We've discussed what happens when I'm bored... But I think this just needed to be done:
The Countdown.
Sunday, April 24, 2011
Monday, April 18, 2011
On grief... and giving it
I am not the first, nor will I be the last intern to express their dislike for the weekend-day call at my current place of employment. But let me again say that trying to be a full time phlebotomist while covering all acute medical beds, plus admitted patients still in the A&E and the patients in ICU/CCU/HDU is virtually impossible. That isn't why this weekend was particularly brutal.
I don't particularly like losing patients. No one does. (not even palliative... that's an old joke). But I do understand when people are actively dying and beyond the reach of western medicine to save. It's a knack; some people can't tell, some people can. And when a patient is dying, it's important to make them as comfortable as possible. I do that. Whether by charting comfort measures myself, contacting a senior to do so, or ringing the palliative team for advice. But as an intern, if the reg or palliative consultant says the patient needs further active management, my job is to do as I'm told...
Also, death in an acute medical hospital is not, I repeat NOT, the same as dying in a hospice. The intern on call is not a palliative care nurse. They do not have just the one patient, in fact, they do not have just the one ward to cover, they have the entire fucking hospital. And it's almost a given that there is more than one acutely ill patient, if not more than one that is actively dying.
Now, let's combine the situation of weekend-day call with three patients actively dying with no palliative input, no comfort measures previously charted, and a reg that is difficult to get on the phone (let alone get up to the ward to see a patient). Disaster. But for the first time since I started practicing medicine, I had a family accuse me of being a bad human being. They tried to "soften the blow" by assuring me that I was probably a good doctor otherwise, but I completely lacked all compassion and empathy. It would have been easier to stomach if it'd been the other way around. I spent 20 minutes listening to them dress me down, accuse me of not caring, accuse me of not knowing what loss is. Then I apologised and had to move on.
Now with some distance, I can brush off the whole thing. Partly because they said some ridiculous things, including, "The most important thing for a doctor is to be with a family and patient at the time of death. Medical emergencies can wait." Maybe in a hospice, but not when you're the only doctor for roughly 130 patients. But that doesn't mean I didn't leave that awful day in tears. And you know what I learned... To stay further away from patients and families at the time of death. Because I can't afford to sit in the res and cry for 20 minutes when there are so many patients that are unwell. And I can't afford to spend 30 minutes with a family when they express displeasure. And I can't afford to lose any more of my self confidence dealing with things that are so far above my pay-grade and experience.
I don't particularly like losing patients. No one does. (not even palliative... that's an old joke). But I do understand when people are actively dying and beyond the reach of western medicine to save. It's a knack; some people can't tell, some people can. And when a patient is dying, it's important to make them as comfortable as possible. I do that. Whether by charting comfort measures myself, contacting a senior to do so, or ringing the palliative team for advice. But as an intern, if the reg or palliative consultant says the patient needs further active management, my job is to do as I'm told...
Also, death in an acute medical hospital is not, I repeat NOT, the same as dying in a hospice. The intern on call is not a palliative care nurse. They do not have just the one patient, in fact, they do not have just the one ward to cover, they have the entire fucking hospital. And it's almost a given that there is more than one acutely ill patient, if not more than one that is actively dying.
Now, let's combine the situation of weekend-day call with three patients actively dying with no palliative input, no comfort measures previously charted, and a reg that is difficult to get on the phone (let alone get up to the ward to see a patient). Disaster. But for the first time since I started practicing medicine, I had a family accuse me of being a bad human being. They tried to "soften the blow" by assuring me that I was probably a good doctor otherwise, but I completely lacked all compassion and empathy. It would have been easier to stomach if it'd been the other way around. I spent 20 minutes listening to them dress me down, accuse me of not caring, accuse me of not knowing what loss is. Then I apologised and had to move on.
Now with some distance, I can brush off the whole thing. Partly because they said some ridiculous things, including, "The most important thing for a doctor is to be with a family and patient at the time of death. Medical emergencies can wait." Maybe in a hospice, but not when you're the only doctor for roughly 130 patients. But that doesn't mean I didn't leave that awful day in tears. And you know what I learned... To stay further away from patients and families at the time of death. Because I can't afford to sit in the res and cry for 20 minutes when there are so many patients that are unwell. And I can't afford to spend 30 minutes with a family when they express displeasure. And I can't afford to lose any more of my self confidence dealing with things that are so far above my pay-grade and experience.
Thursday, April 14, 2011
Deep breaths
Finally a bit of good news...
Ok, it's not a bit, it's a huge chunk, a meteor of good news. I have my jobs for the next 2 years. I accepted the offer nearly straight out. It's a training scheme job (so it's protected), I'll be in Dublin for 75% of the time (and commutable for the other 25% if I'd like), the order of my rotations is practically perfect (I couldn't have designed it better myself), I'll stay in my current flat for another year (so no moving at the moment, woo hoo), and I can get by without really needing my car for the first year (sorry, Timmy, you're going to be upgraded eventually).
This is such an immense relief for me. Sinead said she could see me visibly decompressing... I feel better. It doesn't change what's happened in the past few weeks, and it can't make everything better. But from the job front, that concern is gone now. I can plan for things again. I can keep nesting my flat. I stay in Dublin. Whew...
Ok, it's not a bit, it's a huge chunk, a meteor of good news. I have my jobs for the next 2 years. I accepted the offer nearly straight out. It's a training scheme job (so it's protected), I'll be in Dublin for 75% of the time (and commutable for the other 25% if I'd like), the order of my rotations is practically perfect (I couldn't have designed it better myself), I'll stay in my current flat for another year (so no moving at the moment, woo hoo), and I can get by without really needing my car for the first year (sorry, Timmy, you're going to be upgraded eventually).
This is such an immense relief for me. Sinead said she could see me visibly decompressing... I feel better. It doesn't change what's happened in the past few weeks, and it can't make everything better. But from the job front, that concern is gone now. I can plan for things again. I can keep nesting my flat. I stay in Dublin. Whew...
Monday, April 11, 2011
Can't this time thing go a little faster?!
I'm back to holding my breath. I'm holding my breath for Wednesday night when I get the final word on jobs... Oh wait... I'm on call... screw that. Let's hold out for Thursday. I'm holding my breath, waiting to see where I'm going to live. I'm holding my breath waiting for words from home. I'm holding my breath in hopes that I've been horribly horribly mistaken. And I'm holding my breath for the next break I get.
I want to again express my utmost condolences to the Cutlers. I want to thank my brother for letting me know. I want my dad to know I love him, and want to give him a hug. A friend like Robbie is an absolute blessing.
I want to thank my brothers for handling Zadie. She was the sweetest kitty. I'm sorry I wasn't there.
I've had friends come and go in my life before. I'm sure there will be more that leave. But this time, it feels so much more painful than ever before. Maybe it's the timing... It's been a difficult few weeks for me. Maybe it's the sudden disappearance with no word... Maybe it's because I feel like a total fool in this, believing that people are actually good. So much for restoring my faith in humanity. My faith in myself. Time heals all wounds... But scars can last a lifetime.
I'd appreciate if my friends would stop giving themselves head injuries that land them in hospital, and avoid car accidents that wreck their cars. You two are lucky that I didn't kill you myself... And Aido, you're lucky I wasn't on call.
I really want to clean my apartment. My fingers are itching to scrub everything from floor to ceiling. I've been in a purging mood. I've rid my room of a few bags of baggage that needed to go. But I can't really settle down to clean properly unless I know whether I'm staying or going... Ugh Wednesday... I'm trying to distract myself. I'm trying to find things to occupy my brain. There's not much I can find.
I did make myself some cake... In a mug... it was worth it. I should probably thank the lads for providing some boozy distraction. And Shinners for the everything.
I want to again express my utmost condolences to the Cutlers. I want to thank my brother for letting me know. I want my dad to know I love him, and want to give him a hug. A friend like Robbie is an absolute blessing.
I want to thank my brothers for handling Zadie. She was the sweetest kitty. I'm sorry I wasn't there.I've had friends come and go in my life before. I'm sure there will be more that leave. But this time, it feels so much more painful than ever before. Maybe it's the timing... It's been a difficult few weeks for me. Maybe it's the sudden disappearance with no word... Maybe it's because I feel like a total fool in this, believing that people are actually good. So much for restoring my faith in humanity. My faith in myself. Time heals all wounds... But scars can last a lifetime.
I'd appreciate if my friends would stop giving themselves head injuries that land them in hospital, and avoid car accidents that wreck their cars. You two are lucky that I didn't kill you myself... And Aido, you're lucky I wasn't on call.
I really want to clean my apartment. My fingers are itching to scrub everything from floor to ceiling. I've been in a purging mood. I've rid my room of a few bags of baggage that needed to go. But I can't really settle down to clean properly unless I know whether I'm staying or going... Ugh Wednesday... I'm trying to distract myself. I'm trying to find things to occupy my brain. There's not much I can find.
I did make myself some cake... In a mug... it was worth it. I should probably thank the lads for providing some boozy distraction. And Shinners for the everything.
Saturday, April 9, 2011
Legend...
Robert J. Cutler Obituary: View Robert Cutler's Obituary by The Boston Globe
I've known Robbie most of my life (or rather, I should say that he has known me). Robbie and my father were friends since they were terrorizing the Boston neighbourhoods as kids. They survived college, they survived the Navy, they survived business, they survived marriage, they survived moves around the country. When my uncle passed away, Robbie flew last minute to Florida (I won't say how) to keep my father company. He made numerous trips to Ireland for the craic. He loved golf. He loved the Red Sox (and pretty much all things Boston). He loved life. He was wild in a great way. Absolutely full of life to the end in spite of everything. Robbie, you will be missed.
I've known Robbie most of my life (or rather, I should say that he has known me). Robbie and my father were friends since they were terrorizing the Boston neighbourhoods as kids. They survived college, they survived the Navy, they survived business, they survived marriage, they survived moves around the country. When my uncle passed away, Robbie flew last minute to Florida (I won't say how) to keep my father company. He made numerous trips to Ireland for the craic. He loved golf. He loved the Red Sox (and pretty much all things Boston). He loved life. He was wild in a great way. Absolutely full of life to the end in spite of everything. Robbie, you will be missed.
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