Sunday, December 4, 2016

A doctor's memory of punk rock

I recently started listening to a band called Oslo Ess I found through Spotify.  They're sort of a Norwegian hard rock/punk sounding band.

The energy of their music gripped me instantly and reminded me of all the punk rock I used to listen to growing up.  I listened to the Clash, the Ramones, the Sex Pistols, Cock Sparrer, and a bunch of others like Gang of Four, the Virus, the Casualties, the list goes on.

Similar to going through residency, my teen years were full of angst and I constantly searched for belonging and acceptance.  I wanted to belong.  I constantly tried to find out what really defined "me."

I found an outlet through punk rock in the bands mentioned above because  songs of theirs reflected what I felt personally and also had music relevant to political climate at the time albeit written a bit earlier about different things.

I'm revisiting punk rock again and it feels like the same outlet I had years ago.  I work hard constantly and feel constant burn out.  I'm incredibly disgusted with the way the world is: a world full of war, violence, senseless shootings, economic exploitation, the constant search for more meaning in life.

I think you'd be surprised at the depth of punk rock, especially from the UK.  Most people just paint a picture of punk rock as the music of wild people, destruction, a lack of respect, etc, but you would be surprised at how much of a message the music carries.

Time to study.  Going to bite the bullet an hour at a time every day this week and get through it.  cheers, readers

Thursday, December 1, 2016

Life gets harder

My day was rough.  Rougher than usual.  I have more responsibility, things are more difficult, my patients have more comorbidities and worse health than the patients I've taken care of before, and I have less help.  I can't remember when I had my last day off and I feel like I don't have enough time to truly decompress and recover emotionally and psychologically from work.

I noticed changes in my personality.  I've stopped laughing at jokes and feel more tired and have become more irritable when I've never really been an irritable person.  I skip meals because I'm so anxious and stressed out.  People keep telling me to go eat but I act like I'm too busy or that I'll get to it later.

I'm tired, and really stressed out for work-related and personal reasons.    Difficulty balancing work and life is at an all time high.

At least when I was a med student I had enough time to go to sleep for 30 minutes when I was feeling overwhelmed.

I do good work, I work hard and my hard work is recognized by some faculty.  I'm not a problem resident and I'm not a resident who lives on in stories about their mistakes told by attendings.

I think I have low self-esteem and feel like I don't believe in myself enough or give me myself enough credit, and I don't know how to fix that.

I'm still approaching each new day as an opportunity to really give it my best and impress the people I work with and improve my skills.  I just need more help getting through the hard part of things

Wednesday, November 30, 2016

Life as a tired resident

These days I'm feeling so tired and have this general feeling similar to mild despair and sadness during the day.  I don't know really remember when my last day off was and I've been trying to get through each day an hour at a time.  A lot of my friends in residency make comments about how they're also feeling stressed and worn out.  I don't really laugh at jokes anymore at work and have been feeling more irritable.  I can't wait to get some rest

Monday, November 21, 2016

Residency Pearl #1

Welcome to my first installment of a section where I share some knowledge and experience that I hope helps you become a better doctor.

"You can always give more."

A common phrase in medicine when starting or changing a medicine in the elderly is "Start low, go slow." My phrase applies to patients of all ages, and it comes from a perspective of safety, narcotics in particular.

Patients respond to the same medicine differently, different surgical procedures carry differing amounts of post op pain with them, and the danger of respiratory depression with narcotics is very real.

It takes time to get comfortable with near high to high doses of medicine when you're starting out.  It's easier to give more medicine in small doses, like morphine or hyrromorphone for example in a titrated way than to get the naloxone out and start managing compromised respiratory drive, especially in someone who might have COPD or other pulmonary or cardiac diseases.  There have been a few instances of people going apneic or near apneic with small doses of hydromorphone or morphine, usually in more older and debilitated patients.  It's a good phrase to live by.

Reflections over jazz

So this month has been better so far.  Better but exhausting. I'm lucky to get a day off this week and I'm going to do my best to get the most out of it.

I'm also starting to get more into jazz music again.  I would listen to it a lot when I was younger and found it had a calming effect.  I liked Winton Marsalis and Miles Davis a lot. I like the quieter, deeper and atmospheric types of jazz songs.  I think it's been helping me with stress management and helps me focus a bit more when I read.

I still have a lot of stress in my daily life though.  Especially with exams and meeting the expectations of being clinically great with my attendings.  I would hate to underperform and be treated badly.  I exist in a constant state of anxiety, and it adds up with the long work hours and challenges at work. 

I feel like residency has already eroded a part of me. I used to feel more energetic with a brighter outlook on life.  I used to go out and enjoy life a lot more. I had more self-esteem in college and I could find balance in my life.  

The road to graduation seems so long, but I think I can make it.  It's been helping me to take residency a day at a time and focus on being better.  I have a lot of dreams I hold on to: ones of being happier, having more control over my schedule, living in a city I enjoy, being fulfilled, being less tired.  

Hoping those dreams come true 

Monday, November 7, 2016

Medical training is a roller coaster

I haven't been writing for a long time because I've been so busy and emotionally overwhelmed.  I finished the hardest rotation I've had in a while and I'm glad it's over. I dreaded going to work every time I went to sleep and when I would wake up.  I had dreams about work.  I had to deal with a lot of unpleasant personalities and felt demoralized on a daily basis. I had two "okay" days during that rotation. I never had a truly "good day.".

A lot of my friends are feeling burn out in medicine too, we're exhausted and feel a little unfulfilled because we work so hard and there's little appreciation for us. Enduring residency is hard and it takes an emotional toll on you for so many reasons.

You will feel stressed and overwhelmined in residency and med school but you're not alone.  I'm coming to find many residents feel like I do and that I'm not here only one who is homesick and tired and worn.  There are a lot of people who you can connect with and who can help you get through difficult times.

If you're an upper level, help out your lower levels and interns, it means a lot to them.  I've also found that learning as much as you can on a daily basis at work and reading at home helps bring a little fulfillment and sense of accomplishment to you when you're so overworked and feel like you're burning out.

I was once told by a resident as a med student to not count down the days until residency is over, or you'll go crazy. It's pretty true.  All you can do is try to continue living your life outside of residency  and finding and doing fulfilling things when you can because your life gets taken over by work and studying in residency.

Friday, October 14, 2016

The Doctor and the Servant

I'm pretty beat at this point in residency.  Residency is a long, steady process of gradually getting ground down into dust and then graduating.  I go nearly 24 hours between actual, real meals and feel mostly dizzy and lightheaded and exhausted throughout the work day.  Any time I go to use the bathroom is some kind of rare opportunity.  Any time I finish any task, it's time for another task and I have no control over my schedule.

I went into medicine to serve others but at this point now I live out my days being pushed around, told to do this, told to do that, trying to feel like I'm truly making a difference.  It's exhausting to say the least.  I'm rarely appreciated for the work I do, and that's fine, I'm coming to terms with how thankless medicine is.   I'm hoping I can make it through the next few weeks.  Time for some rest