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