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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Superwoman

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.”

BeepBeepBeepBeepBeep.

“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.”

BeepBeepBeepBeepBeep.

“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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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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