ends of the spectrum

Yesterday was an amazing day. I knew it was going to be a good day when I went to the scrub machine and got the softest, most amazing pair of scrubs out. They were like wearing flannel pajamas, they were so broken in. Heaven.

Then, I started my day. Did a couple of scopes, did great. I made it into the right colon without help, got polyps out with no trouble, and felt very competent with my flex sigs. Then saw my postop patients. Everything was going great; all my patients were happy and pain-free. My pager only went off when I actually had time to answer it. When I answered it I knew how to deal with the issues that I was called about. Amazing, huh? I felt like my intern year was finally coming together.

Then, the greatest part. I got to go to the OR. The breast and endocrine service didn't have enough residents to cover all of their cases, and so I got to do 2 lumpectomies. And the doc let me do pretty much everything. My knot tying was improved, and I sort of knew what I was doing. All in all, a pretty good day. Oh yeah, and I got to work out, hang out with the puppy, and have a quality dinner with Dennis.

Then, I woke up today. First of all, I woke up 15 minutes before my alarm. Not a big deal, I know, but I really wanted the sleep. I normally wake up 5 minutes before my alarm anyhow, which is odd, but this morning I really wanted those minutes of sleep back. But I got up anyhow, got ready, and headed to work. It was raining, and my hair was extremely frizzy, which should have tipped me off.

It was all downhill from there. On nutrition rounds, I discovered that not one, but two of my ICU patients had died. One had care withdrawn, which I knew was going to happen eventually, but the other was a bit surprising. Another patient who's a favorite of mine fell out of bed, and is now in a C-collar. Worse yet, her PEG got pulled out on the way to the floor, so her belly hurts and she has a new tube in her nose. She was supposed to be discharged today, but obviously that's not happening. She's such a sweet woman, and has been in the hospital so long . . . yech.

And then comes my daily scopes. With the most impatient attending there is. I set up for the scope, and page him. 45 minutes later, he strolls in, gets angry that I can't get the scope into the stomach in the first 1.5 seconds, and takes the scope from me and finishes the procedure. After which, he asks me to dictate, talk to the family, and schedule the patient for surgery. Yay, since I've done so much with this patient, why don't I just operate on them too? That scenerio is repeated twice more for his next two scopes (including the approximately 45 minute wait each time), which pretty much takes up the rest of my day. Meanwhile, I'm getting paged by God and everyone who wants a PEG placed now, or sooner if possible. Geez people. In between I try to get as much work done over the phone as I can, but that's difficult sometimes. Its always easier to get information out of nurses in person anyhow.

Side rant: since I spent approximately 45% of my day waiting for attendings, I reflected on how worthless the time of a resident really is. Our job is completely necessary, and hosptials would not function if we weren't there. But our time is dirt cheap and so everyone could care less how long we wait for them. They figure we'll be here anyway. Which might be true, but doesn't make me feel any better as I'm sitting in the endoscopy suite tapping my Dansko clog against the floor, wishing I could just get on with my work. Meanwhile the pile of things I have to get done before I leave work is increasing exponentially, and I'm stuck without a way to do a lot of them. Its just frustrating.

Back to my story. Once out of endoscopy for the day (it was 3:30pm), I ate my lunch quickly and started to see my 5 new consults. All of them were sick sick people. None of them were going to get better from having a PEG, and at least one of them had a good chance of dying if we tried to put it in. Just depressing. Then I went to see another postop patient, who is generally a very charming woman with end-stage ovarian cancer. She's completely incoherent and twitching. Seizing? Tired? I have no idea, so I page the gyn/onc team. They yell at me for not knowing her exact blood pressure when I call them. A girl just can't get a break.

I try to do what's best for my patients, but sometimes that's hard to figure out, let alone do. This patient, for example. Her tumor grows quickly regardless of her chemo regimen, and she's inoperable for now. Anyone who knows anything about cancer will tell you that's a bad combo. But she and her husband are sure she's going to beat this. I'm equally sure she won't. I hate to be a pessimist, but truly the odds are stacked against her. But a consultant, that's not my place to say. I just make sure the Gtube we put in her is working to decompress her bowel. Which it is, as best as it can.

So that's a little blurb on how my days go. The last couple were most remarkable because they were polar opposites. Most other days fall in between, with a nice mixture of good to offset all of the bad. Through it all I'm learning, which is really the point. And I only have 3 more days of endoscopy left. Although I love endoscopy, I'm ready to move into another area. Everyone is; we're all feeling the stagnant sameness of our current rotation, and we're ready to switch.