Today’s prompt for the Daily Post is one I can never resist… “The Satisfaction of a List.” Like the prompt states, I can’t resist the power of a good list. There is just something about list-making that I find inherently satisfying.
This list is a bit of a silly one, although it is something that I discovered just this weekend. I was volunteering/observing at a cancer retreat this weekend, which was an amazing experience both personally and for my professional future. I plan to write a bit more about my general experience another day.
The list that I am writing is a top 6 list of the reasons why I suck at meditating. A big chunk of the retreat was learning relaxation techniques and how to meditate, etcetra. It was cool. I liked the bits of yoga and qi gong we did. The meditation, not so much.
I am a poor relaxer. This would probably actually make for grounds for me to take up meditation, but the problem is that they tell me to relax and I either almost doze off or I start making mental check lists. They say this is okay and that you should acknowledge it and go back to concentrating on your breathing. But it is hard.
Image from i.chzbgr.com.
I have poor posture. Why is this related? Well, you see, most of the meditation we did were sitting meditations. And that involves sitting at the edge of your seat with proper posture. Half way through every session I started to get a pain in my right back (thank you slight scoliosis and North American culture induced poor posture) and then I would try to shift quietly but shifting does not fix it. Not that the laying or standing ones were much better, but the sitting ones were the worst.
Image from barkhamofficefurniture.co.uk.
I have authority issues. This comes off as weird because I love rules and such, but I still hate when people tell me to do something that is optional and not always logical. For instance, telling me to breathe into my pelvis or picture my loving light filling my heart in the middle of my chest does not make practical sense, nor does it sound like something I want to do. I then get all stubborn in my head and annoyed and, well, that kind of dulls the whole experience.
Me during the meditation when told to relax and clear my mind. Image from buzzlol.com.
As much as I believe in holistic medicine some of the imagery and such seemed hokey to me and I couldn’t get past that. I tried being open minded, and I know that visualization is valuable to so many people, but for me it just felt silly.
My attempt at open-mindedness. Image from catholibertariandotcom.wordpress.com.
Doing things like concentrating on my breathing or bum in the seat or what have you make me feel like I am hyperventilating or uncomfortable. Please stop drawing my attention to them. At one point, I was convinced my lungs would implode.
Going through my head whilst concentrating on breathing. Image from education.com.
I am childish. Some things make me giggle. And in a quiet room where everyone is seeming to be listening and doing intently, it is really hard to stifle the odd snicker. And stifling the snicker makes you want to do it more.
Image from erichufschmid.net.
Again, I must re-iterate that I had a great experience at this retreat overall. I just didn’t love the meditation. Different strokes for different folks, I suppose. And my experience should not belittle that some people derive great benefit from meditation and that I may at some point in my life. It is very life changing for some people to have that means of relaxation and stress reduction. You can change neural pathways, alter your stress response and better your self awareness and coping… I get it. But, rightnow to me, it just felt like something I did not want to do and something that I am not good at.
Last Sunday in church, we were wrapping up a series on 1 Corinthians. I have written about the series or related topics a few other times on here (refer to this, this and this)
Something (well, three verses in particular) struck me in the last service. Right in the face (of note, face has been my word of the day today). They are (I learned because it was pointed out) both imperative statements. Things to do because of our victory through Jesus. Things to do to demonstrate our faith and serve our Lord.
So, my dear brothers and sisters, be strong and immovable. Always work enthusiastically for the Lord, for you know that nothing you do for the Lord is ever useless. 1 Corinthians 15:58.
Be on guard. Stand firm in the faith. Be courageous. Be strong. And do everything with love. 1 Corinthians 16:13-14.
Besides this being yet another chunk where the Bible tells you what to do or not do, what does this really have to do with anything? Why did this bit strike me?
I like practical things. I get annoyed when people ask superficial questions that are answered directly in the passage. I get annoyed at discussions about the differences in wording in a certain passage or why something might not mean what it looks like. I am not saying I hate really getting into the meat of something, but I hate when people seem to miss out on something obviously there or try to look for something that probably is not.
Sometimes, when people look for practical applications in the Bible, I get annoyed. The whole thing is practical. That is the point.
But these imperatives really bring out the practical. They are succinct, blunt and basically say how we need to behave. I like that.
But what I liked even more was something the pastor drew attention to. Something I know but something I struggle with. Something that is said in the verses, but is not always obvious on a surface level.
These things are ways of being faithful. Of living out faith. And the cool part is that being faithful does not simply consist of the big stuff. The healings and giving big gifts and doing the obvious. Being faithful to Jesus also happens in the mundane.
The pastor actually used the word “mundane.” I was glad he did. That made it make sense to me. And I totally see it in these verses. That nothing you do for the Lord is useless. That standing firm, being strong and courageous is not just in the giant scary times but even in the every day average times. But, had he not used the word mundane, I am not sure I would have picked up on how big these verses are.
I sometimes feel trapped in the mundane.
I work an average of 60-70 hours per week. Like most jobs, sometimes things are very routine and can be full of going through the motions (I know, this is totally shocking after the exciting world of medicine I paint on here). I am fortunate that there is much variety, every disease process can do something a bit different and, thankfully, people are so unique things do not seem monotonous. But, there is still a ton of paperwork to plow through, meetings to sit in on and all that good stuff. Plus, I have the whole school/studying side. I love to learn. But, sometimes reading books and journal articles, preparing presentations and all that good stuff in your “spare” time gets aggravating.
Plus, I am still a wife. And I want to be a good wife. The kind that keeps a clean house, cooks proper meals and such. Laundry never ends. The house gets messy as soon as it looks clean. Cooking a good meal one day is awesome, but you still need to eat the day after that.
Some days I feel trapped in a work, cook, study sleep cycle. I feel like I am doing nothing “great” for God. In fact, I just feel like I am spinning my wheels.
But that is where the whole mundane thing comes in.
I know my life is not boring by any means. But, monotony does set in (but when yo switch rotations every four weeks, it can’t linger too long). Sometimes, I feel like I am just going through the motions. That most of what I do makes no difference.
I have heard over and over again that “whatever you do, do your work heartily, as for the Lord rather than men.” (Colossians 3:23) But, I forget. And these verses reminded me.
But the mundane bit is what struck me. I tell myself I know it is everything, but really when I read “do,” I think of employment, like when we ask people, “What do you do?” meaning what is your vocation.
It blows my mind that when I am serving others in ways like navigating laundry heaps, making my husband supper or studying to be a better doctor that I am serving the Lord.
I have to admit that I don’t always do this stuff in love. That I am not always thinking about God when I do it. Sometimes, I am resenting the person who gave me the assignment, or my husband for being messy or my friend for being needy. That really isn’t how or why I should do these things. It doesn’t say I have to always “want” to do them, but I do need to adjust my focus… God and love. Such is a life of serving God.
I found myself this afternoon wasting time staring at our tax return and being bitter about the work I have to get done. And then I remembered this passage. The whole mundane thing. That these things do matter and do have purpose. That when I do them in love and with a serving attitude they are serving God.
That is pretty cool.
Does it make me enjoy them more?
Not that much. But maybe a little because trying to be enthusiastic, loving and Christ focused helps.
And then there is the whole be strong, firm, etc. chunk. I just like hearing them. I like the reminders. I need the reminders. I feel like I have been waffling on this stuff lately because things have been overwhelming and busy. I think you need to be on guard for things that deceive, that you need to be strong, not just in times of trouble, but in good times too, that being firm in your faith can help these thing along. And that this combination can make the mundane seem maybe a bit less mundane.
I feel like all of this calls for a song that basically says what I just said to wrap things up…
This week’s writing challenge with the Daily Post is called 2AM photo. I am not all over the creative writing challenges even though I used to write fiction all the time when I was a kid. When I saw the prompt, though, I couldn’t resist. There is a flare of reality to this to me. This is something that could actually happen to me, in fact, I have written a rant about something very similar. However, this post is entirely fiction, at least the situation is and the reaction is, well, pretty much what I would do.
It’s 2AM and your phone has just buzzed you awake, filling the room in white-blue LED light. You have a message. It’s a photo. No words, no explanation. Just a photo. Tell us all about it. And what happens next.
I wake up from my usual comatose sleep to my phone glowing and only 3.5 hours left to sleep… Not cool.
First assumption… Someone died.
Once I confirm it is a photo message, not death, I contemplate the death of the sender. I imagine impailing them with my phone. Sticking the cat (who, for good measure is now pawing at the door because he heard movement and wants to come in) on them. Oh, this best be important… Life or death important or I will be mighty ticked. Well, I already am ticked. But, they will know about it.
I lay there considering just going back to sleep. There are so few precious hours before morning. And people don’t get that sleep is more precious when you get so very little of it.
Finally, I muster the strength to roll the rest of the way over and pick up the phone.
It blinds me.
Great, that probably reset my brain. Now it thinks it is morning.
I pick it up and I look at it.
I stifle a laugh.
The picture is from a friend.
It appears to be of a large, infected looking flesh wound. The body part wounded is a mystery. It is hairy. I hope it is an arm or something…
Ugh… Why would they send me a picture of a hairy wound.
I think for a second. Look at the picture again.
Now I see it. That is an arm pit.
The wound is a ruptured seborrheic cyst. I think.
Someone had a lot of fun with the zoon function on their iPhone.
Kind of what the picture would look like. Pretty nasty, right? Don’t worry, this is the only image I included. Sorry if you already want to die a little. Image from healthtap.com
That is so gross.
But, not as gross as it would be in person.
Wow, am I suddenly grateful to live in a different city.
Have you ever smelled seborrheic cyst? Like, when it ruptures? Ugh, they could clear a room. They are probably my favourite things to incise/remove, though. I am sick like that.
I look at the message again. Geeze, the least they could do is send an explaination.
I mean, I am assuming they meant to send it to me. They do stuff like that. Ask me questions about their health. Send me pictures of weird rashes and stuff. That is what friends do to their friends in the medical profession. And, I mean, it isn’t like I work more often than not. Heck, why would I be sleeping at 2am? I know, probably because I am on call at least once a week that requires me to be awake at 2am. But still, gosh, then I am working. That doesn’t justify them texting me.
I start getting agitated again. I consider sending a nasty “why do you do this to me?” message. But I opt out. Mainly because if that is a picture of either their ruptured cyst or their husband’s, they have had enough grief tonight. That is disgusting.
So, I opt to reply.
My reply is simple.
I put the phone down. I try to settle back to sleep.
I see a bright light again. An explaination?
Sorry I had to puke.
Super helpful. Thanks, friend.
That gets followed up rapidly by what I was expecting.
Am I dying?
Yes, of course, my dear, we are all dying.
But, wasn’t about to say that (I almost did, though). I asked what happened.
Then the phone starts to vibrate.
Seriously? Does anybody realize it is now 2:15 IN THE MORNING?
I answer. I figured this would be more efficient than trying to decipher the texts.
The friend starts to explain herself. She had a weird lump under her arm for weeks getting bigger. At first it seemed pimple sized. She cut it shaving the other day (ah, that explains the slight flesh wound appearance) and since then has avoided shaving it (that explains the hairy). It was big and sore tonight and she poked at it. It didn’t go away. Then, she laid down in bed and it felt like it popped. And it oozed a ton of nasty stuff. And hurts slightly less. But, is all red and seepy. And it reeks. And does she need to go to emerg.
If I had a nickel for every time someone asked me if they should go to emerg, I would be rich.
I tell her to put some polysporin on it. Cover it tonight with some gauze or a tissue to seep up the rest of the grossness. Stop poking at it. Warned her it will probably come back because cysts like that recur all the time. She could see someone to get the thing taken out but that they probably won’t do it after it is freshly irritated. Told her to go to bed.
I also asked why the heck she waited until 2 in the morning to call. Well, because it happened at 1:30 and who else would she call?
But she didn’t call. It was a picture.
She thought that would have better impact.
We hung up. I shook my head. Laughed a bit and went back to sleep… Or tried.
The next morning. Much later in the day, I get another picture. It is just as bizarre. Turns out the whole thing looked much better after the irritation/inflammation settled. I also loved she opted to not give an explanation again.
If we want to be honest, I told some of my work friends the story and showed them the picture. We all get a kick out of that kind of stuff. Everyone gets a health question call, but this takes the cake. I mean, really… I think that would be a silly thing to go to the ED for, but a photo message at 2am? At least it is laughter-inducing nasty. The options are to laugh, gag or get annoyed. I opted for the laugh.
It is the first Monday of the month… You know what that means!?! It is Medical Monday. Use the handy-dandy button below to check out other medicine related blogs of all sorts involved in the blog hop!
Today, I decided to do a top ten sort of post.
I have had a chance recently to think about some of the things I wish I had known before starting residency. But, when thinking about that, I realized that most of this stuff was actually stuff I had been warned about or stuff that I learned the hard way in med school too (I made a list of things I wish I knew starting med school last year). Clearly, I am a bad listener, at least on the advice front.
Carry snacks and change for coffee in your pockets. There are many, many times when you may have a delicious lunch waiting in your locker, but you just can’t get to it. And you will get hungry. And pre-syncopal. Have food on-hand. And be ready to buy coffee or snacks when you pass places that offer that opportunity. Today was a no lunch until 2pm day and I really wished I had a snack with me… I had a single Cert. Suboptimal.
Have a pen and paper with you always. You will get paged to see someone. You will forget that person’s name or location should you not write it down. Writing it down will also ensure you do get that info.
Sleep when you can, eat when you can, pee when you can. You would think it is obvious. But, there are a million times where I could have laid down for a nap and wasted time reading blogs and wound up staying up the rest of the night with a sick patient. Or when I had time to grab food or run to the washroom, but I waited because I would have more time in “a while,” but “a while” was a long while.
On the way to a code, the first thing you should do is check your own pulse. A tidbit from The House of God. It is true. You panic sometimes in the crazy situations. Taking your pulse for that second on the way down the hall makes you focus on something aside from you nerves. Especially those first few times.
Don’t be afraid to call for help. This is something I really struggle with. I like to figure things out on my own. But, when people’s lives are at risk and when you get stumped, it is better to ask for help sooner rather than later. Lots of people know plenty about plenty of things… RTs are fabulous with helping with ventilation, nurses are a wealth of knowledge and radiologists can help you figure out all kinds of weird films. Not to mention there is always a senior or a staff person available when things get hairy.
With the power to write your own prescriptions and orders comes power… And fear… And signficantly more phone calls. To minimize calls, it is useful to write legibly, add details where needed and discuss complicated orders and regimens with the people involved.
Make time for yourself, your spouse and your friends. It feels like you have time for nobody except work, but time with these people, even if brief can make you feel a world of better.
The salary stinks. Compared to the hours worked, you still make no money. At least you can pay rent. But, until you get the same pay for a 60 hour per week rotation for a 90 hour per week rotation, you realize it. That and the fact that it still is tight for money.
People don’t get residency. They don’t get med school fully and residency is, in a sense even more bizarre because you are neither student nor staff physician. Just get used to it.
As dumb as you feel, everyone else felt approximately just as stunned (or they were cocky and potentially dangerous). The stupid feeling is what protects you from doing far more stupid things. Part of growing in knowledge is learning what you don’t know.
It does get better. I keep hearing this. I do believe it… I think.
What residency wisdom do you have or did you wish you had?
Today is post-call day 2/3 in 6 days. I am glad I don’t stem from the day and age that everyone did regular 1 in 2 or 3 call. It is painful. Even the cardiologist I am on service with thinks it is crazy.
Last night was a bit rough. Not Gen Surg rough, but 2h of sleep rough.
But then, I get to come home to my lovely family. Patrick, the cat dog and our apartment house in the middle of a snowstorm. We are dog sitting for one of the other residents in our program and tonight because we like the dog and because the weather is suboptimal for three trips to the dog’s house, we are having a sleep over.
I kind of feel like the song “Let It Snow” is relevant.
I had a nice post-call nap and we are settled in for an evening of books, movies and Scrabble. I am even wearing my sweet new PJs from Patrick’s sister. All in our pretend house with our pretend dog. All we need is a pretend baby (although baby may hamper my sleep).
Also, we found this gem… A snowman either building, kissing, or as I prefer beheadding another snowman.
Simple days like this make life great (I only hope it rains a bunch again to take the snow all way before we have to leave in the morning).
As a result, I have self-diagnosed with labyrinthitis. But not the real medical kind (the type with swelling in the middle ear resulting in dizziness and vertigo). The fake kind I made up.
This form of labyrinthitis comes from the confusion that arises when you are sorting out a new body system, new rotation and new hospital in one go.
I just had a big flare up down in emerg when I wandered forever to find my patient in a hall on a stretcher, then wandered even more to get him admitted (why does every place have to have a different system!?).
My most recent and tiring flare of my made-up labyrinthitis was just now when I finally decided I have some time to lay down and opted to go find my call room. Easy enough. Nope. It was in a hall, down a hall and away from anything remotely civilized looking. On the bright side, it is quite possibly the nicest call room I have been in less the one for obs-gyn in clerkship ( it was nice and had a window, but it failed with the whole being sandwiched between a lounge and a clinical associate who snored like a dragon… This makes it a draw). I wandered and wandered and when I finally got in… My pager went off. Classic!
Wandering isn’t all bad. And I was saved a lot of wandering thanks to Dr. Bond’s tour of awesomeness.
The best part of today is someone realized how bad it would be to leave me unattended all week, so I have a random senior to work with. Much safer. More efficient.
I am remembering why I enjoyed Cardio as a clerk. And also why it scares me.
Sifting through ECGs and complicated charts is just part of the adventure. Plus, I got to feel a pulsatile liver, hear a bunch of murmurs and start to re-learn ECGs in one fell swoop, all the while diagnosing a random TIA and explaining why pacemakers in radiation fields aren’t cool.
I hope the rest of my day is less labyrinthitis-esque. In fact, sleep is awesome, but learning isn’t so bad.
My made-up maze inflammation will improve as I settle more.
Last night/this morning, I finished my last general surgery call shift.
I classify it as a win in my books. I survived. And, to quote Patrick’s grandmother, “I didn’t know if I would ever make it.”
This was probably one of my better calls. Aside from me forgetting my phone at home in the morning and trying to stalk down Patrick to get it back (iPhone=brain). It was the best call for sleep for sure. I got a few decent chunks of sleep time. I had a few sick patients, but they were all stable by midnight or so. It was steady all day up to that point, but from then on, just the odd call and assessment.
The nurses at the hospital I work at are really good. The majority have been around for awhile. They have good common sense. They care about the patients. They help me out a ton. In fact, I think I learned as much from the nurses while working the floors as I did the other residents and attendings. Because the nurses are so awesome, there are minimal really silly calls for trivial issues. I am so grateful for them and the work they do.
The thing is, there are some things that you always have to call someone about. Because it is safer to do so than to not do so. Things that are life threatening… You know, chest pain, fevers, new shortness of breath, excessive vomiting, etc.
This is where I got bitter last night. And similar events have happened in the past.
I got called. Out of a dead sleep at 3am to go see a patient with chest pain. Perfectly reasonable. I was already on my way out of bed as I heard the words.
I ordered the routine bloodwork and ECG and headed to the floor.
There, I was greeted by two of the staff who explained to me the patient is on high dose narcotics at home, is angry because we aren’t giving them more and when they were told this promptly started to complain of chest pain.
But still, you just never know. Bad stuff happens.
So, I go in to see the person. They look comfy. They don’t look sick. Their vital signs were better than mine.
They give a story of having chest pain for the entire day and night. It got worse a few hours ago. The nurses are withholding pain medications. Now, the person can’t move that side because the pain is so bad (as they move said side to demonstrate). And the story kept changing. And was inconsistent with most pain, except maybe post-op pain, but even that was a bit dicey.
Their ECG was normal. Their bloodwork was normal.
So, I had the whole, it doesn’t look like anything life threatening talk with them. And they asked for more pain medication in addition to the additional stuff that I just gave them. I questioned this, as they had just said the pain was subsiding. To this they said they could feel that it would come back. I said to let the staff know if it did.
I am all about helping people. And good pain control. And giving people the benefit of the doubt. But nothing makes me want to punch a person in the face more than when they are clearly trying to manipulate me and they do it in the middle of the night with a complaint that could be really serious.
I had someone else a few weeks ago who was being super rude to all of the nurses and roommates and started complaining about coughing up blood in the middle of the night. Same sort of deal. They did cough up a bit of blood. The also had a nosebleed earlier in the day from pulling out their NG tube earlier in the day. But, they did that earlier, but chose to point it out in the middle of the night when they were starting to be ignored. I ended up getting stuck there for an hour debating the reasons why medications are sometimes given late and why we won’t give him more benzos and the like. Really nothing to do about the mysterious blood.
I had someone else who every time we have tried to send them home, they present with a new problem that precludes discharge. Pain, a new rash, dizzy spells. They are genuinely sick. But they also lean towards the dramatic. It gets frustrating. I just want to see them get well and go home. Partly because it gets tiring for us getting called to assess and making arrangements just to have them changed. But also because sometimes the best thing for people is to not be in the hospital.
I probably sound heartless. I love people. I love my job. I enjoy taking care of people. But, nothing is more annoying than people who take advantage of the system or who manipulate you. Especially in the middle of the night. When other people are actually sick (or you are trying to sleep).
Some people have genuine issues both with their mental or physical health and can come off as manipulative. I take them seriously. I investigate appropriately. Except sometimes it is hard because they don’t give you much to go on. Or it is clear that things aren’t as they say. Then, I kind of secretly want to punch them in the face. Especially when I am in the midst of getting pages about people with more pressing issues. Or when nursing staff are being taken away from sicker people. Or when we are all being abused.
There is an element of common sense here. Some people don’t seem to have it. And I suck at being a jerk. So, often I still get caught up with these people until I get so annoyed or confirmed that they are being manipulative or drug seeking to talk them down. I am getting better at judging this and approaching it. I just don’t like to be mean. So, I try to educate. It takes longer. It works most of the time. It doesn’t mean I still don’t want to kick some people in the teeth.
I guess such is life. There are always those people you want to kick in the teeth. And it is most often at a time when you don’t have the time to deal with it. It amazes me how self centered we as people (on both sides) can be… Me for wanting sleep or to deal with people with problems I need to fix and them for, well seeking attention for problems that, at least from the outside, can seem trivial (though for the person they can be significant).
But, yay! I survived Gen Surg call. And I didn’t kill anyone… Literally or figuratively.
Have you ever had one of those mornings where you just wish you could pull the covers over your head and possibly never get up?
I am pretty sure that if you say you haven’t you are probably lying.
I am starting to suspect I have more of those than not. At least lately.
With all of the surgery stuff, it is difficult to not feel sleepy in the morning. And by sleepy, I more mean fresh from waking up from a coma kind of groggy. I pass out as soon as I go to bed and then scrape myself out of bed in the morning after the alarm. Annnnnd repeat.
It isn’t even like I go to bed late. Well, I did last night because I had to give directions to our lovely friend, LD who is tending Jeter for the weekend. And she didn’t get off work until 10. My bedtime is somewhere around a 9pm pass out time. Thus, last night was a stretch. And subsequently, this morning was death.
I am not one that deals well with reduced sleep.
If I were somehow arrested and tortured, sleep deprivation would likely get me to confess to anything.
So, call and things that require me to be functional and at work by 6am (especially when by the time you get home after work, it is 6:30 or 7) are not conducive to my sleeping habits.
The average adult requires between 6-9 hours of sleep. I fall towards the 9 hour range. If I could sleep 8-9 hours every night, I would be a happy person. But, no. In order to sleep 9 hours with my current schedule, I would have to go to bed at 8. Even going to bed at 9 pushes the limit of getting things done around the house and such. It makes me envy my crazy night hawk husband (although the fact that I can do things like go to the gym, market and back home before he wakes up on Saturday morning is pretty awesome). No matter how much I sleep, I find staying up late a struggle.
I fall asleep pretty quickly presently. Probably because I am so tired. But, as a result, I feel like I don’t get to enjoy our bed. Foolish, I know. But, we have delightful fleece sheets on the bed now. And fleece is like a hug for the entire body. I sleep through the entirety of that hug. By the time the alarm startles me out of a deep sleep, it seems the whole thing just started. But then it is really ending.
My morning goes something like this (when rounds start at 6:30… Shift back 15 minutes if it is a 6am morning- flashing lights make a world of difference in commute time… Also being simply on time is sufficient on those mornings as opposed to the standard 10 minutes early):
5:03: Alarm goes off. I wake up confused. Turn it off. Take pills. Roll over and try to go back to sleep.
5:13: Real alarm goes off. I sing the song playing to myself. Turn it off and calculate what time I actually need to get out of bed to make it to work on time.
5:17: Contemplate the awesomeness of my bed. Figure out what I need to wear and bring for lunch. Snuggle closer to Patrick in hopes that when I look at the clock again, it will not yet be time to get up.
5:23: I really should be up by now. Recalculate amount of time I should take.
5:24: Start whining in my head about how cold it is “out there.”
5:27: Stretch like a cat. Maybe stick an appendage out from the sheets in hopes of startling my body out of bed.
5:28: That fails. Patrick, still mysteriously asleep hauls the blankets off of me. I am unimpressed.
5:30: I moan and groan and roll out of bed.
531: I tear around like a madwoman getting ready and intermittently chased down by the cat.
6:03: Wake up Patrick again whilst downing breakfast.
6:07: Start the elevator (our kind term for hitting the down button).
As you can see, the morning involves a lot of enjoying the bed and then an abundance of hating my life getting ready. This morning, I inadvertently enjoyed the bed a bit too long and thus hate my life a touch more than usual.
Also, you probably noticed I hate even numbers and much prefer activity measured in 3s and 7s… It is odd, I know.
I really do love the coziness that is my bed. I just wish I saw it more often. But not in the stay in bed sick or stay in bed so long I give myself a migraine kind. Just in the pleasant, not rushed enjoyment style.
I also like sleep. Even a few days after getting back to the routine, I miss it. Gosh, just wait until I am a parent. And likely still doing the whole call thing. Then, will I ever whine!
I had one of those call nights where you just don’t sleep. It wasn’t ridiculously busy. Nobody was unstable. But everybody got sick. One at a time. For the whole night. And thus, I didn’t sleep.
There was a point around 2 in the morning where I decided that perhaps call wasn’t so bad. Maybe I could cover surgery call and it wouldn’t be so bad after all. And I don’t mind it because I am helping and getting paid to do it.
Then, 5 in the morning came. I still hadn’t slept. I decided that there are many things out there that sounded more fun than doing what I was.
Strange how things like that happen.
So, I decided to seek out the things one needs to make a good post call day.
I had a great post-call nap. 4.5 hours… Just enough time to feel decent. Not so little that I can’t function. Not so much that I can’t sleep.
I got some post-call cuddles with Patrick and the cat.
I got to have a post-call outing with the Child who is visiting for the week. We did a bit of shopping and checked out a new-to-us cafe downtown for lattes. They were the prettiest lattes we have ever had.
The leaf is mine because I am Tree and the heart is the Child’s because she is lovely.
Then, we got to go out with the Child and her husband for delicious supper with good company.
And… Back to bed.
This was a beautiful post-call day. If only I wasn’t feeling so post-callish.
This week’sDailyPost writing challenge is entitled “Mind the Gap” in which they prompt bloggers to write about what we think about divisive topics, complete with a poll of our readers.
**I misread the actual challenge and wrote about a completely different issue because I thought it was open to any issue. This is clearly what happens when one writes a post in the midst of eating supper and answering pages. Life lesson learned. Apparently the post should have been in response to the issue they presented (kids in adult oriented places) not just any divisive issue. Fail. At least it got me writing, even if it was about the wrong thing. But seriously, check their stuff out on the subject, it is an interesting debate. I am on the fence on that one.**
An issue that has been on my mind lately (especially tonight while I plug away at yet another call shift while working on this) is resident work hour restrictions.
There are few professions where people work more than 8-12 hours at a time. Medicine is one of them. Those people you see working in the hospital at night are sometimes the same people who were there at 8 in the morning when you first came in. They need to be available 24/7. That is safe, that is good car. What you may not know is that most medical residents cover the hospital in shifts that are at least 24 hours in length. Some people do longer.
Studies have shown that residents who work prolonged shifts have higher incidences of motor vehicle accidents the day following the shift and make more errors in judgment.
There is a movement right now to change shift lengths. In some regions, there are new restrictions to keep shifts to no more than 18 hours or 24 hours or 30 hours. But, there is an increasing push to keep people from working more than 16 or so hours. This is done by having a night shift of “call” residents to cover the times the day people often sleep.
This, however produces a logistical nightmare for programs needing to accommodate new shifts not otherwise needed and also increased numbers of handovers, which can also hinder patient care. And the stats on outcomes aren’t as overwhelming as once thought. Yes, there are improvements in safety, but there are also then issues with the amount of training time residents are getting and the quality of said time.
In fact, many argue that by taking away overnight call, doctors are losing out on valuable training opportunities both at night and day. Many feel that as a result, training may need to be extended, thus delaying the entry of physicians into the full fledged work force.
So, the question…
Now that I know your feelings, here are mine…
I have mixed feelings about the whole thing.
As a resident, I do know that valuable learning happens on call. I.e. during the hours that the entire team is not around. It is when you learn to manage the tough stuff and the finer aspects of medicine that make you a good doctor. For some specialties, this is a key time. For instance, surgery residents get lots of valuable operating room time, obstetrics residents deliver lots of babies and radiology residents get to see lots of acute stuff in imaging and manage resources. For my specialty and some others, this does not change significantly, but it is still an important time of virtual independence.
Sure you get to do all of that stuff during the day. But, it is more concentrated at night.
The nights on call also add hours to your week, again increasing learning prospects. Not a bad thing. Also, you get paid a bit extra for doing call. Bonus!
All of this added learning is key when you are a resident because you want to become a great attending.
And attendings in most areas don’t have work hour restrictions, which is both scary and not surprising. Thus, they expect residents to hold similar hours, as residency is training for their job in the future. There are many pressures to work beyond your time. Often such behavior is rewarded as “dedication.” But, one can argue that not having significant work hour restrictions beyond the standard 24-30 hours is being realistic about future expectations.
Then, there is the flip side…
When you do call, there comes a point, particularly around 3am where you want to die. Literally, death seems possible. And you get another wind, but you are still kind of cloudy. Not terribly cloudy, you function on adrenaline, baseline knowledge and help from apps. I don’t think it is so impairing it is really dangerous all of the time, but it can become dangerous if you aren’t held accountable and the fatigue is prolonged (for instance when people stay after handover). I know myself, I wouldn’t want to be making big decisions after 24 hours of work. But, I have to sometimes.
Image via quarksdaily.blogs.
Then, the whole sleep deprivation thing messes up your day the next day. You aren’t around with the team for the rest of the day, so sometimes you miss out on important details and you play catch up some of the next day. And when you have to go home post-call, you miss teaching sessions and such. Plus, even if you post-call nap, you (at least I) still feel horrendous the rest of the day and night. And that next night of sleep really doesn’t fix very much. It takes at least two good normal nights before I feel back to myself. So, per call shift, I am screwed up for two days… Not cool.
On the other hand, work hour restriction complicates things too. It means you need extra people scheduled. It would change the whole dynamic of the medical team with fewer people. It also means more handovers (passing of information from provider to provider) and thus more room for error (also more room to catch missed things and such, which can be good). And some people will get relinquished to nights for blocks of time… Better for sleep habits, poorer again for things like teaching that happen during the day.
There is an argument that if hours get restricted much more; residents will need to add time on to training. I am already in a 5 year program. Do we really want to make it 6?
The good thing about work hour restriction is there are fewer sleep deprived people wandering around. As someone who needs a lot of sleep, this sounds wonderful. I like the protection and the accountability it would provide, as well as the safety for everyone involved.
Also, the costs of medical error and call stipend saved with further hour reduction may cancel out the costs of additional training time and staffing. The long term analysis on this is still lacking, although I suspect it may not be sufficiently significant to warrant complete change.
For me, the extra sleep and safety are worth the loss of call stipend and potential addition of a bit of time to my program. I also have home call for most of my training after my second year, so I may be biased because I am not really affected by it like some of my colleagues. But, as I sit here at 11pm waiting for test results on a few sick patients and wondering what the rest of the night holds, I do think it would be good to have designated night shifts or at least safer hours… I am currently 17 hours in… And still at least another 10 to go.
On the side of not being just a resident, but also someone who needs heath care from time to time, I have to say that I would much prefer a physician who is awake and alert and had their wits about them. I think most people who do call do still have their wits, but everyone has bad nights. The thing is, I would rather see someone than be told there is nobody available at all. So, I guess I fall somewhere in between on that standpoint. If there has to be someone there, then be there, even if you are tired.
So shoot me if you will… I would rather an awake doctor needing some extra training and extra staffing (despite costs) than a sleepy doctor. I know some people won’t agree. And I go back and forth. It is an issue that has been ruffling feathers in the medical field and has been coming to the forefront.
Enough about me… I would love to hear more about what you think on the subject!
Should residents have work hour restrictions? If so, how much should they be allowed to work (currently, were I work, we are expected to leave at 8am, but generally, I can’t go until at least 9 or 9:30. Some places are limiting shifts to 16 hours and others still max out at 30)? What about attending physicians? Should they also be restricted in hours? What do you think of physician work hours as a consumer of health care?