Sunday, May 28, 2017

Emotions in medical residency

I'm happy to say I've been adapting a bit better to my new rotation. It's difficult and challenging, but I'm making progress.  I'm still pretty anxious, because I don't want to make a mistake or be too slow or awkward at procedures.

Anxiety has to be one of the most common feelings I've seen in my co residents.  It really comes up later in conversations, and doesn't usually come up at the start when the other residents and I get together.

I've lost close to 10 pounds over the course of this month, I think mostly from psychological and physical stress.  It's pretty surprising to me, because I haven't made any dietary changes and have a rather light exercise routine.

I mostly deal with my anxiety by knowing I'll eventually get better with my skills and gain more experience. I had very high levels of anxiety when I first started PGY2, and things have gotten better with time.  I sometimes wish I had a special psychologist to help me with work related issues, and I've yet to still find a faculty member I can talk to because I feel like anything I say will make me look like a weak problem resident as opposed to people who just outwardly appear upbeat and confident.

I'm so exhausted today and still have many hours to go until my work is done.  Let me know if you have experienced any anxiety in medical school or residency, and what your experiences have been. Thanks for reading

Sunday, May 21, 2017

Friction With Nurses

Cheeky title but everyone in their medical training starting with med school has had interactions with nurses and have been frustrated.

I've worked with nurses who really are exemplary and who set the standard for professionalism and great care. I've worked with nurses who actually guided me a lot in the ICU and who would never be inconvenienced with any request or emergent situation.  I've worked with nurses who would walk a stat lab through a minefield.

Then there are those who aren't as dedicated. This is in no way a generalization about nurses. This is to help med students and young doctors work better with nurses as a team.

I don't complain about things at work, but many of my colleagues do.

There have been many times I've had to remind nurses to draw the lab I ordered, or remind them to give a medicine I ordered while they sit and talk at the nurses station or as in one case, horsed around doing karate at the nurses station only to seem really bothered by me asking them politely if they had a chance to draw a lab.

I've had nurses talk back at me, literally yell loudly about a new lab being ordered so the whole unit could hear, and plenty of nurses who pressure me to do this and that while they decide that charting is more of a priority than taking that stat lab before it clots and becomes useless.

First thing, don't raise your voice or get antagonistic with anyone. Remain polite and give gentle reminders.  As physicians, we give orders to be followed, and you don't have to explode and go on a power trip.  To even do your best to minimize a delay in orders being fulfilled, emphasize how important it is for patient care and offer ways to expedite the lab or order being given. Some nurses might have many other things to do at once and not all will prioritize the most important thing first unless you tell them.  Usually I've only had that happen with new nurses who are really under pressure with so many things to do at once.

As for nurses who hammer page about extremely low priority things like an AM lab order or diet order while you're running a code or stabilizing a patient who will die without your help and then express anger with you, you just have to be polite and tell them. Some people may say don't explain yourself because you're the doctor, but I find it helps.  They even say things like they were busy with a patient themselves.

The last thing you want to do is make enemies as a resident, or make things harder for you.  Of course, don't be a pushover. You have to be firm or you'll be walked all over by everyone. Always be professional, even if those around you are not.

Tuesday, May 16, 2017

"Medical Training is a Tragedy Waiting to Happen"

I've probably not coincidentally been finding articles about mental health problems with physicians as a whole in my Google home page on mobile.  It's a bit weird, but also seems to make me feel like I'm not alone.  The article I'm sharing with you all is from the Guardian (not political, don't worry), discussing a tragedy of a GI doctor in Australia.  You can read it below:

Medical Training is a Tragedy Waiting to Happen


I know now medicine is a pretty trying "lifestyle," and I've met a lot of people who are divorced, and a few people who have switched residency programs, and about three people who dropped out of residency.

I hear from a lot of people that residency is the hardest time of your life, and from some people that it gets better every year.  Last night I was looking at non-clinical physician jobs, and might investigate that further.   I do have an enormous amount of university and medical school debt, however.

I've been reaching out to a couple of resident friends of mine about my situation and we talk some.  I'm hoping to have more consistent conversations with them.  I feel a little better knowing I have a support network to tap into.  I think it'll help me endure the training.  Something that's hard to endure really are some hard personalities and harsh ways of being spoken to.  I've noticed I'm a "pretty good resident," mostly because I have good exam grades and I don't have "disaster stories" to share with my colleagues.  I think partly it's because I'm so careful and am not afraid to ask for help.  I think the staff appreciate that.

Anyway, I have a lot to take care of.  Thank you for your supportive comments, they do so much for me and help me stay afloat in this long storm.  I will post all of your comments and reply to them when I have more time.  Thank you again, I feel like you are alongside me on this journey.

Monday, May 15, 2017

Returning to blogging

Hi friends, I'm returning from a break from blogging.  I had some trouble accessing my blog from my mobile device so I didn't have many opportunities to write.

I think the tone of my entries has really changed, and I don't even really talk that much about medicine as I used to.  I guess I'm just so consumed psychologically by residency and constantly pushing my body to its limits that I don't have much creativity or will to write more enlightening entries. It really is my goal to shed more light on what doctors do and describe my day and the many times I've saved lives, and I hope to be at that point again.

Residency is hard and many things that happen can be demoralizing.  I'm still learning to cope with it. I do feel like I'm weathering a very long storm.  People tell me things will get better, so I'm a bit hopeful still.

Saturday, April 15, 2017

More burnout

Maybe it's my schedule over the past two months or just today, but I feel more depressed than usual.  It's the second time this month I looked up medical resident suicide rates and read information on the American Foundation for Suicide Prevention regarding physicians.  It says about 28% of medical residents have a major depressive episode and that male physicians are about 40%  more likely to commit suicide. 

There's just something really wrong about medical training and the culture in medical training.  I usually only have 4 days off a month and am discouraged to take sick time unless I'm intubated.  My schedule and the things I experience really wear on me.

I love my family and my dogs, and sometimes wish I could just run away with them to a different kind of life.  I love them and everything they do for me.  We live our lives just missing one another. 

I'm probably due for an inspirational talk or a day off.  I just want to be happy again. 

Saturday, April 8, 2017

Overnight Hospital Shifts: What To Take On Call

So you're really excited about becoming an intern..for some reason unfathomable to me.  Or you're a nurse, paramedic, upper level resident, etc.

As Napoleon once said, an army marches on it's stomach, but there are additional things you need to consider when going on call.  Go on enough calls and the psychological component starts wearing on you.  You might be q2 call or q3 for years..

The unprepared person takes nothing on call but maybe they're wallet and a stethoscope.  You'll have to do your best to be comfortable for an uncomfortable 24h+ stay in the hospital away from people and friends you love.

Clothing:
1. Backup pair of scrubs in addition to the ones you have on.  Expect blood and fluids to get on you every call.
2. A light jacket with pockets.  Soft shell jackets are best because they're somewhat water resistant and you they don't fray like sweaters.
3.  Extra pair of socks, especially if your shoes aren't so well ventilated.
4. A breathable pair of running/walking shoes.  Some people swear by those clunky clogs, but I prefer running shoes with or without insoles for comfort.  Contrary to television and movies, you don't really run in the hospital, so the clogs aren't so limiting.
5.  Extra t-shirt along with some regular clothes (more optional than anything).  It's nice changing out of your scrubs to go pick up some breakfast or something and look like a normal person.

Rations:
1. Real food cooked from home, 2 meals for when you're on 24h+ call.  Who ever truly feels fed after eating a granola bar?  Those don't really do anything for my mood.  Take granola/protein bars for emergencies (as in you're headed to a trauma or going to be scrubbed in for hours and you haven't had time to eat anything).
2. A water bottle, since some hospitals are terrible about having a water supply nearby.  If you get to lay down on call, it'll be nice having water in reach.
3. Potentially a thermos container for warm food/soup.  Soup and stew can do a lot for your morale.

Morale Items:
1. Tablet for looking things up and listening to music when you have time.  They generally have more battery reserve than phones, too.
2. Bluetooth speaker.  Nice to have in your call room, especially if you're an audiophile.  I like this one , but the DKnight Magicbox II is good if you're on a budget.
3. Foot powder.  Might sound weird, but it's great having nice, dry feet on such a long shift, especially around hour 18
4. Toothpaste and toothbrush
5. Breath mints or listerine strips to help you feel fresh  
I'm so tired and still have a long way to go today.  cheers.  I hope your call shifts become more comfortable and bearable

Friday, March 24, 2017

Wearing thin

I'm a few hours into another call and I'm exhausted.  I've started feeling sad again and am even more physically exhausted than before.  I thought about switching residencies for a while. I thought about leaving medicine as part of my future a couple of weeks ago.   I'm just so tired and feel pretty blue.  I'm on call all the time and never feel rested.  I've been getting better at my job but I think I just need time off or a different schedule, even though that's impossible.  

I'm so exhausted in every sense of the word that it erodes my hope of feeling happy and feeling better again.