changed my mind.

When I first went to medical school, I thought that I was going to be an anesthesiologist. For all of two weeks.

We had a lecture series for first year medical students that taught us about different specialties. I was very excited for the anesthesia lecture. But the physician giving the lecture ruined it for me. He kept saying how great it was because you got to be a doctor, but you didn't have to talk to people. I knew that I wanted to interact with people (if I hadn't wanted this, I could have just stayed in my plant lab.) So I left the lecture and never thought about anesthesia again.

After my first pediatric rotation, I was sure that I wanted to be a pediatrician. I loved the children. And the normal hang-ups that people have about pediatrics didn't bother me. Sick children didn't depress me. Demanding parents didn't irritate me.

(Okay, I also really wanted to be an OB/GYN for a while. But I had vacation right after my OB/GYN rotation, and realized how much I liked my time off.)

I also strongly believe in primary care. Being the portal into health care and the first point of interaction, continuity of care, and care of vulnerable populations all appeal to the idealist in me.

So, I created my schedule to best prepare me for pediatrics.

I took pediatric neurology and pediatric IV team. Then I took my pediatric sub-I. (Background: a sub-I is an opportunity for a fourth year medical student to act similarly to an intern (or first year resident) They get more autonomy and more responsibility.)

My sub-I was the most miserable experience of my entire medical school. I was abused by the other interns. I never got to sleep on my call nights. I was told that no one would cover my patients if I went home early on post-call and "golden days" (paperwork only days.) I was so emotionally beat down that I was close to a mental break down. I told my friends, my adviser, and my family that I was going to quit. I couldn't see any end in sight to the emotional disaster that my life was becoming.

One day, near the end of my rotation, I was rounding on a patient that had a severe intestinal condition. His parents had been at the hospital with him every single day since he had been admitted 13 days earlier.

I suddenly realized that I was envious of those parents. Yes, their son was sick. But at least they got to see him. I hadn't seen my children awake in over two weeks.

I came to a realization right there that I liked my children much more than I would ever like anyone else.

I knew that I couldn't do pediatrics. But I didn't know what else to do - besides quit.

About a month later, I rotated in anesthesia. I immediately was drawn in by how happy everyone seemed. Yes, they worked hard. Yes, the work was stressful and demanding (but honestly, in medicine, what isn't.) But they didn't have the same beat-down, lifeless look to them that other residents had. And they had a life outside of medicine. Residents and attendings would talk about movies during cases. Residents had time to see movies?!

And at the end of one day, when I was told that I could go home, I was shocked by how fast the time had gone. I hadn't been constantly checking the clock. I wasn't resentful of the time I had to spend at the hospital.

A week later, Hubster asked me what rotation I was on. Anesthesia.

"Well, you should do this. You haven't asked to drop out for weeks!"

Since then, I have completely fallen in love with anesthesia. The procedures, the physiology, the pharmacology. Everything was intriguing.

When I first told some of my classmates that I was going into anesthesia, there was disbelief. "But you have such wonderful bedside manner. It will be wasted in anesthesia!" "But, what about your feelings on primary care?"

I still get to talk to patients. The better the bedside manner, the fewer sedatives required before surgery. I'm the last one they get to talk to about their fears before going into the OR. I'm the last face they see as they fall asleep.

And I realized although I love the idea of primary care, it wasn't the right avenue for me. I may not ever practice in a small, rural clinic, taking care of people no one else would otherwise, but I still get to be an advocate for my patient. I can make suggestions for better pain control, for better nausea prevention, for faster recover.

I can still be there for them.

A better introduction

Sunday, May 17, 2009

Residency is just a little over a month away.

I've been trying not to think about it. I've been so happy during my time off. Playing with my boys, picking Bug up from school, reading to Monkey every night, catching up on my own reading.

I knew that it, like all vacations, wouldn't last. But it is so easy to pretend.

My first year, or intern year, contains a variety of clinical experiences. So that I have a broad variety of experiences on which to draw when I start dedicated anesthesia training during my second year.

I start in the emergency room.

I think my biggest fear about starting residency is being taken seriously. It never really happened during medical school. No matter how often I introduced myself as "Katherine, the medical student on the team," I was consistently called something else by patients.

Nurse.

Now, I'm not trying to belittle nurses or say that I'm better. Because without nurses, there could be no doctors. But the point is, I'm not a nurse. I'm a doctor.

Many school makes their medical students wear short, hip length white coats. This was to help differentiate medical students from residents and attendings. My school didn't do this. I wore a long white coat like everyone else. But despite this, I was never once "accidentally" called doctor.

Only nurse.

When people would ask what I was in school for, I would respond, "I'm in medical school." I got the same reaction from acquaintances, relatives, and strangers on the bus. "Oh, you're going to be a nurse!"

No. I'm not.

Once when I was admitting a patient from the emergency room, his cell phone rang. He answered it, talked for a moment, and then said, "Sorry. I need to go. There's a really pretty nurse here asking me some questions."

I know which emotion was stronger. I was flattered that he had referred to me as "very pretty" and not "nurse who looks like she hasn't slept in days, had time to comb her hair, and has the biggest, darkest circles under her eyes I've ever seen." But I was frustrated that he just assumed I was a nurse, despite my careful introduction.

It's not just my gender that have worked against me being taken seriously. It's my age. Or more accurately, my perceived age.

I think I can sum up this problem accurately with a single patient encounter. I had entered a room to place an I.V and take a patient back to the operating room. The patient turned to me before I had time to introduce myself and patted my arm.

"It's so nice they let high school students volunteer here."

Aww, thanks.

In the past, being seen as something other than I was and younger than I was made me timid. No one took me seriously, so I stopped seeing myself seriously. It wasn't until the end of medical school that I started to get a little confidence back.

This time around, I'm going to try to not let this past experiences hinder my confidence in anyway.

And this time, I can actually introduce myself as "Doctor Katherine." Maybe that will help.

Through and Through

Sunday, May 3, 2009

Whenever Hubster and I hear anyone refer to themselves as geeks or nerds, we just laugh.

Because we know the truth.

They have nothing on us.

It took a while, but we have completely accepted that we are true nerds, through and through. And now, honestly, we are quite proud of it.

I was a biology major with a minor in chemistry. Hubster got a double major in mathematics and physics. I was president of the science club in high school, winning silver metals in state competition. Hubster led his class to a championship in the "Knowledge Bowl."

And we are doing the best we can to instill these precious attributes in our boys.

They have a model solar system hanging from their bedroom ceiling. We encourage them to "play" on Google Earth for computer time. We spend afternoons at museums. Family movie night? Your pick: Planet Earth or Blue Planet. And for fun...

"Guess what we're going to do today?"

"What?!!!"

"Grow salt and sugar crystals!!!"

And that's what we do. And each day, they would oh and aw about how much the crystals had grown. Until finally it was the day to take them out and eat them.










And then I saw these flash cards on Uncommon Goods. And I WANT them for my two year old!



This is all for their own good.

With a physician mom, and a dad applying for dental school, being a nerd can really pay off. Well, we hope so. Someday.

Take two and call me in the morning

Friday, April 17, 2009

My oldest son woke up with a high fever this morning. Not high enough to rush to the emergency room. But high enough for him to feel achy and for me to call his school and excuse him.

I know that it is most likely some virus that he caught from school. And that he will probably be over it by tomorrow.

However, both my medical training and my panicky parental side worry. Could he have meningitis? No, he has a slight headache, but no other symptoms. Could he have pneumonia? No, he couldn't have a cough. Could he have this, or that, or this other terrible thing? No, he's just got a bug, and it will pass.

But should he not get better, or his fever get higher, or he have other symptoms that scare the crap out of me, it is nice to know that the emergency room is less than 10 minutes away.

We hear a lot about the "good ol' days." But in terms of medicine, there never was never anything good about the old days.

150 years ago, if a child woke up with a fever, there was nothing to reassure a parent that it wasn't that child's final moments. No way to differentiate mild from serious. And if it did turn serious, what was anyone going to do? Bleed them? High childhood mortality has been an extremely common thing until recent times.

It is only thanks to leaving behind the "good ol' days" that we can, for the most part, feel secure that our children will make it through childhood sniffles, fevers, and aches, and reach adulthood.

I am grateful to live in a time where I can give my little boy Tylenol, cuddle with him on the couch in front of our favorite Pixar movie, and trust that he will be fine in the morning.

It's a Match!

Thursday, March 19, 2009

After all the anticipation, the hype, Match Day almost felt anti-climatic.

I was feeling remarkably calm. I even slept reasonably well. I was doing great. Clear up until I was right about to open my envelope. I was shaking. Apparently enough to get a couple of comment.

And it's over.

But actually, it's just the beginning.

Making my mark on the map

We're going to Iowa.

I know, that's actually a state. People kept saying "Ohio" or "That's in the Midwest, right?"

I'm leaving the mountains I have taken for granted for my entire life. I'm leaving my parents and siblings. I'm leaving the roads and cities and canyons that I know so well I can check out while I drive.

It's for the best. Iowa was everything we never knew we were looking for. Living in a state where winter can last up to 9 months, our thought was "warm. We need somewhere WARM." But throughout the interview process, other, real, things became so much more important. Schools, safety, housing market, future job market. Iowa has it all. Minus the ocean. And the warm.

But we're excited.

And scared.

We're going to pack up our little family and move half way across the United States. To a place only I've been (and I was only there for one day.) Hubster is leaving a great job. I'm leaving my family. We're leaving everything that is familiar and safe.

And for what? For great training. A better quality of life for our family. You know, the American dream.

So let the planning begin.