ERs, clinics, exams, applications and nightmares

Another month of family medicine and I'm hooked. I really enjoyed my elective away. Office practice was interesting and well paced for my liking.

My month in emergency has been, as expected, a roller coaster. There were days that were boring, days I didn't have time to think, days I loved it and days I thought the time couldn't pass fast enough. I've had staff who I get along very well with and there have been staff who ask me two questions about a patient and order a test, sometimes without even seeing the patient.

Residency application time is quickly approaching. That constant nag of "did I remember to do that?" is going to make me lose sleep. So many documents and reference letters and forms and deadlines that I'm ready to explode. I feel like I gotta screw my head back on. My focus is all over the place. For example, I just realized that I completely forgot about a lecture yesterday. We get a grade based on attendance at four lectures, I missed one. Also, I just poured a tea and forgot about it. I can't get things done right now. I'm exhausted from a long, eventful month, and not in a good way. Between the GF's friend's death, my grandmother in the hospital, myself having a run-in with the ER as a patient, constantly changing shifts and nightmares for a good month I'm in need of a break.

A break. Guess what I'm doing next? ICU! By no means is this next month going to be a break. In fact, I have a heavy load in terms of rotations and work up ahead. Geriatrics at one of the busiest, craziest hospitals in the city, one that puts the most pressure on students to be assembly-line workers instead of students learning the craft. Up next, plastic surgery, where clinics that are WAY too overbooked and crazy surgeries, with anatomy that I desperately need to refresh on and a shelf-exam at the end of that month. Followed by: Internal Medicine consults! Where I'll be tested to remember the Zebras of medicine, the "Who'd have thought it would be that!" area.

And then finally, a month off. A month with no lectures, no clinics, no wards, no consults, no exams. Whatever shall I do with myself? Oh wait! I know! Interviews! I can only hope that by then I've figured out if I want Internal or Family Medicine. I'm sure it's Family. But the added stress of knowing that I really can't screw up because of the added thought of a Couples Match, where my interview isn't just MY interview, it's an interview for OUR application, TOGETHER to a residency.

But I want family medicine. A program where, usually, the programs are trying to get YOU to go to THEIR school. Instead of the usual, US trying to convince THEM to let US into THEIR school.

Have I enjoyed the hustle and bustle of the ER? Yeah. Was it what I thought it would be? No. Do I think I need to see what it's like in residency to make my decision about doing a fellowship in ER after I finish family medicine? Absolutely.

Ok, I know. I haven't blogged in ages. I could tell you all kinds of stories. I had a guy come in with the cops, another guy who avoided eye contact and would yell over my voice if I tried to interrupt him, one lady who had fibromyalgia and who cried hysterically when I examined her collarbone which had nothing wrong with it. I've had patients look at me like they would kill me, I've had others shake my hand and say "Thank you! You're going to make a great doctor" after I took the time to adequately explain things to them instead of barking orders at them like my attending did. I saw a lady with epiglottitis who became stridorous two hours after I first saw her and needed to be intubated in the OR with a tracheostomy kit ready. I saw a man with generalized fasciculating muscles, who probably is going to be told in the coming weeks that he has ALS or Lou Gherig's Disease. I had one man just recite numbers to me over and over and over and over and over and even when I told him "SHHHHH" so I could examine him he kept going and going and going and going and trying to blow out the fire on my stethoscope.

I love my job. I can't imagine doing anything else. Well I can imagine, but I can't imagine getting as much excitement out of it and feeling inspired to better myself every day, while doing something else.

I just need the nightmares to stop and my concentration, when I'm out of the hospital, to come back.

Time to remake my tea...

Priorities

I loved my internal medicine rotation. Did really well in it too. Loved my family medicine rotation, did really well in that too coincidentally. I was recommended for a career in both, nominated for prizes and everything.

The hard part is deciding what kind of life I want. I have a feeling I'd be happiest in family medicine. You want to know why I hesitate going into family? I wonder if I'd ever be good enough at it; jack of all trades, master of none. Part of me is attracted to being an internist and being "god of the hospital" as one of my residents once described rural internal medicine. A part of me would feel safer knowing more about less things. There's a bit of comfort in not having to deal with pediatrics, psychiatry and obs/gyne. But would I lose that sense of whole person care and following families for years? I think I would. I think I like dealing with preventative medicine as well as dealing with really sick people, which leads me to believe that I would be happiest in family medicine.

You know, today, I was outside for two hours. I sat in the sun with some friends from school, enjoyed life. I love my job, but I love having time to do things more. I think I'm tired of passing up opportunities and saying "oh I can't do it, cuz I'm so busy with school."

I don't think that I'll be any less of a clinician if I do family med. I think that it is what you make it and if you want to be good at your job, you can do it in either field.

We'll see where life takes me, but the idea of being a staff in 3 years and setting my own schedule makes the next little while seem all that sweeter

I'm out...

My first death

I managed to go through Peds, OB/GYN, General surgery, cardiology, family medicine and hematology/oncology without having one of my patients die.

Today that all changed.

Mr. K. was an 80 year old man who presented to the emergency room with fever and bacteremia. While in the emergency, he had a hemorrhagic stroke and went into a coma. He never came out of that coma.

That was 3 weeks ago. I met Mr. K. and his wonderful family yesterday. He was stable. We were trying to get a PEG tube put in for feeding and then we would send him off to a long term care facility. He had a Glasgow coma scale rating of 3/15 meaning that he wasn't opening his eyes, he wasn't talking and he wasn't responding to pain. This morning, his pupils were both non-reactive and he was starting to have Cheyne-Stokes breathing. He was "coning," meaning that his brain was starting to herniate through the foramen magnum. We made him comfortable with morphine, the family was called in to be with him. They started a religious chant when they were all together.

At 15:05 I was called to the room. Mr. K. was dead. I checked for breath sounds, heart sounds, breathing movement, pupillary reaction and corneal reflex. He had none.

15h10, we declared him dead.

My attending staff, who I aspire to be a fraction of the type of doctor he is, asked me about an autopsy. He then asked me if I had ever asked for an autopsy and I replied "no." He graciously showed me. He was empathetic, calm, reassuring to the family. I can only hope that one day I'll be able to talk to people the way he did in such a hard time. I guess that it will be like everything else in medicine that I've been uncomfortable with, I'll get it with time.

I'll never forget Mr. K., even though he was comatose when I met him, and I'll never forget his family.