long lines

This is the first Christmas I didn't "feel" like it was Christmas. Although a group of us carolled in the hospital and I took part in a gift exchange last Saturday, I just don't have "that feeling." I just don't have the time.

when one diagnosis becomes two

the longer you stay at the hosptial, the more chances you'll get sicker or get get some other type of problem. hospitals have too many bugs lurking around and then you have health care workers spreading these bugs. and even worse, you get something called "iatrogenic conditions." These are conditions you may get that are inadvertantly caused by a health care worker or by some procedure, surgery, study, etc. For example, you're dehydrated and so you are given fluids, but that in effect causes you to get pneumonia or congestive heart failure. Or you get a foley catheter and you end up with a urinary tract infection. hospitals are scary places. If you don't want to get even sicker, don't go!

I can't stand indigent/teaching hospitals right now. The poor pretty much end up at these hospitals. Yes, we do a lot of good, but we are so inefficient. It takes a millenium to set up a study or a procedure and in the meantime, the patient gets some infection all because they were in the hospital gathering bugs.

close call

I was on call last night and didn't even have time to brush my teeth till about 3 o'clock today. 36 hours on is killer.

I have this slightly depressed type of feeling, but i have no reason to be sad. the past 1 1/2 days were so busy. We admitted pedi patents, a pregnant women who we had to assess every hour or so, podiatry patients, and then covered the wards. We slept 30 min. Then when I was doing morning rounds on one of my patients, I noticed she wasn't as alert as I remembered her to be yesterday afternoon. The nurse wrote in her note "uneventful 14 hour shift."

the thing was this woman, whose state of disease can easily make you think that her "staring into space" was her norm, was OUT OF IT. the nurse did not know her baseline. anyhow, she would not respond to me and I quickly asked for the oxygen sat. 100% as per nurse. respirations were within nl limits, but she just "wasn't there." I'm not sure what the cause was but MORPHINE OVERDOSE was up there in the differential. Soon, there was action everywhere and before long, the pt was screaming "help me jesus!"

I actually felt calm during the episode even though I totally FORGOT about the ABC's (airway, breathing, circulation). All I knew was HELP ME!!!! Once that was over, it was back to morning rounds, and writing notes and discharging other patients. I felt yucky all day, esp since I was wearing the same scrubs the other residents had seen me wear 24 hours ago.

I feel so consumed by my patients problems right now. I come home and log into the computer to find out how they're doing and then I call in orders. And then when I'm driving, I think about so and so's blood sugar and then how I need to this fax so my clinic pt can have her surgery done and so on and so on. I am up to "here" with medicine.

tired
this is week two of the wards. I'm tired. very. . .

yes, i have managed to escape the verbal beheadings of my chief resident, but some of my co-interns have not. I did pray that i would have favor with my upper levels though. God give me the grace.

some of us are in our late 30s and 40s so I would think it unsettling for someone 10 plus years younger than me treating me with disrespect. luckily, i'm younger, but I'm still an adult. "you don't know your patient well enough. you're patient is going to die" he told one of the interns today. He loves to lecture. But I don't hate him b/c he actually is nice 80% of the time. I had to joke with him that he is mean, but he even admitted, "i'm not mean to you or [the other intern]." He's just mean to the other two (both who of whom are extremely nice, intelligent people).

consults
one thing you do as an a resident is consult other specialties. i hate consulting when I don't know why I'm consulting. In other words, someone tells you to call nephrology, endocrinology, etc and you do it. then the real killer is when the consultant starts asking you all kinds of questions and you have NOOOOOO answers. that's the feeling of sheer stupidity. gotta love that good ole inept feeling!

death's door

my team inherited patients at death's door. they all became unit players (medical intensive care UNIT). luckily, none of them were my patients but this week has still been stressful. my stress is all rolled up into one zit above my right eyebrow.

for one thing, our chief resident likes to yell at us like we're third graders. "i told you to do this and that!" he hasn't quite yelled at me, but I have 3 more weeks to go . . .

predicament

one the 2nd year residents called our team to tell us to go to her patient's MICU (medical intensive care unit) room and support the family while the patient died. the thing is, the resident who had followed that patient for half a day had to go to clinic. I didn't even know her or meet her family and we had 4 admits to work on. I didn't think it would be appropriate for an COMPLETE stranger to try to act that empathetic. "Hi I'm Dr , you never met me, but I'm a friend of your doctors and I heard your wife was dying." No, couldn't do it. I knew nothing about the patient and didn't have time to study up on it. I'm selfish.