One of THOSE days

Have you ever had one of THOSE days?

One of the days where doing your job… The job that you love and feel called to do feel feels like a chore.  Where duties that you like are enough to make you want to gouge your eyes out and you drag your feel at every step?

That was my today.

Well, at least that is how my today turned out.

It started out like any other day doing routine morning rounds on the inpatients when I got a call about one of my sicker and more complicated patients.  They weren’t well and were asking for the attending to come see them.  Instead, they got me.

Needless to say, although we like eachother (I think) they weren’t thrilled to see me.  And I really couldn’t do very much at all to help, except hold hands (until I got yelled at because I was limited in what I could give or do until I spoke with someone else).

And thus began a roller coaster of a day.  I somehow managed to speak to every consultant involved during the course of the day, some of which have starkly different opinions and approaches, all of whom want me to in speaking with my staff have a million changes happen.  And some of them are discongruent.  And I seem to be one of the only common points of discussion except the patient.

As the day went on, I found myself caught up in a he-said she-said drama and somehow managed to get paged at least once an hour about some sort of issue with orders, a need to reassess a new symptom, talk to a new family member/team member and yet still needing to do the rest of my work.  And I still needed to complete my other regular duties (not that they are particularly heavy at the moment, but nonetheless they do exist and I missed rounding with staff on our other patients and teaching and part of clinic due to this important, but relatively non-life threatening conglomerate of events…)

Normally, I would take all of this in stride.  But, by noon, I was frustrated with being pulled in different directions, tired of having to go back to that floor every time I tried to leave and annoyed… Not with the patient or their family or the team, none of this is within their control (one might argue the team could do better, but it is really complicated), but with the whole package and with myself for being annoyed.  I began to feel resentment at whomever was the source of my pages.  A little voice inside my head wanted to yell “No, I don’t want to go up and reassess the patient!”

But, I didn’t do that.   I took a deep breath and prayed for the patient and for myself.  Then, I smiled and ploughed on.  There was a lot of fake it until you make it happening on my end today.

I feel awful when I don’t want to see patients or when I get annoyed with people calling me.  It is my job and it is their job.  I try not to show it ever and it doesn’t happen often, but sometimes, it really can be a struggle. Sometimes calls or duties that are not necessary happen.  Sometimes you work with people who you don’t always enjoy spending time with.  Neither of these sometimes were in this situation, this was more of a sheer volume and confusion thing.   And often, it snowballs and the feelings get more intense if I don’t do something to calm down and regain perspective.

Was I the picture of perfect?

Nope.  I sighed and occasionally rolled my eyes while writing notes.  At one point I contemplated throwing my pager out the window.

By the time the afternoon was starting to come to a close, I thought I was in the clear.  But, then I had to go do a procedure.  Which, of course, like the trend of my day was not without complication and then a page from my staff wanting to see the patient immediately after (which turned out to be longer than they would have liked).

This all made me think of this song by (one of Patrick’s favourites) Mark Schultz… Including the getting the name wrong piece… One of the staff I work with is convinced my name is Krista, no matter what I tell him.

I would like to say I was never so happy to go home, but as it turns out, I was on call.  I missed the last shuttle to the other hospital, so I had to power walk with all of my stuff.  Where it has been busy since my arrival up to right now.

But again, there is something to be said about keeping my cool.

I know the nurses appreciate it.  And as irritated the patient and family are with the circumstance, they probably prefer me to be calm and pleasant (I hope anyway…).  And I always appreciate people who are nice, especially if I expect them to start getting annoyed.

The day is far from over.  And, to be completely honest, I want nothing more right now but to go home and curl up in the fetal position next to my husband. However, I look at it like this… I am usually happy.  I love what I do.  It was a bad day and things like that happen.  I remind myself I did my best.

I am far from perfect.  I know I wear my emotions on my face.  I have been told that before.  So, I am sure someone along the way picked up on my frustration or angst or fatigue.  And sometimes I overcompensate.  But, I like to think I was still helpful and open and wiling to try at a times (and they were multiple today) where I could have thrown in the towel or avoided the situation.

Tonight, I still feel on edge.  I still feel bitter about a ton of things that happened.  I also feel good about some of the things that happened.  About what I learned.  About the progress we made, even if it felt small.

But, the cool part of it all is that this is just one day in a million. There will be other bad days, but there will be many more okay days and some awesome days too.

The other cool part is how great God is at getting me through the suckyness without gouging out someone’s eyes.

Without Him, I would never have the patience or the perseverance to deal with stuff.  As strange as it may sound to some of you “Trisha is all crazy and Jesus-freaky sometimes” folks, the brief pause to say a prayer is time to gather myself.  And my premorbid personality is such that I get annoyed with inefficiency, disorganization and complaining, three things that today was full of.  So, without big changes that have taken place in my life, this would have been much worse.

I also firmly believe that God acts in some of the tough situations to help work things out.  Can I prove it?  Not especially, but I still believe it (maybe I am crazy, or maybe I have seen some pretty weird things work out the right way).

And God keeps my perspective right.  Again, this is something people can do without God, but I like having Him in the equation, I think it makes it easier.  But, I try to see people how God might.  With love, with respect and I try to treat them as such, even when I don’t want to.  It is hard.

I guess you could say I tried to Golden Rule-it-up today by treating others how I wanted to be treated.  And some of them treated me nicely back… Even though their days were clearly going poorly too.  Funny how that works?!

Sometimes, I think people need a V-8 (remember those V-8 commercials where people would smash others on the forehead?  No… Well, I do.).  It isn’t always my place to give it.  And some days, I do too.   And sometimes there doesn’t seem to be anyone to crack me on the head.  So, you get through it and carry on.

When you love what you do, when it is a calling, not just a career, having one of THOSE days is not enough to make you want to quit, but it is enough to require you to take a step back and breathe (and possibly consider taking up some bad for you habit as a vice), but then carry on happily (maybe not quite that same day, but a few days later).

Procedure

Image from hoMed.

“Hello, my name is Trisha.  I am the junior resident.  No, this is not my home service.  Please, let me now stick a needle in your abdomen.  Of course I know what I’m doing.”

Such is life off-service.

I am now back in the world of livers again, which means I am back to doing paracentesis (aka draining extra fluid off of people’s bellies).  It is an immediately satisfying procedure in that you see instant results.  It is dismaying because people often reaccumulate the fluid quickly and you have to do it again in a few days to months.

I am not a procedure person.  I never have been.

Don’t get me wrong, I do them.  And I am decent at them (although also a bit slow and shaky).  But, I don’t derive the same sort of joy other people do in performing procedures.

Most of the people I went to med school with liked their given field for the procedures.  You get to do blah to people.  And they get a big kick out of that.

This is what happened to us on procedure day… Casts, IVs and blood draws all around. Plus some pig guts and dummies to boot. Image from medschool.lsuhsc.edu.

I remember med school procedure days.  I thought they were neat.  I love the feeling of fresh casting material and it was fun to be better at taking blood and doing IVs than average (thank you undergrad), but I was never as pumped as some of my peers.  They could practice hand ties and sew pig guts until the cows came home.

Maybe part of it was that I have always struggled with fine motor skills.  And I hate not being the best at something (and I will never be the best at most surgical-type interventions).

Another part of my procedure issue is that I just plain find it bizarre how we learn in medicine by practicing on real people.  Its not like we can learn on fake people.  And we do sometimes get to do stuff with dummies or each other first.  Some things just need to be done on real sick people.  But, nothing is more awkward than telling someone, “yes, you are indeed the first person I have done this to.”  I don’t know many other professions where you actually torment live people (under adequate supervision) for the sake of both learning and their theoretical betterment.

I am a person who learns by reading and understanding, so the whole “see one, do one, teach one,” thing is irritating when I have yet to read about one.    I generally like all procedures better once I have a few under my belt.  Because then I don’t feel like a bumbling fool (or at least less of one).  Competence is a requirement for me to like something, me thinks.

When I was in Nuc Med, I loved injecting radionuclides.  I loved taking blood.  But, it was that along with the other stuff.  The other stuff made the bits of hand-eye coordination cool.  I worked in Specimen Collection for a summer and it was quite possibly the worst job ever.  In fact, I use it to this day as a standard to compare all other terrible jobs… Gen surg is the only thing that came close.  I liked taking blood.  I did not like doing it 8 hours a day, 5 days a week.

My Nuc Med buddies teased me because I have a ridiculous tremor when I do take blood and such.  It scares people at first, but I really am quite competent (and the tremor diminished with increased practice and caffeine tolerance).  They made me promise when I got into med school to not do surgery ever.  Because my tremor would terrorize everyone.  Have no fear folks, that isn’t the only reason I won’t do surgery.

I picked my field for the variety.  And because once I am out, I have the option to not do a whole heaping lot of time-intensive technical procedures.

I like giving immunizations.  I am cool with the odd blood draw (just not an 8 hour day consisting of 100+ draws).  I will do your pap or use a scope to peer at your larynx or sew something up once in a blue moon.

I, however, can’t do that all day.  Or every day.  I love my sit-down chats with people.  I love clinical medicine and tolerate procedural medicine.  I enjoy paperwork and computer work, but most of all people work.

As cool as it is to impale people with large needles and suck fluid out to make them feel better, I like making differences in other ways (like prescribing drugs or radiation or talking).

My kind of instruments! Image from benitaepstein.com.

It is a personal preference.  I know it is an important part of medicine.  And some aspects of Rad Onc are super procedural as well.  It is all about what you make of your practice (and what sites you focus on and how much time you spend on certain sites).

Will I do procedural stuff?

Heck yes.  Everyone does.  And some of the sites I think are cool may require me to do procedures.  And I am fine with that, if I like the procedures and I get the variety that comes with the career I chose.

I will also enjoy the procedural stuff more when it is better within my comfort zone and training niche. Knowing what one is doing and its relevance to the care of your own patients is huge in enjoying it.  At least it is for me.

It is good to know what you like or not like.  But, sometimes I wish I could get the same kicks out of sewing or impailing that other do.  Instead, I grin and bear it and take joy in the fact that it helps that person and that once I grow up, I will be able to somewhat tailor my practice (or defer to the off-service junior resident… Muahahahaha…. Okay, not so much).

Not JUST an R1 and other difference making moments.

Today, I was answering my attending’s pager and a GP calling from outside the hospital said the nicest thing to me.

It is my first day doing GI consults, which can be rather interesting.  I find consultation services fascinating because you get to see people with all sorts of problems for all sorts of other problems.  The bigger the puzzle, the better in my books and I saw a couple doozies today.

In fact, in one of them, someone with some liver test abnormalities, I solved the puzzle without prompting thanks to my time spent on the liver service!

Anyway, back to my story… So, I answered the third outside call of the day.  The people calling expect to get the specialist, not the junior resident.  And normally this person is excellent at answering.  But, because they were mid-scope or mid conversation, I was sent to answer, so at least the person would get a response and some interim advice before the attending could call them back.

I heard the whole story from the GP and agreed that the person needed to be seen and that things weren’t right (but I had no clue what else needed to be done or in what timeline exactly), so I told the GP that, “I am just the R1, so I can’t really make any suggestions,  but I will get my staff to call you back when they get a moment.”

The GP responded, “You are never JUST an R1… You are a part of the team.  Had you not answered, I would have been stuck waiting by my phone.  At least now I can say I talked to someone and they need to check into things.  This is how you learn.”

Such a nice thing to say.  A simple and obvious statement, but one of those things that you need to be reminded of.

I know that deep down inside.  But, sometimes, especially on a consult service… And new to that service, you feel as if you are just a middle man.

But, that is what I am there for.  To help people.  And to learn.  And part of that learning and helping is answering calls and consults that I really can’t do much about besides take a good history and physical and do some reading around it.  And once I review it with staff, I learn.  And next time, maybe I will know what to do for real.  Or at least have a better educated guess.

I am so thankful for people who understand that situation.  Who take time to teach or understand that I am learning.  It makes a world of difference in my day.

Other world of difference to my day moments were less profound.

I woke up and Patrick informed me that I slept through yet another Habs win.  On the bright side, I stayed awake to the end of the second period (I sure felt it this morning, though).

I finally pulled that darn grey hair out of my bangs.

I realized that the cold Patrick gave me last week has now had me talking like a man for a week.  I think there are people I have met on several occasions now who may think I just have a husky voice.  And for some reason, that strikes me a little funny.

It was unseasonably warm today, so I walked home without wearing a hat and mittens for the first time in ages. Also, I left work at 5 and it was still somewhat light out when I got home.

Clearly, my life is exciting.  Thank goodness that doctor was nice.

Random Bits

Some random bits of my week without any rhyme or reason (no apologies for disjointedness)…

Hockey is back.  And I believe it now that I see it.  I am not one of those fans who was so ticked off I refuse to watch.  I really did miss it when it was gone.   Last night, I watched the first period of the Habs game in broken-up slow motion thanks to poor streaming from a sketchy website.  I thought now that we have cable and a nice TV things would be better this year… The problem is we still don’t have every game televised.  And we can’t afford the NHL channels.  The Habs won, though.  Very good news to wake up to in the morning.

I am on Hepatology right now.  It is a learning curve.  My attending is awesome and loves to grill with questions.  I see it as a personal challenge; even though this is the most stunned I have felt since starting Cardiology last month.  Livers are interesting, I must say.  It has been slow clinically, but I have been making up for that with all sorts of required reading assignments.  I am such a geek.

Yesterday, I decided to fix our vacuum cleaner.  If you don’t know, I am the handy one in the family.  I just have some mad scientist in me.  Also, I am terrified of the vacuum cleaner.  So is the cat.  But, Patrick has been noting for the past number of weeks that the actual vacuum has no suck, even though the hose still works, despite him emptying the bin.  Turns out the rubber belt thingie (technical term) is broken. I disassembled the whole thing to figure that out.  He was going to go buy the part today and tomorrow I will put it all back together again (hopefully).  The poor cat nearly had a stroke with the vacuum being out long enough for me to mangle it.

Patrick gave me a cold.  Who says I work in a germy place?  I am pretty sure  kids are sicker than most of my liver patients, at least from an airborne contagious perspective.

On a related note, my tonsils hate me.  They are huge and whenever I get sick they get huger (not a word, but fitting in this case).  Swallowing is a challenge.  I really should consider getting them resected.  But, they will only do that multiple documented episodes of tonsillitis in a year.  And I will only get them documented if my own documentation counts.    I don’t think it does.  So, like my wisdom teeth, I will procrastinate until I develop a real problem.

Secondary to the whole tonsil issue… Soup and tea are wonderful inventions.

I finally finished reading The Circle by Ted Dekker last night.  It took me over a month.  It was awesome.  I recommend it.  I am also excited to start reading a book that fits in my purse and doesn’t weigh more than some of my textbooks again.

Sometimes, when I am on call and have down time, I start to read my fun book and then I get angry inside when someone pages and “rudely” interrupts my fun reading.  I do not quite have the same reaction if I am studying.

I met a random lady on the hospital shuttle.  She told me her entire life story and all about books she has written and how she decided to go back to university after retiring to get her B.A. and how she intends to travel across Canada after she graduates, just because.  She didn’t tell me her name.  She looked to be at least in her mid 60s.  Good for her.

I have a single white hair in my bangs.  I keep trying to pull it out even though some people say you shouldn’t do that.  I can’t seem to get to it because whenever I notice it, I am in a rush to do something else.

We have friends from the Rock visiting this weekend.  And friends from home moving to town.  Yay.

What randomness is occurring during your week?

From Hearts To Holes

It is yet another new rotation time.

Ah, the life of an intern.

Variety is the spice of life.

Some days I could use a little less.

As I have mentioned (here and here and here, for instance), I dislike change.  Starting new rotations never fails to stress me out, at least a little.  New expectations, new preceptors, new nursing units.  All of it can lead to pretty significant change.

I have been told on countless times that I am very adaptable.

Adaptable, yes.  But, I am a sad chameleon, the change isn’t fun to me.  I quite like consistency.

Although, I must admit, I am excited to be going into a less busy rotation.  And learning is good.  I like learning.  And relevant learning.

Jumping around like this will make me a good doctor.

Today, I went from the world of Cardiology to the world of Gastroenterology.

Thankfully, this isn’t as epic as the change from Surgery to Peds Emerg or Peds Emerg to Cardiology.  At least the two fall under the same Royal College specialty.  Big win.

Image from theunderwearer.blogspot.com.

So, as goes with the start of a new rotation, I have reading to do.  More than I do after I am a week in and more comfortable with the subject matter.  Tonight’s mission… Learn about the management of decompensated liver failure.  This, after a month of managing decompensated heart failure.  It is a pleasant change, to be honest.

On a completely unrelated note… My husband forgot me at work today.  In his defense, I walk home most days, but opted not do compliments of some snow.  In my defense, we did discuss that he would pick me up on the way to work this morning.  I thought it was funny.  Possibly because I frolicked out into the snow to met the car only to realize that it was not our car and our car was nowhere to be seen.  Better me than our unborn children.

This is kind of what I looked like when I realized he wasn’t outside and that it was snowing and I didn’t wear boots. Image from 123rf.com.

On a more related note, I listened to this song  while getting ready for work this morning.  Today marks my PGY-1 half done day.