staying afloat
So much for my attempt to keep this thing updated!
these past few weeks have been some of the most intense so far in my life. I'm on my "medicine" rotation at the VA hospital, and to give you a quick picture of whats been going on:
- I did brain surgery.
A patient on my service was going in for an emergency craniotomy and my resident asked the neurosurgeons if i could watch. They ended up being awesome - esp the resident - and before I knew it I was scrubbed in and drilling a hole with a big bone drill in this guys head. I opened his scalp, drilled three holes, and we cut a triangular plate out to expose his brain, which was completely purulent (pus filled) and infected (he had gotten infected from an open wound from a previous neurosurgery). So here I am immersed in this guys head, discussing making creme brulee with the (incidentally cute) resident...talk about surreal. On the one hand I was emotionally blown away by this guys case and his prognosis....but I'm starting to realize more and more how hard it is to constantly exist in that state of awareness/caring - its draining and easy way to burnout. I realize to do what you have to do as a doctor, it's almost necessary to detach to some degree - or at least to not take home all the burdens of your patients with you.
But i'm getting ahead of myself.
So that was an extraordinary day. Most days i'm barely trying to keep afloat amidst all the information being thrown at me. Studying this stuff in textbooks is quite different than experiencing it hands on...which gives me a new appreciation again for ER/Scrubs...cause it really is like that sometimes! The other day my patient coded (i.e. stopped breathing and they called Code 5 overhead and like 50 of us ran to his room to start the code - luckily he came to before we had to shock him) and i was reading out his med list and watching as the 3rd year resident started a central line and the intern got the machines ready to monitor his heart rythmn and got drugs ready to push and all I could think was Oh my god, i'm going to be responsible for this someday. It's an awesome amount of responsibility, which is reinforced every time a patients family comes into the hospital and turns to me as their loved one's doctor and asks for an update. Luckily I'm still at the point that I can claim student status and offer to go and get the intern to handle the front lines...but when it's Mr. T's family and I've spent all day ordering his meds and monitoring him i start to feel like I actually AM his doctor...and it's scary.
and very easy to become a workaholic.
Last weekend I was on call both nights so I had a 12 day stretch of going into the hospital with no break....made me realize how important maintaining a normal life outside the hospital is...by the end of the second week (friday) i was emotionally drained. Friday of course had to be the day all hell broke lose - I was literally running around trying to convince my demented Parkinsons patient to stay in his chair, calming down the emphysema guy who had become increasingly agitated and was convinced that he had never come into the hospital and that we were all part of some conspiracy plot against him...and trying to start an IV in my own post-code patient...doesnt help that every patient at the VA is 60something with congestive heart failure, chronic obstructive pulm disease, and diabetes, or some combo thereoff.
but i love them, and they break my heart every day. They make me think differently about tough things - like end of life care...when to pull the plug...how i would want to die or let my loved ones die...how our society views the elderly...what its like to get old and to be sharp of mind but trapped in a failing body. Like our patient who has awful contractures of his limbs so he is stuck in a contorted position until someone can come move him in the bed to a new position....but who knows so much history and is so amazing.....or the veteran who has a purple heart and was part of the invasion of normandy who is slowly wasting away from cancer and growing more and more demented by day in front of my very eyes. I know hospitals induce delirium in these patients, and It tears me apart to see them get more and more delirious by day, their arms a mess a bruises from all the IVs we've stuck in them, their families growign more and more upset by their loss of function...
it breaks my heart, really it does.
but i can either come home and cry like i did last wknd, or i can try and leave all of that at the hospital and come home and get ready in my cat costume for a drunken fest of a halloween party.
life is surreal sometimes.
these past few weeks have been some of the most intense so far in my life. I'm on my "medicine" rotation at the VA hospital, and to give you a quick picture of whats been going on:
- I did brain surgery.
A patient on my service was going in for an emergency craniotomy and my resident asked the neurosurgeons if i could watch. They ended up being awesome - esp the resident - and before I knew it I was scrubbed in and drilling a hole with a big bone drill in this guys head. I opened his scalp, drilled three holes, and we cut a triangular plate out to expose his brain, which was completely purulent (pus filled) and infected (he had gotten infected from an open wound from a previous neurosurgery). So here I am immersed in this guys head, discussing making creme brulee with the (incidentally cute) resident...talk about surreal. On the one hand I was emotionally blown away by this guys case and his prognosis....but I'm starting to realize more and more how hard it is to constantly exist in that state of awareness/caring - its draining and easy way to burnout. I realize to do what you have to do as a doctor, it's almost necessary to detach to some degree - or at least to not take home all the burdens of your patients with you.
But i'm getting ahead of myself.
So that was an extraordinary day. Most days i'm barely trying to keep afloat amidst all the information being thrown at me. Studying this stuff in textbooks is quite different than experiencing it hands on...which gives me a new appreciation again for ER/Scrubs...cause it really is like that sometimes! The other day my patient coded (i.e. stopped breathing and they called Code 5 overhead and like 50 of us ran to his room to start the code - luckily he came to before we had to shock him) and i was reading out his med list and watching as the 3rd year resident started a central line and the intern got the machines ready to monitor his heart rythmn and got drugs ready to push and all I could think was Oh my god, i'm going to be responsible for this someday. It's an awesome amount of responsibility, which is reinforced every time a patients family comes into the hospital and turns to me as their loved one's doctor and asks for an update. Luckily I'm still at the point that I can claim student status and offer to go and get the intern to handle the front lines...but when it's Mr. T's family and I've spent all day ordering his meds and monitoring him i start to feel like I actually AM his doctor...and it's scary.
and very easy to become a workaholic.
Last weekend I was on call both nights so I had a 12 day stretch of going into the hospital with no break....made me realize how important maintaining a normal life outside the hospital is...by the end of the second week (friday) i was emotionally drained. Friday of course had to be the day all hell broke lose - I was literally running around trying to convince my demented Parkinsons patient to stay in his chair, calming down the emphysema guy who had become increasingly agitated and was convinced that he had never come into the hospital and that we were all part of some conspiracy plot against him...and trying to start an IV in my own post-code patient...doesnt help that every patient at the VA is 60something with congestive heart failure, chronic obstructive pulm disease, and diabetes, or some combo thereoff.
but i love them, and they break my heart every day. They make me think differently about tough things - like end of life care...when to pull the plug...how i would want to die or let my loved ones die...how our society views the elderly...what its like to get old and to be sharp of mind but trapped in a failing body. Like our patient who has awful contractures of his limbs so he is stuck in a contorted position until someone can come move him in the bed to a new position....but who knows so much history and is so amazing.....or the veteran who has a purple heart and was part of the invasion of normandy who is slowly wasting away from cancer and growing more and more demented by day in front of my very eyes. I know hospitals induce delirium in these patients, and It tears me apart to see them get more and more delirious by day, their arms a mess a bruises from all the IVs we've stuck in them, their families growign more and more upset by their loss of function...
it breaks my heart, really it does.
but i can either come home and cry like i did last wknd, or i can try and leave all of that at the hospital and come home and get ready in my cat costume for a drunken fest of a halloween party.
life is surreal sometimes.
posted by pavstheway @ 4:58 PM
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