Tough Days

**Warning: morbid, do not read**

Hey all-Just finished a 33 hour shift at the hospital, it was my most challenging yet. From the moment I walked in the door we had one patient actively dying and two more heading that direction. My pager would not stop, and family was gathering for our patient "in extremis". I managed to get the paperwork in order, including request for autopsy, between all the wailing and crying. He was a beloved patient over the last several weeks, not sure what happened exactly, so I called the medical examiner myself to make him aware of our concerns. Starting the day this way I knew it was going to be rough!

Just a few hours later another patient rapidly decompensated, troubling EKG findings and rapidly rising enzymes indicative of a massive heart attack. Unfortunately, family had only been recently notified that he was in the hospital because he was found in a ditch having massive head injuries from an apparent assault and it took several hours to find out who he was. So, they arrive to find him "in extremis" as well. Since I was the oncall, I took the lead on explaining his poor prognosis (mostly related to the massive head injury, then the heart attack), and managed to get a DNR order. Autopsy is automatic since this was quickly becoming a murder case. I waited for family to arrive, about thirty of them, and turned off all the drips while started a steady infusion of pain medicine, that is when it got awkward.....

So yea, he didn't die right away like we all predicted, and the family gathering stood anxiously for about an hour - then started leaving, and leaving more, as he lasted late into the night. So, I guess we don't know everything. I kept monitoring him from a remote system, and his heart just hung in there - not enough to sustain life but just enough to make this even more painful for the intern on call. Everytime I walked by they thought I was coming to pronounce him. It wasn't until about 3am that his heart gave out and I pronounced death on my first patient. For the first time, I found myself actually smelling like death, it is very distinct. Pleasant, huh?

All in all, I arrived at 5am that morning and did not eat/drink anything until 11:45pm that night. Though the conditons are extreme, I am learning so much, and my confidence is increasing. I wouldn't trade it for anything, and I am glad I am forced to do it because nobody would choose to be in this horrific situation. As a physician, it is an experience worth having though it is painful at the present.In addition to the awkwardness of my patient sort of "hanging in there", I had several admissions and various mundane issues with the other patients. I was able to start an arterial line and assist with a chest tube placement - pretty good for a rehab doctor. I am not sure how it happened, but the morning came quickly. One of our nurse pracitioner helpers took the day off, so we were severly short handed with more than our normal number of patients. I ended up having twice the number I usually take, which made the morning even more busy. My fellow interns are just not able to help very much, but they are nice people. What a perfect storm!

After all this cr*p going on, working way beyond my hours, and dealing with the aforementioned surgery types, they have the nerve to begin recruiting me into surgery!!! That is like some bully that beats up on you for three weeks turning around and asking you on a date. I just laughed and told them I was not nearly sadistic enough to be a surgeon, which is the truth. I love rehab, and this makes those pastures even greener. I enjoy the compliments and that always makes me feel better, but it doesn't change the circumstances.

Sorry for being so negative, I am actually doing well, I just wanted to share the events of the last few days to keep you up to date. I don't think the shows on tv acurately portray what residency is really like, the pressures, the sounds of the alarms/venilators, the crying families, the distinct odors - it all gets smushed up together in the ICU, which is why I mostly stay in the musky call room with a tv from 1981.

It has been standard for me to miss David while I am at work, but I am really surprised at how much I miss my three dogs. If I randomly think of them I get a little choked up, and I had not considered myself one of those crazy dog people either. If you don't already know, Boston sleeps right next to me every night and even when I am post-call during the day. It made me think that there are some people in my position who have kids, notably the other intern (male) who has a 4 month old, I just don't understand how they do it!! For the last four years I knew internship would be tough and that is why I always decided to hold off on starting a family - and now that decision is proving to be extremely accurate. I don't know how I would do this if I had kids, which is why it is not uncommon for people to leave residency altogether as a result of this particular rotation.

So anyway, the prognosis of this rotation is improving. It appears that three of the four interns during August are American, which is a good start. I think things will improve - if nothing else it is getting closer to being over!Love you guys, back to sleep for me! Becky

Thank you guys! I'm absolutely ecstatic. the only thing I'm sad about is that Shawn probably won't be back in time for the delivery. But I'm not gonna let it get me down. The cravings have begun, but it's for the better so far all I really want to eat is fresh fruits, veggies and lots of soup. I'm currently snacking on prunes and blackberries. My due date is somewhere in early Mar to late Feb.

I'm glad to hear Buster is doing better, he's a real fighter. I hope he stays as positive as he can. Moniquee and Lexi are growing up way too fast we need to work on something to stunt their growth. : ) I miss my little thumb-sucking, amanda-toting, Olsen-twin uber-fan of a cousin, not to mention my cheeky Moniquee.

Being doctor sounds exhausting, but very interesting. All my knowledge of that line of work comes from scrubs and Grey's anatomy though. I hope you have a ton of fun on that cruise. Shawn and I will definitely have to look into that sometime.
Well I'm off to bed now, God Bless you all and I miss you chingos.

Updatin'

This is how most of my patients arrive... In Style!!

Hello Supportive Community of Family and

Friends -
Boy, am I in it now! There is no looking back! Two weeks into doctorhood and it feels like a lifetime. I will spare the gruesome details, but in general, each of my call days consists of: 1) dude +/- beer, riding motorcycle and hits a deer (three so far -always looks like the deer wins) 2) drunk dude + poor decision making + car + pole = braindead badness 3) half-dead dude with no chance of survival sent to University so we can finish the paperwork 4) drunk dude hit with sledgehammer. I have started to call it "social disease" - since these things happen to a very specific population. In fact, it has heightened by interest in the correlation between trauma and unempolyment, since many parents tell me "he was doing so great, then he lost his job, then he started drinking and being irresponsible".

He will mess you up!!

Otherwise I pretty much have no life. I slept about 16 hours on my day off. Today, I ventured to Target which was a big step for me. Before my rotation started I was worried which weekend day I would get off (Sat or Sun), haha, funny story, my day off can only be a Mon-Thur. So yes, I work every weekend for two months, it's great.

Not to be too pessimistic, I actually enjoy taking care of the patients and families. The nurses are the top of the line. In fact, patient care is the highlight of my day. The intense pains and agony come from dealing with the surgery team - transiently incompetent, disorganized, and arrogant to boot. They make things about 100 times more miserable than they should be. It is a punitive environment where a bunch of surgeon types are all positioning to establish themselves as the dominant, omniscient demi-god they have always thought they were. I am like an anthropologist in some chimp colony. They make a bunch of sounds and movements while I try to discern what they are really communicating to us regular folk. So, this set of mammals will move on at the end of the month and I hope that situation will improve. All in all, my plan is working, because I am completing this obstacle without missing any Aggie or Spurs games - because that would just throw this one over the top.

So, tata for now, I am on call again tomorrow. Thank you for all of the support. David dutifully keeps my scrubs washed and folded, and my in-laws graciously bought us a new water heater and room air conditioner. So, a hot shower and cold room post call! Awesome!

Love, Becky

PS CONGRATULATIONS MICHELLE!!

Condolences, Congratulations, Questions and Updates

Condolences
I was very sad to hear of Felipe De La Fuente's passing. I'm sorry for the loss that the De La Fuente family is going through, and if there's anything that I can do please let me know.

Congratulations!
On a happier note, I'd like to congratulate Michelle and Sean (did I spell that right, or is it Shawn?) on their pregnancy! Children are blessings and I'm excited for both of you. You guys are always in my prayers. I know that Sean in training right now, but once he's deployed let us know what his address is and what things that we might be able to send him in a care package. Maybe each family can take turns sending him some items once a month or something like that? It's just an idea...let's discuss it. Here's a funny story--when my step-brother Ted was in Iraq he asked us to send him some Nair! He's pretty hairy and it was so blasted hot over there he needed something to get rid of all of the hair and Nair was it! :)

Questions
Becky, now that you've graduated what's the next step? What are you specializing in? I'm not very familiar with the process of becoming a doctor, so I thought I'd ask.

Dave, I noticed on your profile you said that one of your interests is Hispanic Literature. I really took an interest in American Literature after I took Am. Lit in college, but I've never read any Hispanic Lit. Do you have a favorite author piece that you would suggest that I read?

Updates
How is everyone doing? What's happening in your world--anything new? It doesn't even have to be exciting news, just tell us how you're doing, share a recipe, post a picture, etc...It would be nice if everyone would post some sort of an update. :) How was the reunion? We really wanted to go, but Buster was really sick, and I couldn't see leaving him at home by himself.

The infection is Buster's hand is gone, and he was finally able to resume chemo treatments last week. His next CT scan is scheduled in about a month. Lexi is in no hurry to go back to school, but the summer does seem to be passing by very quickly! I was reminded a couple of days ago that I still haven't mailed out her 9th grade school pictures, and she's about to start the 10th grade! I guess I better do that before school starts, so look for them in the mail soon. :) My garden is doing pretty well. It turned out that it's too small for all of the veggies that I initially planted. The zucchini and the tomatoes took over so the carrots, radishes and onions got blocked from any and all sunlight.

Well, I better go for now.

I love all of you,
Lizard