Then Sings My Soul (alternate title: The day I cried like a baby infront of complete strangers)

I apologize for my extended blogging absence.  I temporarily lost my blogging mo-jo.  Because I was working 80 hour weeks.  So I guess I temporarily lost everything but the basic functions needed to sustain life....heart beat, aerobic metabolism....you get the picture. 

I did another stint in Palliative Care last month and I loved it!  I'm fairly certain that I'll do a fellowship in PC after I finish my Internal Medicine residency.  If you're not familiar with PC, it's functions are broad.  Palliative Care docs help manage symptoms, help patients and families navigate our complex medical system, support patients and families during difficult illnesses and help in end of life care.  That barely scratches the surface of what Palliative Care involves, but I'll leave it at that for now. 

So during my Palliative Care rotation, I got to spend a few days at the Hospice House.  This is a really beautiful facility that houses patients who are often in their final days.  One afternoon at the HH, my attending suggested that I shadow the music therapist.  I'd never seen the music therapist in action, so I agreed. 

We walked into the room of a patient whom I had never met.  I introduced myself to her family and took a seat at a small table.  The music therapist took out her guitar and asked the patient's son what kind of music his mother liked.  It didn't take him long to report that her favorite music had always been hymns.  If there is one thing in this world that is guaranteed to make me cry....hymns. 

The music therapist then started strumming her guitar slowly.  The first sounds of an old familiar song.....How Great Thou Art.  

Hello there, my name is Dr. Bartlett, and I have a tendency to cry.....easily.

It was surreal as she sang:
When Christ shall come
With shouts of acclamation
And take me home, what joy shall fill my heart......
Then I shall bow
In humble adoration
And there proclaim
"My God! How great Thou art!"

She finished How Great Thou Art and went right into His Eyes are on the Sparrow.  

Breathe.....just breathe........weenie.

Then In the Garden, one of my dad's favorite songs.

Are you kidding me, lady? 

All the while, the patient is lying in her bed, eyes closed.  Peace and serenity evident in her wrinkled face.  Her son recalled her involvement in the church throughout the years....up until she became too sick to attend. 

And then.....you can probably guess for yourselves.  The final nail in my coffin. 

Amazing Grace

I tried to focus on something....anything other than the fact that I was in a room with a dying woman and her family, listening to Amazing Grace.

I generally find catheter bags helpful in these situations.  (Hum....wonder how many cc's in the last 24 hours.  Looks kind of dark.  He he....that's pee pee!)  But this patient didn't have a catheter.  Blast!
I managed to hold it together until the last verse.  The last verse is often left out, especially in all of the new-fangled versions of the song (don't get me started).  But the last verse is my favorite:

When we've been here ten thousand years
Bright shining as the sun
We've no less days to sing God's praise
Then when we've first begun

Stick a fork in me.

So there I sat.  Trying to be all professional and doctor-y, but reduced to a puffy-eyed, snot-dripping, tear-streaming, blubbering mess.  Seriously.  I was crying so hard I could barely speak.  In a room full of strangers.

I was sure that the patient's son thought I was nuts, but when the music ended, he put his arm around me and said, "That lump in your throat is what will make you a great doctor.  Don't lose the lump." 

The music therapist and I stepped out of the room and I tried to make a joke about regaining my composure, but I still couldn't even speak.  I spent the rest of the day with red, puffy eyes and splotchy skin.  The curse of a fair complexion....and a tender heart.

T waves

Last month I had a patient with a potassium level of 5.5 when I checked his labs in the morning.  5.5 is slightly elevated.  Slightly elevated potassium scares interns (me).  Slightly elevated potassium can turn into really elevated potassium which can turn into an arrhythmia which can turn into death.  Death is bad - I catch on quickly.  So I did what any good intern would do....rechecked the potassium level and got an EKG.  Sure enough, potassium was still high on the recheck, and the EKG.....well....I'm only on chapter 3 of Dubin's Rapid Interpretation of EKGs, but it looked to me like the T waves might be peaked.  They were certainly tall.  But I wasn't sure.  This is the part where the intern (me) freaks out a little bit.  Peaked T waves can be the first sign that the elevated potassium is affecting the patient's heart.  It was certainly affecting the intern's (my) heart....as it began beating more rapidly. 

Are these T waves peaked?  Well heck....they look a little peaked....maybe they're just tall....tall but not peaked.....or maybe they're just peaked and the patient is going to die in 5 seconds because you don't know the difference between peaked and tall.  Maybe you should just call your senior....or maybe you should sit down with your head between your legs.  Or maybe you should go get a doughnut. 

Just then, a senior resident, who I'd never spoken to before in my life, started walking down the corridor toward me.  I lurched out from behind the patient's chart, clutching the EKG in my hands, knuckles white, thrusted it out in front of me and said, "ARE THESE T WAVES PEAKED!?!?!?!"  My heart was beating 500 times a minute....I was about to call a Rapid Response on myself.  He looked at me like I was crazed....which was an accurate evaluation, but he took a quick glance at the EKG and said, "No....just a little tall.  Give him some calcium gluconate, D50 and insulin, and a little kayexalate." 

Yeah....that's what I thought......

So now I'm much more comfortable managing hyperkalemia. 

Next time....managing an upper GI bleed. 

briefly....

I got to sleep in until 6:40 this morning.  There was a bright yellow ball in the sky when I drove to work.  This frightened me initially.  Then I recognized it as the sun. 

The End

No, but I play one on TV

Most days I feel like a complete and utter impostor.  I walk around the hospital with my long white coat, examining patients and writing orders and wondering who in the world thought it was a sound idea to slap an MD behind my name and let me be responsible for sick people.  Nurses address me as "Dr. Bartlett" and ask me questions about patient care.  They call and tell me that my patient just had a run of sinus tachycardia in the 170s.  Then they ask me what I want to do about it.  My response usually starts with an  "Uh......well......uh......"  Then the pharmacist pages me wondering why on God's green earth my patient with c. diff is on both vancomycin AND imodium.  "Well.....er.....uh....."  I've heard on several different occasions that you just have to act the part.  So far, I think I'm a pretty crummy actor.

And speaking of pharmacists...they must think that doctors are the biggest idiots in the world.  We have a pharmacist that rounds with us daily, and bless her heart, she's as sweet as can be, but the look on her face would suggest that she wonders, frequently, who in the world thought it was a sound idea to slap an MD behind my name and let me be responsible for sick people.  She paged me yesterday and had to explain that the dose I'd written for on a particular medication didn't exist.  Intern fail. 

Thursday was a bad day.  I felt particularly incompetent on Thursday.  I spent most of the afternoon on Thursday cornering my co-interns in the halls and asking them if they felt incompetent every second of every day, like I did.  The response was an overwhelming YES.  So that made me feel better.  Then I called my smartest doctor friend Bethany and she reported that she also felt incompetent on a daily basis.  Again, I was reassured.  I believe, however, if you got a CT of my head, you would see a striking amount of atrophy.  Or nothing at all.  Just a big, empty skull.  Abrainia. 

Today was a better day.  My incompetency meter was probably a 4/10 today, as opposed to a 9/10 like on Thursday.  And I got home at about 4.  And I have tomorrow off.  That means I can go to church and ask God to make me a little less incompetent. 

So, in summary:
 - I am incompetent
 - Pharmacists believe most doctors to be stupid
 - Pharmacists are correct in their assessment
 - I have the day off tomorrow

Differential Diagnosis Part 2

During my Hematology rotation, I became convinced that I had leukemia, or some other horrible cancer that had metastasized to my bones. My symptoms were: weight loss, night sweats and leg pain.  I had several conversations with my senior resident trying to convince him that I needed a bone marrow biopsy.  He thought I was crazy. 

After analyzing the situation further, it was determined that my symptoms were residency induced.  The leg pain was secondary to being on my feet all day, and being dumb enough to wear heels.  The night sweats were caused by my crazy stress and anxiety.  They got better when Danny started turning the fan on at night.  And the weight loss....well, I guess that's expected when you have no time to eat.

So....I feel better now. And I have all day tomorrow to try to re-gain the weight I've lost.  And my senior resident was right.  

Day Off!

Happy Saturday to you!  This is my fourth day off for the month and I'm enjoying the heck out of it!  I went to bed last night at 9:30 and woke up this morning at 9.  During that time I dreamed that I had another baby....who I delivered all by myself.  And then somehow I ended up in a canoe.  And then a strip club.  Freud would love me.  Last week I had a dream that I could palpate my own pancreas.

Enough about my freaky-weird dreams.  Things at the hospital have been good.  I kinda-sorta feel like I'm getting the hang of things.  For one, I've learned that when I go to the bathroom, I should leave my pager elsewhere.  I've also learned not to pimp the med students.  They seem to know more than me.  But my coat is longer, so neener neener neener. 

Oh, and my journalism degree is finally benefiting me.  I've received several complements from my fellow and my attending on how nicely written my consult notes are.  This really says nothing about how knowledgeable I am about Factor IX deficiency or thrombophilia, but how well I can feverishly scribble down what my attending rattles off and translate that into a note.  It's been suggested that I write better than I speak.  I'm not sure what to make of that.  Maybe I'll stop speaking. 

And of utmost importance.....I finally got PAID!  They don't pay the residents very much.  One of these days I'll calculate the hourly rate.  I anticipate it will be in the neighborhood of $3.00ish/hour.  But regardless of how measly my salary is, and how utterly and hopelessly and hilariously in debt I am, when your family income doubles all of a sudden, you can't help but feel like you're RICH!  I've warned Danny that I might go a little "willy nilly" and take myself on a shopping spree (don't tell Dave Ramsey!).  I told Louisa that we can start shopping at Gap Kids and Janie and Jack.  She didn't seem to care.  At the time of this conversation, she was wearing a yellow and white polka-dot halter top and pink and white stripped terry-cloth shorts....happy as a clam.  Okay, so I won't go too willy nilly with my newly found riches, but at least I can buy myself some new underwear so I won't have to do laundry so often.

Alright, I'm going to get back to my day off.  Have a lovely weekend!

-Dr. B 

Hellooooooooooo

Is anybody out there?  Anybody? 

Just wanted to let you all know that I'm still here.....still alive.....haven't been eaten by the boogie man.

Residency is going pretty well so far.  Everyone has pretty low expectations of the interns which is fantastic.  I'm on the Hematology service, so I see lots of patients with leukemia and lymphoma.  Cancer sucks.  That's what I've learned so far. 

My attending is an old salty fellow who is quite legendary at the hospital.  He commands the attention of everyone in the room and he makes my blood pressure, as well as my anxiety level skyrocket when he shoots me his infamous, squinty-eyed glare.  My co-intern and I, as well as the two med students on the service, have taken several a tongue-lashings from him.  But as much as he tears us down, he tries to build us back up as well.  His tirades usually go something like this:

One breath:  Why didn't you check Mrs. So-and-so's fibrinogen?  That is completely irresponsible!  Is this your patient?  Are YOU managing this patient?  Why don't YOU know the side effects of all of the medications she is on?

The next breath:  I remember what it was like to be an intern.  It's hard.  You don't know whether you're coming or going.  You guys are doing just fine.

The third breath:  Did the patient have pulsus paridoxus?  What?  You don't know?  You didn't check?  This patient might have tamponade and you didn't CHECK FOR PULSUS PARIDOXUS!?!?!?

Next breath:  You guys are doing a fine job.  I think we have a really strong team of residents and students. 

I must say, although I might be developing an ulcer, I really like this attending.  When he's not making us want to pee our pants, he's so darned funny that I forget how scared I am. 

So that's what's been going on with me.  I've been averaging just under 80 hours a week, but when I'm at the hospital, the time seems to fly.  I hardly have time to eat and go to the bathroom.  This might be the best diet plan ever.  And when I finally had time to eat today, I really had no appetite.  Hard to snarf down a quick meal when you can't get the sight and smell of your patient's diarrhea out of your head.  (Thank you, Mr. Patient, for saving that just for me.)