Sunday, February 26, 2012

stared at my shoes in the ICU

Today, I did chest compressions on a patient who died.

This man looked like a million bucks yesterday. He was my favorite patient on my service yesterday. He had a pneumonia but he was jovial, he was animated, he was teasing his wife. Overnight, he got transferred to the ICU and just plummeted off the cliff from okay to bleeding from everywhere from an overwhelming infection.

I felt like someone had punched me in the gut. It was the first time I could not really talk to family about a patient's death. I understood, biologically, pathophysiologically, how what happened had happened. I know that things were done appropriately, the right decisions were made, that despite our best efforts, sometimes we can't win. I got all that, logically.

But everything inside of me was twisted up from the suddenness of it all. Internists don't do sudden. We usually have time to prepare and accept and make peace. We usually have relationships with families and patients. We are not trauma surgeons. We don't roll someone into our unit and watch them die before our eyes a day later. Only we did today, and I found myself unequal to the task of reckoning with that. And I will never forget it.

Friday, February 24, 2012

I like to keep my issues strong

Let's not beat around the bush, I was feeling pretty low and pretty sorry for myself. The nadir (which is a term I've picked up since I've grown fond of talking about neutrophils, and now I use in common conversation much to the chagrin of my puzzled buddies, poor things) was right before vacation, and it's funny, because then I didn't talk about it. That's my thing, I guess. When I'm at the lowest of the low, I go on full lockdown and conserve all my thoughts, and try to get by, and I don't talk about how I feel everything giving way underneath me.

It's when I'm trying to scramble back up to normal, to serenity, that's when I start talking about how bad things have been.

Anyway, I was feeling pretty badly about my life and where it's headed and how I live in this horrible bubble, and then AP and I decided, because it's been unseasonably warm for February out here, to go for a drive and take a hike. And let me tell you, when you are met with this sight, you realize maybe there's not so much to complain about:
So things are okay.

Well, not totally. To tell the truth, it was sort of hilarious. AP and I went on this hike about a year ago, and the world was very different at that time, for both of us. Last time, we chatted the whole way, merrily walking along, and came home ready to take on the world. This time, we stopped talking about half way through the hike because we were huffing and puffing so hard we couldn't be bothered to make conversation. It was tragic and funny at the same time. Tragic because internship, that thing that is supposed to turn me into a competent physician able to improve my patients' health, has destroyed my own health.

Oh well, what can you do, but shrug, strap on a bit of bond and realize it's time to struggle back up that hill to well-being, regardless of whether it seems like the task of Sisyphus.

Wednesday, February 22, 2012

this is your life, this is your time

As the senior resident and I were laughing for the better part of the afternoon, while I still managed to finish my work and get out of the hospital at a reasonably decent hour, I started thinking about the continuum that is internship. It sort of goes like this:
  • Holy #!@&!, I'm a doctor, and I don't know what I'm doing.
  • Why is this so hard?
  • How am I going to do this for three years?!?
  • Why don't I have better instincts?
  • How will I ever get any better at this?

  • Then this weird thing happens. It's just like when you get over someone after pining for them for years. It's just like when you don't particularly like someone, and all of a sudden, you catch a glimpse of them, and you see them in a different light. It's just like when you are totally exhausted from climbing a mountain, but still have to climb down from the mountain- arguably easier, but still exhausting. So then it turns into:
  • Holy #!@&!, in five months, I'm going to have to help some idiot like me figure out what she's doing!
  • Why does the senior resident insist on wasting my time?
  • What the heck is the senior resident doing right now anyway?
  • How can I be a second year resident if I still haven't done (fill in the blank) yet or learned how to (fill in the blank)?!?

  • The funny thing about all of that is this should be the sweet spot of internship. I'm of some use to the senior residents, I'm of some use to my patients. I'm even slightly of use to the medical students (though I think I mostly just entertain them at this point).

    But there's just this endless push and worry, this push to be better and this worry of falling short. Of course, residency is designed such that falling short is inevitable. That's not much of a consolation, it's more of a frustration.

    And my only reaction is to laugh and mumble oh well, oh well, oh well, oh well to myself. I am aware that I am becoming boring, boring, and yet, I madly want to become more boring, dive further, drown completely, immersed.

    Tuesday, February 21, 2012

    one step forward, two steps back

    Ugh. You guys, I wish I could operate in my personal life the way that I do in my professional life. That sounds ridiculous, I know. But in my professional life, I am logical and calm. I can be generous but I don't allow myself to be pushed around. And I can get extremely upset by a bad outcome, I can work through it, and then I can move on.

    But when it comes to getting over things outside of work, I am as hopeless as a penny with a hole in it. I don't understand it.

    There's been this running joke, that I'm someone who is to be an internist, which connotes that I am someone who has to analyze a thing to death, look at a thing from every angle, learn its history, follow it until the truth becomes clear. Obsessesive. Relentless. Supposedly.

    In contrast, the surgeon is someone who is supposed to cut or cut loose. Black and white. Either there's something to be done and it's done, or there's nothing to be done and it's over. Ruthless. Supposedly.

    But the internist is the doctor who tells a patient that maybe it's time to let go and stop fighting so hard when the chances of meaningful recovery are dwindling. And the surgeon is the doctor who will fight the most fiercely and break the hardest sweat if he thinks there is a chance.

    At least I spend more time working than anything else right now, so if I'm going to get one part of my life right, it's the right part at the moment.

    Monday, February 20, 2012

    such a bittersweet symphony

    Funny thing about internship is that I feel guilty, somehow, all the time. When I'm at work, I feel like I'm either letting my patients down or the senior resident down, or both. If I get out of work at a reasonable hour, I feel guilty about not reading medical literature or increasing my fund of knowledge. If I have a day off, I feel guilty that I didn't get enough laundry or cleaning done. Or if I have a day off, I feel guilty I am not doing more to enjoy myself. Yep, it is the true height of insanity or depression or some odd mixture of the two- when you come to find that you feel guilty that you are not having enough fun, given the chance.

    But on the other hand, I am tired all the time. I just want to sleep. And when I come home, I just want to watch Downton Abbey and chortle at Maggie Smith's one-liners, and maybe if I'm feeling really adventurous, venture into the kitchen. I was inclined tonight, since I actually had a few hours between getting home and collapsing into bed, to make cupcakes.

    Even then, I felt they weren't good enough, weren't adequate, and I feel guilty about bringing them to work tomorrow. I might as well own to it- I am firmly of the anti-chocolate cupcake stance. Don't get me wrong- chocolate frosting (especially ganache!), yes indeed. Chocolate chips, absolutely. But chocolate cake... firmly meh. Chocolate cake seems designed for people who don't really care for chocolate. I mean, unless you make flourless chocolate cake, which is basically like eating a chocolate bar, and frankly, that doesn't translate well to cupcake form, and I'm too lazy to figure out how to transport an entire cake into work, and my co-workers can't be bothered to cut into a cake to boot.

    But I was tired, and chocolate cupcakes are simple enough to make. The novelty part was the coffee frosting. I've managed to get this far still abhorring coffee, still not drinking it regardless of my extent of sleep-deprivation (long live other forms of caffeination!). I know this makes me an outlier both in the medical field as well as a resident of the greater Northern California area. But there you have it. However, when it comes to baking, I think coffee is a good way to bring out the flavor of chocolate; something about the interplay between the bitter and the sweet seems synergistic. And I also know that interns and residents will ingest coffee in pretty much any form. So that was how I dealt with my daily helping of guilt for the day. We'll see how tomorrow fares.

    Wednesday, February 15, 2012

    this is how you remind me of what I really am

    This isn't a knock on my ex-bf necessarily (but it kind of is, sorry). A while back, my friend RR told me that you shouldn't get too wrapped up in having the same interests as someone you're interested in dating, that hobbies and pedigrees and professions are not what you should be seeking in common with your significant other. And I still think he's right.

    But I do think an exception should be made about certain music choices.

    And now that a lot of time has passed and I'm very nearly back to full strength, I can say, slightly tongue-in-cheek, but also meaning every last word of it- I probably should have known things were not going to work out with my ex-bf when he revealed that he really liked Nickelback. That one is going to go in my Parks & Recreations Knope playbook, in which I am going to cheer up some heartbroken friend of mine with: "once I dated a guy who liked Nickelback."

    Speaking of Nickelback (Haha! It's hilarious to even speak of Nickelback in my opinion. Okay, but seriously, no offense to Nickelback fans, except, really? You're a Nickelback fan? Isn't fan too passionate a word for a band like Nickelback?), I have to confess that the Lost and Walking Dead recaps on Videogum are one of my favorite time-killers ever. I like them especially because I guiltily watch these horrible shows even though they often drive me bonkers, and the recaps reflect this dichotomy perfectly. And I have to admit that the first time my ex-bf asked me if I liked Nickelback (hahahahaaha, that somehow doesn't get any less funny regardless of how many times I mention it), I immediately thought of those Videogum recaps, because characters are frequently telestrated with "Nickelback lyrics" thought bubbles (for the quintessential example, see here.)

    Just a lesson that some misgivings are probably worth heeding. Maybe. Just kidding. Sort of (but not really).

    *titling this post almost caused me to drop to the floor

    Tuesday, February 14, 2012

    when I'm 64

    All week, an elderly gentleman had refused to let his wife go. She was on a breathing machine, she had a bad pneumonia, then her heart failed, so fluid built up in her lungs making breathing more difficult, and then her kidneys failed, making it impossible to remove the fluid from her lungs. This is not a new story. This is a common story of an elderly woman in her 80s who finds herself in the ICU.

    I talked to the old man a few days ago, asked him what his wife would have wanted. He would not say, but he did tell me, "I hope she makes it to Valentine's Day." I found that cute but not necessarily a good reason to prolong the woman's life.

    Today, I discovered that Valentine's Day was their 60th anniversary. Today, the elderly gentleman listened to his daughters, and agreed to take his beloved wife off the breathing machine. Her husband was so upset that the moment we removed the tube from her throat, he said he did not want to sit there and watch her die. As if she knew that he could not handle very much, she passed away about 10 minutes later without the slightest sign of distress.

    It's weird- the amazing things like this which you see in Medicine, and how, regardless of all of these life lessons you see around you, you can't figure out how to apply them to your own life.

    Anyway, I spent the rest of the afternoon getting everyone else home to celebrate. The first goal was my fellow intern, who had to run out and buy his wife a present before he got home. Then the other residents who had significant others. Maybe it's good karma or something. Maybe I'm more of a romantic than I think I am. But don't say that out loud, or I'll deny it to the end of my days.

    Monday, February 13, 2012

    and when I think that I'm alone

    Yesterday, the other intern and I were waiting at the grill to get our sandwiches. The guy behind the counter turned around to grab some bread, and somehow revealed a front and center view of premium butt crack. The other intern happened to look over at me and I could see that he had just noticed the same thing I had, and we both burst into hysterics.

    It's so dumb, and I can't even tell you why we thought it was so funny. When the med student and the senior resident demanded to know what we were in cahoots about, I mumbled that I'd developed ICU delirium. Maybe I had. It wasn't that funny, but we were in stitches, and I think it was just about release. Things are starting to calm down in intern year, but we still work some pretty hard hours, and in the ICU we see a lot of sad things. So maybe, as a result, we have to laugh at stupid things like someone revealing a bit of their backside.

    Sunday, February 12, 2012

    sooner or later, the fever ends

    In the ICU last week, the attending physician, who was a bit of an eccentric, sang the first few bars of Toto's Africa. I was the only one who recognized it. I always forget that I'm frequently surrounded by those much younger than me. The attending pointed at me as if he'd found me out, and accused me, "you're an 80s kid!"

    And let it be known that being an 80s kid is quite different than being born in the 80s. No offense to you younger folks.

    Being an 80s kid means that you knew Whitney Houston. I'm sorry. I know it's played out, and everyone's got the same story, and there's nothing particularly unique or special about mine. But I think that's exactly the point. That's what all of us were doing. We were all dancing along to I wanna dance with somebody and How will I know in bedrooms and bathrooms and basements. We were all so young and innocent, and her harmless, pure pop songs back then became our soundtrack.

    I didn't think until yesterday how weird and dissonant it is to consider now- but Whitney Houston was really a role model for a lot of us when we were young. She had a squeaky clean image, she was a woman of color, standing by herself and holding her own. While her songs were often about teenage complaints (will someone please dance with me or am I going to get stuck sitting on the bleachers? and does this boy like me?!?), they were never desperate, never encouraged girls to be stupid. In her videos, she just seemed overwhelmingly happy. She wasn't necessarily the embodiment of female empowerment in those early videos, but neither was she some doormat. I know it's probably considered some sort of musical sin to be considered safe, and sure, there is something to be said for those other women who pushed the envelope and made people uncomfortable.

    But consider this, when comparing to musicians of today. Whitney Houston's songs were not celebrating getting so drunk that you don't know the name of the club you walked into. They were not talking about getting caught in the midst of incriminating acts you didn't remember on a Friday night. They were not talking about brushing your teeth with a bottle of Jack. Sometimes harmlessly catchy is much preferable to dangerously misguided.

    Also, Whitney Houston, in her heyday, could sing. No disputing that.


    I know no one's really reading anymore, but then let's just say I am talking to myself. In an effort to force myself to write a little more, but recognizing that my ability to come up with much of interest is limited, I am going to start dropping very short posts, hopefully on a daily basis. There will probably be a lot of hospital-related stories, and gripes about television shows, in equal measures.

    We'll see how it goes, stay tuned.

    Sunday, February 05, 2012

    I don't want to talk about it

    So that was horrible, and I am done professionally with both Tom Brady and Madonna. That's all I really want to say about that.

    I thought I would bake a lot during my vacation, but I didn't. So many things I thought I would do during vacation, I didn't. I had no concept of how spent I was. Things catch up to you. When I hiked the Inca Trail, the day we reached Macchu Picchu, we were all fine and euphoric. We were tired and wanted a shower, but we didn't feel it all until a few days later when we were waiting to board the plane home.

    It took me about three days into vacation to realize that, of the 8 weeks previous, I had spent 5 of them working night shifts (and not consecutively, which would actually have been better). It's not that working nights is so hard. In some ways, the skeleton crew working at nights allows for some more independence and interesting learning that is useful around this time in the year. However, working nights will mess with your body. After a while, I did not know whether it was morning or night. Sunlight meant go to sleep, darkness meant wake up. I was drinking obscene amounts of caffeine. But I didn't really think about it at the time.

    Then suddenly, I was sleeping the day away. I was walking around in a fog. I felt submerged. I did not feel like doing anything; actually, I couldn't seem to bring myself to do anything.

    In addition to my body needing a long stretch of time to readjust to living, I found, for the first time since I've started internship, I did not want to even think about medicine. I didn't want to have anything to do with it. Usually, I will start to hunger for reading the latest journals. Usually, I am unable to resist the temptation to check on my patients on my computer. Not this time.

    I don't view it as some worrisome sign that this is the wrong profession for me or anything so extreme. Residency training, despite all the work hour adjustments and attempts to improve wellness, is still just fundamentally exhausting. There are the hours, which are numerous, but also the work just takes its toll. It sucks you in, at first, envelopes you- you submerge yourself willingly. Until you start to drown.

    Luckily, just about then, vacation comes along. So all in all, I am still tired. I sometimes feel disillusioned. I sometimes worry where health care is heading, and where people's attitudes towards their health are heading. I sometimes wonder if I'm learning enough, or if I'll be in a position to teach in a mere six months. It turns out I like this work. It's just that I've now realized that once again, I need to reinvent to allow for a life within this life, if that makes sense.