House Officer

    It’s been an exhausting week as I’ve tried to go from working nights to working days. I'm glad to be done with nights. I hate trying to sleep when it's sunny out, and going days on end without seeing my husband.

    The rotation is called Night House Officer, or night house, or simply the Ho if we’re feeling scandalous. I think the name goes back to the days when residents really did reside in the hospital, it was their like house. Sometimes when I'm facing another 70 or 80-hour work week, I try to remember that it used to be worse. When my grandfather was an intern, for example, there weren’t any rules about not making residents work more than 80 hours a week. But I guess that’s the subject for another post. 

    Being the Ho is cool actually. Your job for those two weeks is to take care of any and all issues that came up with the patients on the 4^th and 5^th floors of our hospital between 8pm-8am. Everyone except the OB patients and the ICU/IMCU patients - I think it works out to be 100 people or so. You’d think everyone would just be sleeping, right? Not quite. The nurses call you all night. In a way, it makes you feel important I guess. Some of the calls are easy – someone needs pain medicine, sleeping pills, IV fluids. Some of the calls are more scary – this postoperative patient is bleeding a lot… that one is having chest pain… his fever is up to 104... doctor, the man in bed 26 isn’t breathing well… and you know the lady in 4? her heart rate is 180 now… what should we do? Suddenly all those multiple choice questions on all the tests I took in med school are real people in front of me. I’m proud of myself because as this year has gone by I less often have the urge to say, “What should you do? You should call a real doctor, that’s what!” Usually I know where to start now. I go see the patient, sometimes order an stat ABG, EKG, chest xray, whatever. When I’m unsure of the next step I call my senior resident who is also in the hospital taking care of the ICU patients. On occasion I wake up my attendings, my supervising doctors, who are also on call but at home in their beds.

    One of the calls from a week or so ago was about a 34-year-old who hadn’t been urinating much. It may not seem like a big deal to not pee for a while, but nurses record that stuff and call us for a reason. I knew that this particular patient had liver failure, and that his kidneys were starting to shut down. I went to see him, to push on his belly and make sure his bladder wasn’t distended. He looked even sicker than I thought he would.  His skin was bright yellow from so much bilirubin in his blood. I sat and talked with him for a little while. He told me he was scared that he was getting so sick. He asked me what was going to happen to him. I listened to him for a while, but I didn’t say too much. I knew what was going to happen: he was going to die eventually from this. I had someone else to check on, so I excused myself and left. I almost said something about God, but I chickened out. I remember thinking I'd talk to him another night. I wish I would have offered to pray with him like I did with that other lady that week. I wish I would have told him that Jesus loves him, that God is the one to turn to when you’re scared.

    He went into a coma soon after that, and he died yesterday while I was on call. I pronounced him. I told his family how sorry I was about their loss.

    I missed my chance.

    Most people that I interact with aren’t that near-death. But even with the semi-healthy ones, who knows how much time I really have, how many chances I’m going to get. If you know me, and you think about it sometime, will you pray for me, that I’ll be bold in sharing God’s love? Thanks.

So much for the gym

    There's a new gym right down the street from our house that I decided to check out. I got a seven day free pass and today is day #4 I think. I went once. Different excuses, really. A 24 workday, small group, general lazyness. Today's excuse is named Anthony. He's 8lbs 10oz and pretty cute for a newborn.
    That's right: after working all night as the H.O. in the hospital, I was in the deepest of dreams when my pager when off. The only reason I got out of bed to check on it was to make sure that my continuity patient wasn't in labor. And guess what, she was. And not only that, but she was having a C-Section. I was told I'd better get there in the next 20 minutes if I wanted to participate.
     As a side note, our program here is one of the few family medicine residencies that trains its residents on how to do C-sections. Most of us, when we graduate, won't do C-sections anymore, because in most of the US, the OBs do them. But it's a great skill to learn, especially if you're considering going overseas or living somewhere rural. Which are both possibilities for us in the future.
     Anyway, back to my story. I love delivering babies. And normally I only get to do it while I'm on an OB rotation. The only other times I get to deliver are when the woman is one of my clinic patients. Those are known in my little world here as "continuity deliveries." And they're the coolest ones. Like this lady today. I met her when she was two months pregnant, and I've seen her in clinic about ten times since then. I've answered all her questions about breastfeeding, labor, gaining weight, etc, etc, etc. And trust me, she had a million questions. "If I bend over to tie my shoes is that bad for the baby? What if I accidentally roll over in the night? Do you think he's still ok?" I've listened to the baby's heartrate at every visit. And today I got to reach into her belly and pull out a healthy little boy that apparently survived the shoe-tying. Definetely worth skipping the gym for. 

THE FIRST ONE

    I’m on an easier rotation, finally. It’s nice to see the sunshine and go walking with the dog in the park after work. And now that I finally have some time, I’m going back and proof-reading and signing the forty-five dictations that I’ve been totally slacking on. They are all, or almost all, discharge summaries. Basically, each one tells the story of one of the patients I took care of in the hospital this last month. It tells the day they were admitted, the day they went home, their list of medical problems and medications, and what happened while they were in the hospital.

     So interesting. All of them are interesting. From an educational standpoint, it was a good month of learning: a few good cases of CHF, some rule-out MIs, pneumonia, dehydration, cancer, cirrhosis, pyelo… you know, the basics. From an emotional standpoint, for me anyway, it was tough. Because mixed-in with the 43 discharge summaries there are two death summaries. And because several of the other 43 contain descriptions of meetings in which we told a patient and their family members that their time left together is short.

    These people are so cool. From all over the world. Speaking multiple languages. Most without insurance, or at least without private insurance, who ended up at a county hospital. One weighed 600lbs. One was covered in sores from head-to-toe, two were veterans, several were grandmothers, several more were drug addicts. And I got to help take care of them. I was their doctor for the days they were in the hospital. I got to meet their families, draw pictures for them of the insides, and wake them up at six AM to listen to their lungs. Me, little me, their doctor.

    There’s so many blogs out there already. Why would I write one too? Maybe for my family and friends far away, to share some of what’s going on out here and tell funny stories of the people I meet. Or maybe more for me, just to have a place to digest and process some of what I’m learning and going through. We’ll see if I can stick with it.