#456

Weekend Round-Up

Well, this weekend was heavy on the emotion and light on action. I certainly prefer the reverse.

I had Friday off, and slept 12 hours by accident. Switching shifts between overnights and days is incredibly difficult, and I'd just like to point out for the record that I come from the greatest family ever because when I told my brother about being on ED and feeling sleep-deprived, he was all like, "Pfffffttt...Swing shifts are hard. I should know. I have to work all weekend because of the Oscars." (My brother works for a national celebrity magazine.) Except today, I found out that he took his kids to the aquarium with Dad, so I'm all like, "Working hard, huh?"


So back to Friday...and please excuse my sass. I'm Grouchy McGrumps today. The sun was shining for the first time in several weeks, so I drove out to my old study haunt cum coffee and wine bar to read my book and write lists about life goals, and my pen ran out of ink and I just couldn't stand the smooth jazz playing in the background, so I ran across the street, bought a fat quarter of this awesome Amy Butler fabric, and then drove roads I had never driven all the way home. I was misty-eyed the whole time, thinking about how I'll be leaving this place in a few short months. I'm divided about whether I would recommend medical school to someone else, and whether I would even choose medicine as a career if I had to choose over again, but I will say that the nearly four years I have spent here have been the best four years of my life. I was independent, self-actualized, comfortable in my own skin.


I made it home for dinner time, and then slipped into bed at 9 to read for an hour. Somewhere along the way, I forgot about reading. It is so much more awesome than watching tv or reading blogs! You learn something, you relax, and you don't get bored. I thought my early bedtime would encourage sleep, but...no rest for the weary. I think I laid in bed and stared at the ceiling until about 1:30 AM.

Saturday morning came early and it was off to the acute side of the adult ED by 7 AM. I was doomed within half an hour when the intern let on that I had scheduled a shift with the world's hardest ED attending. Fun times. I think I did okay, but I worked my butt off triaging a patient in atrial fibrillation whose final destination turned out to be the cardiac care unit. I liked this patient and his family immensely, but I'll never understand why people who are four breaths away from a massive heart attack have a tendency to badger you about sandwiches. Look buddy, I know you're hungry and I know food is an unpredictable thing in hospitals. I know how terrible hunger is - in fact, I never eat on my 8 hour+ ED shifts and am shaking by the time I make it home - but let's work on keeping you alive. Not sure why I pushed myself so hard that shift - could have been the dragon lady attending who threw paper at me when I clicked my pen and accidentally cracked my knuckles. It's kind of silly to work so hard, seeing as I'm going into pediatrics. I have no reason to remember this stuff. But there's a core of me that refuses to separate "doctor" from "pediatrician" and so I operate as if I should be able to treat all patients who cross my path. I passed out for a solid 2 hours on the couch as soon as I got home. A light dinner and a choice: to drink or shop? Drinking is a dicey proposition on clinical rotations because of the erratic work hours and the massive self-imposed dehydration. I chose shopping. Excellent choice as I scored a full set of white towels and sheets at the Lands' End outlet store, and an awesome spring scarf at Old Navy, among other things.

It was back to the ER early on Sunday for a "procedure shift" in which my responsibility was to help the nurses place IVs, draw blood, insert catheters and help the docs drain abscesses and stitch lacerations. Except I've never done half of it. So the pressure was on because I'm convinced you ought to know how to place an IV to call yourself a real doctor. The nurses I worked with were great, and occasionally not so-great. One nurse in particular talked my ear off for over an hour about her rose garden and the hunk she met on e*Harmony. I'm glad she felt so comfortable talking with me, but the doctor side of me was freaking out the whole time about how much work there was to be done, and room turn-over, and we must not socialize in front of patients...I. Blow. At. Procedures. Placed one IV correctly and tied my facial laceration stitches too tight. As Romeo points out: no biggie dear, the ED ain't plastic surgery. But my problem is that I think too much. What happens when you tie stitches too tight? How bad is the scar? What happens if I killed the tissue underneath? Why can I not inject lidocaine properly? Why must I suffer through this shift and annoy the nurses with my ineptitude? Why do I care? My brain nearly exploded from it's mania. I struggle with procedural anxiety a great deal, which is why I am not a surgeon or a dermatologist. I realized yesterday why I liked neurology. I love talking to patients. I love giving them hugs. I don't mind their fluids. But I hate touching their bodies. I clam up like a deer in headlights during the physical exam. I hate doing anything to them. And your brain has to work on so many levels.

1. Remember your steps:
-Gather your supplies
-Palpate and observe
-Cleanse the area (chloraspetic/alcohol/betadine + saline under pressure)
-Numb
-Inject or repair
-Re-cleanse
-Dress the wound
-Instruct
2. Pay attention to your patient. Goodness, they are white. Let's lie them down. Goodness, they have a wimpy pain tolerance. What topic should we talk about to distract them?
3. Pay attention to your emotions. Do not talk. Do not apologize. Do not say "whoops..."

And on and on and on all day.

The bright spot was watching the Oscars. I thought the show was pretty boring, but loved having two hosts. And the last hour was exciting. And of course, my favorite movie won.

I had so many thoughts running away with my head this weekend. About how little useful teaching we receive in medical school. About how explicit you should be when giving directions. About should I let it all out and vent, or suck it up and be strong. About how I wished I hadn't spent so much time planning a wedding instead of studying because frankly (and this is an incendiary statement for a website read by my family), I am proud of my wedding but it was so far away from the best day of my life it might as well have taken place in Africa. About Ace's (my nickname) Number One Rule of Life: things will always look better in the morning. Perspective is important, but it's hard to remember that when you're three short months away from being a resident and there's no difference between you now and in the future, and hard to remember when your usual response of, "Hey, it's not kids with cancer," loses its power because that guy in bed 53? Yeah, he's 4 short breaths away from a heart attack. And would like his sandwich STAT.