life of an intern

Count your blessings

2004-09-21T19:50:00.000-05:00

There are certain patients that you just seem to mesh with. Ones that you can identify with, they could be your best friend, your neighbor, or your sister. My newest admission is that person. She is darling, sweet, intelligent and has two small children 6 yrs old and 7 mths old. She has Renal Cell Carcinoma diagnosed a few yrs ago, she had her kidney removed, had another baby and then developed headaches and back pain. Unfortunately they found a mass in her brain and when they resected it they found renal cell carcinoma. She came in for interleukin 2 therapy, a potent immune therapy which weakens the strongest of pts to their knees. This drug cures 8-10% of pts with metastatic Melanoma or renal cell cancer but it's not an easy course. They get 14 doses of IL2 every 8 hours along with nausea, vomiting, diarrhea, rigors, chills, hypotension, acute renal failure, capillary leak syndrome, pulmonary edema. One of my patients has had a myocardial infarction while receiving his IL2 therapy. It's not a fun treatment. They get to repeat this over and over again for 6-7 cycles every week or so.

Today when I went into see her her family had gone down to grab a bite to eat and she broke down crying. Her 6 yr old had asked her if she was going to die the night before. She cried about how much she loved her kids, how she never knew she could love them so much. She missed them so much and didn't want to leave them. I struggled to keep the tears from running down my face. I could identify with every word. She was just like me, like one of us. The only thing I could do was tell her what she was going through is unimaginable. I listened and held her hand. I cant imagine having a disease that could take me away from my children. Her children deserve their mommy. She deserves to care and love for them and to watch them grow up. I felt powerless. I want to cure her of this cancer, I want to make her well. I came home and squeezed my children and thanked God for everything I have and prayed that he will make her well. I know I should feel the same way about all of my patients. I do want them to get well but I cant help but feel a connection to this beautiful Mom, sister or friend. I pray that she is one of the lucky 8-10% and hope that you will keep her in your thoughts and prayers as well.

Death and Dying

2004-09-04T21:21:00.000-05:00

I used to worry about how I would deliver bad news. How do you tell someone or their beloved family members that they have a terrible disease, they are sick, they will die. I used to prepare before I entered the room. I used to think about what I would tell them, how I would explain the complicated medical terms and help them understand. Today I realized it was coming naturally. It is still sad and I empathize with them but the words seem to flow out of my mouth. I just spoke with a patient of mine who has a terminal cancer, his chances of cure are zero, he is in his 70's and has multiple medical problems. He was telling the nurses he wants to leave. I told him that was reasonable, he should stop chemotherapy if he wants to. I explained that if he goes home he will die and he told me he would die anyway. I held his hand and agreed he will infact die anyway. The silence doesn't bother me anymore. Sometimes people just need you there with them and words don't have to be exchanged. We sat there for a few minutes as we both took in the news. When I left him he was at peace with his decision and I think he felt good that he had the power to make it.

I feel lucky that I can participate in such important moments in patients lives. Hopefully I can make a positive difference.

drug seekers

2004-09-04T20:59:00.000-05:00

They come in all sorts and shapes yet their motive is one and the same. Drugs. I have taken care of so many of them and I still wonder how they ended up that way, what was their life like? Do they think all people live like this?

One was a 22 you guy who came in with this bizarre arm pain, no history of trauma, no clear story just severe arm pain. He screamed and cursed at the top of his lungs for something for the pain. The nurses told him repeatedly that other patients were sleeping. I went into his room a million times trying to calm him down and console him. The morphine didn't do a damn thing until he had repeated doses of it. The next day neurology was consulted, he had xrays, and mri's done and finally left AMA when his drugs weren't given to him in the doses and way he wanted. He had been going to one hospital after another....

Another one was a young heroin addict. She had marks up and down her legs from skin popping. These patients know the pharmaceuticals better then we do. She was from Indiana, was homeless and here with a serious cellulitis resistant to most abx secondary to her IV drug abuse. I wondered how she traveled without money or a home? Where she would go once we discharged her?

My pt today is from Scotland, abused by her husband and wants benedryl IV pushed slowly. She has one million excuses why Diluadid is her Drug of choice and the only thing that works for her. She was allergic to "things" in the air until we informed her that she was on the Oncology floor where all of the rooms are under negative pressure and sterile. Now she is allergic to her sheets, the bleach used to the clean the room, etc... They always have another excuse, and their craving is relentless.

How do people end up this way? Where were their parents? Are these the kids I knew in high school who occasionally smoked a joint? What happened to these lost souls?

Weekends off

2004-07-03T08:49:00.000-05:00

So this is what it feels like to have a normal job. We changed rotations on the first and I had two lovely days of working in the acute care clinic. It is so nice to see people, treat them quickly and usually send them on their merry way. The best part is I have weekends off. I havent had more then 4 days off in an entire month since January, this weekend I get three! I feel like I am on vacation. I actaully slept until 8:18 this morning which is a first for me and now I have three whole days to spend with the family.

Another month is over

2004-06-04T16:41:00.000-05:00

I hate the end or beginning of a new month. It is so crazy. The attendings and residents change on the first and the interns work until the 4th. This is supposed to help with continuity of care so someone knows something about the patients. Of course this month it was so screwed up. Our resident had a family emergency and didn't start on the first. The fellow's wife had a baby so the interns were left doing all of the work as usual. We had 4 admissions on our second to last day and another 4 on the last day. It was such a mad house and on top of it I had to do a paracentesis on a pt who really should have gone to the liver team. Nephrology is just not my cup of tea. I find it be so depressing. To me being on hemodialysis for the rest of your life would be pure hell. Thankfully the craziness is over and now I have regular medicine patients to look forward to. I shouldn't complain I only have 5 calls this month and I am not on geriatrics but they took away my one and only elective so now I have to wait until next spring for one. If I could only have weekends off it would make me the happiest girl in the world.

blogging

2004-05-29T17:37:00.000-05:00

I feel like everytime I have time to sit down and type something I am always venting. It's hard not to become cynical as the long days of intern year drag on and on. Yesterday our noon conference was canceled and we had an hour to ourselves. Most people went back to work. I sat there and ate my sandwich listening to another intern vent. She was sick and tired of the crack addcits, of the idiots who go out to smoke post CABG, of working all night long admitting these idiots who take drugs, abuse their bodies and then expect you to fix them at 3 am. I could relate to everything she said. I agreed with her but realised that it is so hard not to become cynical in this profession. It's hard not to judge people, sometimes it's hard to care. I am sure things will change when I am in private practise. I wont have to take care of crack addicts, drug seekers and all the other low life people that you hear about on the news but dont really know. I dont want to let myself not care. I want to care about each person but it's so hard. There are some patients that I just cant bring myself to like. I guess I dont have to like them as long as I provide good care.

On a brighter note one of my nice, normal patients told me I was like a ray of sunshine and I brighten his day each time I come into his room.

Decisions

2004-03-29T13:30:00.000-06:00

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Being a doctor is about decisions. Each decision you make affects someone's life, their outcome, their fate. Learning to make good decisions makes you a better physician although many times you are unsure if you have done the right thing. Last night on call I was called at 130 am and notified that a patient was bleeding, her bed and the floor were covered with blood. The first thing I asked was is she in any pain? No they told me, they had just given her more iv medication. Over the weekend we had discussed her illness, her prognosis and had decided with her children that she probably wouldnt make it through the weekend. I was dreading that I was on call and she might pass during my shift. I really thought this was it. I went and evaluated her, she was breathing rapidly and laboring with every breath. I decided not to transfuse her and to jsut keep her comfortable. I called the fellow for some reassurance and went back to bed. I laid there worrying that she may die, wondering when my beeper was going to go off again. Had I made the right decision? How was I supposed to go back to sleep when this woman may die? Today, surprisingly enough her blood pressure was stable despite loosing several liters of blood. Her family was by her side and she was hanging on. As physicians I dont think we can accurately predict when some one will die and thankfully some decisions are left up to God.

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Is it worth the hours and aggrevation

2004-03-09T14:36:00.000-06:00

Sometimes I really wonder if this is worth it. Last night I called home at 6 pm and wondered where the day had gone. My two year old asked where are you mommy? and when I told him he asked me to come home. This is only going to get worse as he gets older and I am away. Everyone says it will be worth it in the end but I feel like I am missing out on his life and my 3 mth old looks bigger everytime I see him. Will I miss his infancy completely? I sit in my call room pumping in th middle of the night and get up at 5 am when for once a nurse isnt calling me to go pump again. At least the pumping will end at some point even if the beeper will never stop going off.

Sometimes I feel so disrespected. A nurse called me at 330 in the morning asking me about a pt on 6north. We dont have any pts on 6 north so I told her if this was a new pt she needed to call the fellow first. She proceeded to scream at me and finally hung up me bc I was following the rules. As it turned out we dont have any pts on 6 north so I was having a useless arguement at 330 am for no reason.

Well I am off to get some sleep.

2004-03-03T17:03:00.000-06:00

Today was a great day, I got out early and actually had some time to myself. Tomorrow I start a month of hematology/Oncology. Hopefully things will go well. I am happy to be off the GI service. I learned a lot but our attending was so demanding and he didnt seem to realize how hard I was working. Here's to a new start.