Dec 28, 2011

The Twelve Doors of Christmas

I worked every day this Christmas holiday, 7am-7pm, sometimes longer. It was the first time I'd been away from my family during Christmas, and my first Christmas as a doctor. Here are twelve of the doors I walked into this Christmas Day.

Starting the holiday in the OR, ready to c-section twins in my Christmas scrub hat!

Door 1: The Intern Call Room (A Sad Resident)

I open the door to my call room to change and find my fellow intern sitting on the bed, crying. I asked her what was wrong? She said she had cried all the way into work, because her two small children didn't understand why she had to leave Christmas eve, why she wouldn't be there to watch for Santa and see them open stockings in the morning. I was so sad for her. It's hard to want to be with other people's babies, she explained, when you just want to be with your own.

Door 2: The Gift Shop (Good Sam)

I open the door to the gift shop. Christmas Eve, the hospital gift shop is advertising all holiday merchandise 50% off! I buy myself an ornament, to mark this first Christmas working as a doctor,. The first of many, I'm sure. I named him Sam, after Good Samaritan hospital.

Sam the Snowman

Door 3: Triage (The Reluctant Partygoer)

I open the curtain to the triage room. There is a woman I just can't get rid of. You're not in labor, I explain. You're rarely contracting, your cervix hasn't changed. She refuses to leave, insisting that she's in labor and will just come right back if I discharge her. I wonder why anyone would want to sit in triage on Christmas Day if they didn't absolutely have to. I ask her if she wants to go home, since she doesn't have to stay here? She replies that she has a large family party at her house to go to, and just really doesn't want to she has presented for preterm labor. I ask her when the party ends, and discharge her home afterwards.

Door 4: The Resident Room (My Family)

We all walk into the resident room. It's a small lull in the day, so all five residents crowd into the shared resident room and turn on a tiny TV and make popcorn. National Lampoon's Christmas Vacation is on, and we share an hour and a half of watching it together, laughing, occassionally interrupting to return pages, and just enjoy being together. We are all away from our families this Christmas Day, and are grateful to enjoy our residency family.

Door 5: The Resident Room, later (Her Family)

One of the resident's kids come to visit. They have on their new Christmas PJs (see next photo), and have come for Mom to give them a hug before they get tucked into bed to wait for Santa.

Door 6: Triage, later (Santa Surgeons)

We all put on Santa hats and open the door to triage to take a picture in the emergency birth room. John, one of the second years, later tried to keep wearing it and pass off the hat as a scrub hat. Turns out Santa is not allowed in the operating room. HO HO NO.

Christmas Call Team!

Door 7: The Intern Call Room, later (My Other Family)

I open the door to my call room and open my iPad. My family has woken up in California, and are opening gifts. I have them wait until I am between deliveries, and then get on iChat with them and watch them open presents. My husband even opens a gift for me, with me "holding" it up via the screen. It was fun to feel like I was a part of it even though I was here.

Ryan and me "holding up" my new sweater!

Door 8: An Antepartum Room (Christmas Dinner)

I'm taking care of a girl that has been admitted for weeks for preterm labor. She'll likely be here until delivery, and would not be home this Christmas. I open the door to her room to round on her, and find about twenty-five people in that room, along with a Christmas tree, gifts, and even a crock pot plugged in with something delicious-smelling inside! This girl's entire family has come and brought their Christmas party to her room. I almost fall over with happiness when they invite me to sit down and eat with them.

Door 9: A Delivery Room (The Manger)

I walk through the door after being paged for delivery. I am delivering a nice Hispanic woman, Maria. She names her baby boy Jesus. I love it. How many people get to deliver Jesus on Christmas Day?
The hospital's special holiday newborn outfits, on the delivery table

Door 10: Another Antepartum Room (My Kiss)

I go into another long-term patient's room. She's been admitted with preeclampsia, and staying until she is delivered, which might be a couple more weeks. She has a few family and friends over, and they have a table full of yummy-looking sweets, and a glass jar full of Hershey's kisses. I talk to her for awhile about her baby, the plan of delivery, and ask if she has questions. She says no. I say, "well, I have a question." I point to the jar and smile. "Can I have a Kiss?" One of the guys in the back calls "So THIS is the kind of doctors we have working here. Come back here, sweetheart. I'll give you a kiss!"
I want to die. And definitely not round on her for the next few weeks!

Door 11: Another Delivery Room (Sixteen)

I walk through the door of another delivery room as a baby's heart rate drops. We put the mother her on her side, give her oxygen, and the baby's heart rate comes back up. I'm not ready to leave though. I sit in the rocking chair in her room, watching the heart rate tracing, rocking as she falls asleep. She is sixteen, and here in labor with her first baby. I rock, and think about the Christmas that I was sixteen, eleven years ago. I fell asleep excited Christmas Eve, in anticipation of my stocking. I wanted, and received, things most teenage girls would like- a new pair of cool shoes, some clothes, bubble bath, fuzzy slippers. This girl's stocking would maybe have things for her baby, or maybe no stocking at all, as she labored here Christmas Eve. I rocked and rocked, and watched her and her baby for a long time, until my pager finally pulled me away.

Door 12: Home (At Noor's)

We push the door open to the apartment. I'm staying with my dear friend and fellow intern Noor, who is working the same long Christmas days as me. She lives much closer to the hospital than I do, and offered to let me stay at her house. I am so tired. We share a piece of leftover chocolate cake, and stretch out on the couch with HGTV and a bottle of wine. I fall asleep that night, happy that I've survived my first working Christmas, and happy that it's over.

Me and Noor

Dec 23, 2011

Missing Grandma

Recently my grandmother was sick. I got news of a stomach bug, and didn't think much of it. Then, she was sicker. She went to the OR for a bowel resection after an obstruction was diagnosed, and had subsequent kidney failure. I anxiously pressed my parents for what the surgeon said, for a consent to send me the operative report, for information on previous kidney function, and prognosis. I asked, and asked, and they just couldn't tell me much. I desperately wanted to see her, wanted to talk to her physicians doc-to-doc, to really understand what was going on and evaluate her with my own eyes and hands, to tell her I love her. Because after all my time working in the ER, the ICU, with patients that are very sick, I know that there are no guarantees at eighty-five, that sometimes there are things we just can't fix.

And I was here. Working. Taking care of other people's families, while I just wanted to take care of my own. I would get little bits of information, and tell my parents what I knew about her illnessess, that this was a normal course for bowel obstruction, that often times kidneys can recover if it is an acute failure. I talked to my sister before she went to visit, warning her that Grandma would look sick, and have a tube coming from her stomach to her nose draining vile looking green liquid, and that this was normal and she shouldn't be alarmed by it. I was angry about being here, knowing the only time I would get off for this illness was if she died from it, and by then, what would my being there matter?

I thought about Grandma as I touched my patients, caring for them, praying that somewhere, some other doctor was taking good care of her. That some other doctor was away from his own family because he was taking care of mine.

And she got better. Not all the way yet, but better. The kidneys recovered, as I thought they would, and she was able to eat again. But this experience stuck with me, because someday, someone I love will be sick, and I won't be able to be there. I won't be there to care for my loved one, to explain to my family what is really going on, what these medical words mean, and I'll be making guesses over the phone, just like I did this time, waiting for an operative report to be faxed and feeling helpless. This is an unspoken sacrifice of becoming a physician, and one that I underestimated. Somewhere in the greater universe, it makes sense to me that this is the sacrifice of all physicians, and that we take good care of our patients because these patients could be our own loved ones, and sometimes they are.

But I still wanted to be there.

ToMAYto, ToMAHto

I work with with thirty-three different attendings. Who want patients managed, needles held, stitches thrown, lacerations repaired, knots tied thirty-three different ways. It was part of the learning curve, at first, learning which attending liked what, remembering who to call about different problems and learning to not be upset when I didn't remember who preferred what. And now, I'm starting to develop what I like. Many attendings have offered me pearls, on patient management and surgical skills, and I'm starting to develop a framework of what I want to do, what I think works well. And this is even more frustrating, because then I end up with someone new, who doesn't like the way I am doing something, and makes me do it a way that doesn't feel natural, or right. And really, no one is very wrong, but it means I am never right. It's like how some people say "toMAYto" and some say "toMAHto." No one is actually right, and everyone insists that they are.

Here are some examples:

Yesterday in the OR, an attending showed me a way to reload my needle without touching it with my fingers. Use the pickups, inch it out, and regrasp it in a way that it was ready to throw the next stitch. Better technique, he explained, it would allow me to avoid needlesticks and was a more sophisticated surgical technique. I practice, and look forward to my next c-section, where I can practice it again on a real patient. I start, expecting the attending to be impressed or at least not say anything, but she yanks the needle out of my hand and shows me how to do it....exactly like I used to. I pick up the needle, reload it using my fingers, and silently curse this frustration.

An attending that puts me on the stool in front of the mother. She does this under the assumption that this is a good position for me to deliver the baby, but I have figured out the real reason. She puts me on the stool, then waits for the crucial moment when the baby is about the deliver, then rolls me out of the way and delivers the baby herself.

Antibiotics. Some give antibiotics for GBS+ mothers at the beginning of inductions, and some only when they are actively laboring. The downside to the first option is a mother can receive fifteen doses of a medication that burns their veins and is unnecessary for that long. Alternatively, a mother can labor quickly and not get enough of a dose in and end up with a baby in observation in the NICU for 48 hours. So, I started to ask each attending, when would you like the pencillin started? They couldn't believe I was asking this, like I didn't know. Then, I would ask with one option offered, would you like this when they are in active labor? Some people then thought I was correct, and some thought I was an idiot. So, no matter what I think or what I would do, I look stupid at least half of the time, just trying to please everyone.

I am fairly ambidextrous, and can operate either right or left-handed. Some think this makes me versatile, and encourage maintaining both. Others yell at me to pick a side and stick with it. Now I don't know which side to stand on. Likewise, I can clamp and cut cords after delivery lefthanded. Usually I hold the baby in my right arm, tucking baby's feet under the crook of my elbow, and clamp and cut lefthanded. I don't know why I do this. It just feels right, to hold the baby securely in my more dominant arm, and use my left hand for the instruments. But, attendings sometimes ask me if I'm right or left handed, and when I tell them right-handed but better with fine motor skills with my left (due to violin training, I think), they frustratedly instruct me that I should only be managing scissors around a newborn with my dominant hand. Again, I'm not sure which that is.

There are probably infinite variations on how to do one surgery, one delivery, and that's what I'm learning. Even though I've never had a bad surgical outcome, somehow I am always wrong with how I do it. I'm trying to take the best of everyone's suggestions (ie yelled orders), and compile it into my own technique, but starting to realize that it will be awhile before I can really employ what I think is best. And I can't say I wouldn't be the same later, after a career's worth of doing what I decided is best...I'd probably want to hand my hard-earned knowledge along too. But it's frustrating now.

I think I'll go sit down on the roll-ey stool and practice reloading my needle.