I’ve often heard the phrase, “Don’t bring your work home with you.”  And I used to think that would be an easy thing to do.  And every day before I leave the hospital, I “sign out” my patients to a fellow intern who takes care of them overnight.  Easy, right?

But it’s not easy.  Even if I’m not at the hospital, even if I turn my pager off, I can’t leave my work at work.  Because, unlike other jobs, my “work” isn’t a stack of paperwork or a list of tasks to be completed.  My “work” is taking care of patients.  My “work” involves real human lives, who, even if I leave the hospital, are still sick and still need to be taken care of.

My commute home takes me about 20 minutes.  I turn the radio on and try to unwind and forget about the blunders of my day.  But no matter what amazing song plays on the radio, it is never enough to drown out the voices in my head.  Did I do everything right today?  Did I forget to order anything?  Did I miss anything?

The first thing I do when I get home is tell my husband about my day, which usually involves telling him about a patient I’m worried about who is really sick and hopefully will be okay through the night.  I usually log onto my computer before bed to double check my patients’ charts, make sure all of the orders are correct and that everyone looks stable.

And when I finally lay down for bed I go over and over in my mind the different patients I’m taking care of.  And it’s rare to sleep through the night without having strange dreams or nightmares about my patients.  The other night I dreamt that I went to check on a patient that I was worried I had made a mistake on and the patient shot me in the leg.  Even after I woke up, I could still feel the pain in my leg.

It’s hard being a doctor.  And not just for all the reasons you would think.  It’s hard to be a doctor because you hold so much responsibility.  Your patients’ lives are in your hands.  And that isn’t a responsibility to be taken lightly.

I have always been very hard on myself.  I strive for perfection, and I beat myself up when I make mistakes.  As an intern this trait can really take its toll on me.  For example, I had an experience where I ordered a very important and time sensitive medication for a very sick patient.  Hours later as I was discussing the patient with my attending, we realized the medication had yet to be given.  I wanted to so much to blame someone else.  Did the pharmacist change the order?  Why didn’t the nurse give it?  I was so angry.  Who was responsible for this error?

And it sucks to realize that no matter what happens, I’m responsible.  It was my patient, so it was my responsibility.  I should have followed up on the medication.  I should’ve double checked the chart or called the nurse or gone and looked in the patient’s room.  No matter how much I want to complain and blame someone else, I am the one who messed up.  And it kills me.

It’s so hard to let things like that go.  This is just one example, but there have been little things here or there that just eat me up inside.  Things I can’t forget.  And even if I relive the situation over and over and figure out what I could have done differently, or realize I did everything right, or convince myself it wouldn’t have made a difference in the outcome, I can’t just let it go.  I can’t just leave my work at work.  My patients follow me wherever I go.  Because no matter what, my patients are my responsibility.

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Whenever people learn that I’m not only a resident, but I am a mother as well, they inevitably reply, “Ohmygosh!  How do you do it all!?”  In fact someone just this past week referred to me as “superwoman.”  And although I enjoy the compliments, I have to admit that I am far from superwoman.  And I undoubtedly do not “do it all.”

For as long as I can remember, I had big plans for my life.  I had always heard that you “can’t have it all,” but I always felt that applied to other people and not to myself.  And in my own mind, I really was going to be superwoman.  I worked hard in college, got into medical school, and here I am now, an actual doctor.  And to top it all off I’m married, and I have a beautiful daughter.  To any outsider it might actually look like I have it all.

But I can tell you from the inside that it’s not that simple.  The reality is that every moment of every day I feel overwhelmed.  I have a running list of tasks in my head that need to be done and the list is never ending.  If I’m at work, I’m constantly checking things off my list, running from patient room to patient room, attempting to finish notes and put in orders, all while watching the clock, trying to get my work done so I can leave in a decent time so that I can get home and steal a few precious moments with my daughter before she goes to bed.  And even when I get home, I often only get to snuggle next to her as I feverishly try to finish writing discharge summaries, all while fighting off her tiny fingers from pushing the buttons on my keyboard.  Then, far before I’m ready to say goodnight, I have to give her a bath and wrestle her into her PJs and read a dozen books before bedtime because my daughter’s new favorite phrase is “one more.”  I tuck her into bed and we say bedtime prayers and just as the door closes to her room I hear the unmistakable sounds of “Mama! coming from her crib.  I sigh and head back in for another ten minutes of rocking in the rocking chair, secretly cherishing every second as this is the only quiet time in my day.  And deep down feeling guilty that my tiny baby gets such little time to spend with me.  Then, of course, I tackle a sink full of dishes and realize I have yet to eat dinner.  Luckily there are leftovers in the fridge.  Maybe my husband and I will get to watch an episode of one of favorite TV shows together while we eat.  And by then it’s time for bed, as we both will have to get up by 5am the next day and do it all over again.

My house is never clean enough.  I struggle to find time to cook meals.  I am constantly worrying about my patients and it often keeps me up at night.  I’m always exhausted and fantasizing about the next time I can get some sleep.  My husband and I haven’t been on a real date in months.  And my daughter gets to see me for maybe and hour every day.  This is not what I would call “having it all.”

My life is anything but simple.  It’s anything but glamorous.  And even if I actually had it all, I don’t have any time to really enjoy it.  I’m not saying I’m unhappy, and I’m not saying I don’t love my life.  But there are moments here and there where I look at my husband and say, “Do you ever wish we had a normal life?  And we each had normal 9-5 jobs?  And weekends off?”  To which he always replies, “Yes.”  And we both sigh and think of how different our lives would be.

The best way I can describe my life is, “I’m surviving.”  I’m not thriving.  I’m not going to be winning any awards for being awesome anytime soon.  I’m just trying to make it through each day.  And even if it looks like I’ve got my life together and like I’ve got it made, I have a long way to go before I really do.

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Night Float

It’s 3 AM.  I’m lying in a dirty call room at the hospital.  My eyes are closed, and I’m just getting into that hazy twilight that precedes sleep when it happens.  BeepBeepBeepBeepBeep….my pager goes off – again.

I dial the number on the pager.  “Hey.  It’s Dr. Howard.”

“Yes, Dr. Howard, I paged you because this patient is complaining of shoulder pain and there is nothing ordered.”

“Okay.  I’ll put something in.”

I drag myself out of bed and out into the hallway where the nearest computer is located.  Still half asleep, I log on and put in an order for percocet.  I then head back to bed.

Ten minutes later.  BeepBeepBeepBeepBeep.  Another page.

“Hey, Dr. Howard.  This patient doesn’t have a diet order in, and I’m wondering if she really needs to be NPO?”

“Yeah, I think the primary team was concerned for aspiration, so we will just keep her NPO.  If they want to feed her they can change it in the morning.”

Twelve minutes later.  BeepBeepBeepBeepBeep.

“Ya, Dr. Howard.  This patient is complaining of blood when she pees.  She says it has been happening for four days.”

“So ya, I’m not really sure what you want me to do about it right now.  Her primary team already knows, and they haven’t been doing any further work-up  So I will let them know, but we can just watch her for now.”


“Dr. Howard, this patient’s blood pressure is 89/56, but she has been hypotensive this whole admission.  Just wanted to let you know.”

“Ok.  Noted.”


“Hi, Dr. Howard.  This patient is still having 8/10 shoulder pain.  He refused the percocet, and now he wants to talk to you.”

“Okay.  I’ll be there in a minute.”

Abandoning all hope of taking a nap, I walk down the hallway to talk to the patient.  Trying to remain strong and not be suckered into a demand for a stronger pain medication.  Meanwhile, the nurses spot me.

“Hey!  Are you Dr. Howard!?  I was just about to page you about my patient in bed 6.  He wants a nicotine patch.”

“Oh, Dr. Howard!  There you are.  My patient wants something to help her sleep!”

“By the way, Dr. Howard.  This patient lost her IV and she is refusing to let me put another one back in.”

Sigh.  Being the night float intern means getting paged about anything and everything at all hours of the night.  You’re the doctor taking care of all the other interns’ patients while they are gone, so anything the nurses need, has to come through you.  Sometimes it’s really important, like a critical lab value or a patient complaining of chest pain.  Sometimes you have to wonder if the nurses are just bored and playing a prank on you.

And you never know what the next page will bring.  Hopefully it’s something simple, like renewing a foley order or ordering some benadryl.  But there’s always a small amount of fear that a patient will be decompensating, and you’ll be called upon to know what to do.  So far I’ve managed to keep all the patients alive, which is always my primary goal.  But I’ll be working nights all month, so I won’t count my chickens just yet!

Watching Scrubs during Night Float

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I’ve been struggling for weeks to come up with a topic to blog about.  It has been brought to my attention that my posts as of late have been somewhat depressing.  Well, sorry to all my readers out there, but that is my reality.

I wish I could write to you about all the amazing experiences I’ve had saving lives or about the special bonds I’ve made with my patients where they’ve hugged me and told me I’m the best doctor they’ve ever had.  But that would be a lie.  A big lie.  Because the truth is most of my patients are kind of awful.

I don’t mean that in a bad way, but I take care of some interesting people.  Prisoners.  Homeless people.  Drug addicts.  Patients with severe psychological disturbances.  And they’re not always nice to me.  In fact, I get yelled at a lot.  Sometimes my patients refuse to let me touch them, even to listen to their heart and lungs.  Sometimes I’m a little afraid for my own safety.  And it’s pretty rare to have a patient who is excited to be in the hospital and excited to have me take care of them.

And that’s okay.  I get it.  Sometimes my patients aren’t in their right mind.  Literally.  A lot of my patients have schizophrenia or dementia.  A lot of them are under the influence of drugs.  And the hospital can be a scary and unpleasant place.  So I don’t take it personal.

But some days it is really hard to take care of people who don’t even want your help.  Sometimes patients aren’t able to make their own medical decisions, and so you really do have to treat them against their will.   And it can be really draining to give and give all day long.  To work 12-14 hours days and be completely exhausted only to be yelled at by a patient.  Or to never hear “thank you.”  Or to be treated like a waiter and here complaints about how awful the food is.

The reality of being a doctor is much different than the dream.  Like most things in life.

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Doctor for a Month

So I’ve officially been pulling off this whole “doctor” thing for a month!  It has gone very fast, but yet it feels like forever.  I’ve gotten less sleep, skipped more meals, and cried more times that I can count.  But I’ve survived.

It’s hard to describe the feelings I’ve been experiencing this past month.  Amazement – that I’m actually a doctor and I get to take care of patients.  Frustration – at my lack of knowledge.  Anger – at the unfairness of life.  Gratitude – that I have my health when so many others don’t.  Sadness – that I can’t save everyone and that I have to watch so much suffering and death.  Happiness – that I am blessed to do what I do.  Doubt – that I picked the right career.  Fear – that I don’t have what it takes to do this for a lifetime.  Exhaustion – beyond belief.

Some days I come home so excited to tell my husband about my day, the cool things I’ve seen, the procedures I’ve performed.  And other days I am silent, because how do I tell him I spent the last hour of my day listening to the last dying breaths of a patient my own age.  But everyday I carry the burden of my patients’ sufferings with me.  Even when I have a day off, I find myself constantly checking charts from home, making sure the right orders are in and that my patients are still alive.  I lay in bed at night worrying that I’ve forgotten something, or that something will be missed while I’m not there.

Some days I want so much to scream, to cry, to hit something, someone, anything.  I thought I knew what I was signing up for when I decided to become a doctor.  But I had no idea.  Not even an inkling of how hard it would be to do this job.  On so many levels.  I underestimated the physical and intellectual challenges that being a doctor would bring.  I had no idea the mental exhaustion it takes to work 15 hour days over and over and over again.

I was once asked by a physician during residency interviews if I believed in the concept of Informed Consent.  Of course, I replied.  Then he explained that he believed informed consent to be a myth.  Because no one can ever be truly informed.  So when we describe a procedure and the risks involved to a patient and they give informed consent, it’s a fallacy because they don’t have the medical knowledge required to truly understand the procedure and what they’re agreeing to.

I think in many ways he was right.  If I had truly known what being a doctor was going to be like, I wouldn’t have signed up for this.  And that’s the honest to goodness truth.

But I did sign up for.  I signed my life away, and it’s too last to take it back.  So for now I’m going to try to take a nap before my night shift tonight.  I’ll try not to lay awake thinking about my patients, even though I know I will anyway.  And I’ll probably have strange dreams about blood transfusions and horses in the ICU (yes, this is what I dream about nowadays).

1 month of Intern year down – 11 to go.

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Last night I was asked by a patient, “How long have you been a doctor?”  My reply:  “Three weeks sir.”  If that doesn’t instill confidence in a person, I don’t know what will.

But it has been only three weeks.  Yet, somehow, it feels like a lot more.  Maybe it’s because I’m blogging right after a 14-hour night shift.  Maybe it’s because I’m exhausted and tired and hungry.  Or maybe it’s because deep down I’m feeling completely overwhelmed.

Being a doctor is hard.  The hours are long.  I barely get to see my family.  My brain hurts.  My feet hurt.  I could go on and on.  But I’m not one to complain (yeah right).  But in all seriousness, I feel completely overwhelmed.  So far my experience of being a doctor is one in which every single day I feel inadequate.  Every day I’m confronted with my own personal flaws and intellectual deficits.  I’m constantly asked questions that I don’t know the answer to.  And I’m frequently confronted with decisions that could be life-or-death, all of which I feel unprepared to address.

And today was the first time that I really messed up.  I can’t describe in too many details the case or what happened.  But basically I ordered too high of a dose of a medication for a patient.  I didn’t kill the patient or anything, but an attending brought it to my attention.  I took full responsibility.  I took the blame.  And it sucked.

Not because I got yelled at.  Not because I was embarrassed.  But because I did something that wasn’t the right thing to do for my patient.  And it feels awful.  And in the grand scheme of things it was a very small mistake that had only minor consequences.  But it hurts.  It hurts deep down knowing that my best wasn’t good enough.  I  should have known that it was too high of a dose.  I should have known the effect that it would have.  And I just didn’t.

It just amazes me that after four years of medical school I can still know so little.  I feel like I’m an intelligent person.  I;ve always gotten good grades and good test scores.  But medicine is such a complicated field.  No two cases are exactly the same.  And there is an infinite amount of things to know.

It’s very hard not to get discouraged.  Logically I know that I’m just starting my training and that this is normal.  I see the residents who are one year or two years ahead of me in their training, and I see how much they know.  I’m hope that I get there eventually, too.

But right now it seems almost impossible.  It seems like I have so far to go and so much more to learn.  I feel like I should know more for where I’m at.  And I feel like my patients deserve better.

So for now, I have to stomach the fact that I screwed up.  I made a mistake.  And I have to get over it.  I won’t make this mistake again.  But there will be others.  Lots and lots of other mistakes.  But in some ways this motivates me to work harder and study more and continue to learn as much as I can and ask as many questions possible.

I hope I’m not as dumb as I feel.  I really hope that it wasn’t a mistake that somebody let me call myself “doctor.”  And I hope that tomorrow I can do better.

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The Scorpion

I’m not sure which was the more terrifying experience for me this week: finding a scorpion in my living room or starting Intern year in the ICU.  We’ll call it a tie.

There is such a huge jump from being a medical student to being a doctor, and until it actually happens you really have no idea how big that jump is.  As a medical student everything is theoretical.  But as an Intern, when someone asks you what you want to do, they actually want you to do it.  And you should probably actually know the answer instead of guess.

Or you could do what I do and just ask the nurse.  My favorite part about working in the ICU is that the nurses are all pretty good.  They’ve been around longer than I have and so far they have all been very nice.

One very friendly young nurse kept coming up to me and saying, “Dr. Howard, the patient in Bed 8 needs this.” Or, “Dr. Howard, what do you want to give to this patient.”  After about the third time I said, “You know it really freaks me out when you call me Dr. Howard.  You can just call me Emily.”  She had a good laugh, but I was being completely serious.

It’s very strange to be Dr. Howard.  It still takes me a second to respond when someone calls me that.  I still forget and introduce myself to patients as Emily.  And I always fumble to find the words when I’m talking on the phone.  “Dr. Howard” sounds like someone who knows what she’s doing, and that is not me.

I do love the ICU, though.  And even though it’s a scary place to start as an Intern, in many ways it feels like home.  The familiar sounds of beeping ventilators and IV machines.  The familiar faces of the nurses and attendings who I met during my student rotation.  And lots and lots of sick patients.

So far I haven’t killed anyone.  I’ve gotten to do several procedures.  I’m slowly learning how to use the hospital’s computer system to write notes and orders.  And little by little I feel like I’m becoming a doctor.

14-15 hour days are long and exhausting.  Especially night shifts.  And it doesn’t help that I’ve already gotten myself sick.  I think it’s going to be very hard to take care of myself during residency.  I probably need to eat more and drink more water.  And eating bacon from the cafeteria every morning should probably not become a habit.

I don’t know how I’m going to make it through this.  It can be overwhelming at times when I don’t know what I’m doing and there are lots of sick patients to take care of and they’re all decompensating at the same time.  But it feels really good to have survived my first week as a doctor.  Now if I can just survive these scorpions…

First Day of Intern Year

The Scorpion

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