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Silent night... - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
Silent night...
Slept almost 14 hours last night. It is a day off. I finished charts and did H&P dictations 72 hours overdue.

I have recovered something of my old strength, but not enough yet, O Best Beloved. The memories, I think, were never clear. I fall asleep on the dictaphone at 0300 when it has been a steady stream of admissions - seven in a night, one to the ICU. Four had last names beginning with "P"; three were GI bleeds, and I cannot even remember the rest of the diagnoses. Or perhaps I can.
Two calls ago:
Vomiting bright red blood; alcoholic; drunk on presentation.
One-week history of dark red stool and vomit; alcoholic; hemoglobin of 2.4 - barely enough to be alive. He survived. I was congratulated. I'm still not certain whether I deserved congratulations - I don't know that I did much at all except write the orders for blood transfusions and get scolded by GI for giving fluids to a man in liver failure with a blood pressure in the 60's systolic.
Heme-positive stools; kidney failure; anemia; severely overanticoagulated.
"Nervous" and took too much clonidine and Serax (a benzodiazepine).
Seizure disorder, noncompliant, seizing on presentation. Acutely delirious the next morning.
Acute stroke.
Group admission for deep venous thrombosis.
Med student L took call with me; he made it possible to survive by doing several of the admit H&P's for me, in essence. He hit all the right points and asked most of the right questions and then told me I was teaching him something. I hope I was; I don't always feel very smart. I try to teach - when I have a student with me, I try to remember my father's example and the good teachers I have had in the past. I have N firmly in mind when I have a med student with me, and the day we sat down and discussed ventilator management. Thus far, I have caught no-one rolling their eyes at me.

Last call, Saturday's call, I had six admissions including a woman I cannot cope at all well with; her medication list is some thirty meds long and she cannot give up any of them. Not to mention she's got chronic pain. It's all a nightmare. I don't know if I did the meds right when I wrote discharge papers last night either, but I trust in R to fill in the blanks. It was 2100 and I had to go home sometime.
I admitted a patient from clinic yesterday. At least I will not have any more clinics this week. Tomorrow is call; Friday is post-call. Everyone has asked me if I need time off for Grandpa's surgery. I do not. Angel will drive me in there when he gets off work on Friday and we will see him in recovery - what good would it do to pace outside the surgery? I would rather work. I have the weekend off.

I am a shadow of myself; I am empty and lost and I feel no joy, no pleasure in anything right now. I have brief crystalline memories - I was animated Friday night, late, after watching The Chronicles of Narnia with unexpected friends - but the days are days and the nights are too brief and I am dragged down, low, empty.
Medicine is almost over. OB next block, starting Monday; four weeks of every-third-day call and then back to Medicine for the third block of five this year. I never want to do it again. I can only hope it will get better - and I can only feel that I am complaining without justification when our medicine chief is rounding every day all day until 2100 and I am out by 1900 on clinic days, and earlier when I do not have clinic. I only hope I am doing my share.

A day of rest, O Best Beloved, and I am hoping that it will suffice me for the next few days. I am looking forward to OB. This weekend, I will tell you some stories.

Tags: ,
now feeling:: exanimate exanimate

7 whispers echo . o O ( ... ) O o . whisper a word
lemur_lady From: lemur_lady Date: December 14th, 2005 06:50 pm (UTC) (etched in stone)
Sorry if this comes across as creepy and weird, but are you Nykki Keim, Indiana Academy class of 1997?
ayradyss From: ayradyss Date: December 14th, 2005 06:52 pm (UTC) (etched in stone)
I am...and now you get to reveal yourself :)
lemur_lady From: lemur_lady Date: December 14th, 2005 07:04 pm (UTC) (etched in stone)
Holy crap it's a small world.

I'm Carolyn Kibbey, same year as you but I burned out before graduating. I friended you on here many many months ago because someone quoted you in metaquotes and I enjoy your writing style and was interested in your subject matter. It wasn't until a few weeks ago, when you used an icon that shows your face, that that nagging sense of recognition started tickling the back of my brain. I checked your profile and saw you belong to iasmh, so I thought I'd venture a guess.

From: drake18746 Date: December 14th, 2005 10:15 pm (UTC) (etched in stone)
Whenever I teach somebody something and they truly understand it, I always feel like I haven't really taught them anything. Same goes for learning; whenever I learn something very well from somebody, be it becuase I understand everything on the first run through or for some other reason that I can't fathom at this time, they always say that they aren't really sure if they taught anything to me.

I think it has something to do with the fact that you teach it so well on the first run through, and the understand it completely at the same time that gives you that feeling.

Also, the fact that you helped anybody to survive anything earns you congratulations. I don't have any sort of knowledge with healing in any form other than basic first aid and CPR; stuff everybody should know. To be honest, I just don't have the brains for medicine in any form. The fact that you can is already impressive. Right there is more than I could do. Helping somebody to live through something that years ago would have most likely killed them is something that earns more than congratulations. It earns admiration and respect.
deadrose From: deadrose Date: December 14th, 2005 11:13 pm (UTC) (etched in stone)
You *will* survive this. Not only that, it will give you a core that you 'll use in years to come, knowing that you did it, that you can get through the constant onslaught, the near-delerium of trying to learn, use what you've already learned, and do it all in real time with real patients.

(This message funneled through me from my father, who did it too)
From: clypheous Date: December 14th, 2005 11:15 pm (UTC) (etched in stone)
I'm amazed that with the stress and the working conditions and the hours that as many people as do become doctors. It's a great calling to be in and if I had it to do over again I might have chosen that field instead of the one I did end up in. I can only hope that your sense of accomplishment and knowing that you're helping so many people can keep you going.

I'm proud of you (and brag about you to my friends at every opportunity) and what you do. There's almost a sense of reverence when someone is a doctor, especially one who actually deals with patients in critical cases, not just someone like a plastic surgeon. For some reason, that sense of reverence seems unique to doctors and other medical professionals (heaven knows my field doesn't get it, we're lucky if they don't come after us with torches and pitchforks).

You're incredibly talented, smarter than me by far and doing something I don't know if I would have the patience or the mental stamina to handle. I wish you all the best and hope that you prosper in your field! You're making the world a better place, one patient at a time.
reignofjade From: reignofjade Date: December 15th, 2005 12:57 am (UTC) (etched in stone)
I look foward to hearing your stories.
7 whispers echo . o O ( ... ) O o . whisper a word