Rehabilitation
My month of working at the children's rehab hospital has almost come to an end. Tomorrow is my last day of this call-free month, but as nice as "call-free" sounds, it's not all that it's cracked up to be!
Needless to say, I've had many loooong 12 hour days. And something about about working in this particular environment is like working in slow motion.... and stresses me out to no end!
The number of patient's isn't bad - usually I carry about 8 patients. And they're typically kids with acquired or traumatic brain injury who are admitted acutely or for rehab, all with crazy/sad stories: the varying car accident patients who were either thrown 50 feet from the car/an unrestrained kid who goes through the windshield and back again/a car that rolled several times and passengers who needed to be cut out of the car/etc., the baby who fell out of a 3 story window, the teenage kid vs. semi truck (seriously sad), or the baby with a rare congenital rib asphyxiating thoracic dystrophy. And this is just a sampling of the heart-wrenching stories of the kids we treat.
Most of the patients will have long, drawn out courses with small victories of starting to have some purposeful movement in the hand or being able to finally eat by mouth... but you wait for the incredible recoveries. I was fortunate to have a patient that I actually took care of in the PICU and wards during my previous month in Peds Surgery. It's rare to actually see your patients get truly better after a tragic accident, and it was truly remarkable for me to witness. In the PICU this kid had an ICP monitor bolt in place, and had periods of "storming," a GCS consistently around 6-7, chest tubes that I eventually pulled for her pneumothoraces, and was overall pretty non-responsive. By the time I got to send her home, she was walking well with the aid of a walker (still barely ataxic, if you looked close enough), and she was cognitively close to her pre-morbid baseline... a bright kid, actually learning spanish during her rehab!
One morning as I pre-rounded and did my morning exam, she sat up and asked, "So... what kind of doctor are you?"
"I'm a pediatrician," I replied. "I get to see kids from babies up to teenagers."
"Oh," she said. "So where do you work?"
"I get to work in many different places in the hospital and clinics, and actually took care of you at the other hospital too."
"Oh, wow," she said. And after a second of pause, replied, "I want to be a family doctor, so I can see everybody, and even have a day that I can see kids in an office."
I have no doubt that one day she might be able to do just so.
What I appreciate most, as I look back over this month, is the amount of time I've been able to spend talking with families. On most rotations the business of rushing around with scutwork or menial tasks, the pressure of endless admissions and discharges, leaves you with little time leftover to connect with your patients, to have them identify you as their doctor, and trust you with their questions or concerns. I hope to take a piece of that back with me as I start back on the wards Tuesday. I start the wards with a bang too! I'm on call Tuesday, which is always hard because you're covering all the patients that you know very little about!
What I will NOT miss about the rehab hospital is the seemingly "optional" nature of orders that I enter for the nurses to complete. It's truly frustrating when you write for something to occur and it takes like 3 days for it to actually get done. In my opinion it's really dangerous for patient care. Without trying to get in too much trouble for this statement, and in the tongue-in-cheek words of another resident, "it's where the lazy nurses come to die."
On a completely different note, today I attempted to savor my last day off for the next 2 weeks! I slept in AND took a nap! Lately I just cannot get enough sleep. Yesterday I felt very accomplished as I cleaned the apartment from top to bottom and did loads of laundry. Therefore, today I did next to nothing!
Lately, I've also been unofficially in charge of "beach week." Beach week occurs during the last week of intern year. We all get the entire week off from work and take a vacation together to the Outer Banks. This year we're going to stay here. This is what I'll be thinking ahead to during the next several months. Intern year has started to wear on me a bit. I think it's mostly due to the emotionally draining nature of working at the rehab hospital, along with this particular time of year.
Last week was the first time I have EVER questioned my desire to do pediatrics for the rest of my life. I know deep down that I love what I do, but it will be nice to figure out what type of practice in which I would like to eventually find myself. General vs. fellowship. Academic vs. community. I will figure it out in time... And find that certain balance that will make me happy.
Needless to say, I've had many loooong 12 hour days. And something about about working in this particular environment is like working in slow motion.... and stresses me out to no end!
The number of patient's isn't bad - usually I carry about 8 patients. And they're typically kids with acquired or traumatic brain injury who are admitted acutely or for rehab, all with crazy/sad stories: the varying car accident patients who were either thrown 50 feet from the car/an unrestrained kid who goes through the windshield and back again/a car that rolled several times and passengers who needed to be cut out of the car/etc., the baby who fell out of a 3 story window, the teenage kid vs. semi truck (seriously sad), or the baby with a rare congenital rib asphyxiating thoracic dystrophy. And this is just a sampling of the heart-wrenching stories of the kids we treat.
Most of the patients will have long, drawn out courses with small victories of starting to have some purposeful movement in the hand or being able to finally eat by mouth... but you wait for the incredible recoveries. I was fortunate to have a patient that I actually took care of in the PICU and wards during my previous month in Peds Surgery. It's rare to actually see your patients get truly better after a tragic accident, and it was truly remarkable for me to witness. In the PICU this kid had an ICP monitor bolt in place, and had periods of "storming," a GCS consistently around 6-7, chest tubes that I eventually pulled for her pneumothoraces, and was overall pretty non-responsive. By the time I got to send her home, she was walking well with the aid of a walker (still barely ataxic, if you looked close enough), and she was cognitively close to her pre-morbid baseline... a bright kid, actually learning spanish during her rehab!
One morning as I pre-rounded and did my morning exam, she sat up and asked, "So... what kind of doctor are you?"
"I'm a pediatrician," I replied. "I get to see kids from babies up to teenagers."
"Oh," she said. "So where do you work?"
"I get to work in many different places in the hospital and clinics, and actually took care of you at the other hospital too."
"Oh, wow," she said. And after a second of pause, replied, "I want to be a family doctor, so I can see everybody, and even have a day that I can see kids in an office."
I have no doubt that one day she might be able to do just so.
What I appreciate most, as I look back over this month, is the amount of time I've been able to spend talking with families. On most rotations the business of rushing around with scutwork or menial tasks, the pressure of endless admissions and discharges, leaves you with little time leftover to connect with your patients, to have them identify you as their doctor, and trust you with their questions or concerns. I hope to take a piece of that back with me as I start back on the wards Tuesday. I start the wards with a bang too! I'm on call Tuesday, which is always hard because you're covering all the patients that you know very little about!
What I will NOT miss about the rehab hospital is the seemingly "optional" nature of orders that I enter for the nurses to complete. It's truly frustrating when you write for something to occur and it takes like 3 days for it to actually get done. In my opinion it's really dangerous for patient care. Without trying to get in too much trouble for this statement, and in the tongue-in-cheek words of another resident, "it's where the lazy nurses come to die."
On a completely different note, today I attempted to savor my last day off for the next 2 weeks! I slept in AND took a nap! Lately I just cannot get enough sleep. Yesterday I felt very accomplished as I cleaned the apartment from top to bottom and did loads of laundry. Therefore, today I did next to nothing!
Lately, I've also been unofficially in charge of "beach week." Beach week occurs during the last week of intern year. We all get the entire week off from work and take a vacation together to the Outer Banks. This year we're going to stay here. This is what I'll be thinking ahead to during the next several months. Intern year has started to wear on me a bit. I think it's mostly due to the emotionally draining nature of working at the rehab hospital, along with this particular time of year.
Last week was the first time I have EVER questioned my desire to do pediatrics for the rest of my life. I know deep down that I love what I do, but it will be nice to figure out what type of practice in which I would like to eventually find myself. General vs. fellowship. Academic vs. community. I will figure it out in time... And find that certain balance that will make me happy.