watch me unravel

Seriously, you guys, how do people do night shifts? I've now done five weeks total over the course of internship. But again, in my sixth week right now, I just want to melt into a puddle of goo. It astounds me that there are people in this world who work night shifts as a standard part of their entire career! How?!? How are they not insane? I'm only on my fourth night of the week, and I have been getting crankier and more sleep-addled by the moment.

These nights have not been quiet either. For some reason, people seem to have a proclivity towards having cardiac events at night. Endless, endless elevated cardiac markers. Because of how busy it is on this service, so far the only thing I've learned about cardiology are things I already knew- alcohol, methamphetamines and cocaine are bad for your heart. So is smoking. Also, if you walk into the hospital with chest pain, you will have to put up quite a blockade to prevent a cardiologist from catheterizing your coronary arteries.

I don't usually do countdowns when I am on a rotation but I am starting to X off the days to getting off this service, and not living like a vampire anymore.

the weary kind

Well, I certainly understand now why work hour regulations were put into effect in the medical field. For a couple of reasons actually. First, and foremost, residents are cheap, dirt cheap, salaried labor. Very hard to find a crop of people in any other field who have invested so much money in education who may as well be holding a sign that says "Will MD for Food." Secondly, people in the medical field have remarkable deficits in short-term memory. Interns have no recollection of the terrors of being a medical student, residents have no sympathy for the grueling job of the intern, and attendings can't understand why residents are running rounds by themselves. Finally, and perhaps this is the only part that has ever really justified the work hour regulations- it is not sustainable and compatible with being a good doctor.

You can work a 16 hour shift. That's really not a big deal. You can even work two 16 hour shifts. But working a relentless cycle of 14-16 hour shifts is grueling. It sucks out your soul. It makes it difficult to empathize, to keep your head on straight, to make good decisions, to communicate properly with everyone. And get this: all of that is within work hour regulations. Last week, I thought I was going to completely fall apart, and I had only broken the regulations by 4 hours total. I can't imagine what it used to be like when you could work for 100 hrs without anyone questioning the sanity of such extremes.

Yesterday, I worked from 5:45 in the morning and got home at 8:15. Amusingly, that was early this week. I took 20 minutes for lunch, but other than that, everything was work, all day long. No surfing the internet or checking my email or texting or tweeting. I never quite appreciated how hard it can be to return correspondences on a regular basis until working in the hospital. There is just no time. I don't know where it goes. It's a hundred million things- writing notes, talking to nurses, talking to patients, examining patients, talking to patients' families, writing orders, talking to consult services, talking to the senior resident, talking to the attending. It's no wonder I've done such few procedures during internship- who knows when I would have actually had the time.

Anyway, when I got home, at 8:15, I was so angry, for no good reason, just out of sheer exhaustion I suspect, that I had a scary amount of adrenaline pulsing into my bloodstream. I took advantage of it and made, without a whole lot of effort, peanut-butter chocolate chip cookies. Thankfully, I can almost make these in my sleep by now. It's like all my previous experimentation was preparing me for this year. The facility I feel in the kitchen, with my oven, is so welcome right now. Butter, flour, sugar, eggs. Right now, it's the only thing keeping me from becoming unhinged. So I appreciate it.