jcd1013: (Med - Medical tools)
I'm so sorry. I forgot.

You were such an enigma of symptoms that I got caught up in working you up, and then when it took me so long to get all of the different consult teams involved, it almost became a comedy of errors when I came to see you in the morning. "Sorry, Radiology thinks we need to get this one test, Surgeon X thinks that it's too small to biopsy, Team Y doesn't think it's anything serious." I was so excited when I got the right people to see you, the right consult, the right tests. Things came together. I got the tissue and sent it off to pathology and was excited when finally, after weeks of uncertainty, I had the diagnosis.

Melanoma. Finally, I could call in that last consult to hematology/oncology and start you on the right treatments. Until I realized. Metastatic melanoma. Stage IV. There were no treatments that could cure you. You, young and healthy, you are going to die and I can't do anything to change that.

I'm sorry. I'm sorry that I couldn't tell you that you are going to die. I'm sorry that I couldn't tell you that there isn't a cure. I know that I failed you as your doctor by being less than honest, by leaving that task to the cancer doctors. I couldn't do it, because I had already sat in the team room and cried and there was no way that I could maintain composure if I had been the one to say the words. I'm sorry, because suddenly this was personal and all I can think of is the two little kids you'll leave behind and the fact that with your limited days, you had to spend too many of them in the hospital, waiting for us to do the detective work and I had been so flippant and rushed in my morning assessment that I forgot that we are human and frail. Maybe that's the hardest part of all.
jcd1013: (Med - Medical tools)
My patient told me that [they] were going to die. I had come up to see them as they were having some difficulties and not getting better with the treatments that I had ordered over the phone. Patient looked anxious and uncomfortable, but vitals signs were stable and were certainly nothing to worry about. I ordered some tests and stayed there, while we started some treatments, reassuring that everything was okay and to just calm down. And I watched, horrified, as eyes rolled back into the head and the lungs stopped taking in breaths. Within seconds, the pulse was gone as well.

This is the second time that a patient has died in front of me and it felt like deja vu (really starting to dread the 5-6 o'clock hour). I felt only slightly more competent this time, listening for breath sounds, feeling for a pulse, directing the chest compressions. The medical ICU team was there within minutes and took over directing the code. I won't go into any more details as to what happened next, because this is flirting close enough to HIPAA noncompliance, but as always, it's really causing me to doubt me as a physician. I want to do critical care, but I just feel like a fish out of water in these situations. I know that it's lack of experience, but there's a big part of me that instantly defers when others arrive on the scene, and that's wrong. I should be taking charge. I should know enough that I'm making decisions instantaneously--that why we learn the algorithms so it becomes second nature. And of course, there's that part of me eating me up inside, wondering what I should have done sooner, faster. I chalked up the complaints to anxiety, when there was something seriously wrong. Am I that bad on my assessments? Even looking back, I still think that that I would have acted in same if I did it over again and that's not good.

I was going to write more about my date tonight, but I got three hours of sleep this afternoon and I am utterly exhausted. The short version: I had a great time, I like the guy (as in, I haven't found anything yet that is overwhelmingly a turnoff, otherwise, I'm still being cautious), deer hunting is loads of fun, and he gives pretty good hugs. :) Look for more tomorrow.

hubris

Jun. 21st, 2007 05:58 pm
jcd1013: (Med - Medical tools)
I am 9 days from completing my internship, the first year of my residency. After this, it will be me in charge of the interns, directing the team, and helping the fresh-faced, confused recently-made-doctors in taking care of our patients, making sure that nothing is overlooked, that we consider everything that could be potentially causing our patients symptoms and that it gets worked up properly. A whole new level of responsibility. Instead of 5-10 patients, I'll be responsible for knowing about 15-20. It's the next step to becoming a Real Boy independent physician. I know that I have areas of weakness (still hate EKGs, still hate drugs), but overall, I think I'm doing pretty good. I've even gotten praise from my attendings and residents in reviews, stating that I'm performing above the level that I should be. Maybe I let some of that go to my head...

I missed the diagnosis of an aortic dissection yesterday. Completely and totally missed it. Granted, my patient didn't come in complaining of the classic symptoms and we thought we had the reason for the other chief complaints--once we got the blood pressure controlled, the headache disappeared and the abdominal pain was gone as well. I was ready to discharge, had all of the paper work ready and was rather upset at my attending for wanting to get an echo, and then a CT scan on a patient who already had a reason for a murmur and was doing fine. Eating, breathing, walking, with no complaints. But there's a reason for the hierarchy, and I got the scan without too much arguing (just a lot of internal grumbling).

Even then, I missed it. I looked at the scan yesterday morning, saw a little fluid at the lung bases and that was it. I completely missed the large bulge in the aorta, as the blood leaked out. I didn't get it, until the radiologist called and informed me what the pictures really showed.

Aortic dissections are deadly. They can rupture, causing instantaneous, massive blood loss. In medical school, it is one of the "red sign" diseases that are always top on the differential, as they are the worst case scenario.

And I missed it.
jcd1013: (Default)
You know when you have one of those days where nothing really bad happens, but you still end the day in a very crappy, "get out of my way" mood? Yeah, having one of those today.

I overslept because I forgot to set my alarm yesterday, was so late that I decided it wouldn't hurt to be later, so actually had somewhat of a leisurely morning (10 min shower instead of 5). And nobody was too upset that I was gone--I hadn't missed any important lectures, just one of those cutesy "what color is your personality" tests that ALL conferences must include. Most of today's lectures were interesting, just long, long, long. Third day of 8-5 classes, and I'm dreading the next two days.

My clinic patient called. Again. Fifth time since I saw her a week ago. It's really wearing on all of my sympathies. Note to patient: believe me, I believe and sympathize with your pain; as one who does have chronic pain, I do actually know something of what you are going through. But since you have tried 50 medications in the past several years AND NOTHING HAS HELPED, you can not expect over night improvements from me. I appreciate the trust, but you have to allow some leeway into figuring out what is going on.

I could continue the rant, but I think I'll stop. It gets my blood pressure up.

The parking people called and changed my parking pass to the one that is clear on the other side of the hospital and clinics where I work. (gee thanks) I go to park there today... and the gates won't open. Wonderful.

I can't access the computer programs that I need at the VA where I'm doing classes this week, so trying to fix my above patient's problems is even more fun.

I haven't had a chance to go grocery shopping in over 6 weeks.

I haven't been able to go to the gym in a month.

I probably won't be able to fit into the bridesmaid dress that I paid over $100 to have altered because my weight is skyrocketing because of the stress.

I've spent the last five days working with Chris on his personal statement for residency. It's been slow and painful, trying to edit it and make it sound good and professional, and above all memorable in the right way. He's already freaked out about applying because of some earlier difficulties, and so there's been all this pressure to really make an excellent product.

Last night, we decided to scrap half of what the PS was focused on. I just about cried.

I have friends visiting for this weekend. I haven't been able to clean my house at all. It's a disaster. I'm working on the paper again tonight and still won't have time to clean.

I'm up to two migraines per week. This isn't good.

It's rained for a week straight. Last night, it downpoured. And I discovered that the basement leaks, because the sidewalks and front porch drain towards the house. I don't even want to contemplate how much it's going to cost to fix that.

I'm really missing the sun.

Thanks for letting me get this rant out of the way. It was either whine here or break down in tears. And Michelle was wanting me to update. :)
jcd1013: (Eeyore by angeleyesjg24)
Snippets of conversation from the past two days.

Patient #1: "I was telling the psych nurse what a wonderful doctor you are and how I easily I can talk you."

*continues before I can interject a sincere thank you*

"She didn't know who you were, so I tried you describe you. The little (indicates a height approximately two inches above his bed) blond girl with glasses who's not very skinny but more plump. Kinda pretty."

Um. My hair is still red, isn't it????


Patient #2: *reaching over and patting my belly* "So, are you pregnant?"

(after I politely, without too much blushing, tell him that I'm not)

"oh! I'm sorry. The nurses were just talking and wondering, so I didn't know...."

Yep, great day for the self esteem. I apparently need to work harder on finding a gym that is a) affordable (sorry, I'm NOT spending $63 dollars a month for the privilege of working out) and b) open past 6 at night.

*sigh* These are definitely the times when I think seriously about a tummy tuck or liposuction...


But to be fair. The Good Things That Happened Today
~ My patient (#1) has said that he's going to write a letter to the hospital and tell them what a good doctor I am.

~I've been able to get blood cultures, AND I've been able to teach my little "Baby Docs" (the medical students, as one nurse affectionately terms them. Was humorous when she called them that, not so much when she used the label for me) how to do them and get them on the first stick as well. Am very proud.

~The oh-so-cute pharmacy student whispered sweet nothings in my ear.... about drug names and dosages that made me look like I knew what I was talking about. I swooned. :) I think he calls me Jules, or at least it's never come out as a complete Julia. Hmm...

~My medical student called me "darling." He's got a girlfriend that he's planning to propose to soon, but the fact that he is comfortable enough with me is great (or maybe it's not, should I be fostering an environment of respect and authority?). Oh, did I mention he's cute too?

~ My attending, after I paged him with some results, paging back with the message "Strong work, doctor." After the atrocious presentations that I've given recently (my mind does not work post call), that's a very nice compliment.
jcd1013: (Default)
I am not a superstitious person.

Or at least I didn't used to be.

Now, I rap on tables when passing on my patients to the covering night intern that "there's nothing to do. They'll be like lambs all night long and not bother you." I stop mid-sentence when talking about how calm things have been, or how we haven't gotten any admissions.

Just so I don't tempt fate. Or the powers that be. I forget in those moments that I believe in a supreme, benevolent God who doesn't smite out vengeance at a lark.

Right now, I'm regretting writing about how good things have been. Because I did that, today was the worst day I've had yet.

I had two patients yell at me, swear at me of how I wasn't listening to them and keeping them there and making their lives miserable. One was probably justified... my patient with the fever that I stuck a half dozen times trying to get some blood...and whom I walked in and informed that we needed more, and he was going to be my pin cushion again. It didn't matter to him that I had practiced, that I had talked to the nurses and IV team and had gotten tips of how to do it better and get the vein when I needed to. He told me to leave, and I did. I got the other intern and begged her to do it.

The other was a patient that I had been trying to transfer back to another unit for two days and came in and discovered that all of my plans had come to naught. He was upset, I was upset and spent the rest of the day, trying to figure out what went wrong.

I haven't cried. I didn't get hurt or really upset, because I do understand that this is hard for them. But they don't understand that it's equally hard for me, to figure out my place, to be told that I, who have only practiced on fellow students, must go in and get blood on my patients...and my fellow students with their nice, plump, healthy veins are a far cry easier than these gentlemen. Thrown into the wolves and I have to fight my way out.
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