Life in Triage

2 months in. Overwhelmed. Don’t feel like I’m improving as fast as I should be. Still too disorganized. Disillusioned and disappointed at how green finished. Hopeful for this month.

-For my own personal notekeeping, I wrote this almost a month ago, but its been sitting around waiting to be published for some reason

Wow, it has been quite some time since I scribbled anything down in here. Things have changed for me. A lot. I’m now living 2,500 miles away from home, thus shattering my previous record of 200. I’m a doctor, which is a fact continually amusing and terrifying to me, and every time I have to answer the phone as Dr. Louis, I feel a twinge of pride mixed with a tidal wave of fear.

I’m absolutely in love with this part of the country. I can’t imagine why the whole population of our great land isn’t actively trying to move here. Granted, its the summer and the weather is amazing, but when I look out a patients room to see a panoramic view of Mt. Hood, Mt. St. Helens, and the Willamette River…its just….well good Lord its majestic. Its difficult–damned difficult–being so far away from the love and support of my family, but I think its good for me. They are now only a skype call away…and I feel like I’m really creating my own life here. Its a good thing, I just miss them so much.

Then, there’s the job. I’m exhausted. Its currently 3:10am, and I’ve been here since 5:30 this morning. And I have almost 9 hours to go before my shift ends. I don’t care who you are…that sucks. And yet, and this is truly astonishing to me, I’ve never been this happy. I’ve never slept this little or worked this much, but I’m absolutely filled with joy every time I wake up in a fog of half-arousal. You people that know me know I’m kind of a bitter old man…but I think that guy might be dead. I’m genuinely happy right now, and I’m going to cling to it as tightly as I can. I had a patient’s family from pediatric surgery send me a letter of encouragement, and it absolutely meant the world to me. I’ll be clinging to that feeling for quite some time.

Pedi surg was…well…not so bad, really. We had a relatively light census, and I feel our team was really strong (Nikki really picked up my slack). I didn’t get to be around Bliss as much as I would have liked, he really is a great teacher and I feel like I missed out on it because I spent the majority of my rotation on nights. Oh well…the time will come again. And now…Green. The bariatric and colorectal service. Taking care of the aches and pains of pre and post operative 400lb people is….well, I guess it should be miserable…and there are parts of it I loathe…but dammit I’m so irrepressibly happy right now. I have an awesome team, and the med students actually really rock, its hard to really get down about having to go change the wound dressings on a 350lb woman with an open abdomen, as truly disgusting as that really is.

I did my very first disimpaction the other day, and boy howdy, was that an experience. If you don’t know what that is, google it. If you do…mourn with me.

The people in my program seem universally…just dang great. I generally don’t like most people, but these folks seem a whole lot of OK. I’ve made some pretty good friends quicker than I usually do, and I can’t help but hope that continues. There’s just so much to do here! Between hiking, going to the coast, snow skiing, beer drinking, bike riding, etc. I doubt I’ll ever have a spare moment to relax. And dang it, that’s a bit of ok by me.

So, I think I’ve decided to stop having some noble goal of cataloging useful information in this journal and will start using it as an actual journal. Not enough people read it to really matter, so off I go

Its 3, the night before we find out if we matched or not. I’m so nervous I can’t sleep and feel like I’m about to vomit. Rationally, I have no real reason to be afraid. I have 10 programs on my list, several of which have been courting me rather vociferously. Granted, they are not my top programs, but at least I have that on which to hold. The odds that I will not match are, I hope, pretty dang minuscule. Even so, the nagging doubts linger at this time of night.

Plus, this stupid P90X thing is absolutely destroying my back. I love it, and I’m taking it even more seriously than I thought I would, but it’s gotten to the point where I am taking 6-8 Advil a day just to keep my back pain in check. If it keeps getting worse I’m going to have to bite the bullet and go back to the doctor. All that to say this: the back pain isn’t helping me sleep either. But my arms, chest, and legs are sore in wonderful ways, so I’m going to keep up the program, in all its masochistic glory.

So, yeah. I’m scared. Hurdle #1 tomorrow, here’s to the next 4 days of elevated blood pressure.

My thought a couple months ago was to sit in my hotel room the night after each interview and record my thoughts on the program, as a way of helping me keep track of how I felt about it at the time. Well, it turns out I’m lazy and just plain old didn’t do it. In retrospect, however, it was probably for the best, as my opinions of each program I’ve been too has been so constantly molded and shaped by the subsequent interviews.

So, here I sit, 9 interviews down, and absolutely no idea what I want or need to do. I have my favorites right now (Portland, Denver, UTSW, and Cornell), but even that list is constantly changing. Its coming to a time where I have to decide what I really want out of life. There are two paths laid before me right now, and I don’t really know how to choose between. I have two primary goals on what I want out of residency: 1) to become a technically proficient and clinically competent surgeon, and 2) to land a fellowship which will allow me to do whatever I want with the rest of my life career-wise.

Now, these two goals don’t necessarily need to be mutually exclusive. In fact, I think any one of my top 4 programs right now will allow me to do both of those things, but there are definitely skews. For example, I will probably do a larger number of more varied cases at a place like Louisville or UTSW, and probably be a better surgeon at the end as a result of it. On the other hand, the fellowships that the residents land coming out of Cornell are among the best in the nation. Not to say that there aren’t great fellowships going to the other schools, there just seem to be more of them going to a place like Cornell.

And then, there are the intangibles, the most prominent of which are the personalities of the residents and the city itself. In the former category, UTSW and Cornell probably win, but it could just be happenstance that I connected with some of the guys there. In the latter, Portland and Denver stomp all over the other cities.

I’m tired. I’m tired of traveling, tired of the interview process, tired of not knowing where I’m going to spend the next 7 years of my life. It really is incredible the humiliation that we subject ourselves to on the path to becoming a doctor. I’m hemorrhaging money that I’m borrowing from someone else, paying someone for the “opportunity” to do some resident’s bitch work and paying to fly my happy ass around the country and paying for my hotel rooms only to show up at 6:45 in some time zone and try to sell myself. Screw this. Ok rant over. Its 3am, I have no idea why I’m awake, and I’m mad at everything

In a zen moment, I’m going to leave this post with a picture of why Portland is awesome

30 minutes away from the hospital...

I originally intended this journal to be a collection of stories that I picked up on the wards. I thought my days would be ripe with stories to tell. Stories of pain, heartache, inspiration, and joy. I am sad to sat that it simply didn’t happen.

I can’t say if it was my own lack of involvement in my patient’s lives, or that simply what happens around the hospital just isn’t all that interesting. All I know is that my moments of connection with patients were few and far between, and moments of inspiration were almost nonexistent.

It seems as though, unfortunately there are really only two kinds of patients (with the rare exception). They are either a) not all that sick, or b) so sick that they have lost the ability to effectively communicate. So, either way, establishing a real connection with a very sick patient is nearly impossible. Sure Ms. Smith who comes in to have her HCTZ refilled is a nice lady, but she’s not sick enough to make her interesting. And Mr. Jones with his end-stage pancreatic cancer is dying, but the drugs we are giving to keep him pain-free eliminate any chance at real communication.

And to top it all off, when the day ends, this turns into a job just like any other job. I come here, I get the things that I need to do done, and I go home. I pray that my M.O. will change once I am a physician and directly involved in the care of my patients, but I can say that while playing doctor as a med student (get ready for that post), I found it unbelievably hard to get really involved.

As this is my second month of pediatrics, and its almost over, I’ll run down the highlights (for my own memory) of the first 7 weeks:

Dr. Cochran (If you haven’t worked with him, you don’t get it, and never will. If you have, smile quietly to yourself and remember your favorite times with him…)

Leaving the ER 4 times over the course of a 12 hour shift to get random things for Dr. Viets

“Acute Gastroenteritis” HA! 9.5/12 sucker.

Height: 5′10″ Weight: 275 Age: 9 freaking years old

Performing a Lumbar Puncture on a 8 moth old kid in status epilepticus.

The first time I was attracted to an attending.

H&P times a million

Being able to confidently tell people what I’m going into…without regrets.

Boredom on the Wardom

Harriet Lane

Having nothing to say to a crying mother watching her child die. Feeling bad about getting annoyed at how much time we spent in the patient’s room.

Feeling, for the first time this year, like one of my residents doesn’t like me.

Musical attendings.

Team Badass/Bad patients. Team Disaster.

Kairi

Landon

Anna Belle

So, my mind is finally made up, I’m going into surgery. Am I going to stay there? Who knows. Going through a surgical internship, even if I decide its not for me, will provide a lot of options of other things I can do with my life.

If I was a betting man, however, my bet is that I’ll stick it out. I like the OR too much to do anything else with my life, I think. I like the whole philosophy of surgery, a get in-get it done-get out way of thinking that suits my ADD just fine.

So, I thought I wanted to be a surgeon. I really, really though I did.

Then, I had a meeting with an interventional cardiologist that I met through family. He has what I want in life. Do I go through the horror of a medicine residency to get there?

Help!