Twenty-one and counting
Twenty-one more days remain in my medical career that I have to take care of adults.
After a day and a half of this, I am more than thankful for that.
Three bad things happened today.
1. Mr. Fucked had to be intubated this morning. He was transferred to the MICU service yesterday but when I was rounding on my patients I heard an overhead page for anesthesia to go to 6H. I strolled by on my way to another unit and I found the nurses bagging him and saying that he was found to be not breathing and unresponsive and that his creatinine (measure of kidney function) was through the roof and he wasn't making urine despite being loaded with fluid. Yeah, not good. So he's truly fucked. They're not sure what's going on with his lungs.
2. A patient came up last night from the OR after a femoral-popliteal bypass (normally I'd put links in but I'm too tired to look right now) and pretty much tanked the entire night and all morning. He was acidotic and on full doses of all the meds we use to keep heart rates and blood pressures up. He died just before noon today because no matter what we did, he still crumped. Elyssa took it hard - it's the first patient she's ever had die.
3. A patient was admitted overnight and was awaiting formal brain death evaluation. She was found unresponsive in her apartment by paramedics. The long and the short of it is that she was found up against her stone fireplace and that her apartment was completely trashed. She had bruises all over her body and upon further review, was believed to have been a victim of sexual assault. When she came in, she still had some brainstem reflexes but after she got back from the scanner, they were gone. She had an MRA done and it showed very poor blood flow to the brain. I took her as a patient this morning because I knew Farrah would have a hard time with it (I worked with Farrah on peds surg; it was her sister that was in the massive car accident and had the neck injury and was the one who coded when they went to fix her in the OR...whenever we have patients that are crumping, I just see this look of horror on her face, as if she's reliving it all again). I was fine until I checked her legs to see if she had any compression stockings or pneumatic boots on. She had bruises all over her legs. She literally got the shit beat out of her. I hate that I live in a place and time where this happens.
Now, a bit of an essay on my feelings about death and witnessing death and dying patients. I would be wrong if I said it doesn't bother me. It does, or else I wouldn't talk about it. I think I handle it much better than others. I'm comforted by the fact that I know we exhausted all our energies and resources trying to bring this person back and if it doesn't work, then it doesn't work. I'm also comforted by knowing that wherever they are and wherever they believe they are going is a much better place than they're in right now. It is a place without pain, without fear, and without illness. It is a place of light and comfort. And whether you call it heaven or something else, that's what it is. So if I appear to be trite or boorish or condescending or trying to make jokes about death, please understand that it's my way of dealing with it. I deal with it by talking. I felt much better after telling my dad what happened at work today. As long as I can talk about it, I'm fine. This month is going to suck the last bit of life out of me. It's going to suck me dry, rehydrate me, and then suck some more. Please bear with me. It's going to be hard. I'm not one to back down from a challenge, but I'm also going to admit when it's not easy.
Enough of that.
I got another 3 hours of sleep last night. I went to bed at 10:15, was about to fall asleep around 12:15 when my husband got home and flipped on a hall light. I sat straight up in bed. He asked me if anything was wrong. I immediately started crying and wailing about how tired I was and that I couldn't fall asleep. I was so overtired and cranky by that point I just started crying. Of course, he crawls into bed and takes less than five minutes to fall asleep. I finally fell asleep around 1 and woke up at 4:20, 25 minutes before my alarm went off.
Tonight we are covering the clock with a pillow, taking 50mg of benadryl, stretching, and putting on the sports radio station in lieu of the classical station. Last night saying the alphabet backwards helped too but we'll see.
I also had clinic today. I got to see two of my regulars. One is an incredibly complicated patient that I first saw last year as a third year during my clerkship. I love her to pieces and want nothing more than to make her better. She's getting there, but there are still a lot of unexplained puzzle pieces. My other one was a kid I first saw two weeks ago and diagnosed him with major depressive disorder. We started him on celexa last week and so far, so good. We'll see him back in two weeks and go up on his dose. He smiled for the first time today. Either he's feeling better or he's accustomed to my strange sense of humor.
Oh, and fes42? GO TERRIERS! w00t!!!
Ok, benadryl, stretching, bed and hopefully soon after, SLEEP.
Moment of Burrito: "There is absolutely nothing that can be taken for granted in this world." - Robert Anton Wilson
After a day and a half of this, I am more than thankful for that.
Three bad things happened today.
1. Mr. Fucked had to be intubated this morning. He was transferred to the MICU service yesterday but when I was rounding on my patients I heard an overhead page for anesthesia to go to 6H. I strolled by on my way to another unit and I found the nurses bagging him and saying that he was found to be not breathing and unresponsive and that his creatinine (measure of kidney function) was through the roof and he wasn't making urine despite being loaded with fluid. Yeah, not good. So he's truly fucked. They're not sure what's going on with his lungs.
2. A patient came up last night from the OR after a femoral-popliteal bypass (normally I'd put links in but I'm too tired to look right now) and pretty much tanked the entire night and all morning. He was acidotic and on full doses of all the meds we use to keep heart rates and blood pressures up. He died just before noon today because no matter what we did, he still crumped. Elyssa took it hard - it's the first patient she's ever had die.
3. A patient was admitted overnight and was awaiting formal brain death evaluation. She was found unresponsive in her apartment by paramedics. The long and the short of it is that she was found up against her stone fireplace and that her apartment was completely trashed. She had bruises all over her body and upon further review, was believed to have been a victim of sexual assault. When she came in, she still had some brainstem reflexes but after she got back from the scanner, they were gone. She had an MRA done and it showed very poor blood flow to the brain. I took her as a patient this morning because I knew Farrah would have a hard time with it (I worked with Farrah on peds surg; it was her sister that was in the massive car accident and had the neck injury and was the one who coded when they went to fix her in the OR...whenever we have patients that are crumping, I just see this look of horror on her face, as if she's reliving it all again). I was fine until I checked her legs to see if she had any compression stockings or pneumatic boots on. She had bruises all over her legs. She literally got the shit beat out of her. I hate that I live in a place and time where this happens.
Now, a bit of an essay on my feelings about death and witnessing death and dying patients. I would be wrong if I said it doesn't bother me. It does, or else I wouldn't talk about it. I think I handle it much better than others. I'm comforted by the fact that I know we exhausted all our energies and resources trying to bring this person back and if it doesn't work, then it doesn't work. I'm also comforted by knowing that wherever they are and wherever they believe they are going is a much better place than they're in right now. It is a place without pain, without fear, and without illness. It is a place of light and comfort. And whether you call it heaven or something else, that's what it is. So if I appear to be trite or boorish or condescending or trying to make jokes about death, please understand that it's my way of dealing with it. I deal with it by talking. I felt much better after telling my dad what happened at work today. As long as I can talk about it, I'm fine. This month is going to suck the last bit of life out of me. It's going to suck me dry, rehydrate me, and then suck some more. Please bear with me. It's going to be hard. I'm not one to back down from a challenge, but I'm also going to admit when it's not easy.
Enough of that.
I got another 3 hours of sleep last night. I went to bed at 10:15, was about to fall asleep around 12:15 when my husband got home and flipped on a hall light. I sat straight up in bed. He asked me if anything was wrong. I immediately started crying and wailing about how tired I was and that I couldn't fall asleep. I was so overtired and cranky by that point I just started crying. Of course, he crawls into bed and takes less than five minutes to fall asleep. I finally fell asleep around 1 and woke up at 4:20, 25 minutes before my alarm went off.
Tonight we are covering the clock with a pillow, taking 50mg of benadryl, stretching, and putting on the sports radio station in lieu of the classical station. Last night saying the alphabet backwards helped too but we'll see.
I also had clinic today. I got to see two of my regulars. One is an incredibly complicated patient that I first saw last year as a third year during my clerkship. I love her to pieces and want nothing more than to make her better. She's getting there, but there are still a lot of unexplained puzzle pieces. My other one was a kid I first saw two weeks ago and diagnosed him with major depressive disorder. We started him on celexa last week and so far, so good. We'll see him back in two weeks and go up on his dose. He smiled for the first time today. Either he's feeling better or he's accustomed to my strange sense of humor.
Oh, and fes42? GO TERRIERS! w00t!!!
Ok, benadryl, stretching, bed and hopefully soon after, SLEEP.
Moment of Burrito: "There is absolutely nothing that can be taken for granted in this world." - Robert Anton Wilson