My 2nd call was sooooo much better! First of all, I only admitted 3 patients. Secondly, 2 of them arrived before midnight! The third didn't arrive until 2:30am, but I was already up and dealing with a very sick patient, so it didn't matter. I even got a couple of 20 minute naps between 2 and 4am. It's not much, but it does make a difference at rounds. I was also able to leave the floor for about 15min and have dinner at 7:45pm.

So, in a nutshell, fewer admits a couple of cat naps and food at a decent hour. :goodvibes:

So I'm off for the rest of the day and my hubby has driven to Arkansas with the kids to drop them off at my parents' house. All by myself. So bizarre! I can't decide if I should sleep, cook for the team tomorrow, watch tv, go see a movie or just sit here and type. :laughing:

Happy 4th of July! :unitedstates:

Wow, more time has passed since my last post than I realized.

I really miss my kids. They're coming home on Saturday, which is also my day off. :guilty:

Sorry for needing to write about all this. I can't get it off my mind, though. It's hard to have a day off when all I can think about is this patient who's parent initiated the withdrawal conversation with me yesterday. I feel responsible for them both and they aren't even mine. I was cross-covering for a fellow intern who had the day off yesterday. I can only hope that the continued conversation today goes well. I feel my obligation is to make sure that the conversation goes as comfortably and with as much dignity as possible.

*phew*

What's going right? I think I'm doing pretty well. I'm getting better and better at multi-tasking and prioritizing. I'm getting better at anticipating things and looking ahead to the next step. I'm also better at communicating with team members and families. It feels very good to be a trusted confidant for these families. My attending is very happy with our work and even told us so yesterday. Compliments are always nice!

Today my husband, best friend and I are going to eat at an Ethiopian restaurant. I haven't been to one in at least 15 years. I've only ever been to a couple of them and none here. After that we're going shoe shopping. No, I'm sure my husband isn't interested in the shoes. I think he's willing to do anything today to distract me and see a smile of my face. I'm a very lucky woman. :yes:

On call again tomorrow. 4th of 6 calls for this rotation. My last 2 have been much smoother than the first. I think I could even handle 9 admits again with a little more grace this time.

Turning a sort of corner.

I'm not sure how to start this post or exactly what to say, but the title came to me. I figured the words would follow.

I was on call this past Monday. The day started rough. I had this strong suspicion that we would have a mock code on my call day. I was right. I wish I could say that I had rehearsed everything in my head, reviewed my PALS course material and things went flawlessly. But they didn't. I did rehearse a few things in my head and I did look at my PALS material. What I didn't do was figure out how a mock code really runs. It's like being in a play and not knowing what your lines are.

Oh, I should probably explain a bit. Mock codes are practice codes where everyone (doctors, nurses, RT's, etc) pretends like a patient is coding but it's a plastic doll in the hospital bed. We have one each month on the wards and this was our first one of intern year.

I'd better also say that while it didn't run smoothly, the parts about it that didn't work well had more to do with not knowing how to conduct the "mock" aspect of the event and not the not knowing how to resuscitate a patient.

For instance, I was running the code because I was the on call intern that day. As the "code" was being run, I kept drawing blanks because I was staring at a plastic dummy and trying to decide what to do next. It took several mintues for things to kick in and for me to ask all the right questions. In a mock code you have to ask the person creating the scenario what the patient looks like, what the monitors say, what the history is, etc. You'll only get the info you remember to ask for!

Anyway, the code was a bit of a bungle. My fellow interns were as completely frazzled as I was. That was the start of my day.

Shortly after lunch, all my fellow interns and my upper level left for various clinics and an inservice exam. I was alone on the floor by 1:30pm. Then the admissions started rolling in. Around admission #3 at 1:45pm (literally), my husband called to tell me the vet had called him to say that our elderly cat was terminally ill and we needed to put her down to spare her pain and suffering. We've had this cat 17 years, since we got married. My husband was catching a flight at 5pm, so I would have to go to the vet the next day when I was post-call (having worked a 30+hour shift) and take care of our kitty. Then I got 2 more calls for admits.

So I'm walking down the hallway sniffling, grieving my cat, coaching my husband on how to tell our daughter (who has been caring for the cat as her own for the past 5 years and sleeps with her every night), all while taking pages and organizing my notes for what is now 5 new patients on the floor in the space of about 45 minutes.

I wish I were exagerrating.

One of my fellow interns had popped back up to the floor from clinic to check on something and saw my distress. There was a collection of consultants outside her patient's room who wanted to speak with the "intern" about what to do with the patient that afternoon. Normally that would have fallen to me, the on call intern. But I just couldn't handle it at that moment. I asked my fellow intern to go late to her clinic and take care of her consultants so that I could see the possibly septic leukemia patient that had just arrived to the floor. She took pity on me after I told her about my cat and my dilemma. Eventually she called the oncall upper level to come help me out.

Thank goodness for that because one of the new admits was a child with a DNR receiving palliative care whose family was trying to get home before she died.

There are no words for this.

The rest of my night did not really improve from there.

My husband, bless him, took off from work that afternoon to see about our kitty.

I was finally able to call my kids (still at grandma's house) and talk to them at 9pm. :guilty: You can imagine how distressing the whole evening was for me.

So what about this was a turning of the corner?

Well, I think this is when I fully realized what it means to be a doctor and to have a commitment to patients that can challenge your own commitment to yourself and your loved ones. Of course if the death had been a friend or a family member instead of a pet I would have asked for back up to be called and would have gone home or whatever was needed. But for a beloved pet, well, the patients needed me more and my husband and my parents were there for the kids. And for me? Well. Nothing staves off crying like having work to do and people waiting on you.

It helped me realize something too. I signed up for this. I chose this. And, I wouldn't change it. As much as I suffer emotionally working with some of these kids and their difficult situations, I wouldn't change for the world the fact that my being there might somehow make it better or easier or somehow less awful. If only by being a listener and a sympathetic ear when parents have to ask the tough questions or tell the bad stories.

And there are good things about it as well. I got to discharge a baby who'd been in the hospital since April yesterday. 99.9% of it had nothing to do with me, I'm sure. But I'll still take some of the credit for advocating hard for my patient and helping him get strong enough to be home today. There's also all the kids who've been sick and gotten better while they've been on my service. If I'm going to suffer for the ones who don't do well, then by golly I'm going to take pride in the ones who do do well.

Call is tough. Life is tough. Sometimes life is tough while you're on a tough call. But I did survive. I did my job and I did it well. I'm finding my way and starting to think ahead and formulate my own thoughts and plans and going to the fellows and attendings for clarification and advice instead of answers. That feels good. Surviving a week like this feels good.

Plus, my kids are coming home on Saturday and my son has promised that he owes me about 100 hugs. I plan to cash in on those!

Life can be chaotic. Things happen all the time that we don't plan for, even that we don't want. Blessings happen in the same way, often unlooked for and unexpected. The blessing I find in all of this is that I am getting stronger and better at what I'm doing. I like what I'm doing and I want to do it well.

And hey, I'm still running 4-5 mornings a week! What does that mean anyway? Does it mean I'm crazy? No. Does it mean I'm rail thin? Nope, I've even put on a couple of pounds thanks to the baking talents of some of my compatriots and my tendency to eat when stressed. But what it does mean is that I can still take care of myself and that I'm still claiming something that is exclusively me and mine. I run for no one else but myself. Precious little else in the life of a wife, mom and doc is about that!

ps- I shouldn't have said last Sunday that I could handle 9 admits again, 'cus that's exactly what I got! :p

My kids are home! :goodvibes: After lots of talking and hugging, they are now upstairs watching tv and playing on their computer. I think they're really really happy to be back in their own spaces. I sure am happy to have them here! I can't believe how mature they look. I mean, I know I have a child about to start her Freshman year of high school, but I didn't really realize it until I saw her at the airport gate. She's a teen! And the boys have this swagger that older boys have...

I enjoyed sleeping in this morning, until 7:45am! You know you're an intern when you consider this "sleeping in." But hey, I was in bed at 10pm, so it counts.

Life feels pretty manageable again. This week was rough with all the emotional issues layering on top of the physical and mental demands of our service. But I keep reminding myself that every time I survive a call or day like that, that it'll never be that hard again.

Now that I'm getting past some of the hardest first days, I need to think about taking better care of myself. I've been eating loads of carbs and sweets, partly because I'm tired and emotional and partly because that's what people bake/bring and what's easy to buy anytime of the day or night. But it isn't really healthy. I think I may have gone a couple of days last week without a single fruit or vegetable. Not a disaster once in a while, but not a good habit to form either. So this week or next I will work on perfecting the "bring your own healthy food" approach to feeding my body and brain.

Only 10 more days on this service and then I can move on to something different. I'm enjoying aspects of my work, but oncology is definitely not for me!

I was about to post a good ole vent when I noticed my blog is on the Features sidebar. Now I feel like I should write something useful and insightful...

But I can't think of anything...

All I can think about is how unsettled I'm feeling at the moment. My kids are out of town again. They're at camp this time. They were home for 48 hours and I was on call for about 28 of those hours. They did come up to the hospital with their dad and bring me dinner Sunday night. That was lovely. But I've just been so homesick for them! My house is too quiet, my sleep uninterrupted. There are no stories about friends breaking up on AIM or new Wii games coming out or stories from the poolside. What's a mom to do? Add to that the sick kids I see everyday and all I want to do is come home and hug my babies. Not that they're babies anymore, as evidenced by the AIM drama and the Wii reports.

Anyway. I haven't run in 3 days. Monday I was postcall. Tuesday I was tired and cranky. This morning it was pouring rain and I told myself I'd workout after work. Right. Ha. It's almost 7pm and I'm in my pj's! The mental and emotional and physical fatigue are leading to me eating everything in sight. Yes, I know that food doesn't make up for lack of sleep and certainly doesn't make me feel better for more than the time it takes to finish the m&m's, but I've seriously slipped right back into the old habits that got me starting med school 40lbs overweight. Now I'm only about 15lbs over my goal, but I seem to be trying to sabotage myself! *grrr*

Okay, enough about that. I'm going for a run tomorrow morning (ellipticle if it rains again) and I'm eating grilled chicken and salad for lunch. And no cookies, donuts or whatever other evil gets put on our table during rounds tomorrow! :p

Oh man. I know what it is. It's the stress. This week I sat in on the initial diagnosis conversation for the parents of a young boy who was being diagnosed with an inoperable brain tumor that responds poorly to the current therapies available. :guilty: Today I sat and listened to the parents of a kid, who is actually doing well, recount their struggles with another physician and the trauma they went through with his diagnosis and treatment. [I know I can't stop talking about the bad outcomes and tough stories on this rotation. It has really affected me. sorry!]

Yesterday I started my continuity clinic. That's a half day each week for the entire residency at a private practice pedi office. Nice pediatrician. Long time established practice. We saw at least a dozen patients... I don't like general peds that much. I was really hoping I would love it and that would simplify my plans for the future. You know, the part where my husband interviewed for a job in another city and where if I wanted general practice I would be done and out in the "real world" in 3 years. Instead it sorta confirmed to me that I am an intensivist at heart and Fellowship is in my future. Dang. Not the convenient answer I was looking for!

As if in confirmation of the path that I'm supposed to be on, the second journal we submitted my paper to has tentatively accepted it with some requested revisions. Also, I've been asked to assist in the writing of a handbook for Neo (along with a couple of other residents who have expressed interest in the field).

So why so crabby?

Maybe it's the adjustment to the 70+ hour workweek and only having one day a week off.

Maybe it's the lack of children at home.

Maybe it's the sleep deprivation.

Maybe it's the lack of time and energy to do things that distract me from work, like running and hanging out with friends and reading for leisure.

Maybe it's all of the above! :yes:

As always, I feel better for having written about it. Tomorrow is another day and I'm going to start it by doing something for myself.

You know, I just reread the quote in my sig and realized that I could sit here and feel bad about how things are right now or I could go do something not related to residency for the next 90 minutes. Duh! :laughing:

"All you have to decide is what to do with the time that is given to you."

So I worked out for 20 minutes or so and towards the end of my workout the song "Say" by John Mayer comes up on my playlist. I was sitting there, cooling down and listening to this song when I realized I haven't really said what I need to say. So here it goes. My apologies in advance.

Cancer sucks.

Death sucks.

Children dying of cancer has got to be one of the suckiest things I've ever witnessed.

I grieve for the parents.

I grieve for the children.

I can't accept the death of a 5 year old boy.

I can't accept the death of a girl just about to graduate from high school.

I can't accept the pain, the suffering, the need for hospice care, the massive doses of morphine that don't take away the pain and suffering.

I can't accept that this is a world in which there is a diety who answers prayers. Because surely, surely in a world where He was actively participating there would be no call for this.

I'm sorry. I'm sorry for the death I can do nothing about. I'm sorry for the suffering I cannot fix. I'm sorry for being witness to these most dire moments without anything to offer but my own tears.

I feel helpless in the face of this. I don't want to write DNRs for preschoolers. I don't want to send children and their families back home to the countries they left in search of a cure, only to find there is no magic, there is no answer.

I know there's another side to this. I know His hand is in all this somewhere. But right now all I can feel is the raw grief of standing at the bedside of a child at death's door with the devasted parents on the other side and having nothing to offer or say to make it right or better or different.

What I need to say is that cancer sucks and I cannot bear one more death or devastating diagnosis right now. I don't want to do it anymore and I cannot wait for this month to be done.

I'm sorry, but that is what I needed to say tonight.

Today is my day off for the week. I'm on call this weekend, thus the weekday break. On the one hand, it's nice that I can do things like go to the grocery without a crowd or make calls for business type things that only happen on weekdays. On the other hand, everyone else is at work! I think I'll appreciate the quiet weekday now and again when my kids are home and life is busy with them and their activities. Right now it's just...quiet. :p

I thought I would write a few words about being on call since many readers may not know what it's really about. I've been surprised at how poorly people understand what happens when a resident is on call. Then again, I shouldn't be surprised. Why would anyone not in medicine know these things?

So, as a resident, taking call on the wards means being the only doctor on the floor overnight. Wards are the inpatient floors with all the rooms full of patients. For most of us, call starts on Day 1 at 7am, technically. (though many of us arrive between 6-6:30am to get a jump start on the work.) Once the shift starts, you carry your pager, the code pager and the hospital phone (cordless phone only works in the hospital). The code pager goes off whenever there's a code (as in, a patient is not breathing or has no heartbeat and needs immediate resuscitation). If the code pager goes off, you respond immediately. (There are also things called RRT, rapid response teams, that are also called over the code pager, you only respond if it's on your floor. That's another story.)

So, from 7am Day 1 to 7am Day 2, you see every patient admitted to your floor and do a thorough history and physical and initiate whatever medical workup that patient needs. Since there are 36 beds on each of our floors, this can be a large number of patients! The record for # of admits that I'm aware of is 17. Considering that you would need a minimum of 30 mins just to get to know the patient, his history and current issues and decide what course of action to take, I can't see how that number could be done. On average on my floor, we admit about 6 patients each call. The most so far has been 10.

Additionally, you take all cross-cover calls. That means that once the other residents have left the floor for the day (often as early as 1pm because they have to go to clinic, etc), you take care of their patients. On a floor like ours, cross-cover is the majority of the work for the on-call resident. Sometimes your pager will go off 40-50 times in a call shift! Each one of those pages has to be returned and the patient seen/assessed on a heme/onc floor. You can't just order tylenol over the phone for a patient with a fever and no immune system to speak of.

Yes, there is back-up. There is an acting chief who is an upper-level resident who provides back-up for 5 floors worth of patients. (that's 36 beds x 5 floors)We have had fantastic acting chiefs who have really helped us out this month. For the h/o floor there is also a fellow on home call, meaning he/she will answer the phone/pager anytime day or night for oncologic/hematologic issues with their patients.

As you might imagine, calls come at all hours of the day and night. Patients seen in the ER at 4pm come up the floor and have to been seen and taken care of at 2am. Patients spike fevers, get nauseous, have pain, develop breathing trouble at 3am as well as 8pm. You don't get much sleep on call. On our floor, 2-3 hours sleep is considered a really good night. Most nights you just don't sleep at all because by the time you finish taking care of that 2am admit, the 3am fevers are spiking. :p

But call isn't just those trying 24 hours. It's also the regular day's work that you have to get done on Day 2! So you arrived at ~7am on Day 1 and you usually get to leave at 1pm on Day 2. Technically, you get "kicked out" at 1pm because there is a 30 hour time limit to call shifts.

On day 3, unless it's your one day off that week, you show up at 7am and put in your regular 8-10+ hour day!

Since we're only q6 on my floor (that means on call every 6th night) I'm only averaging 70 hrs/week. Other floors are q4 or q5 and push the 80 hour/week limit. I'm just grateful that we have this limit now! Speaking of which, I need to log my hours for the week, a required duty to track our time over the weeks and months.

Okay, so I'm meeting my husband for lunch today and then going to look for a light-hearted book to read when I'm not working.

Oh, I think I forgot to mention that my paper has a conditional acceptance from a journal! It's really just beginning to sink in, even though I heard about it a couple of days ago. That means my other duty today is to locate some numbers from my data set so that I/we can make the requested revisions to the paper. I'm very excited, now that I think on it. I may be a published author soon! :crossfingers:

Tomorrow is my last day on the Heme/Onc floor. I would be lying to say I was anything but hugely relieved! :goodvibes: I can't wait to pick them up from the camp bus! I know they'll be exhausted and sad because camp is over, but I just can't wait to have my home messy and full of kids again. I'm going to hug them as much as they'll let me. (which isn't much with 11 yr old boys!)

My husband is being courted by the client he's working with and he's very happy about it. I don't know that he'd really want to go work for them, but it's very flattering and if nothing else sorta increases his value with his own company. He's looking for a major promotion next Spring.

Time to think about where to eat dinner tonight. We still haven't cooked since the kids have been gone and I'm tired of frozen dinners. :p