fear

i was thinking today after hearing this woman, who is an intern in family med after completing three years of a general surgery residency - that fear at this point has stopped me from being great. She said, "if you hide in the call room, no one is going to come looking for you, you have to get out there." And i realized that I have been hiding in a metaphorical call room. Cowering away from questions, procedures, opportunity. why? because I am afraid of not knowing the answer, fumbling, looking dumb in front of my peers. Because its really not a fun feeling - looking dumb in front of your colleagues, your residents, your attending. Maybe one of our practice cases or standarized patient experiences should be practicing not knowing, fumbling around, looking dumb in front of everyone. i have escaped most humiliation but maybe its not a good thing.

angry surgeons

Most people either love or hate surgery. These people are so busy that they don'' have time to have lives outside of the hospital. My first day of peds surgery I was told to show up at this vague computer and find the "list " of patients. The team consisted of myself, R3 and the surgeon, who we only saw on the day of surgery. Once I found the list i was to update it with vitals, labs, and new info for each patient. I couldn't find the computer. I tried calling the previous med student to find out but she was not answering. I asked the nursed and they had no idea what I was talking about. I found a computer with a paper list next to it from earlier in the week with the names of patients. So I went ahead and used that one. A half and hour passed and my resident still wasn't there. So i just kept reading my review book. I didn't' want to page him as I know a lot of times the residents show up late. Finally he came in red faced and angry. "What have you been doing this whole time? I've been calling you." "Reading, I updated the old list. I couldn't find the computer." "SO you've just been sitting here? Why didn't' you ask, see all these nurses here, you have to ask? Keep looking around? I already filled out the list for today. " That was our first encounter. Then i had to follow him around and help him with each patients note. I felt like crying. I felt like melting away. I tried not to make peep so as not to make him more mad. I felt so incompetent. Felt so small. I looked for every way that I could help to make up for the time i had wasted him. All day i was on my toes. Replaying the moment in my mind. I even stayed extra late that day to do an H and P on a patient to help him out. He didn't yell at me again but he certainly wasn't very nice. The next day he semi apologized for yelling at me, and in good med student form i said, "oh i guess i deserved it. I should have been more proactive." Even though in my mind I thought you bastard! It was my first day how was i supposed to know, huh? and I'm a med student not ur intern, interns do all the stuff you are asking gme to do. But that's how it is, you put ur best face forward and just suck it up, especially on surgery.

here's looking at you kid

I'm not sure if every young doctor experiences this sort of thing, but I certainly do, mainly because I'm petite and have young face i guess. I recently interviewed a patient who is 71 years old, lives in a motor home, alone, and eats once a day at the salvation army. He suffered a stroke about three years ago and since then has weakness on his left side as well as short term memory loss. He said he was luck that he was even at the appointment since he usually can't remember. This man was clearly frustrated at the world, at his situation, at life. He was pissed at his brothers for not supporting him even though he had for them. And I think he even had pissed himself, in reality. Maybe there is no shower in his mobile home. maybe he couldn't remember to change his clothes? regardless he was a grumpy old man to say the least. I tried to do a SIGECAPS assesment for depression. I got to suicadility and he said, "Listen carefully before you start writing any of this down. I want to die. I'm dying means I will be in heaven and not here then I want to die. I still take my pills, excercise, watch my weight and do as I am told, but I want to die." I comisserated with his sentiment and told him I didn't blame him for being pissed off and grumpy, not in those words of course. I asked him what we could do for him, physical therapy? counseling? start an antidepressant? All of which he turned down, and said, "Thanks for trying, sweetie." and Pinched my cheek the way my uncle would. He pinched my fatty little cheeks. He went into my space. I wasn't mad but I did feel belittled. For a second I thought i was sitting with my grandpa and not as a doctor sitting with her patient. I know he didn't mean anything by it but it was a strange feeling. As physicians we frequently push our hands into the space of others but remain untouched ourselves, with an imaginary shield that protects our space. When my shield was broken I felt strange.

people in white coats

its weird how when you see us in our white coats we look important - nurses defer, pts defer, and who are we really? what do we really know? we don't really know anything. its just a coat. underneath we're just kids. people with regular lives, problems, people who make bad decisions, party it up on the weekend with friends, act irresponsibly. its just a white coat. i never realized that before and now that i have to wear i feel like its so unnecessary and builds us up to be something we're not.

trials

i have so much to catch up - life as a surgeon, characters, peds, delivering babies later.
for now i just can't help but feel like a kid. Its fourth year, you're supposed to know stuff, right? I feel like I'm just a scribe who takes notes, reports, and has no idea what they're doing unless you tell them. its hard to take charge when you don't even feel like an adult outside the hospital.
my patient came into today with acute on chronic kidney failure, full out uremia, possibly secondary to infection - now what? or my frail bedridden patient with chronic RA that has pretty much incapacitated her and left her hooked on morphine tablets that just give her constipation and a bowel that doesn't want to move. at times you just don't want to deal with those types, they whine, they plead, they demand, they do more ordering than the doctor, and you get irritated and say wait a minute, who's the doctor? how do you know what pain meds you should get and when and how. So many times we encounter these people that we cant stand - but we have to take care of. and its so hard to not be annoyed by them. nothing is unbias, even an umpire.
after i finished the hand p on my patient my resident went over the case with me - line by line. you shoudlna written this, you should write this. why do you think that is? why is that? secondary to what? how do you calculate this? what does it mean? what are the different causes of that? what else do you want to do? and on and on. each question caused by whole body to get a giant heat wave, sweat, and just feel so on edge. and its a completely no pressure situation. there is just such a pressure to be smart, to know the answer, to not look dumb in front of others. i feel like i won't ever know any of the answers. i just know that intern year is going to be a HUGE learning curve. there is so much information, not enough ttime to sift thru it and make all the right decisions for every patient. that is scary.

time is passing

I finished psych and somehow survived inpatient medicine. My very first day I cried in front of both my R2 and R3 as if one was not enough. I felt so overwhelmed by my patients problems and didn't have the slightest idea of where to begin. I scored my book trying to find an answer - at least one. the fear of failure, embarrassment, and not being able to help my patient spinning thru my head, like a mantra, that gradually wore me down to the point where I could hardly contain my tears from welling in my eyes and my there it all went i couldn't' breath and i felt my body convulsing with all the emotion I had been working so hard to keep inside. of course my poor resident didn't know what to do with me - a crying, convulsing medical student, he quickly apologized profusely, and felt horrible as if it had been his fault that i was crying. somehow i was able to stop and I he walked me thru the patients list of problems and sent me home. the days to follow were not as agonizing but difficult nonetheless. In my three weeks I had three case of EtOH Cirrhosis complicated by varices, HCC, ascites, etc. One patient with intractable orthostatic hypotension and diabetic autonomic neuropathy, and one with SLE. It was my own patients and all the patients in between that i took home with me emotionally everyday, I carried them with, and couldn't let them go. I still can't. The old man who lives alone, family and children nowhere to be found, he uses a walker to make his way across the street to where he says there is a restaurant where he occasionally eats since his arthritis is so bad in his feet, hands, back, elbows, knees he really can't do anything for himself. He tells us, they've tried everything, just let me go, there is nothing you can do. We beg him to let us call a rheum consult, to let us try to take him out of his pain. Really all we wish we could do is take him home and take care of him as our own, to feed him, listen to him, and give him love. He's so frail yet so full of spirit inside that we can see pushed to the back from being in pain. We walk away from the bed, as a team, with heavy hearts, and push it behind us, to linger in our minds for the days to come until it is replaced by yet another patient whom we feel hopeless for. On my last day of inpatient, I wanted to say goodbye to my little drunk as I liked to call him. He wouldn't wake up from sleep, so i whispered to him that I wished him the best and that I wished he would get better and stop drinking. I don't know when he'll be able to get leave, or where he'll even go to. No body wants him, and he is ready to go right back to the bottle. can you help someone who doesn't know they need help? or who doesn't want help? the days were long and arduous, climbing up stairs and downstairs, constantly on the move, constantly brimming with things to do and peole to see.
Now on outpatient the pace is much slower, my patients are on top of their health and want to be better. My patient gave me a hug today for being so patient with her because she couldn't hear. i can't wait to have my own patients, for whom I've cared for for many years and they know me in and out as i know them in and out. right now its hard to catch up on 25 years and no all of these patients problems. i am up for the challenge. and i am starting to feel smarter everyday even though i only pick up things here and there. one thing is for sure, i will never run out of things to learn.

"crazy stories"

Maybe cuz i didn't really tell you any stories - i just generalized.
lets see - there was the 21 yr artist who after a trip on shrooms said he had an epiphany god had chosen him as the angel to save the world. he expained the government is controlled by the devil and thats why if you look at barcodes, there are barcodes on everything all have 666 in them. also that shrooms, lsd and weed are good they are like brain food, and the reason they are illegal is cuz the devil controls the govt. alcohol and smoking which are bad are legal again its the devil. unfortunatly the devil gets all the best people to work for him and do his work. the pt explained that i was an angel. and so was he obviously, he was like you can't see my wings but they're there, you guys just won't let me do my work he said. he also explained to me that the world is going to end on dec 12 2012 when the aztec calendar ends, god is going to close the gates to heaven - so watch out. he refused meds cuz obviosly if i was an angel controlled by the devil then meds are bad.

lets see there was the guy who looked like a girl who kept talking in different voices. he said he had multiple personalities, one of which was drag queen. and one of his personalities had disappeared and now there was no order in his life, and the other personalities were fighting. one of the personalites was trying to come out of his back. when asked to change personas the pt convulsed and spoke in tongues.

there was the old black man who said he heard voices that told hiim to get naked and run in front of a train.

the woman that thought she had bugs all over her body and had gone to numerous drs even going as far as to save her feces in tuperware to prove to her dr that she indeed had a bug. eventually she had collected so many tuperwares of feces she didn't know what to do with them.

and there are a ton of people who think someone is out to get them, they are a dime a dozen.

the girl who cut her wrists then tried to say that what really happened is that she had a n itch on her arm and she was just trying to itch it wit h the edge of opened can.

the woman who had no idea where her family was - they found her on the beach totally sunburned and clueless. no drugs invovled and no brain tumor. she's just totally confused. and very sunburned.

and ofcourse ur random scabies. i totally thought i had caught them like three times, i was itching all over.

the guy who chased some people with a machete because he said they were tyring to attack him because he is a major film director, in fact he is the director of the director.

and one of the funnier ones, a man who said he heard cholos i n his head making fun of him and his conversations with other people. can you imagine - cholos in ur head? ur own peanut gallery?

anyways that is all i can think of right now. psych has been great, i learned a lot. and despite the entertainment that somepeople derive from these strange encounters there a lot of people who just sincerely want help. and it happens to everyone not just the poor or the rich or the white or brown.