mottos to live by

1) Never trust anyone.
2) Be wary of everyone.
3) Wear clean underwear.

a day in the life

...of an MS3 on pediatric surgery:

-Arrive at 5am to pre-round on patients
-Round at 6am. Keeping it concise, I report that my post-appy pt is afebrile, making good UOP, and now eating well with no nausea/vomiting. Proceed to get yelled at for not reporting that he ate "tacos."
-Be intern's bitch and do discharge paperwork all morning on pts I've never even seen before and thus have to read the entire chart to do said paperwork. Finish approx one patient per 5 min but get yelled at anyway. "Are you STILL working? God!!"
-Fellow mumbles to me about how it's his wife's birthday and he's on call tonight and he forgot to reset the alarm for her this morning, thus making her late for work on her birthday, and also leaving their two small children with her tonight. Alone. On her birthday. Then realizes he's talking to a (idiotic, subhuman, truly worthless) med student and stops talking.
-Find out about interesting case in the afternoon and actually manage to scrub in.
-So interesting in fact that TWO attendings, a fellow, and a surgery intern also scrub in, thus leaving me an amazing view of the back of someone else's head as I am elbowed out of the way. This is also poor sterile technique, but who am I to say anything?
-Wanted to at least suture the trochar sites, but since an intern is here, she gets to do this instead. Stand there uselessly and fog up my mask due to my hasty/poor tying prior to scrubbing in.
-Begin pimptastic teaching rounds at 5pm. On a Friday. Don't you people have families to go home to?
-Before leaving, am reminded that students are "encouraged, but not required" to round on weekends. This is so freaking passive-aggressive, and I refuse to buy into it. Also I have not had a weekend off in over a month. When I receive poor evaluations I guess I'll know why.

down

Death happens. No big deal. Even this early in our medical careers, it's unnervingly easy to shrug it off when trauma patients die right in front of you, when you discuss patients in Morbidity & Mortality conferences, when geriatric patients pass away. As inhumane as it sounds, there were definitely times when it was like - oh that Level I patient was DOA. Oh, my DNR patient coded. Now then, who's up for coffee?

Somehow it's different in young patients, though I know it's technically not any different. Somehow it's more tragic when teens end up paralyzed in MVCs. Somehow it's more heartbreaking when children die before organ donors become available. Today I found out one of my old patients was sent to hospice. Later today my school-aged, previously healthy, now quadriplegic and vent-dependent, patient looked me straight in the eye and said "Please kill me. I want to die."

God. How do you forget something like that?

defeated

Maybe tomorrow will be better.

real quotes, part 2

Jo (to patient with suspected small bowel obstruction)

So when was the last time you passed gas?

Patient, writhing and moaning inconsolably

I'm not. I dunno. A week maybe. Ohhhhhh my stomach!!

Jo

A WEEK?? (Mind reels frantically. This is a surgical emergency!) Are you sure??

Patient

Yeessss!! Ohhhhhh!!

*proceeds to rip one loudly*

**********************

Fast forward: Jo presents patient to third year resident. R3 and Jo re-enter room.

R3

I hear you're having some abdominal pain.

Patient

*rips another one*

R3 shoots Jo an amused look. Jo almost falls over laughing on the spot and nearly suffocates while choking back laughter.

R3

So, uh, you said you don't think you're passing any gas? When do you think the last time was?

Patient, with "duh" expression

Just now.

real quotes

Two 100% real conversations with patients on trauma surgery:

Jo (to drunk injured driver brought in after motor vehicle collision)

Is there anyone we can call right now to let them know you're here?

Patient

Yeah, uh, I got a woman.

Jo

Sure, what's her name and a number where I can reach her?

Patient

[gives first name and number]

Jo

And her last name?

Patient

Uhh... I dunno. It don't matter anyway, we getting married soon and it's gonna be MY last name.

****************

Jo (to drunk combative patient, who will be a convicted felon upon release from hospital, with gunshot wound to upper thigh)

Sir, I'm going to need you to lay still so I can examine this wound.

Patient

No!! Stop touching me!! That hurts, b****!! [thrashes around wildly]

Jo (yelling)

Be still! I need to stop this bleeding. I'm going to lift up your gown and look at your thigh now, okay? [looking around desperately for his accompanying police to restrain him]

Patient concedes, lifts his entire gown, and exposes his genitalia and anus with legs splayed

How's that? You like THAT, b****?

Jo

Sir, please just lay still. There is no need for you to do that.

Patient

Shieeeet, I ain't just putting on a free show here!

my new home

Today is Tuesday, 5pm. Since Sunday I have spent 45 hours at the hospital. This is somewhat absurd. Please direct all mail to my new home at Parkland Memorial Hospital ER, Trauma Hall.

My last call was Sunday before Labor Day... trauma call is always worse on weekends or holidays when people are out drinking, boating, firing guns, etc. This ended up being 33 straight hours of being awake and running around, barely sitting down for 20 min to eat dinner. It drove me beyond the point of utter exhaustion and took everything out of me physically and mentally. It's so surreal... your entire body and head hurt, you can barely see or think straight, and you hope the adrenaline of life-and-death will get you through the night. Two Level I traumas were pronounced on the spot late in the night; by that point I just felt empty, emotionless, and numb to the smells of blood and sweat and death. After the patient was pronounced and the time called out, we all robotically returned to our work - peeling off bloody gowns and masks, returning to paperwork, and dreading the sound of our pagers going off signaling the next case on its way to our ER.

By the time a drunk, psychotic, frighteningly combative patient rolled in at 3am - physically restrained by 5 policemen on capital felony charges - I was shocked by how weary and unemotional I felt. This guy was seriously scary: he was foaming at the mouth, eyes rolling back in his head, bleeding profusely and flinging blood everywhere, spitting, reeking of urine and vomit, speech barely intelligible, cursing and lashing out at anyone nearby, violently jerking at his handcuff restraints. Even now the thought of him scares me, but I guess the weariness took over at the time; I just yelled at him to lay down and hold still while I dressed his gunshot wounds. One of his policemen pulled me aside later in wonder to comment how much it looked like I totally had my shit together. Yeah right. More like I was too tired and my brain too slow to be scared. When I finally went home at 1pm the next day, laying down and feeling the blood rush back into my legs was literally orgasmic.

Is this what the culture of medicine does to us? Belittles weakness and demands superhuman concentration after over 30 hours of being awake? Makes us feel indifferent to human suffering and death? People dying right in front of us, their relatives screaming in agony, patients in excruciating pain, and we're too tired to care? I don't want to become callous by disconnecting mentally, but at some point it's the only way to get through the night.