Inevitable

As a doctor it is inevitable that I will face death, as a new doctor I have not dealt with that inevitablity until now. This week had been a good week for me, I rode on a private jet for a transplant case, I got into the operating room FOUR times and have actually been able to do things, my hours were manageable, overall it was a good week. I imagined that this post would be about one of those big things until I arrived to work on Friday and my patient was dying. Out of respect for him I will write very little about what actually happened or the details of his death, but instead about what I feel as a result.

Choosing death
The stories are countess. A person tells family that he has had enough, says goodbye...just changes, and shortly thereafter he dies. Amazing our own internal power to sustain life - just highlighting that doctors and medicine will always be limited by the human spirit. My patient did the same thing, although I realized it only in retrospect. On Thursday, I only wanted to encourage him more and planned to do the same thing on Friday. I didn't realize then that it was out of our hands. After weeks of losing control to disease, this was his last statement of independence.

Two sides
I chose surgery because of the ability of a surgeon to immediately affect the process of disease. Cancers removed can yield instant cure. Today I realize that there are two sides to that argument.  What surgeons do is step into the natural process of disease and change its course. The hope is always that the disruption of nature prolongs life, but nothing is without consequence.  The results of surgery can also hasten death.  No statistic regarding human life is 100% good, and 0% bad.  Some will not be saved.

Life leaves
There is a point at which life leaves the body.  As I said goodbye on my way out on Friday I realized that the man I had taken care of for a month was gone.  As I left and held his hand telling him I'd see him on Sunday, I knew in my heart that time would likely never come to pass.  I prayed a prayer without words or request.

Grace
My patient made it through the first day with maximal support, he died when I was away from the hospital.  I originally though I'd want to rush back to say goodbye, to be there.  But, when it actually happened, I was standing in my beautiful sunny kitchen, and I wept alone, with the comfort of quiet.  It was grace that ended his suffering and gave him peace.  It was grace that allowed me to have this moment in the stillness of my own space to grieve for my patient, and his wife and his children and his sisters and brothers and his family and friends and the space he will leave behind.

Selah

But what about life?

Three weeks in and I'm essentially exhausted all the time. My body is in constant sore pain. My last call kept me up all night during which time I had the pleasure of irrigating a rectum, disimpacting another rectum and dressing an anal wound. I left post call right around noon and my husband picked me up. After a quick lunch I was home and sleep on the floor. For some reason I just couldn't get in the bed in the middle of the day. My husband had told me earlier in the week about a work barbecue he was invited to. I had planned to try and go since I was going to be post call and therefore assured to be able to get there in time. I try to attend as much of his stuff as I can because I know there will be lots of stuff I will miss. However as soon as I got home I knew it was going to be tough to wake myself up and make myself decent enough to attend one of his work functions so I told him he may have to just go to this one alone.

By 4 o'clock I was sick of the floor, I woke up briefly to transfer myself to the bed and immediately passed out again. A bit later I groggily opened my eyes and saw my husband kneeling over the end of the bed typing away intently on his laptop. "Hey" I said. "Hey back" he smiled, then I asked when he was heading out to the barbecue, I though maybe I might have time to shower and go with him, but as I asked I looked at the clock. It was 7:30 already and the barbecue started at 6:00. He hadn't gone, but instead had kept vigil at the foot of our bed, "I missed you, this way I knew I'd at least get to see you." I instantly felt like crap, my husband had talked about this barbecue all week, excited that I'd actually be able to come with him since I would be post call. I felt awful that I'm gone so much that kneeling in front of me while I slept was the only way to spend time with me. I wondered if this all was really going to be worth it.

We regrouped, went grocery shopping together and he decided to cook dinner for us! In the middle of food prep, my husband turns around and tells me not to worry about missing the barbecue and said he'd have a light day tomorrow, maybe he'd take off early or call in and we'd do something fun together. "But I have to work," I told him. He was thinking I'd be post call the next day, when I explained that today (the day I slept through) was actually my post call he shouted in exasperation that I work all the time! I miss my husband. I hate that he misses me because I'm not there. Earlier this week he compared our life to dating, where you see each other a few times a week and have fun dates and do special things. And it is true that our time together is very special when we have it, and we always try to make the most of it. But, do I really want to date my husband for 5 years. What will I lose in the process...

The operating room...

I finally had my first case. The highly anticipated first case as a doctor, as a surgeon! And it was shockingly anticlimatic. By the end of the day it was really just a blip in a day of all the regular grind of answering pages, putting in orders, checking labs and vitals, same day to day. But at the same time something feels a little different, like there's a little bit of surgeon swagger in my walk. I must say though that I thought it would feel different. Maybe I have to slow down first before I realize how I actually feel.

Pee ... and poop

My life revolves around pee and poop. Poop by day, pee by night. Each morning I see all of my patients and my major objective, find out if they pooed, or at least farted (excuse me, I mean if they had flatus). If they pass the fart or poo test, they get more food and get closer to going home, hooray!

Now, add diarrhea into the mix and I become a poop consultant. What color, how runny, how solid, how smelley? Oh how fun to talk about poo. Meanwhile, I already rarely get to eat for running around and now I can't eat because I keep thinking about poo. Ughh.

At night, being on call is all about pee. At least one or two people who just got out of surgery is not peeing. Especially older patients. So my mission as intern of the evening is MAKE THEM PEE! Little bolus, big bolus, touch of lasix, wait, more fluid, wait, wait...now PEE! Yellow pee, dark pee, bloody pee, cloudy pee, I am the queen of pee.

Another week survived, only 257 to go. Yesterday I had my first day off! Unfortunately, I can't stop thinking a little about whats going on at the hospital. Looks like I'm hooked.

better...

As promised, my report of week two will be better. Victory #1 - I don't want to cry everyday! Victory #2 - EYE CONTACT, yeah!

Now don't be fooled, this week was quite the emotional rollercoaster, but its 3pm after my post-call nap and I don't feel awful and I think thats pretty good. So here are the up and downs:

Down: Monday morning I got hit with the news that just as I started to feel a little comfortable with my job description, due to shifting in the class above me, I would now have twice the work and twice the call! I was speechless!! A response that was met with a reply that I should just learn to deal with it.

Up: Twice the work turned out to be heavily shared and twice the call really turned out to be procurement call every other day. So, although its a pain to not be able to drink, EVER, if I get called its for the coolest surgery of all! Also, getting in the OR on a case like that as an intern is a pretty sweet deal. Once I realized the upside (with the help of my hubby), I actually got pretty excited and more into my rotation. Also, voicing my excitement to upper levels seemed to earn me some cool points!

Down: I was minus one husband for a lot of this week while he was traveling...lonely.

Up: My interns come through like family every time. I have an intern with me on my team now and its nice to have someone to talk to and get work done with. Also, I had a few post work "please make me happy" hours with other interns which just makes this all more doable.

Down: It sucks when kids don't get the transplant. Especially after they spent the last 4 hours jumping on the bed with excitement, just sucks. Transplant is weird that way, happiness for one is always sadness for someone else.

Up: Randomly, and I mean randomly in the middle of attending rounds, the attending who yelled at me last week apologized! Pretty cool... and it turns out he's a pretty good teacher!

Down: I have not had a day off yet, 14 days and counting...

Up: I have survived two more nights on call and I'm starting to feel like the doctor. I'm not as terrified all the time. I know how to do a few things independently and who to call for help. I can actually think through problems and usually come up with a pretty good plan on how to address them. Also, I realized that I'm far from alone in the hospital when I'm on call, I just didn't know where to find my help before.

So I can conclude that as week two ends, I feel a little more at home. I feel a little less crazed, I feel better...