Diary of a high school teacher turned doctor (i.e. resident)

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  • #117313
    lmb10lmb10
    Participant

    It is March and thus three and one-half months until I will start my sixth year of training “to be a doctor”…four years of med school and nearly into one year of a family practice residency…and I wonder every day if I made the right decision. I used to be a teacher…used to get to look out over the lab table at the front of the room and see young and often excited faces. They were usually healthy and as I taught at a private school, generally respectful, and they loved to tell me about their lives. I think that is what I miss most…the openess of adolescents with their thoughts and affection…or their fear or anger. Unlike adults, kids can be so transparent about their emotions and are still willing to get excited about things.

    Now I find myself at 5:50 am knocking lightly on a heavy wood door without a lock to enter the room and personal space of a usually very ill human being and their concerned family/friends…the “patient’s room”. Despite having done this for 3 years now, I am still amazed that we practice hospital medicine this way…waking sick folks before the sun has risen…interrupting restorative rest…to quickly ask them how they are, do a cursory physical exam, and then run back out to the nurses station to get the required note written before meeting the attending for rounds. This certainly can’t be in the patient’s best interest and yet every morning I knock on the door, put on my pleasant cheerful face, and enter a world usually populated by illness and fear.

    It is not that I don’t think I am doing something worthwhile…I know I help people sometimes…even if it is only writing an order for the nurses to help the patient shower…I just hate the part where I wake people up or make them gag with an NG tube or write the order for the nurses to restrain the elderly man who has belted the nurses aid and pulled out all of his IV’s.

    I am doing an internal…as Erin has called it in her diary “Eternal”…medicine rotation this month and am dutifully waking sick people up every day in the predawn hours to fulfill my reponsibilities as a “doctor”. I have decided, indeed decided a long time ago, that I hate hospital medicine. The way we manage hospital care seems so counter to what is truly healing to the mind/body/spirit. I am not really even a big alternative/holistic medicine person…but it is common sense that interrupting a sick persons sleep, having IV machines and monitors that beep at them, telling them they have to wait for their nurse to pee and then lying in their own urine, putting them on unhumidified oxygen and having to wait on the pharmacy to send up an important or pain relieving medicine….does not make people better.

    I miss the young bright eyes of my former students, their intermittent enthusiasm for science and unflagging interest in one another, and definately I miss the hours!!!! I worked 81 hours last week, approximately 46 hours more than I worked each week teaching…and I worked those hours on several floors of a hospital rather than in the classroom which I lovingly decorated with plants, fish, posters of various biological subjects, and even a large stuffed owl (product of past roadkill donated to the school).

    What I don’t miss is the lack of money (not that I am rich right now) or perhaps the lack of future opportunities to make enough money to support myself. What I don’t miss is the lack of intellectual stimulation after teaching the same lesson 3 times a day X 9 years.

    I know that being a doctor gives me the opportunity to work with people, help them, counsel them, teach them, learn something new everyday, and make a living which will support me and my family…but I am just not liking my life right now and wonder if I will ever love being a doctor as much as I loved being a teacher.

    I just found mommd today and appreciate the chance to share some of my story…here’s wishing you joy and moments of peace …until the next installment.

    #117314
    lmb10lmb10
    Participant

    Another day in March of my intern year…another battle with depression. I find myself fighting hard to stay afloat…to not quit and make the journey to my dream career even longer. The first step was starting this diary yesterday, the second was contacting another intern in my class and making plans to have some “support time” together, the third was not blindly answering “fine” when someone asked me how I was today, and the fourth was seeking out the psychologist who works in our office and asking for some crisis counseling…I still want to quit but feel better about starting to take better care of myself.

    I went in to work today after having Sunday off and saw drawn on the white board a cross next to Mr R’s name. The moslem intern who was on yesterday got the call that this sweet old man (who had given given up on life several days ago) had suddenly began gasping for air…and he had to basically be with the man’s wife of 59 years an help her to respect Mr. R’s wishes to be DNR. I learned today that after Mr. R. was pronounced dead, she actually called Mr. R’s nephrologist and said “Isn’t there anything you can do?”. Mr. R. was in the hospital for weeks and she has yet to face the reality of how ill he was…and how he gave up several days ago…….my moslem colleague had then returned to the resident’s office and drawn a christian cross next to the patient’s name. When I saw the cross, at first I was confused, then sad, and then to my embarassment so happy that I had missed the whole drama and so glad that I had one less note to write this morning. Mr. R. had seemed so miserable over the last few days, I found myself wishing at times for his passing into a more peaceful existance and I couldn’t help feeling relieved this morning too that I wouldn’t have to continue to witness his and his wife’s suffering.

    So that was the first five minutes of my workday in a nutshell. Then off to the floors where the computers weren’t working, and two bed alarms kept going off, and where I had to look for about 10 minutes for one patient’s chart.

    I am so tired right now and my head hurts. My husband is late coming home from his part time job and I could go to sleep right now (it is only 5:30 pm). Tomorrow I am on call again all day and I wonder if I will sleep at all during the 30 hours that will entail…I hope so…I hope that I will have the time and then actually be able to sleep. WHO DOES THIS? Who came up with this system? Maybe someday I could help change it….who knows.

    So wish me well in my battle against the fears, the anger, the sadness, the frustration which is threatening everyday to overwhelm me…and I will wish the same for you.

    #117316
    lmb10lmb10
    Participant

    I made my medical student cry today…well maybe not exactly “made” her cry…but I looked at her, noticed something different, and asked her what was going on…and tears sprang into her eyes. She seemed so uncomfortable and the situation so public that I backed off and did not probe further. I suspect it is related to her recent break-up with her boyfriend…but knew that pressing the issue would mean opening the floodgates and knowing all to well how hard those are to close, I chose the practical route but added that I was always there if she wanted to talk. She is a beautiful brilliant young woman and I watch her fighting to close the floodgates and not “break down” and I know exactly how she feels. As she had no patients to follow today, I encouraged her to take an hour to take a walk or just relax, but she wanted to “keep busy” and my heart went out to her.

    For any reading my diary, I hope I am not just depressing you. It is helpful to me to just get this stuff out there into the etherland and know that I am not the only one. We humans are such strange creatures that way…craving to be one of many rather than isolated by our grief or joy.

    Over the last two weeks, our hospital has taken food out of the residency lounge that it had been supplying, cut back on the number of on call meals it would supply, changed its parking policy so that residents have to park farther away, cancelled the 12-3am cafeteria opening for night shift, got rid of the “sandwich” lady in the cafeteria who would make sandwiches to order, increased the cost of food in the cafeteria,and tried to make the “real” doctors pay for the food in their lounge. Two days ago, I got a contract with a salary which is basically only a 1.5% increase over last years salary (less than Cost of living increase). To re-phrase: I AM FEELING UNDERAPPRECIATED. The amazing thing is that I am in a WONDERFUL fam. med. program. I have a meeting with the prog. director on Wednesday to discuss all of the above changes…and know that he is my friend and will listen and do all that he can to help. That and my colleagues make this a wonderful place to be……….the AMAZING thing to me is how I am so unhappy in a program which has been really supportive and healthy compared to other programs. I cannot imagine working as a resident in a program which is less supportive.

    Perhaps my previous experience having a career that I loved helps me to know that I can always quit…which is not an option to most people. And somehow, knowing that I can quit makes it easier not to quit. My parents would DIE if I quit…but I was also lucky enough to grow up with an Aunt who taught me that: “It is never too late to change your mind”. She is one of the happiest people I know and has helped shape my understanding of the world in wonderful ways.

    For today, I choose not to quit. I hope tomorrow that I will make the same choice. For now, this is a day to day decision…and I guess the wonderful thing is the recognition that THERE IS a CHOICE. May you choose your bliss.

    #117317
    lmb10lmb10
    Participant

    Today was a very good day. I got 3 hours of sleep last night…solid sleep…which is a blessing on this rotation. I discharged two patients home, did some important problem solving about a difficult case, and left early to meet with my fellow intern and program director about the recent hospital changes I alluded to in previous entries.

    Dr. B. was wonderful and the meeting reminded me of why I chose this program…of the support and the friendship. My primary criteria for choosing a residency (and I would encourage all Med Students to use the same criteria) was a program where the people were happy. Of course, I am not happy all the time (obviously) but I feel like I can be myself, ask questions, call my attendings my colleagues and partners, and basically feel loved an appreciated by the community around me. I needed the meeting today to remind me of this all over again…and I am sure that I will need to be reminded again in the future of this. Perhaps the key is that when possible I must be the one to help remind others in my community of the same thing…the new interns who become part of our community as of tomorrow, the attendings who are exhausted after two weeks of being on hospital service, my fellow residents who like me become disenchanted by long hours and the spaces between life and death, and the men, women, and children who honor me by consenting to be my patients.

    Tomorrow I will try to focus on good deeds. Sweet dreams all.

    #117318
    lmb10lmb10
    Participant

    I can see new life welling up around me today. The weeping willows which line the creek by the road which winds up to our home have sprouted what looks like green fuzz on their braches…the birds are singing…there are daffodils blooming in our yard which I did not know were hiding underneath the ground!

    As well, we have 8 new people joining our practice as interns next year. Up until this point in the year, I have only been thinking about how much I am going to miss my 3rd year partners when they leave. But today with the Match complete and our program full, I find myself rejoicing in the prospect of all that the new interns will add to our community.

    Tomorrow is the first day of spring and even though it is Saturday and a call day, I am feeling happy about the new greenery and new potential friends that will be available next year. I have gone from super depressed a few days ago to making cinnamon rolls tonight to take to share with the on-call team. I am not bipolar but am amazed by how the world shifts when you choose to look at things in a different way…feeling trapped changes when you realize that you can always quit…it can be winter one day and promising spring the next…telling a friend about the your worst fears and problems can make them feel so much more manageable. I am grateful for this fleeting but definite sense of peace and celebration of new life.

    #117319
    lmb10lmb10
    Participant

    Today my topic is noise in the hospital. I am amazed daily at the ambient noise in the hospital. Right now, I am sitting at a nurses station and can hear a radio playing, a TV in the waiting room spewing some news program, the air conditioner is blowing softly, the printer printing, a tube just arrived in the tube system which is wining incessantly, a patient’s bed alarm is going off and no one seems to be going to stop it, a patient is ringing the front desk, the phone is ringing, pagers are going off, some poor soul cries out repeatedly “help” down the hall,and off in the distance someone’s IV Pump is occluded…Whew! How do our patient’s put up with this? How do we? I can only be thankful that I am not ADD and can filter out most of this and write this diary entry. Here’s wishing you a moment of silence…or at least only the birds and crickets singing in the background! :wave:

    #117321
    lmb10lmb10
    Participant

    Today I finally had to concede that my favorite patient on the hospital service is slowly losing the fight…her lungs are filling up and with low blood pressure, renal failure, allergies to certain meds, etc…there is nothing we can do but watch and make her comfortable. I spoke with the family today and for the first time in my professional career, burst into tears in front of a family. I have cried in front of colleagues, attendings, nurses…but never lost my “mask” in front of a patient or their family. The family was/is wonderful an we are all struggling to support one another and Mrs. R. as she passes from this life. I was able to contain the tears while talking with Mrs. R…I am not embarrassed by the tears but do not want her to feel that she has to worry about me. I have no idea what the next few days will hold, but I hope and pray that we can get her more comfortable and help her to die with dignity.

    On the other end of the spectrum, I had a wonderful compliment today. One of the most brilliant specialists I know asked me what year resident I was and when I answered “intern”, he looked me in the eye and said “you do a really good job”. This from a taciturn man who knows more than I can imagine knowing. I am constantly questioning my fund of knowledge. It always seems that my fellow interns remember more about what is the standard of care or latest treatment for some malady than I do. What I am good at is working hard, trying to make sure I have dotted all my “i’s” etc, and communicating with people. It astounded me that this man who I am always asking questions believes that I am doing a good job. It helped remind me that the above qualities can be more important at times than a flawless fund of knowledge. As long as we recognize our weaknesses, ask questions, research, and know when to refer…being a good doctor is more about being dedicated and caring. I hope that I will be able to hold this belief strong in my heart and maybe stop beating up on myself when I cannot remember as much about the lastest treatment or research as my medical student.

    “may the beauty we love be what we do” (paraphrased from Rumi)

    #117322
    lmb10lmb10
    Participant

    I have gotten home somewhat early and am bored. My husband is gone somewhere and it seems that this is why I am bored. I have only been married for 10 months…in residency for 8 months…and I find myself more dependent on him than I have been with anyone in a long time. Us strong independent women hate to admit to dependency…but I find that I need his positivity and different way of dealing with things when things get hard during residency. I know deep down that I can get these things from others if need be…but for now, he is my sweetie and life is just more fun when he is around.

    I am 37 years old and before I met my hubbie, had decided that I would most likely never marry. I could not imagine getting along with someone on a day to day basis…I could not imagine being married to most of the southern conservative hunting men who watched football every sunday who I found myself surrounded by. I also could not imagine having to care for myself and “take care” of someone else in the way it seemed most men required. I had begun making plans about adopting children as a single woman and began my medical carreer…and then two and 1/2 years into my medical training, I met this wonderful, funny, liberal, vegetarian man who cooks biscuits and makes things with his hands and never takes life too seriously. He may not love to talk about his emotions or always understand it when i am taking life so seriously but I find that I can live with him days, months, years at a time and still feel like myself. I don’t have to take care of him…and he doesn’t take care of me…but we care for one another and share so many views about the world. How amazing life really is…it just goes to show that one should never say never…life can always surprise us.

    #117324
    lmb10lmb10
    Participant

    Only two more calls on “eternal” medicine. Then an easier month with some annual leave days and more free time during the day. It makes life easier when you have something to look forward to!

    Mrs. R. died this morning at 5:45 am. Once again, it was my colleague that pronounced her. I felt relieved that she and her family were beyond the “suffering” and able to move on to grief. I felt relieved that I would not have to watch their suffering and close that chapter of my medical life. I seem to like the order of finishing one thing and moving on to another. Lingering debts, duties, pain, confusion…have always been fairly uncomfortable to me. Life is full of such lingering…but I have always had a sense of satisfaction when I can turn the page and move on. I know that Mrs. R. is in a better place. I can even fantasize that she was being kind to me when she passed away while I was at home getting ready for work…that she chose to die two days (rather than two weeks) after we all agreed that continuing treatment was only prolonging the inevitable and her suffering. She was a beautiful human being and I am honored to have known her. Her family tell me that she was famed for her bisuits and gravy and her turkey and dressing…she raised her grandchildren and some of her neices and nephews…she loved working in her garden and lived amiably with her oldest daughter. Her family spent the last week and a half alternating staying with her in the hospital. She was surrounded by love and respect…and a family who held her until her last moments and then quietly let her go. What more could anyone of us wish for.

    Mrs. R., thank you for all you taught me and for the love and kindness you shared. God be with you til we meet again. :cloud9:

    #117325
    lmb10lmb10
    Participant

    Tommorrow is my last internal medicine call this month…and only one more month of internal medicine to go. I am a family practice intern and our first year we do three months of internal medicine. The call and patient load is harder…and the attitude a little colder…but we sure do learn a hell of a lot. So I guess it is worth it but I am glad that May will be my last month!

    It is Saturday Night and I am sitting on the couch with my husband and my cats watching the movie “Radio”. It is a beautiful spring evening in the mountains and the sweet spring air is coming through the open windows. I crave more moments like this…more time to savor the pleasures of everyday living. The irony of it is that having less time to savor life tends to make those moments that I can do so all the more precious.

    Well, let me go and savor the evening. Sweet dreams all.

    #117326
    lmb10lmb10
    Participant

    My subconscious has a way of voicing itself in song. I will find myself humming a tune…or outright singing a song on the elevator (when I am alone…does anyone else do this?) and realize how appropriate it is to the situation at hand. Yesterday…my last day of my internal medicine rotation…I had to laugh when I found myself singing “Ding-Dong the witch is dead, the wicked witch, the witch is dead”. I was striding out to my car with an irrepressible smile on my face feeling free as the munchkins on the day Dorothy arrived. The best thing about a difficult rotation is how much you appreciate time when it returns and perfuses your life!

    Today I started the first day of an OB rotation with a terrifically nice attending. I met him at the hospital at 9am…three hours later than I have been coming in for the last month. It was heaven. Next month I will start another Internal Medicine rotation and I am sure that the return back to a 6am start will be as difficult as 9am is wonderful…such interesting times.

    Lastly, I cannot close this short diary entry without remarking on the slow unfolding of Spring in my area. Driving home each day, I never stop being entranced by the subtle changes which are occurring around me. The trees which have been dark silhouettes framing the line where the mountains touch the sky have started to be touched by pale green, yellow, purple as the flowers and leaves unfurl. The brown-gray hills have started to be dotted with color…almost like a painting which is added to everyday and I love watching the change wash over the land. Yes this is corny, but I cannot explain how much I love living where the horizon is broken by uneven lines and you alternate between looking up towards a peak or down over a valley. I have only lived here for 9 months…but I find something every day on the drive home which is eye-candy for the soul. Please God help me stay this way.

    Here’s hoping you find your soul-eye-candy today!

    #117328
    lmb10lmb10
    Participant

    Well, it has been over a week since my last entry. Interestingly enough, I have been on an easier rotation with more time…and have needed a diary less. I took my husband to Dollywood on Friday as a surprise. Good idea…bad day to go. I believe that everybody and their grandmother were there that day…and unbeknowst (sp?) to me, I was coming down with a stomach flu vs. food poisoning. My head was hurting, I felt more and more tired, and my muscles started to hurt…so after about 4 hours of amusement park we started the 2.5 hr drive home. By the time we got home, I had a fever of 102 and was feeling horrendous. The stomach part started later that evening. Today is the first day (now is monday) I have been able to get out of bed for longer than 5 minutes without getting sick. Luckily, I was not on call and had some sick leave I could take.

    Being ill like this has increased my empathy for my patients…especially the ones with nausea that we try to give PO meds…and especially the ones without a loved one to help them while they are stuck in bed sick.

    Even sitting up for a while makes me feel a little sick, so I will finish this for now and write again when I am more on the mend!

    #117329
    lmb10lmb10
    Participant

    Hello All,

    what a long time it has been since I felt inspired to write. All kinds of things are shifting for me now (when do they stop shifting in residency?). My husband’s grandmother died week before last. I was lucky enough to be on a rotation where I was able to take some time and go with him to attend the funeral and commune with his family. Then last week, I attended the American Holistic Medical Association conference in Albuquerque, NM…from family to home to New Mexico and lots of new ideas and approaches. I was forced to face how negative I have become this year…how ready I am to decide that the universe/God/etc. is against me. Then back home and we get a call that one of my hubbie’s best friends from high school had chosen to take his life. The recent two deaths have cracked through the cool I have adapted at times to deal with sadness in the hospital…and tears come easier. K. (husband) will have to go back to FL on his own for this funeral as I am back again on “Eternal Medicine” rotation. I will really miss him…miss being with him and feeling brought together by adversity.

    I am trying to change my viewpoint so that I find the wisdom or pearl I can glean from bad…and good situations….rather than lament “why me?” It appears to be a lifelong choosing every day to see life this way. Wish me well!

    #147198
    JosJos
    Participant

    Hello Imb10,

    Just read all of your posts. Your “diary excerpts” have been so amazing, I feel like I can read them all day, like I am in trance reading a great book. I wanted to say that I hope you stuck out being a doctor. I find it amazing that even after 14 years, I can still read your blog! I came across your posts because I am a licensed K-9 teacher and have been thinking about becoming a medical doctor. I don’t know yet, but I was curious to see what others “out there” have said; either they have done it or are thinking of doing it. I am 25 years old now, and I realize that if I follow the “12 year” path to becoming a doctor, I would be around the age you wrote this blog. I know that it was hard when you started, but I am wondering and wanting to know how you feel about it now. I feel like your posts were a book that ended with a cliff hanger for me, and I must know what the ending was! ;D

    Thanks so much for taking the time to read this, and I hope all is well in your day and in your current life,

    Joselyn

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