Wednesday, June 27, 2012

A Day in the Life. Internal Medicine. Day shift.

5:07am alarm. No snooze, means shower. Snooze, means, well, no shower. Yup, I admit it, I don't shower everyday.  Sometimes I need those extra 15 minutes. Sometimes I don't shower, just so I can stop at Starbucks on my way to work.  Somedays, you just need something to look forward to in order to get out of bed, and for me, that is a Caramel Latte. For timeline-sake, let's say no snooze. So, I shower.  If George woke up and ate during the night, I continue on to get dressed, make some coffee, pack up my pump equipment and walk out the door.  If he didn't wake up, I get him out of bed, and force him to eat, then scramble to get out of the door on time, but likely, I will be 4 minutes late for check out rounds.  Somedays I remember breakfast, somedays I don't.  Generally, there is food lingering around that is available to eat while on inpatient medicine, so I rarely starve. Somedays it's too busy to really care or be concerned about eating.

6:15am (if I successfully made it on time) is check out rounds.  I meet up with 4 or 5 of my fellow residents, and the overnight call person who managed the entire list of 7-34 patients depending on the current census while admitting all the new patients, from 7pm until 7am, tells us about their night.  Some nights are nice.  Some nights you get no admissions.  Some nights are hell.  You get 8 admissions, then someone codes, then a "bad baby" is being born on the OB floor and you have to rush off to assist in the delivery and maybe even intubate a newborn. Meanwhile, you have not answered the last 11 pages that are "FYI" pages from the nurses.  Some of these "FYI"s are helpful, responsible, necessary pages.  Some of them are, wtf, why do I give a sh*&, please don't bother me with this kind of information pages. 

Anywho, back to the day person shift, we are not talking about nights.  This time. So, we listen to the overnight resident, jot a few items down on the patients we are expected to follow, and then, the most relaxing part of my entire day, until about 9:40pm (or 9:53pm which is the time it is at this exact moment) is over.  Oh wait, you didn't think those first 2 hours of my day sounded relaxing?  Huh. Strange.

7:00am let the fun begin. Let's say, on this particular day I have only 5 patients for which I am responsible.  Only 5 patients that I must read about, do extensive research finding out their past hospitalizations, tests run, labs drawn, how much they've peed, how much they've pooped, have they vomited, are they eating, are they conscious, are they breathing, if they are breathing is it at a normal rate, what does their heart sound like, oh crap, it doesn't sound normal, which valve is the problem, is it even a valve, eff it, I'm consulting Cards, are they getting fluids, did we replace their potassium, which medications did they get, what medications should they get, I am not actually sure how we are supposed to treat that, let me search for it on Up To Date...shit. It's 7:30am and I have only looked up one patient.  I quickly sort through the charts of the other 4, make a little chicken scratch and head off to see the patients, 5 of them, in 25 minutes.  Actual face time, with the patient to ask them how their night went, do a physical exam, explain labs, medications and the plan of care is 5 minutes.  And there goes the pager.  It's 8:36, rounds were supposed to start 6 minutes ago.  Rush back to the resident rounding room.

8:37am rounds.  We head to the ICU first, here, the whole team of 6 residents, 2 attendings, some pharmacists, a few med students and a nurse or two all enter a room.  If this so happens to be MY ICU patient, I present the patient to everyone.  I speak, in front of a group, and try to put all my research from an hour ago into one, nice, succinct, presentation.  I attempt to appear as if I know exactly what I am doing, and what I plan to do.  While in my head, I am panicking, because I kind of don't know what I am doing. I really dislike talking in front of groups. I am not good at it.  Even if I write everything down, my mind is bouncing like a bee bee in a rubber room, and it all comes out scrambled. Crap, now, even if I did know what I was doing, no one believes me. I just hope the med students can answer the questions from the attendings...

...the rounding continues, and now, it's after 10am.  I NEED to pump.  I can no longer concentrate on the task at hand. I am walking around with 2 bricks on my chest, and it's just going to continue to get worse.  I start sweating, I kind of get chest pains, and am on the verge of an anxiety attack, and it's my turn to present again.  Whatever comes out of my mouth at this point is on auto-pilot.  It's all I can do to quickly record the suggested changes to the plan from my peers and attending. I am still sweating.  It's a cold sweat.  Perhaps, I am even nauseous at this point.  And I feel like am being judged. All morning.

10:24am sweet silence. I sneak away for 15 minutes to pump. In order to "let down" and have a successful session, I need to relax.  So, I turn on the TV in the resident on call room, it's Roseanne.  This show used to remind me of my mom and dad and my family.  Now, it reminds me of Matt and I. Gross.  I find it amusing anyway. I finish, re-pack all my gear and scurry back to the rounding room.

10:46am radiology rounds.  The whole team (residents and attendings) make the trek to dark radiology reading room.  We crowd into a teeny space.  The anxiety, cold sweats start again.  I am beginning to realize that I am claustrophobic.  We look at CT scans, chest xrays, ultrasounds, mostly it's boring. Every so often it's fascinating.  I could never be a Radiologist, wish I could.  We file back up to the rounding room.  Now, it's the race to finish with the paper trail.

First, I must discharge the people going home. I have to schedule follow-up appointments. Make sure they are equipt with all their medications, write scripts, even for refills of meds they should be getting from their primary care doc. I have to write a discharge note, and make a discharge order, and make sure all of their labs and tests have been completed.  Then I finish daily notes on my other patients. I call Cardiology, Psychiatry, Surgery, the lab, Radiology, all to find out how the tests went, when are the tests going to happen, oh the tech is out today, we have the keep the patient one more night just for an Echo, you want them downtown for an MRI, can I advance their diet, can they get another pain med, did you want morning labs, did you mean to order those labs, why aren't there any labs?

Before I know it, it's 12:15.  We are required to go to a Noon Conference daily.  I am interrupted in my work flow.  Well, nevermind, there was never any flow.  I get lunch and attempt to make it to the lecture. I get there, it's 12:34, the lectures almost over.  I don't really listen, I need 20 minutes time to let my brain shut down for a moment. Time to refuel. Absorb the energy from my tiny lunch. I don't eat much. I am, of course, trying to lose 30lbs in the meantime.  Somedays though, you just gotta get the meatball sub and a Snickers. I'll lose weight another day.  Back to the floor.

1:01pm admission time.  I am over the hill, I see the end in sight.  Just a few more notes, one more phone call and I am done.  Perhaps, I will have a chance to finally make my required daily check of my work email, or my personal email, or I can fax the paperwork for my loan consolidation that was due yesterday, or tomorrow, or was it last month?  Have I paid any of my bills? Do I have money in my bank account? Or I can text my husband or nanny back.  Or take a quick peek at Facebook on my phone to see if the real world is still out there.  Pump without feeling rushed. Then, the resident in charge comes over to me, "hey, we've got an admission, you ready for it?" No.  But yes.  I smile, say something to the effect of, "I was wondering when you were going to bless me with an admission, things have been too quiet."  I appear to gladly accept the patient, while on the inside there is a constant stream of curse words, no reason to ruin someone else's day by obviously being annoyed by having to do my job.  It's my job.  It's what I get paid a measly little salary for, I signed up for this.  And I say I am not good at acting...

...I will spare you the details of the long patient interview, and there are too many to pick from; the drug-seeker, the frequent-flyer, the chest pain, the dizziness, the homeless-I-need-a-place-to-sleep, the drunk I ran out of money so am going to withdrawl, or the truly sick and maybe even interesting patient.  I put in the orders, I write the History and Physical, I call the attending, I tell them about it, they tell me more orders. Somewhere in there, I sneak off to take care of my mommy duty.  Ahh, it's 4:30pm.  Time to check out.  We run the list again. I tidy up my work, and I leave.  It's 5:17pm.

In the car, I call Matt.  "What do you want for dinner".  No reasonable response, usually, it's just, "We'll worry about it when you get home." My favorite idea.  Yes, instead of discussing this while we are both quietly driving home in our cars, let's wait until I walk in the front door to 3 loud, attention-seeking, missed-their-parents-all-day, on the verge of meltdown due to starvation boys, and one large, thinks the end of the work day means it's time to relax boy.  It's is now nearly 6pm, and no dinner plans have been made.  Sometimes we get take out, sometimes we make something from the freezer, sometimes, but not usually during an inpatient month, I have gone to the grocery store and planned out meals.  We make something, it's 6:45pm, we all sit at the table together and eat.  It's not real relaxing, but it's nice. I am over-joyed and so happy to be with my family. I am exhausted, but all is right.  I made dinner, Matt does the dishes. Matt made dinner I do the dishes. No dishes get left for tomorrow, they pile up way too fast. It's an unspoken rule. 
7:15pm family bonding time.  Depending on the weather, this is walk time.  Perhaps even a trip to TCBY or a park. If the weather or energy level is too low, it's play with the kid time.  If it were up to Matt, it would be lay on the couch while the kids crawl all over me time.  He get's his way sometimes.  Perhaps I will do some laundry or tidying up during this time as well.  And every 3rd night, or so, it's bath time - the boys love it. I don't. 3 kids stripped, bathed, shampood, rinsed, dried off, lotioned, diapered and dressed - not easy. Not relaxing. The result is wonderful though, the smell addicting, and I can't get enough of my clean babies.

It's somewhere between 8:15 and 8:45pm. Bedtime.  Matt brushes the older ones teeth, pajamas them, reads to them and kisses them goodnight.  I nurse George, cuddle him, and get him to bed.  When he finally settles, I am off the clock.  It's my time.  I should study, catch up on some work, check my bank account, do something productive. But I can't.  I just can't do it.  So I veg out. I watch a TV show, get on Facebook, Pinterest, maybe even blog if there is time.  I stay up way too late.  I look at the clock, see it is 10:43.  Crap. This means 6 hours of sleep at the very, very most.

I trudge upstairs.  I don't really want to go to bed. I want to continue to enjoy my quiet time.  I brush my teeth, put on my PJ's.  Check my phone one last time. Turn off the light and roll over to turn on my alarm, it's 11:17pm.  Not even 6 hours of sleep now.  And there is always that chance that George will wake up.  Close my eyes.

Ding!! It's 5:07am.

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