There is nothing better than being a dad. Being a doctor and getting to help people is rewarding as well but nothing beats hanging with the little man and playing games or just making silly sounds and faces at each other. The only downside is that just as I feel this intense, unstoppable love for my son, I now torture myself with intense fear at times as well. Fear that grows from the knowledge that some people in this world are not people at all, but monsters. Unfortunately, I have seen pure evil acted out on people and worst of all children and I can never un-see these things.
It is not the death of these people that haunts me. I see death a lot. I diagnose it in front of the grieving family whose palpable will fills the room as they hope I am wrong and their loved one will rise to prove it.
They never do.
The family cries and I offer sympathies, oftentimes a hug, and a gentle rub of the shoulder of the deceased before leaving the room and blinking away any tears that may be forming in my own eyes before a med student or nurse can approach. It sucks. It sucks big time and I'm just this goofy resident who took care of this person but probably never got the chance to speak to them. This wasn't my father, brother, mother, aunt, wife, child, dog (threw him in there because I really love my dog).
Death is inherently sad. Resolution or acceptance typically comes to us all though. Some find peace through faith, others may find peace knowing that their loved one is no longer suffering. There is some sort of formula where the death happened because of X, and I can understand that X happens. Then comes the Y, which is what we do to deal with it. "They are with Jesus now and I'll see them again some day," or, "She doesn't have to hurt anymore," or, "It was just his time." If the manner of death can be rationalized or logically explained, it is much easier to cope and begin healing.
But what if...
X = he died after being stabbed to death by mom's boyfriend
X = she died after being shot randomly walking down the street at night
X = a stranger abducted and murdered her
How do we make sense of X when it is terrible? I haven't figured it out yet and there have been way too many unspeakable Xs, happening at work and on the news for me to process and the weight is making me crack. Couple that with the fact that my wife and I are now in the process of finding a good nanny for our son and I am faced with nausea inducing anxiety. The thought of putting his safety in the hands of someone whom I haven't met yet is just too much.
BUT, it has to be done, lest he becomes a weird bubble boy who's only friends are mom and dad...
The majority of people are good right? The people applying for these jobs are doing so because they love little kids and taking care of them right? It wouldn't make any sense in this world for someone to be so sick that they would obtain a job like this for the purpose of hurting kids. That is what logic and reason tell me. Logic and reason tell me that not everyone is a psycho held barely at bay, waiting to snap.
But when I close my eyes I see the lifeless faces of Xs that didn't make sense. The thought of what they experienced in their final moments produces a deep, visceral sick feeling and I can't sleep.
I'll get over this stuff in time and we'll find someone to help us out of our quickly growing list of applicants. Someone that baby and dog will both like and someone that makes my wife and I feel at ease. Then it will become the new normal and we will be cruising again...
Sorry for the depressing post, but just watch this video:
Dog Snacking
Friday, February 21, 2014
Sunday, February 16, 2014
Happy times
What a great day. I am still full of left over happy feelings after getting to spend time with my family and baby who is now one year old. I don't even care that I'm at the hospital and it's 0330 because I actually slept so much earlier that I'm not even tired now! Wow, that is a really small/depressing victory to be excited about. But look at this picture and don't smile... You can't.
Pretty hot shit right?
It has been amazing to watch him go from a tiny creature, who I thought was for sure going to spontaneously explode the second I took my eyes off him, to this cruising (not quite there yet with walking), jabbering (Vietnamese?), gourmet, hug giving, cartoon watching, professional book page flipper, ball rolling, bath tub pooping (typically when dad does the bathing), laughing, crying, pretend piano playing virtuoso, perfect little dude. It is hard to be mad or upset about much of anything when you're lucky enough to get a daily dose of this guy. I really should remind myself of this more often.
I also need to remind myself that I am in the last 1.5 months of being off neurosurgery during my intern year, (who's counting?). I imagine my return to the home team to be something like this...
So my wife showed me a blog that was a collection situations commonly encountered by OB/GYN residents with animated gifs to really emphasize the "feel" of the moment. These are hilarious.
http://whatshouldwecallobgynresidency.tumblr.com/
So here are some of my own common situations expressed through gif...
Watching a CT scan scroll by after placing a ventriculostomy catheter that went well...
Watching a CT scan scroll by after placing a ventriculostomy catheter that didn't go so well...
What I wish I could do when the nurse calls saying, "Hey the family would like to talk to the doctor and they are really upset!"
When the MICU tells me the neuro exam on a new consult...
What spine call feels like...
When the outside hospital transfer who needs emergent neurosurgical evaluation actually arrives...
OK enough.
Reflected on a good day? Check. Killed some time? Check.
I'm excited to go see the little booger soon. When he's happy, playing, and giving me hugs, I want to have 20 more of them. When he is staring me in the face screaming while trying to turn the gas to the stove on in between his signature, "I'm pooping," grunts, one seems like a really good number... I'm also excited to finally not be an intern anymore. Two years is more than enough. Then my knowledge of the force will grow and I will get my own light saber... I'm just typing to type now and need to stop.
Have a good gif related to residency or hospital madness in general? Please post. I love this crap.
Friday, February 7, 2014
To Coin Some Phrases...
Let's take a break from catching you up to speed on where I'm at and how I got here and what I've learned type of stuff to talk about RESEARCH. A very important topic in medicine, discovering break throughs and what not. But lets talk about all the turds you have to sift through to find a perfect peanut.
As I read another long article about some studies about a specific problem only to finally reach the stunning conclusion of the tale, "more research in this area is indicated to guide practice," I sigh and mourn my precious lost minutes. Don't get me wrong, I understand that research and studies allow us to overall improve how we take care of patients. Awesome right? YES, but...
Begin sarcasm.
Definitions: mine of course, not to be mistaken for anything real
the Literature - collection of all the text published in medical and scientific journals. Often given the impression that it is a living, breathing, divine being who sits atop an ivory throne in Valhalla and judges doctors by their clinical decisions by comparing them to the available Literature. Most often used in a smug comment by a Journal Doc (see below).
Example 1: "You don't know what dose of Flintstone's gummies to give a pregnant dwarf after she's suffered extensive light saber injuries? How about you search 'the Literature' and get back to me tomorrow."
Example 2: "Well yes the patient obviously has a bruise on their buttocks, but what Elmo grade do you assign it? Oh you haven't heard of the Elmo grade on buttock bruises have you. I suggest you read "the Literature." There is a paper by the Cookie Monster that you should know by heart.
_from_Die_Helden_und_G%C3%B6tter_des_Nordens,_oder_Das_Buch_der_sagen.jpg/220px-Odin_oder_Wodan_(1832)_from_Die_Helden_und_G%C3%B6tter_des_Nordens,_oder_Das_Buch_der_sagen.jpg)
You get the idea...
Journal Doc - attending physician who may come in any age or gender and gives the impression that they do absolutely NOTHING unless there is a randomized controlled trial or meta-analysis proving that it works and is safe. That is unless there is NO such data regarding the subject, then the attitude shifts to, "hell let's try this because I think it makes sense in my head." This person creates constant scenarios where one must defend every decision they make with an article that proved that it won't make the patient explode instantly. Also, when these folks are presented with an article that contradicts their practice, the typical response is, "well that isn't the standard of care here yet." These speed reading encyclopedias of "the Literature" must refer to "the Literature" at least 10 times before lunch or they begin sobbing uncontrollably followed by soiling themselves.
As I read another long article about some studies about a specific problem only to finally reach the stunning conclusion of the tale, "more research in this area is indicated to guide practice," I sigh and mourn my precious lost minutes. Don't get me wrong, I understand that research and studies allow us to overall improve how we take care of patients. Awesome right? YES, but...
Begin sarcasm.
Definitions: mine of course, not to be mistaken for anything real
the Literature - collection of all the text published in medical and scientific journals. Often given the impression that it is a living, breathing, divine being who sits atop an ivory throne in Valhalla and judges doctors by their clinical decisions by comparing them to the available Literature. Most often used in a smug comment by a Journal Doc (see below).
Example 1: "You don't know what dose of Flintstone's gummies to give a pregnant dwarf after she's suffered extensive light saber injuries? How about you search 'the Literature' and get back to me tomorrow."
Example 2: "Well yes the patient obviously has a bruise on their buttocks, but what Elmo grade do you assign it? Oh you haven't heard of the Elmo grade on buttock bruises have you. I suggest you read "the Literature." There is a paper by the Cookie Monster that you should know by heart.
Google Image search result for the Norse God Odin who rules Valhalla and is probably Literature incarnate
You get the idea...
Journal Doc - attending physician who may come in any age or gender and gives the impression that they do absolutely NOTHING unless there is a randomized controlled trial or meta-analysis proving that it works and is safe. That is unless there is NO such data regarding the subject, then the attitude shifts to, "hell let's try this because I think it makes sense in my head." This person creates constant scenarios where one must defend every decision they make with an article that proved that it won't make the patient explode instantly. Also, when these folks are presented with an article that contradicts their practice, the typical response is, "well that isn't the standard of care here yet." These speed reading encyclopedias of "the Literature" must refer to "the Literature" at least 10 times before lunch or they begin sobbing uncontrollably followed by soiling themselves.
Google image search for "smug"
End sarcasm.
Research is ever tipping the helping versus hurting ratio of medicine towards the former. But please, can I just read the "good stuff?" I know that eating ten Big Macs per day is not a good idea. I don't need a randomized controlled trial where 50 people eat Big Macs for ten years and are compared to a control. Some things just are.
"Well, huh, might as, might as well ask why is a tree good? Why is the sunset good? Why are boobs good?"
-Joe Dirt
Back to the turd sifting...
Thursday, February 6, 2014
Blog-orrhea
So when I left off I was in the first half of one of the tougher years of my life. Baby on the way, my wife and I were both fresh interns, and the uncertainty of what the heck would I be doing with my life this time next year was driving me crazy. You see, you don't just get a job as a doctor when you graduate medical school. You first have to complete a residency of 3-5+ years, not including any time spent in a fellowship. My one year spot in the grand scheme of this process was essentially useless as far as getting me towards "attending physician" status. It also sucked having to go over my situation no less than 3 times each day when people asked the inevitable "What's your plan?"
While internally moping and probably being a big baby much of the time, I outwardly put my nose to the grind stone when I was at work. I responded to most request with an attitude of, "I may not know but I'll make it happen." The funny thing is that residents are quickly labeled as being either "good" or "bad" by everyone in the hospital. Here are a few examples of how you can earn the designation as "good" by various hospital roles...
Nurses
But it turns out that it did. I became known as a "good" resident. I made friends with residents in other specialties as well. One such friend happened to be a neurosurgery resident, and due to certain things going on, he recommended that I move my schedule around to rotate with them and see if I liked it and wanted to throw my hat in with them as well.
I thought sure what the heck. At this point I had to stay in the current city to be with my wife and ever approaching baby and was only applying to ortho and general surgery this time around. So in December of 2012 I rotated on the neurosurgery service and I FREAKING LOVED IT.
The work was intense sure, but these are the people that operate on your BRAIN when there is a problem. And they quickly integrated me in to their system and it wasn't long before I was drilling holes in people's heads.
While internally moping and probably being a big baby much of the time, I outwardly put my nose to the grind stone when I was at work. I responded to most request with an attitude of, "I may not know but I'll make it happen." The funny thing is that residents are quickly labeled as being either "good" or "bad" by everyone in the hospital. Here are a few examples of how you can earn the designation as "good" by various hospital roles...
Nurses
- Return pages promptly
- If they are concerned, come see the patient. It shows that you respect their assessment of the situation and are handling it.
- Don't be a jerk. Unfortunately, it is too easy to snap when the pager won't stop going off and you're in the middle of ten things. Just don't do it.
- If you have an issue, talk to the nurse privately and again, don't be a jerk about it
- Stand up for them. They are stuck spending more time with the difficult patients/families than we have to and most nurses do their best to diffuse things before giving us a call.
- If you happen to be passing by and see a couple nurses moving a large patient or untangling thousands of IV lines or doing any of the other thousands of things they do, give them a hand. It really goes a long way.
- And anything else I have probably left off this quick list
- Don't leave shit (post op checks especially) for the team coming on to do that you should've done yourself. Everyone hates that guy.
- Help when you can, no matter what your level. We're all very busy and a little help goes a long way and helps us all get home to our families.
- Best put by one attending I really liked, "You are either a lion or a gazelle. Gazelles graze in the grass and wait for things to happen. A lion chases his food down and takes it." If every resident was a lion, the work load per resident would drop significantly.
- Be someone your seniors can assign jobs to with knowing that it will get done fast and well. This makes your service look slick, your chief look good, and attendings happy. All of which are good things.
- Be honest. This would seem to go without saying but be honest even when your actions hurt one of their patients.
- Be efficient.
- Be available to do whatever whenever
- Show that you are learning, teachable, and interested.
- Keep them in the loop.
But it turns out that it did. I became known as a "good" resident. I made friends with residents in other specialties as well. One such friend happened to be a neurosurgery resident, and due to certain things going on, he recommended that I move my schedule around to rotate with them and see if I liked it and wanted to throw my hat in with them as well.
I thought sure what the heck. At this point I had to stay in the current city to be with my wife and ever approaching baby and was only applying to ortho and general surgery this time around. So in December of 2012 I rotated on the neurosurgery service and I FREAKING LOVED IT.
The work was intense sure, but these are the people that operate on your BRAIN when there is a problem. And they quickly integrated me in to their system and it wasn't long before I was drilling holes in people's heads.
Cranial Access Kit
(or trephination kit if you want to sound cool)
Performed centuries ago to release demons, trephination and my new exposure to neurosurgery caused a ray of light to break my negative funk and bring hope back to the table. I saw people brought back from the brink on a day to day basis and I even got to help in that process. This was all done while operating on one of (maybe the most if you ask us) unforgiving and sensitive organs in the body. In my first post I mentioned the initial terror I felt when starting out that my actions may be the ones that hurt or help someone in their time of need.
Turns out, I now FREAKING LOVE THAT TOO.
So I rotated, worked hard, came early, stayed late, got my hands on procedures whenever possible. They took notice and in March 2013, almost one month after my son was born (yes of course way more important but you can go to my Facebook page or look at my phone to see/hear me talk about the most amazing little person in the world) I got the news that I matched and would therefore begin training officially as a neurosurgery resident in July 2013.
That is the majority of the first year. I now had the "categorical" spot. I had a place. I had a new son. I still had my beautiful wife who was a rock through it all. I'll likely post more significant stuff from that time if I think about it but it is nice just to move on.
Thus began the even more crazy but infinitely happier times.Bl
Where to Begin: pull up a seat on the porcelain throne
I have wanted to start blogging for a while now. The urge typically comes after I experience something totally awesome, something terrible, something that makes me lose faith in humanity, or the inevitable event that restores it. Eventually, I slip back into the routine and buzz of my day to day life and the starting of a blog quickly drops down the ladder of important things I need to accomplish, but not today/night/whatever though. Today, I will start typing while Jimmy Page rips apart the Stairway solo at 0200 on 2/6/14 and I am on night float at the hospital.
Where to begin...
This is not a place to tell my life story (thank God right?). Though I love my life and look back on younger days very fondly, I feel the purpose of this blog should be to pick up where residency started.
Why then?
June 2012 by the way...
Because that is the time that also coincided with graduating medical school, a big move away from family/friends, recent news that I would become a father in 9 months, and to add some fear sprinkles to my delicious anxiety cake, I had a one year position in a specialty I hated and I had no idea what/if any job I would have at this time next year.
Stop whining right? I was/am married to a beautiful and smart woman, was technically a doctor, owned my home, had a kick ass dog, and was going to be a dad!
But something happened. I was supposed to become an orthopedic surgeon dammit. Hell I played football in high school, did respectably as far as my academics, and thought I nailed most of my interviews. But it didn't happen for me (likely for several reasons, that if you're dying to know, I would be happy to recount the painful details for you). I had to scramble for a one year position as a general surgery resident in the same city that my wife matched in her specialty. I had climbed the mountain of getting in to and through medical school only to fall off the mountain, cursing myself the whole way down. I hated to see my stupid face in the mirror and felt like a dog rubbing my own nose in my stool after an in-the-house accident.
With that mind set I started my "residency" on two months of night float. Starting out as a "doctor," I felt terrified that a situation would come where someone's outcome would depend on me. And of course it did. More frequently than I liked (at first anyway but more on that later).
OH and by the way this blog will be littered with stories of events that were memorable (to me at least.) They will also be injected at random and totally interrupt my previous thought. And the grammar will always be bad always.
Barely over a week into residency, I got called to the ED to evaluate a patient for "bleeding." A man coughed while watching TV and blew his AV fistula (<-- site for dialysis access) in his arm and had a suspiciously blood tinged gauze wrapped around his arm. I unrolled the gauze wrapping and once the pressure was released, blood shot the wall to my left.
I wrapped it back up quickly and called my chief (<-- senior resident for supervision although not always in house). He asked, "You ever do a figure-of-eight stitch?" I said I was familiar with it (<--saw a picture in a book). He then said, "Good, grab a med student to hold pressure and throw one in quick." So I did. I took a mega-eager medical student, (always happy to help), had him first get face masks for everyone and then got my supplies ready. Once all set, I had the med student squeeze the arm tight and I quickly undid the bandage. Blood again shoot out, only this time it smoked the med student's shirt, face, and (thank God) mask. The "field" was simply red and the patient's blood pressure was low. I took my needle bites, tied my knots tightly, wiped the blood away and held my breath.
It held! And I felt like my nuts drug the ground. The patient? All he said was, "Yo doc, can I get a sandwich in here or what?" I got him a sandwich.
And so it went for the first part of the year. Periods of crippling depression at the perceived hopelessness that I would never be an orthopedic surgeon or any type of surgeon at all. The odds for someone in the position I was in were very poor. I neglected my increasingly pregnant wife (for which I still apologize today) and just wanted to sleep (and drink) all the time. I did take the gumption I could muster while at work to try and show my face with the orthopedic residents at my hospital in an attempt to seduce them into taking me on as one of their own next year. This felt as fruitless as it probably was and didn't do much other than make me not like some of the snarky assholes I so desperately wanted to be a part of.
BUT
Things. Got. Better.
More on that later though. This is way more than I intended to write for the first go (once I start talking about me it's hard to stop). I suppose next post I'll pick up where things started to get more hopeful last year and try to quickly catch up to now so I can drop more funny day to day stories (funny to me at least :P).
Where to begin...
This is not a place to tell my life story (thank God right?). Though I love my life and look back on younger days very fondly, I feel the purpose of this blog should be to pick up where residency started.
Why then?
June 2012 by the way...
Because that is the time that also coincided with graduating medical school, a big move away from family/friends, recent news that I would become a father in 9 months, and to add some fear sprinkles to my delicious anxiety cake, I had a one year position in a specialty I hated and I had no idea what/if any job I would have at this time next year.
Stop whining right? I was/am married to a beautiful and smart woman, was technically a doctor, owned my home, had a kick ass dog, and was going to be a dad!
But something happened. I was supposed to become an orthopedic surgeon dammit. Hell I played football in high school, did respectably as far as my academics, and thought I nailed most of my interviews. But it didn't happen for me (likely for several reasons, that if you're dying to know, I would be happy to recount the painful details for you). I had to scramble for a one year position as a general surgery resident in the same city that my wife matched in her specialty. I had climbed the mountain of getting in to and through medical school only to fall off the mountain, cursing myself the whole way down. I hated to see my stupid face in the mirror and felt like a dog rubbing my own nose in my stool after an in-the-house accident.
With that mind set I started my "residency" on two months of night float. Starting out as a "doctor," I felt terrified that a situation would come where someone's outcome would depend on me. And of course it did. More frequently than I liked (at first anyway but more on that later).
OH and by the way this blog will be littered with stories of events that were memorable (to me at least.) They will also be injected at random and totally interrupt my previous thought. And the grammar will always be bad always.
Barely over a week into residency, I got called to the ED to evaluate a patient for "bleeding." A man coughed while watching TV and blew his AV fistula (<-- site for dialysis access) in his arm and had a suspiciously blood tinged gauze wrapped around his arm. I unrolled the gauze wrapping and once the pressure was released, blood shot the wall to my left.
It held! And I felt like my nuts drug the ground. The patient? All he said was, "Yo doc, can I get a sandwich in here or what?" I got him a sandwich.
And so it went for the first part of the year. Periods of crippling depression at the perceived hopelessness that I would never be an orthopedic surgeon or any type of surgeon at all. The odds for someone in the position I was in were very poor. I neglected my increasingly pregnant wife (for which I still apologize today) and just wanted to sleep (and drink) all the time. I did take the gumption I could muster while at work to try and show my face with the orthopedic residents at my hospital in an attempt to seduce them into taking me on as one of their own next year. This felt as fruitless as it probably was and didn't do much other than make me not like some of the snarky assholes I so desperately wanted to be a part of.
BUT
Things. Got. Better.
More on that later though. This is way more than I intended to write for the first go (once I start talking about me it's hard to stop). I suppose next post I'll pick up where things started to get more hopeful last year and try to quickly catch up to now so I can drop more funny day to day stories (funny to me at least :P).
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