It is March and thus three and one-half months until I will start my sixth year of training "to be a doctor"...four years of med school and nearly into one year of a family practice residency...and I wonder every day if I made the right decision. I used to be a teacher...used to get to look out over the lab table at the front of the room and see young and often excited faces. They were usually healthy and as I taught at a private school, generally respectful, and they loved to tell me about their lives. I think that is what I miss most...the openess of adolescents with their thoughts and affection...or their fear or anger. Unlike adults, kids can be so transparent about their emotions and are still willing to get excited about things.
Now I find myself at 5:50 am knocking lightly on a heavy wood door without a lock to enter the room and personal space of a usually very ill human being and their concerned family/friends...the "patient's room". Despite having done this for 3 years now, I am still amazed that we practice hospital medicine this way...waking sick folks before the sun has risen...interrupting restorative rest...to quickly ask them how they are, do a cursory physical exam, and then run back out to the nurses station to get the required note written before meeting the attending for rounds. This certainly can't be in the patient's best interest and yet every morning I knock on the door, put on my pleasant cheerful face, and enter a world usually populated by illness and fear.
It is not that I don't think I am doing something worthwhile...I know I help people sometimes...even if it is only writing an order for the nurses to help the patient shower...I just hate the part where I wake people up or make them gag with an NG tube or write the order for the nurses to restrain the elderly man who has belted the nurses aid and pulled out all of his IV's.
I am doing an internal...as Erin has called it in her diary "Eternal"...medicine rotation this month and am dutifully waking sick people up every day in the predawn hours to fulfill my reponsibilities as a "doctor". I have decided, indeed decided a long time ago, that I hate hospital medicine. The way we manage hospital care seems so counter to what is truly healing to the mind/body/spirit. I am not really even a big alternative/holistic medicine person...but it is common sense that interrupting a sick persons sleep, having IV machines and monitors that beep at them, telling them they have to wait for their nurse to pee and then lying in their own urine, putting them on unhumidified oxygen and having to wait on the pharmacy to send up an important or pain relieving medicine....does not make people better.
I miss the young bright eyes of my former students, their intermittent enthusiasm for science and unflagging interest in one another, and definately I miss the hours!!!! I worked 81 hours last week, approximately 46 hours more than I worked each week teaching...and I worked those hours on several floors of a hospital rather than in the classroom which I lovingly decorated with plants, fish, posters of various biological subjects, and even a large stuffed owl (product of past roadkill donated to the school).
What I don't miss is the lack of money (not that I am rich right now) or perhaps the lack of future opportunities to make enough money to support myself. What I don't miss is the lack of intellectual stimulation after teaching the same lesson 3 times a day X 9 years.
I know that being a doctor gives me the opportunity to work with people, help them, counsel them, teach them, learn something new everyday, and make a living which will support me and my family...but I am just not liking my life right now and wonder if I will ever love being a doctor as much as I loved being a teacher.
I just found mommd today and appreciate the chance to share some of my story...here's wishing you joy and moments of peace ...until the next installment.
Another day in March of my intern year...another battle with depression. I find myself fighting hard to stay afloat...to not quit and make the journey to my dream career even longer. The first step was starting this diary yesterday, the second was contacting another intern in my class and making plans to have some "support time" together, the third was not blindly answering "fine" when someone asked me how I was today, and the fourth was seeking out the psychologist who works in our office and asking for some crisis counseling...I still want to quit but feel better about starting to take better care of myself.
I went in to work today after having Sunday off and saw drawn on the white board a cross next to Mr R's name. The moslem intern who was on yesterday got the call that this sweet old man (who had given given up on life several days ago) had suddenly began gasping for air...and he had to basically be with the man's wife of 59 years an help her to respect Mr. R's wishes to be DNR. I learned today that after Mr. R. was pronounced dead, she actually called Mr. R's nephrologist and said "Isn't there anything you can do?". Mr. R. was in the hospital for weeks and she has yet to face the reality of how ill he was...and how he gave up several days ago.......my moslem colleague had then returned to the resident's office and drawn a christian cross next to the patient's name. When I saw the cross, at first I was confused, then sad, and then to my embarassment so happy that I had missed the whole drama and so glad that I had one less note to write this morning. Mr. R. had seemed so miserable over the last few days, I found myself wishing at times for his passing into a more peaceful existance and I couldn't help feeling relieved this morning too that I wouldn't have to continue to witness his and his wife's suffering.
So that was the first five minutes of my workday in a nutshell. Then off to the floors where the computers weren't working, and two bed alarms kept going off, and where I had to look for about 10 minutes for one patient's chart.
I am so tired right now and my head hurts. My husband is late coming home from his part time job and I could go to sleep right now (it is only 5:30 pm). Tomorrow I am on call again all day and I wonder if I will sleep at all during the 30 hours that will entail...I hope so...I hope that I will have the time and then actually be able to sleep. WHO DOES THIS? Who came up with this system? Maybe someday I could help change it....who knows.
So wish me well in my battle against the fears, the anger, the sadness, the frustration which is threatening everyday to overwhelm me...and I will wish the same for you.
I made my medical student cry today...well maybe not exactly "made" her cry...but I looked at her, noticed something different, and asked her what was going on...and tears sprang into her eyes. She seemed so uncomfortable and the situation so public that I backed off and did not probe further. I suspect it is related to her recent break-up with her boyfriend...but knew that pressing the issue would mean opening the floodgates and knowing all to well how hard those are to close, I chose the practical route but added that I was always there if she wanted to talk. She is a beautiful brilliant young woman and I watch her fighting to close the floodgates and not "break down" and I know exactly how she feels. As she had no patients to follow today, I encouraged her to take an hour to take a walk or just relax, but she wanted to "keep busy" and my heart went out to her.
For any reading my diary, I hope I am not just depressing you. It is helpful to me to just get this stuff out there into the etherland and know that I am not the only one. We humans are such strange creatures that way...craving to be one of many rather than isolated by our grief or joy.
Over the last two weeks, our hospital has taken food out of the residency lounge that it had been supplying, cut back on the number of on call meals it would supply, changed its parking policy so that residents have to park farther away, cancelled the 12-3am cafeteria opening for night shift, got rid of the "sandwich" lady in the cafeteria who would make sandwiches to order, increased the cost of food in the cafeteria,and tried to make the "real" doctors pay for the food in their lounge. Two days ago, I got a contract with a salary which is basically only a 1.5% increase over last years salary (less than Cost of living increase). To re-phrase: I AM FEELING UNDERAPPRECIATED. The amazing thing is that I am in a WONDERFUL fam. med. program. I have a meeting with the prog. director on Wednesday to discuss all of the above changes...and know that he is my friend and will listen and do all that he can to help. That and my colleagues make this a wonderful place to be..........the AMAZING thing to me is how I am so unhappy in a program which has been really supportive and healthy compared to other programs. I cannot imagine working as a resident in a program which is less supportive.
Perhaps my previous experience having a career that I loved helps me to know that I can always quit...which is not an option to most people. And somehow, knowing that I can quit makes it easier not to quit. My parents would DIE if I quit...but I was also lucky enough to grow up with an Aunt who taught me that: "It is never too late to change your mind". She is one of the happiest people I know and has helped shape my understanding of the world in wonderful ways.
For today, I choose not to quit. I hope tomorrow that I will make the same choice. For now, this is a day to day decision...and I guess the wonderful thing is the recognition that THERE IS a CHOICE. May you choose your bliss.
Today was a very good day. I got 3 hours of sleep last night...solid sleep...which is a blessing on this rotation. I discharged two patients home, did some important problem solving about a difficult case, and left early to meet with my fellow intern and program director about the recent hospital changes I alluded to in previous entries.
Dr. B. was wonderful and the meeting reminded me of why I chose this program...of the support and the friendship. My primary criteria for choosing a residency (and I would encourage all Med Students to use the same criteria) was a program where the people were happy. Of course, I am not happy all the time (obviously) but I feel like I can be myself, ask questions, call my attendings my colleagues and partners, and basically feel loved an appreciated by the community around me. I needed the meeting today to remind me of this all over again...and I am sure that I will need to be reminded again in the future of this. Perhaps the key is that when possible I must be the one to help remind others in my community of the same thing...the new interns who become part of our community as of tomorrow, the attendings who are exhausted after two weeks of being on hospital service, my fellow residents who like me become disenchanted by long hours and the spaces between life and death, and the men, women, and children who honor me by consenting to be my patients.
Tomorrow I will try to focus on good deeds. Sweet dreams all.
I can see new life welling up around me today. The weeping willows which line the creek by the road which winds up to our home have sprouted what looks like green fuzz on their braches...the birds are singing...there are daffodils blooming in our yard which I did not know were hiding underneath the ground!
As well, we have 8 new people joining our practice as interns next year. Up until this point in the year, I have only been thinking about how much I am going to miss my 3rd year partners when they leave. But today with the Match complete and our program full, I find myself rejoicing in the prospect of all that the new interns will add to our community.
Tomorrow is the first day of spring and even though it is Saturday and a call day, I am feeling happy about the new greenery and new potential friends that will be available next year. I have gone from super depressed a few days ago to making cinnamon rolls tonight to take to share with the on-call team. I am not bipolar but am amazed by how the world shifts when you choose to look at things in a different way...feeling trapped changes when you realize that you can always quit...it can be winter one day and promising spring the next...telling a friend about the your worst fears and problems can make them feel so much more manageable. I am grateful for this fleeting but definite sense of peace and celebration of new life.
Today my topic is noise in the hospital. I am amazed daily at the ambient noise in the hospital. Right now, I am sitting at a nurses station and can hear a radio playing, a TV in the waiting room spewing some news program, the air conditioner is blowing softly, the printer printing, a tube just arrived in the tube system which is wining incessantly, a patient's bed alarm is going off and no one seems to be going to stop it, a patient is ringing the front desk, the phone is ringing, pagers are going off, some poor soul cries out repeatedly "help" down the hall,and off in the distance someone's IV Pump is occluded...Whew! How do our patient's put up with this? How do we? I can only be thankful that I am not ADD and can filter out most of this and write this diary entry. Here's wishing you a moment of silence...or at least only the birds and crickets singing in the background! :wave: