Monday, October 16, 2017

Checking in

Hi readers. I just wanted to tell you how much I appreciate your readership.  My life has been so busy and it's been hard to find some peace and time to reflect.

Things have been a little bit better than last year but the remainder of my year is going to be much harder.  Thank you for all your support so far.  I'm going to take things one day at a time

Sunday, September 17, 2017

Solo challenges in medicine

It's been a while since I've written. Things have been good since the ICU rotation.  I'm starting a different rotation where there's no in house attending and I have to respond to code blues, emergent airways, and unplanned surgeries. There's no upper level or any in house support and no techs and no pharmacists.  I think there'll be respiratory therapy available but that's the extent of the support.

I've been anxious about this for days and didn't even sleep last night.  There are so many anxiety inducing things for the trainee in medicine and so many new situations.

I've been trying to build confidence but you never really have the experience you need until that certain situation is already over.

I got into the mindset to "wake up and attack" to paraphrase Navy Seal Jocko Willink.

I'm nervous because people's lives rest in my hands and this is my first time without support. I think it's dangerous for patients but for some reason the hospital is okay with this set up.  I can call an attending for help, but 20 minutes is a long time for help with an emergent airway.

I just have to be brave enough for the gods to follow me into battle.

Friday, August 4, 2017

Saturday night in the ICU

I have a flood of memories.  On a night where people are usually going out and enjoying themselves in dim bars or or under bright club lights, a family member waits outside an ICU room while their loved one is intubated. 

The patient wanted everything done despite a terminal prognosis of a few days of life at most.

The family sat outside, in shock as everything sank in.

Later on the patient passed away intubated unable to tell their family they loved them. 

Not many people choose comfort care because they think they're giving up.  But if you're not expected to live for more than a few days, there's nothing wrong in having your air hunger treated and receiving medicine to help you be comfortable and give you the best chance to say goodbye, since it's extreme difficult and uncomfortable to communicate while on a ventilator. 

Flashback to intern year

I've been reflecting a lot about previous months over residency as each year goes by. 

A long time ago I was working in the ICU and can't forget hearing sobbing in the hallway at all hours of the day and night. 

Every other day seemed like it had an emotional end of life discussion.  I pronounced a patient dead and filled out all the paperwork during pre rounds. 

Families who wanted everything done often saw their family member just get put on more and more pressors or require higher mechanical ventilation settings. 

I've met some med students who are so interested in critical care but the emotional aspect took such a toll on me that I could never consider it as a fellowship. 

This week I will have my first day off in 2 weeks of 12 to 14 hour work days and I can't wait to just get away and think and reflect and be at peace. 

I'm going to spend time with my family and hug them and catch up with them and feel some of my sadness and stress bleed away. 

Thank you to everyone who continues to read my blog. Thank you for being a part of my lonely journey.

Sunday, July 30, 2017

I feel so weary.  I feel like I'm beyond coffee helping me feel like I can cope with the day.  By the end of this week I'll have gone 2 weeks without a day off.  I'm so emotionally exhausted and I don't think I've had enough time when I'm not exhausted physically to just decompress and reflect. 

Sometimes I wish I were simpler and didn't think so much.  I'm getting through life one day at a time and sometimes an hour or a task at a time.

I miss my upper level resident friends who graduated and moved away, too. I feel like that adds to things.

Maybe one day things will get better

Friday, July 28, 2017

A nurse asked me to write for opioids for a hypoxic fluid overloaded patient in acute renal failure. 

How are these people paid more than me?

Wednesday, July 26, 2017

Been working so hard and been so busy since I started residency that I only eat one meal every 24h.  You kind of enter a stress state that suppresses your appetite sometimes.  But I feel like I'm making progress, especially with challenging high risk procedures