Day 515: Crap !

wow...well not sure where to start. It was around 4:30pm and I was about to sign out my patients on the floor, when the nurse on my bed 5 came into the resident room and said "the sister of bed 5 is here to talk to you." As I walked towards bed 5, I couldn't help but be glad to be able to talk to her. I had been talking to her daily about her brother and giving her updates and she seemed to be on board and was always cooperative and friendly. (I didn't know what I was in for.) As I walked over the room I can see a mature woman in her 50's outside the room crying and being held by the father of the patient. I had seen him before daily at the bed side, and always spoke to him daily. I went up to her briefly, but I sensed that she wasn't who I was talking to over the phone. So I then proceeded to go into the room. I walked in and the mother was at the right head of the bed, and the sister was at the left side of the head of the bed. She had her hand on her brothers head, and she was rubbing it and telling him how much she loved him and how much she cared for me. (He had been intubated in the ER for airway protection after he was found to be in delerium tremens and was extremely aggressive- pulling out iv lines and almost hitting the nurses. He also got a case aspiration pnuemonia and was in ARDS. He had been on the vent 13+days and was a candidate for Tracheostomy if we are not able to wean him the next 2 days.)

After she spend a few minutes "talking" with her brother she came over to me and I introduced myself. We spoke a bit and updated her on his progress. Then all the sudden the intensives/pulmonologist walked into the room to see how he was doing. (we had been trying to wean him off the vent and he came to see how he was doing) He walked in without greeting us and went up to the vent.I followed him to see what he would say. He looked down on the patient and said. He doesn't look like he will be weaned, his stomach is assisting his breathing, and just walked out of the room. The daughter asked me who was that, and I said that he was one of the pulmonologist that was on the case. (I got a sense she didn't like him very much. He is usually straight forward talking and is not friendly with everyone, but he is probably the best intensive pulmonary attending in the area. He has a "super surgeon" type personality- overly confident,aggressive and cocky, which would be the personality you need to be an intensive care specialist) We stepped out of the room and she spoke to me at the outside of the room.

She said "so how many years have you been practicing medicine?" the question caught me off gaurd. I said "I'm a 2nd year resident. I have been one for 1 year and a half." She kind of look perplexed and said "And what were you doing before that?" I said "I was in medical school before that." Probably not the best answer to her question, but I didn't want to lie to her.

She then said "And why is it that every time I talk to you, all I hear is- maybe,possibly, most likely, hopefully?" I didn't know whether to laugh or to argue back, so I decided to stay quiet. She seemed a bit angry. "And who was that doctor that walked in? I don't appreciate and like his bed side manner.He just walked in and was not very polite." I told her "he is one of the pulmonary specialist and intensive doctors working with us. He is one of the doctors on the team." "well you know what, I want to talk to him." At this point, I knew things were about to get worst. The pulmonary attending was sitting right behind us and was on the phone. As soon as he got of the phone and continued to write a note he was writing she came up to him and said "HI. I would like to talk to you. what is your name and number?" He looked over her and said "ok" she then continued and said "and you know I don't like your bed side manner. I want you to stand when you talk to me!" At this point the other residents had walked into the area and I looked over to one of the seniors and she stared back at me as if saying what the heck happen here?. He stood up as if he was about to kill someone, but remained calm. "who are you ?" He said to her "This is my brother you are talking care off." He said "I'm not his doctor. He is not my patient I just came here, I was covering for the other pulmonologist who is on vacation. I saw him today for the first time" She then looked at me, I tried to become invisible, but it didn't work! She responded "What?" he then said, realizing what he had just said "I'm the pulmonary doctor for today and I know what has been going on with him and I'm taking care of him for the next couple of days."

"do you think he is getting the right care here? how long have you been a doctor here? He stood quiet 2 seconds then said "I've been a doctor here since 2001. I wasn't aware of who you were so when You approached me the way you did I was taken back. But I can tell you that he is getting all the proper care. If you feel he is not getting the proper care you can always transfer him, but I don't think you should."

He then went on to tell her what he thought about his prognosis and the fact that he might need possible tracheostomy. She then asked a few more questions and seemed to be calm for the moment. I was going to walk away and run to my bat-mobile plane to fly home, but I realized I hadn't signed out yet to the resident on call, so I decided to stay. I then went over to the sister and tried to calm her down. I told her "I think that you would feel comfortable if you spoke to the primary care doctor, he would help you with any of your concerns,. And anything you need please don't hesitate to call us." She seemed a bit more calm, and then ran-walked over to the on-call resident to sign out.

I signed out and then got in my car and drove off.... I felt as if though I had just dogged a bullet, but this wasn't the matrix, and I still have him for another week. I'll let you know how it turns out. If I write another blog, you will know that everything turned out ok.

God Bless you
Dr.mike

i.e. I found out that the sister is bipolar. The mom told us. Well i guess that could explain a few things.

Day 500: Pouring rain in the Intensive Care Unit

Sometimes it seems like when it rains, it sometimes pours.... today was no exception. It was one of those days. It's been a long time since I felt the way I do now. When I was an intern their was days where I felt my entire spirit and mind drained. Drained by the stress and activities of the days. The days when you drive home crying and feeling as if you just got run over by a truck of stress and being over worked.

I'm back where it all started- the intensive care unit. This time around, I'm no longer an intern, but the senior. I'm forced now to supervise and watch over the interns very carefully. However, their was this one patient we have, who happens to be the son of one of the nurses we have in the hospital, and his son has been in the unit for 4 weeks. He has a rare genetic disorder and has been in and out of multi-organ failure. He is also on dialysis daily and CHF with ejection fraction 15%. (His heart is hardly working.) He was intubated originally for a large infiltrate and collapsed lung. He was in ARDS but got out of it. HE is on mechanical ventilation and has been having difficulty getting weaned off the ventilator. Every time we shut off the sedation so that we could extubate, he starts to get tachypnic and tachycardic and starts geting agitated. It has really been a struggle. I guess what makes this case different is that it is the son of one of the nurses we work closely with. So you kind of pay extra attention to detailed. We have even seen him sleeping in the empty unit bed next to his room.

Today was a bad day. Are plan was to try to wean him off the ventilator today, and as a last resort if he didn't tolerate weaning then immediately do a possible tracheotomy and possibly peg tube or even yet let him go entirely and let nature take its course.

We started around 3 pm. We had the trauma surgeons and the pulmonologist in the room along with 5 more people and at first we took at the tube. The anesthesiologist place another tube in his trachea just in case it would close do to a stricture. He initially seemed to be doing well. But then trouble started. He started to have a lot of secretions. he seemed very "wet" he was getting tachycardic and tachypnic. hr 140 and np 160/110. His respiration was around 37. His saturation was 92%. We left him like this for 5 minutes while we waited for his father to come.

WE were surrounding the bed when his father walked in. He immediately went to the left side of the bed. He grabbed his head and kissed him on the cheek. His eyes were all red and slightly watery. (he is a stocky man. He is very muscular not the type you would think would be this emotional, but yet again this is his son.) Seeing all this was really took a lot of us back. I stood their silently trying to figure out what to do. The intensivist was their (one of the top in the region). he turned to me and ask "you think he will make it?" I just stood there not really sure what to say. He went up to him and started listening to his lung and observing him.
you can hear the crackles across the room. IS sounded like a lot of gurgling sound. They kept on suctioning him, but he still had it. He then turn to me and said not good. I wasn't sure what that would mean. A few minutes later I came back into the room and he was close to the nurse talking to him and had his hand over his shoulder and he said "I'm sorry. we tried everything we could." I still wasn't fully sure what would happen next, till I saw the anesthesiologist saying "pass me the tubs" They were re-intubating him again and they were saying that they will put do a tracheotomy on Monday. The reason this was really big news was that the family was thinking that is might not be a good idea. He would have a trach and be stomach pegged for nutrition and maybe on full restraints so that he could not pull out the tubes. He would literally be a "prisoner" tied on a bed. And add dialysis possibly every day. It would be like slow torture. As I stood thinking about all this. I looked at the back of the room. And the nurse was in tears crying and hugging the father. He was sobbing. I turned away and gave him his privacy. I stood out side the door. I could feel all the energy in my mind and spirit leaving me, as I stood their looking at the anesthesiologist re-intubating the 20yr old kid.

The intensivist came out of the room and said "put him back on the same ventilator settings... we will see what we do on monday." I placed the orders in and I walked down the unit floor. As I walked away I met up with my friend who seemed to be upset. He turned to me and said "I can't believe the schedule they have me on this weekend. I don't know why the chief gave me the schedule she did this month." I turned to him trying to be polite. In my mind I was like "are you kidding me? your complaining about a schedule? did you just see what just happen to that 19yr kid in bed 5." I turned to him and didn't say nothing. I pointed at the schedule and told him "if its any consolation, I have an extra three days more than you, and i'm on call 2 more weekends days extra than you." He kind of stayed quiet after I said this. He got the sense I was feeling tired and drained.

I told him I was leaving earlier and I signed out the other 2 patients that I had. Along with the last hour and several other patients and situations throughout the day, I felt so tired and drained. It was tough to see this type of suffering. Its a very hard thing ti get use to. Specially when you form bond with certain patients and their parents.

I drove home in about 30 minutes . I even gave superman a call over the phone. He graduated and is working as a hospitalist in Florida. I still call him when i need help. eh gave me ideas and told me not to give up. It was nice to hear those words. he told me to try to do more dialysis before extubation monday and try to limit the fluids as much as you can. even if you have to change the in antibiotics to po and limit any fluids you can. It was nice hearing his willingness to keep going. I will try to do what he recommended.

I went up stairs and sat tied on my couch. My wife came into the room from work. I asked her how she was feeling. She said "is was a bad day, I'm so tired. (she works in a busy clinic in the city) I turned to her and simply said "I know what you mean."


God Bless

Dr.Mike

Day 491 Discovering the Goodness of Life

Well its been a long since I last wrote, and I'm really sorry about it. I know a lot of you follow the blog. I have blog entries that I have written but have not been able to upload them and edit them. I promise to log them all in the coming 2 weeks. I'm about to start my UNIT rotation tomorrow. It will be throughout the month of December. As i'm writing this, it is the last day of my short 2 week vacation.

Overall the year as gone surprisingly fast. Already it is December, and we are in the 7th block. Already there are people coming in for an interviews and tours. I have not been in the hospital while they have been going on, because I was on night float before vacation.

The new interns have been adapting well to the program. And are slowly coming into their own. Slowly they are gaining more confidence and learning the practical aspect of medicine. A few of them are very cocky and proud, but they are good people. you can't help sometimes to be proud and you feel good when you start practicing medicine. One day while you are on the floors, it will kick into to you. And you realize that its not as hard as people make it out to be. And you learn the practical aspects of what you really need to help people.

On another note, I just have not been feeling myself. I have not been able to fully enjoy myself this year. A part of me feels something is missing in my life. I have spent some much time and so many years trying to get here. I think a lot of you understand what I mean. The countless hours studying to no end. Constant disappointments and surrounded by people that just don't understand what you are going through- having to takes these exams over and over again, sometimes to no avail. It use to seem that there was no light at the end of the tunnel. You read these experiences daily in the forums. Countless people frustrated and in tears over their plight. And can say that i understand a great deal of them and you.

I use to wake up in the morning not caring, not smiling, pondering the unforeseen future. It seems as though the impossible would never happen. Its as if you are walking in a circle over and over again.

I went through the match about 3 times, and each time it seemed more pointless and meaning less. Countless of times I use to sit at my table in the room, staring into the blank walls. Motionless and with no emotion. You become numb to the situation. You get to the point of surrendering. you get to the point where you just say "I'm gonna try and do everything I can, and if it doesn't work out, then so be it."

I'm not saying that we all go through this experience like this. A lot of us are fortunate to have the support from people will love and our families, but even then deep down inside you realize that they don't really understand fully what you are going through.

And one day the time will come. All your hopes and dreams seem to come true. You go on interviews over and over again. never expecting and always hoping. And then finally a good email !! Not the ones from ecfmg that simple crush your dreams in a two line sentence, but the email-the one offering you a positions in residency. It seems that for a while the sun is always shining. even in the raining days you still can see the sun, well at least a part of it. Almost every problem seems minuscule compared to what you have just tackled. And yes as time passes by and you receive what you have always wanted, it seems as though something is missing.. you look around yourself. you see that you are surrounded by people you love and care about it. You help them with their problems. You live the life you have wanted and yet their seems like something is missing in your heart.

Cold play in one of their songs "fix you" says sometimes in life " you get what you want but not what you need.". And think that's exactly what happens to many of people that attain things they have been fighting for their entire lives. Be it a career or position. May material possessions or relationships. you see it all the time in holly wood. The super rich with everything anyone could "want" out of life. And they are some of the most unhappy people you see. Sigmund Freud was once ask who did he prefer to treat "the rich or the poor?" he responded by saying "the rich, because they understand that money cannot solve all your problems." Perhaps this comment might ring true for many of us. We spend our life chasing material things, but maybe their is more to life than wealth, power and positions. Don't get me wrong. I think what we do with our lives is special. We need to dedicate our lives for a higher purpose in service of others, but what i'm talking about perhaps takes it a step further.

I can only speak of what I'm experiencing now. I feel that something is missing in my life. I think I have reached a peak, and yet it seems I'm still not thinking clearly. Its as if I'm not complete yet. I have been thinking about it for weeks and hours at a time. I have tried to put it off and tried to take my mind off of it. But I still feel a hole in my heart. An empty space.

There are certain people that attain tremendous wealth, and when they reach to that level and realize that they are still not happy. they panic. They are perplexed. They don't understand how they could have what everyone wants and what everyone thinks will make them happy. And yet when they have all these things and they are still not fully happy, they go into s state of depression or denial. many of them reach out to different things to try to relieve the feeling. More expensive homes, more vacations, more exotic gifts and spending, more dating, more of "everything". And yet at the end of the day, while they lie their on their bed staring into the dark ceiling of their bedroom they can't help but still notice that emptiness inside. Its what I have been feeling now for a while. I didn't want to share it, but then I thought it would not be truthful and I wanted it be part of my written journey throughout residency. I guess that's why I haven't updated the blog recently.

Furthermore, as I looked back on my experience and present moment. I analyzed and pondered over my life daily and I realized what I had been missing. It was a spiritual hole in my heart. I wanting for something deep and spiritual which i haven't obtained. A deeper inner emptiness that God once filled in my life. Its a separation with God that hurts. Its the same feeling you get when you haven't been home in a long time. Its also the same feeling you get when you are away from your love ones for a long time. When they are not with you. You feel empty. You are not the same. Your time and happiness is not complete. Its the best way that I can describe to you what i'm feeling and what I have been going through.

I've come to realize that their is a higher level of being in life. One that you don;t often discover, since we spend our lives chasing our dreams.. Chasing positions and people. We rarely get what we want in life. And sometimes when we do get it, we realize that there is more to life that what we expected. Their is a higher level of happiness found in other things than what we were chasing. It could probably take someone a long time to discover. It has taken me all my life, since trying to become a doctor is usually a lifetimes work. But overall my life has been a blessings. the lessons I have learned have not been easy, but sometimes that's how we learn them- the hard way. But the knowledge and realizations of these truths are probably worth a lot more than anything that possibly life could offer. A deep spiritual peace and love cannot be purchased. I hope that in time I could unlock its secrets. I hope that god can fill the emptiness in my soul. I pray that God has mercy on my soul and shows me his way. I hope i can learn to know him better like I once did. I think I have been to distracted by the things in life. And I have separated myself from all the goodness of God.

Let us hope in the coming weeks and new year that my happiness may one day be complete.

I wish you the best in the coming match. Congratulations to those that have gotten interview and have gone on them. Don't give up. keep your head....

God bless

Dr.Mike