feel the burn...

I've often wondered just how many miles we tread when we are on call. 30 hour shifts can be exhausting, especially when we are on the move every minute.

So, I wore a pedometer during my last call just out of curiosity.

And at the end of my run-of-the-mill, no sleep, bone-tired call, I glanced down to see my tally.

4 miles.

So, there you go ladies. Next time you are on call and running to the ER, running to a code, and running ragged, be confident in those steps!

Who knew? Call is actually decent exercise.

Perhaps now I don't have to feel as guilty about getting that midnight grilled cheese and fries from the cafeteria.

outliers...

Because we work in the hospital non-stop, our views are skewed. We see and take care of the sickest patients you can imagine and sometimes it seems as if we are drowning in death. We forget about the hundreds of quick stays and visits and concentrate on those who always required an uphill battle, those that modern medicine just could not save. We see the extremes, the outliers, and often forget about those average Joes hiding out under the bell-shaped curve.

Because of this, we have adopted a few simple rules:

First of all, nice guys finish first. This would be great for the Chicago marathon, but not so much for the timeline of life. The nicer and sweeter a person is, the more likely they will have an incurable or debilitating disease. It's not uncommon to realize you really like a patient and then become angry because that most likely means they won't fare so well.

And secondly, assholes live forever.

It's true. In the hospital, life does not follow suit with the whole idea of karma. Bad things happen to good people and unfortunately we see this more often than others.

Perhaps this holiday season, we all should laugh a little heartier, have a couple more drinks, and let loose. Be just bad enough to not be the nicest person ever and maybe then we'll land ourselves some extra time.

Average is where it's at.

over the hill...

Today, one of my clinic patients asked me casually if I had reached forty yet.
Forty what you ask?

40 years old.

He honestly believed I was almost 40 years old.
Sadly, he is more than a decade off.
I know he's 82 with hearing aids and glasses but every human with any brain cells knows to always shoot younger with women and never, never ask about weight or age.
After an awkward conversation, he was embarrassed and I am now thoroughly depressed.

Previous Christmas list: music, books, cooking utensils

Current Christmas list: Botox, weekly facials, high heeled pumps, and a personal trainer

sweepin' the clouds away...

Whether or not they believe it to be true, at some point or another, residents and interns speak of their "cloud status." No, this is not the cyberspace sharing cloud, but rather the luck of those on call.
The intern or resident "on call" admits new patients to the hospital to the service they are currently covering, whether it be the MICU, Oncology, Pulmonary, Renal, etc.

Those with the "black cloud" status admit patients non-stop. They endorse busy call nights, rare sleep - basically the worst of the worst. Another key feature of the black clouds are their constant acquiring of rocks. "Rocks" are patients that stay in the hospital forever - well not forever, but longer than most. The average hospitalization ranges from 2 to 10 days. Rocks usually reside there for at least 3 weeks, some for months, and only a few for years.

Those who are "white clouds" have mostly nice call nights filled with zero or few admissions, restful sleep, and minimal annoying pages.

You would think that these terrible call nights would even out since all interns and residents do the same amount randomly throughout the year.
You would think.

However, this just does not seem to be the case. There are people who get killed every single call, admitting patients non-stop and if not admitting, tending to the very sick. And on the same token, there are people who breeze by most call nights, admitting a few here and there, taking time to nap and have dinner in the call room. I exaggerate of course - no one has it that easy - we are after all, residents in one of the toughest medicine programs in the country. But still, it seems the balance is always off and someone takes the brunt of the beating.

As an intern, I was a black cloud. I completed roughly 65 30-hour calls and only ONCE did I admit zero patients. And even then, this wonderful night occurred because there was a snowstorm outside, preventing travel to the hospital. I slept only a handful of times and there were dozens of sickies that needed the doctor in the wee hours of the night. Some months were worse than others, but overall, I was definitely on the black cloud side of things.

I've heard that this topic has actually been studied in residencies and that it was true - the balance was skewed. For whatever reason, some people have more work to do than others.
But someone told me a few months ago that this whole "black cloud, white cloud" thing was simply a matter of perception, or superstition if you will. If you think you're going to be busy, you will be and if you think you're invincible, maybe you are.

So, I adhered to his policy. I put my foot down and decided that I was no longer going to be a black cloud.

And with that, the craziest thing happened. I became a white cloud. No lie. As soon as second year started, along with my new mantra, my call nights have been....manageable. I will never use the word easy because some nights are so bad I want to "accidentally" stab myself in the eye, but averaged out, I've been free of thunderclouds and rain. It's only October and I have already had TWO no-hitter calls where I was able to sleep soundly to my iphone sound machine, snoozing to ocean waves.

So, if you are having bad luck, think again. No seriously, think again. Things may turn around for you - perhaps better weather is in your forecast.

mmm, mmm good...

What is it about being sick that can make one so vulnerable? Illness can bring even the mightiest of soldiers to his knees. Your body is tired, you feel lousy, and let's be honest - you want to whine a little and let someone wait on you hand and foot and nurse you back to health.

I'm on call tonight, which means I've been here for 12 hours and I'll be here for 16 more. And I have a cold. No, it's not a hospital-admission-kind-of sickness, but it's just enough to make me wish for my sweet momma, some steaming hot Campbell's, and a cozy blanket. But alas, my mom's not here, no one cares that I'm not feeling 100%, and there's a lot of sickies worse off than me. So, I'm going to stick my kleenex in my pocket and suck it up and do my job, counting down the seconds until I can crawl into my bed tomorrow.

Despite centuries of valiant attempts, there is no cure for the common cold - except for a mom and bowl of chicken soup.

say cheese...

I hesitate to put this out there, but I'm going to say it: there are mistakes in medicine.
Of course there are - we are humans taking care of humans - and with that comes mistakes.

Most are honest without the slightest bit of malice or harmful intent. Small mistakes that cause no problems for patients are very common. These are minor incidences and are often the result of oversight. It usually takes several mistakes from multiple steps in the system (often called the swiss-cheese model) to cause a major fumble, one that actually affects the patient and their outcome. These are the mistakes that are hard to swallow, no matter where you fell in the arrangement.

It's a difficult situation. We take care of many, many patients at once and we are working as hard as we can to deliver excellent patient care. But these things happen. Things fall through the cracks. Our healthcare system is broken and there aren't enough checks and balances in place to properly identify every little (or big) miscalculation or error.

I fall asleep each night wondering if what I've done that day was the right thing for my patients. I dream about my decisions and I often have nightmares about poor outcomes. I and most other residents obsess about our decisions to ensure we are doing everything humanly possible to bring our patients out of sickness and into good health. Oftentimes it feels as if we are carrying the world on our shoulders and it would only take a feather to cause a stumble.

Spider-Man said it best: "With great power, comes great responsibility." Mistakes happen, even in the most sincere, good-natured circumstances. And they will always happen because we are only human and always will be.
And that's just something we have to live with because, after all, this is the life we have chosen.

intern year, check...

Just like that, in the blink of an eye, intern year is over.

It's unbelievable really. I've been sitting here typing then erasing, typing then erasing - it's too difficult to describe this past year in words and phrases. The growth of an intern is ridiculous. "The learning curve is steep" I was told and boy, that's the understatement of the century. The learning curve is not only steep, but the steepest incline you can imagine, perhaps almost perpendicular, straight to the top. I remember my first blurry days in the ICU, shaking with trepidation, thankful I had knowledgeable upper-level residents to ask about every order, every decision, every minute. My, how recent and at the same time long ago that seems. It's been a fast, yet incredibly slow year that has revolved around change, growth, and getting better every second. All the while, we were improving, advancing - and we've just been too busy to notice.

Now, here we are, one full year later. I am the upper-level. I am the resident. And as luck would have it, I'm back in the ICU, home of the sickest patients in the hospital and the state. Now that I have interns to supervise, I realize how new, pristine, and naive I seemed. They are newbies - full of ambition, questions, and fear and it's my job to guide them along like little ducklings while also allowing them their own autonomy.

While interns work grueling hours, residents have the most responsibility and I'm starting to see that this year is going to be hard in a different way than last. Growth will be set in a cleaner, softer light than last year, perfectly formulated to help me become a better physician. It's a beautiful transition really, one I have never understood until now.

Residency is a marathon, not a sprint - and the worst year is over.

So begins life as a resident.

counting sheep pages...

It's the middle of the night. I am not yet delirious (that doesn't happen until sometime tomorrow afternoon) and I am about finished admitting a new patient.
AND I CAN'T SLEEP.
Perhaps it's the large 20 oz. cup of coffee I downed an hour ago or maybe it's because I am getting paged every other minute with silly, not-important-enough-for-middle-of-the-night-pages questions about urine output, flu shots, and headaches.

Thus, I am now sitting in the call room listening to good music and wishing this:

were actually this:

But alas, I take what I can get.
At least I have a place to lay my head, which is a lot more than I can say for some of the folks down in the ER tonight.