Numb

I’m sure you’re wondering what I’m up to.  Wondering if I’ve forgotten about my blog.  Wondering if maybe life as intern just got so busy and hectic that I could no longer find time to write.  I haven’t forgotten. And I’m not too busy.  Lately I just haven’t been able to find the right words.

Life as an intern is almost over.  It’s been a long year.  And I want nothing more than for it to end.  I started the year as a bright-eyed new doctor, looking forward to seeing patients and learning the ins and outs of patient care.  But slowly through the year, I’ve grown tired.  Physically.  Emotionally.  Just, tired.  And this month especially, as I am working in the ICU (Intensive Care Unit), I find myself feeling a little burnt out.  Numb.

Being an intern, being a doctor, is so much more than I ever imagined.  More difficult.  More tiring.  More consuming.  More challenging.  More of everything.  One minute can be thrilling and exciting.  The next can be emotional and terrifying.  And I just don’t feel like I was prepared to feel this way.  Medical school taught me a lot about medicine.  But it didn’t prepare me to deal with the emotions that come along with a life in medicine.

Nobody prepared me to pronounce the time of death on a patient.  Nobody prepared me to put in orders for “comfort care only.”  Nobody prepared me to call someone’s family and tell them their loved one is dying.  Nobody told me how to deal with the fact that I was the last person someone ever spoke to.  And nobody ever told me how to deal with the haunting feeling that maybe if I had done something differently, maybe if I had been a better doctor, my patient might still be alive.

So most days I’m left to myself.  Left with my thoughts.  Left with my feelings.  Left with my worries.  And the worst part about being a doctor is, that you feel isolated.  You feel like you can’t talk to anyone, because how could they ever understand.  When I come home after a 14 hour shift where I spent half of those hours managing a dying patient, how am I supposed to tell my husband about my day?  How can I explain to him that I don’t want to talk about it?  That I can’t talk about it.  That I just want to forget.  That I just want for it to never have happened.

Believe me.  I’ve thought about writing.  I’ve thought about how to explain everything I’m feeling.  But there are no words.  There is nothing to say how this feels.  There is nothing that can make it better.  It is what it is.  This is what being a doctor is like.  And some days, I just wish I wasn’t a doctor.  I wish that I didn’t have to know what this feels like.

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Limitless

There is a limit to what people can take.  In my short time as a doctor I’ve seen a lot of people who have reached their limit.  Their body, their mind, their spirit has had all it can take.  I’ve met people whose body hasn’t reached its’ limit, but their spirit has.  And I’ve seen people whose body has reached its limit, but their spirit is still going strong.

This month has probably been my most difficult month as an intern.  This month I have been rotating at a different hospital.  I started off the month by getting sick with a bad cold.  Of course I didn’t want to call in sick my first day at a new hospital, so I toughened up and pushed through.  The commute to this hospital is more than double what I’m used to, so the hours have been long.  I’ve been getting up about 4:30 every morning and trying to be in bed before 8:30 every night to get a decent nights sleep, especially trying to recover from being sick.  And I’m really outside my comfort zone.  It’s a different hospital with a different computer system and different policies and different practices, and it’s been a steep learning curve.  Meanwhile I’ve had some really, really sick patients who I’m responsible for taking care of, while struggling to take care of myself.

But this month I’ve met some amazing individuals.  Some amazing physicians.  Some amazing patients.  And some amazing physician patients who have reminded me that every day is a gift.  They remind me that even doctors get sick, and that good health isn’t guaranteed to anyone.

One evening I was leaving the hospital quite late, and I stopped to see one of my patients before I headed home for the evening.  Being a physician himself, he felt compelled to have me pull up a chair so he could give me a lecture on physician burnout.  I appreciated the advice, but couldn’t help but see the irony in spending 30 minutes at the end of a long day talking about physician burnout.  But his advice was this: find something in life that makes you happy and find time to do it.  And if you need help, never be afraid to ask someone.

Some days I feel as if my mind, my body, and my spirit are at their limit.  Some mornings I can’t imagine getting through the day.  It takes so much energy and effort to get out of bed and spend the entire day taking care of others.  But then I see my patients.  Those whose bodies can take no more, but their spirit drags them onward.  They refuse to give up, no matter how terrible the odds.  They inspire me.  And I know I haven’t reached my limit.  Not yet.  They’re the reason I can get through the day.

Being a doctor is such a strange profession.  Every day is new and exciting.  Every day I meet new patients who teach me something.  No day is predictable, and no two patients are alike.  Some days I wonder what I’ve gotten myself into.  And some days I can’t imagine life any other way.

I feel so extraordinarily blessed to do what I do, and there is no limit to what life has in store.

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What I Love About Being an Intern

As promised in my prior blog post, I’ve been trying to focus on the good in my life.  This month of ambulatory rotation has been a much-needed breath of fresh air.  I’ve caught up on my sleep.  I’ve been cooking and baking.  I’ve cleaned my house.  My Christmas letters will go out in the mail tomorrow.  And I’ve had time to regroup.  I feel a little more like my normal self and a little less like an “intern.”  In short – working forty hours a week agrees with me.

So as I near the half way point of my Intern year, I wanted to share a few of my favorite things about being an intern.

1. Being Dr. Howard

Now I’m not saying this in a snooty, please-call-me-doctor way, but being Dr. Howard instead of “justthemedicalstudent” is definitely a step in a positive direction.  At least it means the nurses take you seriously.  Well, maybe not seriously, but they sure seem like they listen.

2. Increased medical knowledge

I have learned so much in the past 6 months.  And in such a different way than I did during medical school.  Every day I learn more and more, and it’s exciting to go to work and never feel bored.

3. Friendships

I love my fellow interns and residents.  My favorite part of the day is hanging out with them.  Getting along with the people I work with makes work so much more enjoyable.  I can’t imagine spending 80 hours a week with people I hate.

4. Level of Responsibility

So this might seem counterintuitive, but I enjoy being low on the totem pole.  It’s nice to know that I have a senior resident and an attending above me to make sure I don’t mess up.  From this point on my level of responsibility is only going to increase to a point where I am solely responsible for my patients and my patients’ lives.  For now I’m going to enjoy the fact that I have help.

5. Support

One of my favorite things about being an intern is how much support I have.  Not just from my family and friends, but from all of the people I work with.  I’m so blessed to work at a place where people encourage me and inspire me every day to work hard and be better.

Being an intern is hard.  But I’m half way done.  And in 6 months I will be a senior resident.  Which, honestly, sounds even harder.  I hope I’m ready.  For now I’m going to count my blessings that I’m an intern.  Because it isn’t all bad.

Just a sample of some of my baking this month

Just a sample of some of my baking this month

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Doctor and Pilot: A Love Story

I recently celebrated my 6th anniversary with my husband, Nicholas.  I can’t believe we’ve been married for six years!  We got married when we were both 22 years old, which to most people, seems very young.  We dated for 10 months before we got engaged, and we got married exactly one year later, which to most people, seems very fast.  But marrying Nicholas was undoubtedly the best decision I’ve ever made.

We started dating in college.  The first time we discussed marriage, I told Nick that I wanted to wait until I was finished with medical school before getting married.  That quickly changed as I realized that Nick was the one for me.  We weren’t even finished with college by the time we got married!  But Nick knew from Day 1 that I wanted to be a doctor.  He never questioned it.  He never asked me to reconsider.  When I got my first rejection letter, he was the one who encouraged me to try again.  He was there for me during interviews and when I finally got accepted.  He moved to the middle of nowhere Missouri with me for the first two years of medical school, and then he drove halfway across the country in a moving truck with me for my last two years.  And now that I’m in the most difficult year of my training yet, he watches our daughter when I work nights or weekends.  He cancels flights and rearranges schedules to pick her up from daycare when I have to work late.  And the only thing he has ever complained about is that he just wishes he could spend more time with me.

The life of a doctor is not a simple one.  It’s not an easy one.  And it’s not one that many people understand.  Being a doctor is one thing, but being married to a doctor is a different thing entirely.  I’m not sure if Nick knew what he was getting himself into when he married me.  Sometimes I question whether or not he did.  How could he know our life would be this crazy and chaotic?  Would he still marry me if he did?

I’m so proud of my accomplishments in life.  I worked very hard for years and years to become a doctor, and every day is a struggle.  But being a doctor is nothing compared to being a wife.  Being a wife is probably the toughest role I have.  It takes the most work and the most effort.  And it usually falls lowest on my list of priorities.  I have patients to take care of at work.  I have a daughter to take care of when I get home.  I have a house to clean and bills that need to be paid.  And at some point I just need some “me” time.  It’s so easy to forget to make my husband a priority.

I don’t know how I got so lucky to find such a supportive man to marry me.  Our marriage has endured more than most in these past six years.  It seems impossible that a pilot and a doctor could ever make it work, but I wouldn’t trade my husband for anyone else in the world.  I think someday when we are old and grey we will look back on our marriage together and wonder how we ever did it.

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Swim

In the past 5 months I’ve started so many blog posts.  I’ve finished so few.  I can just never find the words to express what I’m really feeling.  The experiences I’ve had since becoming a doctor are so emotional, so exciting, so sad, so thrilling, so crazy, and so personal that I usually just give up trying to communicate them.  And I’ve come to realize that although I started this blog to help others understand what it’s like going to medical school and being a resident, there is no way to truly tell you what it’s like to be a doctor unless you experience it for yourself.

In the past few months as a doctor I’ve diagnosed people with cancer.  I’ve told family members that their loved one is going to die.  I’ve dealt with alcoholics and drug-seekers and addicts.  I’ve performed lumbar punctures and placed central lines.  I’ve taken care of people with AIDS and Valley Fever and Tuberculosis and Neurosyphilis and GI bleeds and Endocarditis and Lupus.  I’ve taken care of patients with delirium and dementia and schizophrenia.  And I’ve seen people die.   Too many people.

I hate carrying the burden.  But I can’t share the burden, either.  I hate to write depressing blog post after depressing blog post because who wants to read about that kind of stuff?  Who wants to hear about people dying?  I know I don’t.  But this is my job.  This is my life.  And it’s hard not to get depressed seeing and taking care of sick people every day.

And so I press backspace.  If only I could delete the memories from my mind as easily as I erase the words that I type.  Because it’s hard to forget when you lose a patient.  It’s hard not to worry about patient’s when they leave the hospital.  It’s hard being a doctor.

Every day that goes by I feel like I know less and less.  Even as I gain more experience, the more I realize that I don’t know.  And sometimes I just don’t feel good enough.  I don’t feel smart enough.  Sometimes I feel totally inadequate at being a doctor.

But the other day I sat down at the nurses’ station to use a computer while I waited for an interpreter to see a patient.  And one of the nurses sat down next to me and started to make small talk.  He told me that I was doing a great job.  I tried to brush it off and said, “Well, I’m pretty good at pretending.”  And he said, “No.  When you work here long enough you can see those that sink or swim.  And you’re handling your own very well.  You’re doing a really great job.”

He could have just said it to be nice.  Or maybe he was lying.  But it was a really simple thing that made my day.  Being an intern is so difficult.  It’s like being thrown into a job where you’re supposed to be responsible and knowledgeable but you have no idea what you’re doing.  It’s scary.  And challenging.  And exhausting.  And some days it’s just awful.  But that was a nice thing to hear.

Somehow I’ve survived my first five months of being an intern.  It’s scary that the year is almost halfway over – to think that in 7 months I’ll be a senior resident with even more responsibilities.  I worry that I won’t be ready.  Then again, I don’t feel ready to be doing what I’m doing now.  This month I’ll be working in the outpatient clinic.  I’ll get normal hours and weekends off.  Which, considering that I’ve had 2 weekends off since June, sounds almost like a vacation.  I’m hoping I can rest a little bit and reenergize.  I’ll still have 6 months of intern year to get to, so it should be a nice break to focus my mind again.  After working 5 straight months in the hospital it will be nice to see patients who aren’t so sick.  And maybe I’ll have some less depressing things to blog about!

 

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The Good

Stress is a major part of my life.  It always has been.  You know that phrase, “Don’t sweat the small stuff?”  Well, I do sweat the small the stuff.  And the big stuff.  And the medium stuff.  It just all stresses me out.  And I feel like for a 28 year old, I have a lot of things in my life to stress me out.  There’s my job, and my husband, and being a mom, and trying to focus on my career, and trying to take care of patients, and being an intern.  I mean, I think anyone would agree that I have things in my life that warrant a lot of stress.

But then I go to work.  I get in the elevator, I look down, and there is a small child riding in a wagon.  She is covered in blankets up to her face.  Her big eyes look up at me, and I can see that the rest of her face is covered in burns.  Really, really bad burns.  And it breaks my heart.

I go to see my first patient.  A patient recently diagnosed with cancer.  And I have to talk to his wife about his poor prognosis.  And deep down I know that he isn’t going to live much longer.  And it kills me.

But it puts things in perspective.  Every day I get perspective.  My life isn’t that bad.  It’s stressful, yes.  But it could be so much worse.  I have so, so many things in my life to be thankful for and to celebrate.  And those things should outweigh the bad.

People have told me before that I’m kind of pessimistic.  To which I always reply, “No, I’m realistic.”  Which is still true.  But sometimes the reality is not that good.  And the reality I live in is that everything is not always fine.  People get sick.  People die.  And it’s not fair.  But that’s reality.  So it’s hard to focus on the good sometimes.

I heard a speaker a few years ago who was speaking to medical students and residents about stress and staying positive.  And he recommended a simple daily exercise, which I still do to this day.  Every day on my way to work I tell myself three things:

1. I’m a good person.

2. I deserve good things.

3.Today is going to be a good day.

Those things don’t always end up being true.  Some days I make bad choices, and I’m not the best person I could be.  Some days aren’t good days.  There are really, really hard days.  But at least it reminds me that every day is a new day, and that anything can happen.

I would encourage you to try this in your own life.  No matter who you are or what you do, it’s important to focus on the good.  And even when reality sucks, you can still be optimistic.

Me in my TB hood that I wear if a patient could possibly have tuberculosis

Me in my TB hood that I wear if a patient could possibly have tuberculosis

 

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Responsibility

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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