Reality

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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Better

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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The Doctor is In

The Doctor is In

In T-minus 3 days, I will see my first patient as a real doctor.  And I’ve never been more afraid in my whole life.  You would think with four years of college and four years of medical school I would be prepared for this, but I’ve never felt less prepared for anything.

I started orientation last week.  So far I’ve become great friends with all of my cointerns.  It’s fun to meet new people, especially since they share the same interest as me since they’ve chosen to go into Internal Medicine.  I can already tell that these are going to be some very important people in my life, and probably life-long friends.

I received my long white coat (which is way too big) and my badge that allows me to eat for free in the cafeteria and park in physician parking (which saves me a 5-minute walk in 120 degree heat).  I’ve listened to lots of talks about professionalism and dealing with specific situations that arise in practice.  I’ve downloaded almost a dozen apps onto my phone to help me look things up.  I’ve been recertified in basic and advanced life support and practiced lots of procedures on simulated manikins.  And I’m getting computer training tomorrow.  So I should be all set.  Right?!

The truth is, I’m scared out of my mind.  The same thought keeps popping into my mind.  What if I kill somebody?  And no matter how many people reassure me that won’t happen, I can’t shake that thought from my mind.

Probably doesn’t help that my first month will be spent in the ICU.  I remember my ICU rotation at this same hospital when a nurse told me she felt sorry for the poor interns who get placed in the ICU for their first rotation.  I guess it was a premonition.  To make matters worse, I am working my first weekend on nights in the ICU, which does not always have an attending in-house.  Luckily, I’ll have a senior resident supervising me, but I have this sinking feeling there will be a record number of Codes called, and I’ll be on my own.

And aside from first day jitters, I can’t help but feel scared for the entirety of residency.  I’m going to be working really long hours.  I’m not going to have nearly as much time as I’ve had as a student to spend with my family.  The thought of not even getting to see my daughter for 4 days at a time just gives me a sinking feeling in the pit of my stomach.  And deep down, I’m afraid that I just can’t do it.

I’m afraid I can’t be a doctor.  I’m afraid my marriage won’t be able to survive residency.  I’m afraid that my daughter will miss me and cry for me and I won’t be there.  I’m afraid that I’ve made a huge mistake.  That it’s all just too much.  That I’m not good enough to do it all.

But in 3 days it doesn’t matter.  Because I’m a doctor.  And I’ll have patients who depend on me.  And I just hope that I don’t let them down.  I hope that I can handle the pressure.  I trust that I’ve learned something in medical school and that I’m not completely unprepared to take care of my patients.  I just hope I don’t kill anybody.  One of the speakers during my orientation said it best, “You don’t get to be like everybody else anymore.  But not everybody gets to call themselves doctor.”

 

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Becoming a Doctor

It’s official.  I’m FINALLY  a doctor.  And, I’ve got to say, it’s pretty much exactly as I pictured it would be.  Now I can just relax and start cashing my giant paychecks.  I’ve basically just been too busy deciding what to do with all the fame and fortune that has been bestowed upon me to blog lately, so – apologies.

Riiiight.  But I really am a doctor.   And I feel pretty much the same as I did before graduation.  But now people jokingly call me Dr. Howard.  Well, half-joking, I guess because I’m actually a doctor, but…come on….I’m no more a doctor that I was a month ago.

Graduation was indeed a momentous occasion.  But it wasn’t a day I was particularly excited about.  I was excited to see my friends and classmates, many of whom I hadn’t seen in the past two years.  And I was excited to have my family come and see me walk across the stage.  But even after walking across the stage and moving my tassel from right to left, or left to right, or whichever way it is, nothing momentous really happened.  The diploma they handed me wasn’t even real.  I have yet to receive the real one in the mail.  (And with the hundreds of thousands of dollars I paid in tuition, I’m expecting it to be made out of gold.)

I’m not sure why I wasn’t that into graduation.  Maybe it’s because I wasn’t technically done with rotations until after graduation since I was behind from taking maternity leave.  Maybe it’s because I still have six years of training left and graduation doesn’t really feel like the end of anything.  But I think the real reason is that becoming a doctor doesn’t happen in a day.  It happens in a lifetime.  Becoming a doctor has been a journey that started almost 28 years ago.  And it’s one that will continue throughout my liftetime.

 

Following my graduation I traveled back to my hometown of Harvard, Nebraska to spend time with my family and attend my ten-year high school reunion.  I saw so many of my old teachers, neighbors, friends, and classmates.  So many of them were excited to see me and be one of the first to congratulate me and call me Dr. Howard.  I was overwhelmed with the unexpected multitude of people who knew I had just graduated because they have been reading my blog these past four years.

Many of you might not know it, but I grew up in a very small town of roughly a thousand people.  I graduated with a class of only twenty.  And only one or two other people that I know of have gone on to become doctors from my hometown.  And it never really occurred to me that me becoming a doctor was something that my whole town would be proud of.

And they should be.  Not because I’m some big shot doctor now.  But because the love, support, and example of my family, friends, and community are what shaped me into the doctor I am today.  These past four years of medical school might have taught me what I need to know in my career, but it takes more than knowing medicine to be a good doctor.  It takes love and hard-work, sacrifice and determination, empathy and compassion.  It takes kindness and humility.  There is so much more to being a doctor than medical school can teach you.  And that’s what I learned from my small town.

I’m sure you’ve heard the phrase: It takes a village to raise a child.  I think the same can be said for good doctors.  I wouldn’t be here today if it wasn’t for so, so many people who have helped me along the way.

For my family who has loved me and cared for my whole life.  For my teachers in elementary and high school who taught me how to read, how to write, how to calculate, and how to think.  For my classmates who taught me friendship and how to work as a team.  For my neighbors and church members who set amazing examples of me of what it means to be good, decent, and moral human beings.

So many people share in my success that it really seems wrong to think of my becoming a doctor as a feather in my own cap.  The reality is, becoming a doctor is what I was supposed to be.  It’s what everyone has worked so hard at helping me to become, and for me to become anything less would have meant letting all of those people down.

So, thank you.  To all of you.  Especially those who read this blog.  Your silent support by simply reading my stories is almost tangible at times.  To write and have my words be read is one of the biggest compliments I have ever received.  So I thank you.  I hope that this blog has lived up to your expectations.  As I hope that I have lived up to your expectations.  I will continue to write, as being a writer is also one of the things I must do with my life.  And I hope you will continue to read.

Graduation

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Life Lessons that Medical School has Taught Me

As my medical school education comes to a close, I find myself reflecting back on the last four years of my life and the things that I’ve learned.  I’ve learned a lot about medicine – how to diagnose and treat all kinds of diseases.  I’ve memorized countless pharmaceuticals, both generic and brand name, and their most common side effects.  I can recite CHADSvasc scores and TIMI risk calculations, which probably doesn’t mean much to you reading this.  But I have learned a lot of things that I didn’t expect to.  I’ve learned a number of lessons about life that I think I can pass on to everyone, even those who may never set foot in a hospital.

  1. You can’t know everything.  This is one of the hardest lessons I’ve learned as a medical student.  I went into medicine because I have a thirst for knowledge.  The more that I’ve learned, the less that I feel like I know.  But at some point you have to put the books down and say, Hey, I can’t know it all.  And that’s okay.  Just because you’re a doctor doesn’t mean you’re an expert at every aspect of medicine.  It means you’ve worked your butt off and you know a whole heck of a lot because of it, but at the end of the day, you’re still merely human.
  2. Know your limitations.  It’s hard for me to admit when I don’t know something, but the best physicians I’ve worked with are the ones who readily admit when they don’t know the answer.  Admitting you don’t know an answer is much better than guessing or making something up, especially when you’re dealing with people’s lives.
  3. You can’t do it all.  I’ve always thought of myself as superwoman (humble, I know).  But the last four years have taught me that you really can’t do it all.  I pride myself on being a wife, mother, writer, and now, doctor.  But it’s a lot to juggle, and I can only be in one place at once.  As much as I want to say that I can do it all, the reality is that every day I have to make tough choices about how I will spend my time.  That means choosing to work instead of stay home with my daughter or choosing to study instead of spend time with my husband.  Something always has to give.
  4. A little chaos is okay.  This is a lesson I try to remind myself of constantly.  I am a very neat and organized person, and having a toddler is a constant internal struggle for me.  My daughter enjoys making piles of things and making all kinds of messes around the house, and it takes a great amount of strength to watch her mess things up.  But at the end of the day, my daughter is having fun, and everything that gets messed up can be put back.  Or not.  Somebody will clean it up.
  5. You’re stronger than you think you are.  I’ve always believed that God never gives us more than we can handle.  But I also believe he gives us exactly as much as we can handle and never any less.  So, so many times during the last four years I’ve felt like quitting and giving up, but somehow I’ve pulled through.  I think we are all capable of much more than we give ourselves credit for.  Then again, we’ll see if I survive these next three years…
  6. Be thankful – it could be worse.  My patients are always reminding me that my life could be so much worse than it is.  I’ve seen children lose parents, parents lose their children, and spouses torn apart by death.  So many days I run home to my family and thank God that I’m so lucky.  No matter how bad things get, I try to remember that it could always be worse.
  7. Every day is a blessing.  Very similar to Number 6, but a lesson just the same.  We never know what tomorrow brings.  Today could very well be your last.  So carpe the heck out of this diem and remember that every day is a blessing.
  8. You can learn something from everyone.  Every person has a story, and every person is on this earth for a reason.  If you are able to spend time with them, talk to them, and figure out what that reason is, then you can learn something from everyone.
  9. Learn from your mistakes.  Every failure is an opportunity for growth.  If you make a mistake, learn from it.  Move on with your life, and don’t make the same mistake again.
  10. All bleeding stops eventually.  A common saying in medicine that basically means this too shall pass.  No matter how bad things get, they won’t be bad forever.  Some days you just have to get out of bed and put one foot in front of the other.  Then repeat.  Again and again until things get better.
  11. And last, but not least: Take care of yourself first.  Definitely my motto, aka I am My Own First Patient.  But this applies for everyone.  You can’t help others if you are a mess, so always take time for yourself when you need it – a little bit every day if you can.  Those around you will thank you for it.
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