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.