Day 140-160: Reader Beware, there are no Rainbows here

I may have completely forgotten about my blog these past 2 weeks. I am sure anyone who was reading this has long abandoned the cause. I will not fault you for losing faith in an unreliable writer.

What have I been doing these past 2 weeks? Losing confidence.

I have had the misfortune of admitting numerous very sick people to the general medicine floor, who required more intensive care. And so their outcomes and hospital course have left me feeling as though I must be the worst intern of all time.

There may also have been a very harrowing 3 days in which I neither ate or slept much; at the end of which even my senior resident said I looked like shit and should go home early to sleep.

Thank you senior resident for being so blunt and caring at the same time. If only you were actually present on the floor to help your interns beyond those 3 hours in the morning.

Into the sixth month of residency:
Have I become a bitter little person - most definitely so.
Am I verging on the cusp of clinical depression - it is only a matter of time.
Do I have any medical knowledge - little to none.
Do I have a kick ass Christmas tree in my living room - damn right.
Do I get time to sit and look at said Christmas tree - do I get time to sit?
What would I do if I was fired as an intern - pack my bags happily and go back home to CANADA to find a regular sane job.
Is this the most gloomy blog entry of all time - is this the last blog entry?

Day 132-139: Matrimonial

One of my friends was forced to sign up for a matrimonial website by her concerned parents. This is one of many professions of "love"/oddity she has received. This has not been edited in any way. The world is full of winners:

"Please, schedule time to talk with me. I want to talk about family, love, relationship and trust and many more. Loving is never waste of time. so, Prepare to chat through webcam. we can understand each other well. We all waste our time by finding right, instead of Creating right person. Husband and wife relationship is like 1000 years of crops. please pour the water timely to nurture it. I plan to visit usa in January 2011. Visa processing is ongoing through MNC. Company ready to support provide H-1B section. But iam demanding for L-1 section(for clearly immigration and naturalization in future to attain green card). Iam keenly to settledown in usa after the marriage. so, please take timely decision with true love. My mom and 4 sister everybody want to see my marriage as soon as possible. But i Promise them that there is time for everything.

Yours Lovingly,
(mr gentleman)"

Day 129-131: Butterflies

Pretty picture hanging on the wall of my thoughts;

Nose pressed to the glass, breathing streams of fog

Onto the pitchers of lemonade, not a lemon in sight.

Tumbling into the speeding frame, tucking in my arms just in time.

How curious this place;

My familiar sweater hanging in a shop window.

Waiting for me to try it on at last;

Haven't we met before, old friend?

And those awful butterflies, those raging flutterbyes

The ones flapping their wings in a battlefield within,

They've mysteriously been tucked into bed,

Vanquished to a quiet place by sparkling armor clad calm.

Out of the din into the open hush,

Following the voices of friends on the wind,

Words of comfort drifting and reflecting

On the water, tumbling like pebbles bottled in my mind.

Crisp fall breeze shooting between tall maples;

Soft dirt below foot, quieting my steps;

Path winding ahead, as far as I can see.

My hands searching for a map, eyes searching for signs.

Picking courage, like webs off the shrubs,

Clutching it tight in my pockets

Lest I be left alone, as I embark

On the first day of a dream realized.

Day 121-128: G.I Jane

G.I Jane is that resident who is in a word, "hardcore". This is either a co-intern or senior resident who is always moving, speaking, working as though we are in an army drill exercise. They bark orders at their colleagues, and march systematically on the floors always with purpose and power followed by a sound track of war music. Most likely under their white coat there is an armed forces issue uniform.

And lest you not meet their expectations, and are caught smiling or enjoying your day- you are pushed out into the pouring rain and forced to run laps and do push ups. Ok, at least some medical task equivalent of physical exertion.

This person makes you dread coming across them; eventually, you find yourself acting extremely busy and absorbed every time they stomp around a corner toward you.

I have not yet figured out how to deal with the G.I Jane resident. I always end up feeling like Ben Stiller vs. Sean Connery.

Day 120: Mayhem

I used to watch those Allstate commercials with Mayhem on t.v and think, "wow, this is ridiculous." I have recently come to the realization that I am Mayhem.

This morning while backing out of my parking spot in the underground garage of my apartment I "nudged" another parked car. I left behind some silver paint and left with raised bump. If anyone views the security footage they will see me stop abruptly, sit shocked with my eyes as wide as saucers, then spaz out and jump out of the car to assess the damage. Subsequently, I held my head in my hands while I tried to figure out how to let the car owner know it was me.

This would be the second time I've done something like this. Mayhem.

Mayhem, decided to leave her name and number with the front desk in case the red car owner wants to kick her butt.

Day 113-119: Multitasking Success

I often put friends and family on speaker phone while I attempt to do several other things at the same time, usually this leads to small scale failures and a lot of burnt food.

Me: blah blah blah...(puts brother on speaker phone and starts multitasking).

Brother: Why does it sound like you're in a cave.

Me: Hmmph? Cawe? Wah cawe?

Brother: What are you doing?

Me: Flossing my teeth, while I talk to you.

Brother: This is something Liz Lemon would do.

Me: I fink thif if working ouf well.

Day 108-112: The Fleece Sloth

Hello readers,

I have become very lazy about writing. Actually, I've become very lazy about everything once I step out of the hospital. So, I apologize for the paucity of entertainment in my writing and what appears to be a complete lack of luster.

I've begun to fell like the passion is sucked out of me every day at the hospital, so by the time I come home I am reduced to trying to get through those basic activities that I need to do to stay alive. Such as eating, sleeping and of course laying on the couch with my fleece blanket and watching t.v.

I have been known to hate on Snuggies, especially that Snug-a-rena commercial. I have a confession: I am a hypocrite. I have a pseudo-snuggie. Basically, 90% of the time I am at home I am wrapped up in my brown fleece blanket, this in turn limits my activity level to that of a slot - sitting/laying/lounging on the couch. I wonder if I had arm holes in the blanket I would actually accomplish more, as my mobility would be increased. Like maybe I could actually hold my reference books and read some medicine, if I wasn't so reluctant to expose my arm to the frigid environment in my apartment.

My options at this time are to:
Bite the bullet and by a Snuggie; or start wearing leg warmers on my arms when they are outside the Snuggie; or figure out how to turn the heat on in my apartment.

Side note, occasionally I have tucked my pants into my socks because I have been so cold. Yes, I said that.

Day 101-107: Things Learned

I have discovered the key to having a conversation with a stranger at work. I am sure that regardless of the place in which you work, even if it is not a hospital where everyone hates the world, this magical tip will have you wishing to hit people across the head much less than previously.

Use their name when you speak to them.

I have found that when I need to call a fellow or a pharmacist or some random person from the company that supplies glucometers, they greet you in a way that includes their name. If you pick up on this and use their name, even if it is only once, while speaking to them, they instantaneously become nicer and try a little harder to help.

This also works with the impenetrable fortress of walled of nurse feelings. If you sneak a peek at their name tag and use it - miracles can happen.

I don't hate people as much at the end of the day thanks to this little tip. You're welcome.

Day 100: One Hundred

It's day 100 bitches.

And I am still going, and still semi-human and still getting at least 1.5 meals and 5 hours minimum of sleep daily. And only a mean jerk 40% of the time.

WHOO!!!

Day 97-99: Godzilla

Lately, there are many things that make me feel like Godzilla - the giant perpetually enraged ape.

Yup, I said it.

The biggest instigator of these Godzilla type enraged feelings - 4:30 A.M. Waking up that early makes me want to rip a building in half and then eat a piece of it; these feelings are short lived and soon overcome by a desperate effort to remain awake enough to efficiently get ready for work, without falling asleep at the sink.

Other igniting factors - the entire emergency department and their poor decision making skills and tendency to send giant batches of patients to the floor all at once; rude people; and the idea of living in Cleveland for another 2 and 3/4 years.

Day 95-96: Poetry is Lovely Part II

Maybe I'm losing the happy shiney a little, but I like this:

Invictus
By Willam Ernest Henley

Out of the night that covers me,
Black as the pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds and shall find me unafraid.

It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul

Day 89-94: Broken Hearts

I have the tendency to feel heart broken over the lives of my patients. Their poverty, their illness, their humiliation - if I am not careful weigh me down and eventually by the end of the day I've accumulated so much grief my chest is heavy with the burden.

And so, I have found I have begun removing myself emotionally from the stories I hear. Refusing to acknowledge the sad thoughts creeping into the fringes of my mind, extricating feelings from the rational judgments required of me.

Unfortunately, this has led me to question my long standing ambition to join Doctors Without Borders after completing residency. I am not sure the impact of the experiences would be reparable. I assume it would be much like returning home after experiencing the gruelling realities of war. And the things I would see would haunt me for the rest of my life.

But if we were all to think this way, no one would set off to the forgotten corners of the world to make the problems of the people over there our own.

I recently read a speech by J.K Rowling, the romanticism of which only confused me further; she says, "It is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all – in which case, you fail by default."

To be continued.

Day 88: Nurses

Nurses are not your friends.

The end.

Do not ever forget this. They may be nice to you one second, but do not let your guard down because in another minute they will stab you in the back.

Day 83-87: Denial

Many times we give our patients a truck load of bad news. We try to space it out, so as not to overwhelm them. We repeat ourselves to help it sink in, we give ample opportunities for them to ask questions. And for the most part patients remain confused and unclear as to what their diagnosis is and what it means for their quality of life and survival.

At other times, the problem is so blatant and obvious and still the patient doesn't react appropriately. Imagine someone walks into the ED with an arrow sticking out of their chest and all they want to talk about is how in 5th grade they had a difficult time with grammar lessons.

While I was on call, one of the cardiac patients who had had a pacemaker placed, began to bleed from the implantation site in his chest wall. Continuously oozing and soaking through even a reapplication of his pressure dressing. And so, I found myself standing over him, putting all of my weight onto the wound to stem the bleeding, willing it to stop so he wouldn't crash and require multiple transfusion to keep up with the loss.

Clearly, this was serious.

This is what the patient had to say when I told him I was concerned about the blood loss -
"How old are you? Fifteen?" And then he launched into a story about how he grew up in Mississippi and at the age of 15 he had already been working for 5 years.

Denial and humor or just plain clueless?

Day 79-82: Remember Poetry. It's lovely.

I carry your heart with me:

E.E Cummings

i carry your heart with me (i carry it in
my heart) i am never without it (anywhere
i go you go, my dear; and whatever is done
by only me is your doing, my darling)
i fear
no fate (for you are my fate, my sweet) i want
no world (for beautiful you are my world, my true)
and it's you are whatever a moon has always meant
and whatever a sun will always sing is you

here is the deepest secret nobody knows
(here is the root of the root and the bud of the bud
and the sky of the sky of a tree called life; which grows
higher than soul can hope or mind can hide)
and this is the wonder that's keeping the stars apart

i carry your heart (i carry it in my heart)

Day 76-78: Flirty Old Men

Men over 80 love to flirt, even when they have just had a heart attack, have a crazy infection taking over half their leg or they can barely remember where they are. Here's todays flirty old man line:

Scene: me trying to do abdominal exam
Me: Are you tensing your abdomen
Old man: No those are my muscles, do you like them. HAHA.
Me: !

Day 71-75: Co-workers

For the most part my co-interns are friendly and there are many that will go out of their way to help you get your work done or make your life easier. There are of course many that slack off and their poor work ethic ends with you spending an extra couple of hours fixing things. Then there are these people:

Scene: waiting for lecture to start, sitting around conference table.

Co-intern: (pulls out nail clipper from white coat pocket and starts to use it on her NAILS.)

Me: GAHHH! OMG GROSS!

Co-intern: Says something pessimistic as per usual

Me: Um...

Resident: So are you guys all categorical, oh wait pessimistic intern, I think you're a prelim!

Me: Oh! So pessimisstic co-intern (mispronounces cointerns name because it is a confusing name that does not sound as it is spelled) What are you doing next year?

Co-intern: THATS NOT HOW YOU SAY MY NAME!!! Goes into super weird rage mode. I don't know yet. Mumbles more things under her breath.

Resident: So what do you want to do? Did you apply? Are you matching?...10 other questions...

Co-intern: I'd really rather not talk about, it makes me upset, this topic is not a good one, blah, blah. RAAAAAAAAAGE.

Me: Oh dear...nail clippers gross...wishes attending would come and pimp us on really difficult cardiac topics that are way over my head so we can stop having this awkward moment.

Day 66-70: The Code

My goal to avoid trouble this year was to avoid being the first one at a code. That goal had a short life.

Once again I was in the wrong place at the wrong time. If only I had left the floor after signing out to the night intern, I wouldn't have been the only doctor around when a family practice patient started to code.

Big fat UH-OH.

An extremely panicked nurse came sprinting out of the patient's room and so an extremely panicked me went sprinting in. The patient was gasping for air and there was no one else around. So after being in there alone for a good minute or so calming the patient and trying to keep her breathing, all the docs on call came rushing in. And the patient lived.

I am certain that during the process of keeping that patient breathing - I myself may have been coding. I may also have stopped breathing and most definitely almost threw up everything I have ever eaten afterwards.

There's a book called the House of God that details the life of a medical intern in the 70s; in it there are 13 rules for being a good intern, this one is relevant here: "At a cardiac arrest, the first procedure is to take your own pulse."

Day 63-65: Lost

I went to go visit a friend about 20 minutes away which was excellent, until I tried to drive myself home.

In the dark.

I don't know if I have mentioned this, but I am a terrible drive. Unfortunately, I have the lethal combination of being a terrible driver and direction blind. This is at baseline during day light hours, once it gets dark it's as though I am functioning upside down and with a middle ear problem.

It started out fine, my GPS Karen from New Zealand and I were getting along just great; until I reached a road that was blocked off due to construction, at which point Karen lost her mind and attempted to redirect me through a creepy Cleveland suburb back onto the blocked street- repeatedly. No matter which way I turned I could not find a way around this torn up, yet pivotal street on my route home.

At this point it was midnight. I had begun to hyperventilate because I became worried some psychopath was going to find a way to stop my car and kill me because I was driving around aimlessly. Another 5 minutes of trying to get around this road and I have discovered no open gas pumps or restaurants from which to get directions.

I began to wonder if I should phone a friend to ask them to Google me directions out of this awful situation, but that could potentially lead to even more panic and chaos. Another u-turn and I found myself pleading with the Universe to help me get out of this horrendous suburb where all the streets look the same and an episode of Law and Order was may have been filmed.

At one point in despondency I wondered if I could be lost forever, and thanked myself for having the foresight to fill up my tank of gas - if need be I could drive until day light when maybe I could find the way home.

Eventually, I came to my senses and back tracked my way to the main road I had been on and got on the right road home.

I should advertise for Honda. If I can succeed in surviving in one, anyone can.

Day 62: Damn You Spiders

To say that I am easily startled is a gross understatement. On occasion I have been so startled it has caused my shoulder to dislocate. That's actually one of the reactions the body has when electrocuted.

Yesterday during a serious moment on rounds while I was presenting a patient to the attending, a giant fly sat on my notes and I mistook it for my arch nemesis the spider species and threw my papers away from myself and actually screamed a little.

My attending thought I was dying and although I tried to explain I thought it was a spider, he pretty much not only thinks I am dumb as a door but now also a complete idiot.

Day 60: Worker's Comp

One of the few good things about living alone:

When you pull every muscle in your upper back at work because of all the paperwork you had to do while you were on call, you are at liberty to come home and put Bengay all over the affected area. Then whilst smelling like an 80 year old, you are free to put on a hoodie with the hood pulled over your head and the strings pulled tight while blasting the AC because you can't quite figure out if you are hot or cold. And there is no one there to judge your appearance.

The bad thing about living alone in this situation is that when you start to wonder if maybe you have fractured your spine because normally Bengay is a miracle drug that can cure all, no one is there to tell you to shut up and stop being a baby. Subsequently, you spend half the day calling your friends and family for reassurance instead of studying for the in-service exam.

The riveting discussion that arises from this conundrum is: would you rather have a personal masseur or a personal chef?

Day 56-59: Hair-mets Are Cool

Yesterday I was post call and in my post call stupor I tend to do dumb things I would not normally do in my sane state of mind; such as perhaps watch a Jennifer Lopez movie. Maybe watching a J.Lo movie is inexcusable no matter what your state of mind.

What is also inexcusable is the lawless state of Cleveland. Apparently there is no law about wearing helmets on motorcycles here. Like this bright young fellow people use their helmets as an accessory instead of a life saving tool, that will insure that when that dude making a left turn in a red light hits you, you don't end up a paraplegic and instead you will only have a colostomy.

I hate motorcycles. And I have become prematurely jaded by medicine. WA-OH!

Day 55: Thought Process

I was on long call in the telemetry (cardiac) unit the other day. My worry the entire time was that a nurse would call me up and tell me someone was having chest pain. Of course it happened. This is subsequently what went through my head:

I'm going to throw up.
Don't throw up, that won't even help.
He's having a heart attack.
AAAAAAAAAAGGGGGH!
Nitroglycerin, no his blood pressure is too low, yes, no, yes???
What if it's just musculoskeletal.
I'm going to throw up again.
No, I think I am now having a heart attack too!
AAAAAAAAAAGGGGGGGGGH!
Must call the senior.

Day 54: Unwelcome Habitants

My car needs a wash, it's painful to see. There are spider webs on it, bird poop, leaves, Cleveland's acidic rain, did I mention spider webs.

Behind my driver's side rear view mirror lives a giant fist sized hairy beast of a spider. He's been spinning a storm and I am no certain that the inside of the mirror must be a place of horror, full of mosquito carcasses and his personal disgusting remains.

I am totally grossed out by this spider but incapacitated by my fear of creepy crawly things to do anything to annihilate him.

I'm actually afraid that if I try to kill him with my shoe that he's going to turn out to be some kind of flying bat spider that will jump onto me and attack me. I can actually visualize this in my mind.

So, my plan of action at this point is to take the Honda through a drive through car wash and hope that the vigorous cleansing will purge him from my life.

Help. :|

Day 51-53: Post-call Judgement Lapses

I highly discourage multitasking while driving, it's dangerous and comes with an increased risk of accidents. So I don't pick up the phone either to answer or dial while driving. I am however, guilty of trying to do other things while driving. Today I tried to eat a banana cream pie while at red lights because I was so hungry post call I couldn't wait. This was a very bad idea.

There are things that it is probably appropriate to try to eat while driving, like maybe pretzels, or other bite size snack foods that can be easily accessed without visual and that aren't gunky and goopy. Banana cream pie is totally inappropriate. My passenger side seat agrees.

Day 49-50: Debbie Downer

Welcome to work: 3 out of 7 of your patients are trying to die today. And then your co-intern is going to be post call, so you also get to take care of 10 extra patients. Yipee. Also your boss is being a jerk and you have a killer migraine. And cherry on top - there is no cherry, you don't get to eat today, because you will be paged incessantly by a nurse who thinks talking about a patient's chest tube in minute detail is the highlight of your life.

Some days I definitely forget to be happy; and shiny I don't even know what that word means! Have I lost my youthful glow and idealism already? Well, lets just say I'm a little surprised that over the last 2 months only 2 of my patients have said I look too young to be a doctor. I highly doubt its because I carry an air of medical confidence.

At one point I walked by the gift shop in the hospital and there was a plaque in the window that said "Enjoy the small things". Touche life, touche.

Day 48-49: EK-who?

Next month my attending on the telemetry service is the program director. I just barely know that the heart is located in the chest. Cardiology is my weak point. Now I have 4 days to learn everything about cardiology. Right now EKGs look like squiggles to me. Up until now I have been leaving the cardiology chapter to last on my study list, every time I have studied for an exam. So basically, I usually end up cramming a few high yield points into my head long enough to pass the exam. This time next week I may no longer be in residency, once the program director realizes I'm as dumb as a door.

I should just start working on my resume.

Day 45-47: Wise Words

"Never allow someone to be your Priority, while allowing yourself to be their Option." Mark Twain

Day 42-44: What are you Watching?

I am post call and I have realized that when I am so exhausted pretty much anything will entertain me. Presently I am watching some channel I have called EWTN, there's a super low budget cooking show on with a British lady making candied apples, except she sucks at it. Also at the end she said "Happy Bart's Day", what is that?!!?

I have never had a candied apple and most likely never will, I fear at least one of my teeth would get pulled out. Also my dad pretty much drilled into my head that getting a cavity is the most disappointing thing I could do in his eyes. I guess parent's tend to feel over protective of your teeth when they spent a small fortune straightening your teeth!

Day 41: And Then...

It began as a nice day at work, only 3 patients to take care of. But by lunch there was drama, and politics and betrayal.

Even if you keep your head down and do you work diligently and try to be a good person; the big bad world will find you when it is your turn and it will bite you in the ass. All you can do is brace your self for the moment and grow some damn body armor to deal with it; and maybe forget that there is a such thing as feelings.

Am I currently jaded yes. But wait there's more:

And then I came home and my kitchen started flooding and then I looked at my pet plant Billy and noticed that he was starting to wilt and die.

It was one of those days, as my friend put it, "When you're just trying to do your best, not to throw yourself out of a window."

Just to clarify: No actual suicidal ideation on my behalf there.

Day 39/40: The Joy Riding T.V

This weekend I got cable installed in my apartment. The following day I decided to purchase a t.v. This is the first t.v I have ever purchased; and so I was both excited and very caution with the new purchase.

Televisions have come a long way, they now only weight 20lbs and even a featherweight like me can easily carry them around. I was overjoyed to learn that I could retain my independence and move the t.v into my apartment on my own. This was the end of any happy feelings for the rest of the afternoon, as subsequently a series of rather unfortunate evens unfolded.

It all began when I underestimated the amount of things the 'moving cart' could handle carrying and so I ended up having to move the grocery laden cart a few feet and then returning to carry the t.v a few feet to catch up, repeating this process a few times I made it to the elevator, after bottle necking back door traffic for 10 minutes.

The real catalyst to the subsequent chaos was the spilled milk. Inexplicably, my half a gallon of milk began to spill into its containing bag; I sheepishly attempted to rub the milk around on the floor with a plastic bag to make it less obvious; although a quarter of a gallon of milk is a lot of fluid - do not be fooled, it will not end up looking like extra shiny floor.

I believe at this point I was sufficiently hot and bothered to lose some of my speed and agility. When I managed to get the t.v into the elevator by the time I turned around to get the cart of groceries in after it, the elevator door began to shut. I am nearly positive that at that point, time slowed down as I lunged for the door and when that didn't work, lunged for the "up" button.

Too late.

The elevator headed up, and up, and up. All the way to the 17th floor. Where it stayed for about 2 excruciating minutes, during which I imagined another tenant coming across my television all boxed up and ready for them to install into their apartment. Then the elevator went down, did not stop at "ground" despite my mad and continued pressing of the button to summon it. I assume the fact that we have 6 elevators did not help my cause as a number of other elevators turned up.

The elevator then shot up to the 6th floor, at which point I imagined that another tenant had come across the t.v and was now taking it to his 12th floor friend to sell for a nice price. At this point my body was full to the brim with panic and so I sprinted to the reception and in a shrill and delirious manner tried to relay my dilemma to her. Naturally, she stared at me as though I were the village idiot and she slowly told me she would call maintenance.

I sprinted back to the elevator and thank you Universe; there, in all its theatric glory, was my elevator yawning open to reveal my T.V still inside and the 1/4 jug of milk.

Day 37/38: I think...

Occasionally, I come across a senior resident or attending who really cracks the whip. Last night on call, I suspect my senior resident was a trained army sergeant. Apparently, no matter how hard you work, no matter that you dedicate 90 hours a week to your job, or that you have spent all your energy and youth on your work today, you are not doing enough. This was the type of senior resident who hounded me the entire night, looked over my shoulder at everything I did. And not only reprimanded my every decision but scorned them.

At one point she demanded to know why I wasn't hungry at 2 am. At this point I became thoroughly confused and wondered where I had gone wrong in life and why I too did not have a pb&j sandwich to voraciously tear apart as she was. I almost apologized for not eating a meal at 2 am.

I think she considered making me do some sort of laps or push ups as punishment, I could see the wheels of torture turning in her mind.

Finally, in the morning I was turned over to my regular senior resident; who i had previously regarded as being a big sheep dog herding little scared sheep interns. I now see my own resident in an entirely new forgiving light. At least she is capable of smiling and kindness and has a beating heart in her chest. I also suspect the night resident is made of titanium and has secret weapons concealed upon her robotic self.

Day 35/36: Be Careful What You Wish For

The other day we were sent our schedules for the month of August. I thought that this month was the worst schedule possible, with 3 days off the entire month.

If you ever think things could not be worse, you are a sucker; things can always be worse. In the month of August I get one day off. One day off when I don't have to go to work.

So, subsequently I found myself wishing something nice would happen to me. That night, I had a dream I was dating Leonardo Di Caprio.

I don't even like him.

I was hoping for something nice like, maybe somehow all of my med school debt would be erased. But, o.k universe; I'll take anything at this point.

Day 34: People are Weird

Today I went to the ER to admit a patient. She had her finger in her nose when I entered the room, she did not bother to remove it. Instead, she continued to pick her nose during the interview and exam.

I tried not to notice.

I mean, maybe if she was like 100 I would be like, you know what you're so old you deserve to do whatever the hell you feel like doing. She was only 60.

I really wanted to say "I CAN SEE YOU! Stop it! This is making me want to puke. Argh!!!"

Day 33: Nudity

If you ever worry about what your doctor is going to think of your body when you go in for an appointment - don't. If you actually took a shower in the last 2 days, you're already above average. We don't actually care or judge unless you pose a threat to our personal hygiene and safety.

As in, if we are worried a bug is going to jump off you onto us then we may cringe or hold our breath the entire exam.

But if you are stressed about us seeing your cellulitis or rolls or exceptionally hairy back, we WILL see it but unless we think it's medically relevant, it will flit out of our minds as soon as we write down the exam in your chart. We're usually too concerned with missing a medically relevant detail to spend any time at all judging people's bodies and most likely we're actually just poking at your belly to see how big your liver is.

We've seen it all, so don't feel conscious. And for God's sakes don't wait to come to the doc because of your fear of nudity, nothing about your appearance could distract our attention more than that gangrenous foot covered in parasites you've been sitting at home with. Yup, I've seen that too.

Day 32: I Love You Man!

Happy Munsary! One month of internship down and one month of Intern 365!

And for those who have been reading and giving me positive feedback - thank you, you guys are superstars! And now before I start profusely emoting due to post-call delirium, I will end this post.

Day 31: Hope

In an hour I'll be at the hospital, the only intern covering the floor. ALONE. I hope I make it through the night. I hope no one codes. I hope no one complains of any pain. And above all I hope this is not how I feel in the AM.

I feel like I'm in the movie Independance Day, the part where the president gives the speech. Too bad Will Smith doesn't work at my hospital.

Godspeed.

Day 30: The Pep Talk

I caught one of my co-interns post call and this is what he had to say about the experience:

Being on call is like that initial scene from Saving Private Ryan. The scene where they are storming the beach and something blows up near Tom Hank's ear and he loses his hearing and is looking at a silent scene of battle unfold in front of him. There is carnage, gunpowder, blood, gore, complete chaos. War.

And then all of a sudden he regains his hearing and immediately hears a loud explosion.

That is like being on call, and that explosion is your pager.

I'm on my first overnight call tomorrow.

Day 29: A Healthy Home

I had a patient today, who was well and stable enough to go home. I thought it was difficult and overwhelming for me to figure out how to treat his cardiac issues. I did not realize until today that, that was only one piece of his illness.

This man is an illegal immigrant who is chronically ill and cannot work; and as a result lives meal to meal and is home less. Hospitals cannot discharge patient's to the street. That is neither an option on the form we fill out, nor the option your consciousness should allow.

And on top of it all he cannot afford his medication. He is not eligible for a government voucher, nor can he afford medical insurance or apply for it without a SSN.

This is a sickness.

He may have exacerbation of his heart failure which causes him to feel suffocated and unable to catch his breath and to make him feel as though a giant weight is on his chest. But that is 1 week of a disease manifestation. The social issues this man deals with are a life time of suffocation, of an insurmountable weight on his shoulders.

This is what my task is tomorrow, to help him sort out his life enough to find a safe and stable place to sleep and to get him the medications he needs; at least for a short while.

Cherish your life, because you have no idea how good the hand you were dealt really is.

Day 27/28: In the Dark

Today I went to work while it was dark out and came home in when it became dark out - 5.30am-10pm. I am even more disoriented than usual, and I am pretty sure I am seeing double at this point.

For the last 2 days, I have just been doing, doing, doing. There is no time to sit and process what is happening. It's just a blur of interns running around with to do lists, hoping their patients are getting better and not worse. And above all hoping no one dies or codes.

So, essentially I am in the dark on all fronts.

Day 4 on the floor and I pretty much hate my life. Where is that inspiring patient? Where is that motivational attending? How DID JD have so much time to day dream and play out musicals in his imagination? You led me astray scrubs, you led me astray.

Day 26: Bunny Ears

Basically, today on the floor the inside of my brain was like when you get "snow" on your T.V. Not just the "snow" but also with a lightening storm electrocuting it continuously.

I don't even know what I did over at the hospital today, it's mostly just a blur of beeping pager and this one nurse and social worker continuously harrasing me. I think I got most of the work done and everyone was still alive at the end of the day. Day 1 : success? We shall see, if when I show up tomorrow no one is handing me a pink slip.

I don't know what the intern equivalent for the "T.V snow" is, but if those bunny ear antennas would help do some paperwork, I would definitely strap on a pair.

Day 25: Second, First Day Jitters

Tomorrow is my first day as a floor intern- if you're fortunate and not familiar with the hospital world, the "floor" refers to the general medicine inpatient service. Or where sick adults get admitted when they are in the hospital.

I was not nervous on my actual first day of work. Today my body decided that it was time to teach me a lesson for being so chilled out all month and having a lovely time on electives; and so due to that pukey stress feeling, I was reduced to vegetating on the couch watching Netflix dvds.

About a month ago "swimming pool party" was going to get me through the first day; I have become immune to the magical healing power of the swimming pool party Youtube video; and now must smack myself into forced optimism. Hence, this is what I will be doing at 4 am for the next 4 months.

Day 24: To Be Cotinued

If you take anything away from this completely tangential blog, let it be this:

If you ever feel like you are in a ridiculously awkward situation and it could not possibly be more uncomfortable; you are wrong my friend, things can always become more awkward.

Stay tuned tomorrow for a real life example.

Day 23: Boogie Woogie

Have you you ever had one of those moments when someone is pronouncing something horribly incorrectly and you think that you should correct them, so that they don't go the rest of their life making that mistake? Now what if that person is your boss, your senior, basically someone higher up on the totem pole?

Now what if the same sort of "higher up" is pronouncing your very name incorrectly? Do you correct them, do you loudly introduce yourself to other people in their presence, do you glance pointedly at them when someone says your name CORRECTLY?

To go even further, what do you do if your boss or senior has a booger in their nose? If you are me, you try to first ascertain that, that is in fact a booger. Then you wonder if pointing it out would embarrass your senior so much that he/she will resent you forever. Then you wonder if you, yourself may have something awful sticking out of your nose or on your face (then you would just be a pot calling a kettle black). And hopefully, you will spend so long reasoning this out, that the person will eventually leave and you will be left reassuring yourself that someone else will point out that booger to them.

Day 22: What's for dinner?

Monday thru Wednesday I am a fairly efficient human being. Since I'm trying not to be the dumbest intern in the history of interns I try to come home and read about a thing or two. Thursdays I usually hit a wall and turn into a completely different person, the disheveled kind of person that other people shake their heads at, wishing she would pull herself together and maybe brush her hair also.

This usually ends with me attempting to do a regular task and crashing and burning instead. Today, I thought I would go over the section on asthma for the billionth time and maybe because I've read it so many times things would be quick. I recall reading the first three lines, then it was half an hour later and I regained consciousness with one leg on the couch, one off; leaning sideways into the back rest with my head at a painfully awkward angle and the book miraculously still in my lap.

Subsequently, I decided to make up for the lost time by "making" myself something to eat. Unfortunately, I was still not awake and put some frozen samosas in the oven and realized 20 minutes later that I never turned the oven on. I then debated eating the frozen samosas as is because I was so hungry. But that induced nausea so I made a sandwich instead.

Don't complain, nobody ever said every blog entry would be riveting.

Day 21: Sleep Fighter

When I was a medical student attending teaching conferences at the hospital, I was pretty shameless about my fatigue. I would start nodding off, and my blinks would became progressively exaggerated, eventually I would end up with gaps in my recollection of the past hour; unless of course, a trusty friend was sitting next to me to play hang-man with.

Now that I am a resident, I am probably more fatigued; however, not once have I even thought about feeling tired during conference. What is the secret? A new coffee laced with lethal doses of caffeine? No dear reader, my stimulant is fear itself. I have so little medical knowledge that I feel perhaps I suffered from a head trauma after graduation which would logically explain my complete memory loss. So now I must cram every fact I can get my ears on, into my brain.

Additionally, we all realized that residents, though they provide cheap labor that real live doctors would rather not do; are still dispensable and can be fired. I worked very hard to get a job which is going to be quite likely a hellish journey, that will make me question my sanity at every turn, but will in the end be what I always dreamed of doing - a whole lot of paperwork and sometimes making someone feel a little bit better.

Day 20: The Stay At Home

Me: "I wish I had a stay-at-home husband who would be glad to cook and clean for me, and fill my car up with gas and wash it too. And maybe sometimes drive me around."

Friend: "That's called a maid."

Me: "You have to pay a maid; also never mind, I want to be a stay at home person without all that housework."

The things we say when we are deliriously tired.

Day 19: Camera Shyness Explained

I am not photogenic; during one brief 2 year period in the past I was photo-adequate; as in people were ok with sharing pictures with me and did not feel like I ruined that memory. That was in the past; post-puberty and pre-super stress life.

Unfortunately, those years are behind me and also unfortunately this lack of photogenicity is only amplified a million times on I.D card pictures. In fact it is so ridiculous that I usually don’t even look like the real life me on my ID cards. Once, a customs official looked back and forth at my picture and me for a solid minute before deciding that it must have just been a bad day and I was indeed the same person.

In my defense, on the Canadian passport picture we are not allowed to smile and instead must maintain a neutral expression. I’m not sure what a neutral expression is, but whatever I interpreted it as, has me captured in film looking like a constipated criminal.

I was hoping I could surmount this rather awful lack of photo talent on my hospital I.D badge, after all I would be wearing this on my lapel for the next 3 years and as you all know during residency things in the looks department only go downhill.

People should be able to look at my I.D badge and think, “Man, at one point this was a regular looking person, maybe things have just been really rough and that explains her current status.”

I really wish there were do-overs in life, I would use that pass on that fateful day I had my I.D picture taken. The I.D picture was taken the same day the ‘pee fiasco’ occurred, read here for more details. So, in summary on my I.D I look vampire pale, and for some reason my cheeks are super flushed and my mouth is inexplicably garishly red. I’m glad I never have to look at it, and in a few months when everyone knows my name I’m going to flip it over.

Day 18: Lists are for Losers

I have many compulsive tendencies, unfortunately remembering what groceries/toiletries I need is not one of them. And so this is how I find myself wandering around those really cheap mega stores that are a giant conglomeration across this nation - for an hour or more every other week. Lists are for losers who can't remember the insides of their own fridge - I am better than that! I got this!

These are my sentiments, until I find myself moments later aimlessly going up and down aisles with more toothpaste because I have forgotten how fat the tube was at home, clutching more milk when the carton at home probably has another 2 weeks left. And worst of all - collecting useless things that seem like they would make an amazing improvement in my life, and everything would start falling into place because, I now have that one thing that I never knew existed until now; but will surely organize my life into some sort of zen haven.

And this is how I end up lugging a number of heavy bags of groceries on one arm while clutching a giant plastic organizing contraption under the other, up 3 flights of stairs; I know if I just focus hard enough, I will not crush all the bread against my side and there is no need to make 2 trips to the car.

Day 17: Confessions of a Dork

I can’t afford a TV, which is rather unfortunate because now when I come home from work I am forced to sleep for lack of more entertaining things to do in my post-work stupor.

Additionally, my internet is weak since I didn’t opt for 'Roadrunner ultimate super duper speed' and instead got the 'Road kill Roadrunner Speed'. And so watching TV online is not a good option unless I want buffering to drive me insane.

These are the circumstances which caused me to sign up for Netflix yesterday. Drum roll for the revelation of the exciting DVD I chose to watch first – Mythbusters. Yes, friends I am a tremendous dork.

If this in itself was not attestation to my dorkiness, I will reveal another secret – although, I am not a Star Wars fan I believe I do a good Jar Jar Binks impression.