Anniversary and the ICU

I am gearing up for my big push through 12 straight days of work, including 3 calls, one of which is whole house. So let me explain that. Normally there are three residents that cover the hospital. Typically its two first years and a second year. One of the first years and the second year cover the hospital. So any patients of our clinic, of other FMS clinics around the area, and any patients without doctors or who are from out of town are taken care of overnight by those two. The other first year (or sometimes a second year) covers the OB department by him/herself.

Now, I prefer FMS call. I am just not an Obstetrics kind of guy. Not my thing. And I think that FMS call is usually paced a little better. You get called more often, but its more consistent, and even though you have to run about through the hospital, you don't feel terribly hurried most of the time.

OB call however, there is oftentimes way more work to do than one person can do in a night, and its a common occurrence for certain things not to get done, in favor of C-Sections and Deliveries (you know, the important stuff).

Well, on a whole house call night, its just the two FMS covering residents, and there is no OB resident. Which means that two have to do the work of 3. As well, that extra one that we are covering is often too much work for one.

Basically, it sucks. And I have to do it on Thanksgiving. The nice part is we only have to do one of these an academic year, typically. Thanksgiving, Christmas, Easter, 4 retreats, and a few random days. At most we do three in our 2 years doing in house call.

On top of this, I am on ICU. Which means before and after call I have to round on my patients. So I will be covering the whole hospital for 24 hours, likely without sleep, only to have to go and try and fix the sickest patients in the hospital. Don't tell me I'm not a badass ;)

And I am not necessarily complaining, just sharing. I knew I signed up for this. This isn't really a surprise. But its not fun either. I will be missing turkey and pumpkin pie this year :( But thats the way it goes sometime. Hopefully this is the last time.

On a much more fun note, Mandi and I are celebrating our 2nd anniversary tomorrow. I can't believe it has been 2 years already. Time sure does fly. She's the love of my life, she is God's joy for me incarnate. And she is my greatest earthly blessing. I love my wife. A lot.

So happy anniversary to us.

On call.

So its 05:55 and I am sitting at the desk in Labor & Delivery. One of those rarer calm moments, waiting on results and physicians to call back. More of the same really. This is also hour #22 of this particular call. I don't know whether it is depressing or exciting that I only have a full, regular-person's work day between me and blessed sleep. Probably a little bit of both.

It was an interesting night, but nothing that I can talk about of course. Overall I can't complain, hard to do that when I know what I have waiting for me at home, a beautiful wife, beautiful house, with some Filippo's pizza and my new TV. Should be a good time.

I can tell you right now that I am definitely "done" with MNPS (OB). Just not my cup of tea. I understand the noble nature of the field, and I will be the firs tto admit that OB/GYN's do a lot of good work, and do tons of good for their patients. But the lifestyle... I don't care if it brands me as selfish, but I can't imagine ever having this kind of lifestyle. Nothing is worth this too me. Even the noble pursuits of medicine.

And I wonder if that isn't part of the problem. Through this false image of the "altruistic" doctor who puts their perception of the patients' well being above all else, along with this misguided ego-driven idea that only "I" am the one who can properly care for "my" patients... we have created this bizarre social dynamic in which we elevate ourselves as martyr's while being highly paid and increasingly resented by the patients who's best interests we believe we should be, and are working in.

I think it would be far better if we admitted that we are just people. And that sometimes breaking continuity of care is okay. Because if it came down to me having "my" doctor after 22 hours on call, or someone else's doctor who is working a regular, reasonable 12 hour day... I would pick the "other" doc everytime.

Of course, these patients, they are getting some "other" doc who has been on for 22 hours. Where is the benefit there?

Again, this isn't a personal complaint. I will do the work. Its hard, and long, but its doable. And the light is there, ever present at the end of the tunnel. I have no doubts that I am one who can go that distance. Heck, I'm cocky enough to believe that I can even do it with relative ease. My comments are more along the line of pondering what is best for everyone, patients and doctors. And not even everyone, but myself, in the future, when I can chose when and where I work. And while I might not be able to say definitively what will be best, MNPS has certainly shown me what is not.

Maybe thats the point? I hope not, because I got that point a long time ago.

Delivering Babies

Had OB call last night. So I was the guy for delivering those babies. Arrived on the L&D floor and saw that there were 5 laboring patients. For the record, thats not a small load. Not super busy, not crazy, but certainly enough to convince me that I was going to be up all night. Because if you have five, you can probably count on getting one or two more that come in during the night. And the five patients were a mix of primes and multis, meaning that some were having their first, some their second or third time around. This also means that some are going to go faster than others... so I am expecting a night of steady deliveries. Between that, outpatients, and progress notes I was ready to rock and roll.

Well, as per the theme of L&D this is exactly how it didn't go. Three of the mothers progressed pretty rapidly, and the three of them gave birth to three perfect kiddos in a matter of 18 minutes. Now I am pretty good, but I am not good enough to be in three places at once. So I miss out on two of them.

After that the night was actually pretty slow. The other two mothers took their time, and there wasn't a single outpatient until 6 AM. I got plenty of sleep, and even got to deliver a few babys. Always a good time. I will be honest though, I don't think I am ever going to get to a point where deliveries don't make me nervous. Its just not a smooth process. There is pushing, fluids, and then screaming, contractions... you get the idea.

AND, bonus, because I am doing ER this month, and you aren't allowed to see new patients after a 24 hour call, I got to head home "early"... that being 16 hours later than any reasonable person, and 12 hours later than every other high liability performance intense job does (pilot, trucker, heavy machinery, captain...). But I digress, the point is that I had this whole day post call, AND I had plenty of sleep. Its like a bonus day. So I am pumped. Now if only the weather was nice I could mow the lawn :)

Residency in Full Swing.

So I have been cheating on this blog with my other blog: How To Be Totally Awesome. And because of that this blog has taken a huge back seat. Which is somewhat unfortunate because this is the blog that I intended to use to chronicle my journey through residency, as well as to put some of my views out there for ideas and comments.

But that aside, I am back. I will try to work with both blogs, this one will always play second fiddle I think, only because my other one has advertisements, and there in needs to be updated more frequently to stay entertaining. That said, this one probably has more meaning, and hopefully a lot more depth.

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A lot has happened between my last post and this one. For one, we closed on our house. Which was a great thing. An expensive thing, but a great thing. We are so happy with our home. Check out Mandi's Blog for details on that. She covers things a lot better than I do.

We have done some renovation, mostly painting with a few other things. Again, Mandi's blog has details on that.

Probably a greater change for me was the beginning of my Family Medicine Residency here in Peoria. Its been a huge adjustment. Going from a lifetime of learning, to a lifetime of clincal decision making. I know this is an abstract way to think of it, but having information poured into your brain for year after year after year, and then to have to turn around and spit it out in a way that helps people, and that works... its an interesting change.

I think I am doing a fair job, I try to ask the other doctors around me to critique me, and to offer me feedback and so far its all good. I feel confident in my knowledge, and in my ability to make the proper calls on the floors.

And speaking of the floors, call has been a real adjustment. There is nothing positive to say about staying up all night, being sleep deprived, hungry, and annoyed for more time than I care to think about at a time. Our call on weekdays lasts from 5:00pm to 7:30am the next morning. Keeping in mind I have to work the day before, and until 1:30 the day after too. Thats 30 hours at a time. Sometimes without sleep! Its nuts, not fun, and probably not safe. I am hopeful that the policies that are being considered will change that. For my sake, but moreso for patient's sake.

And weekend call isn't much better. Its only 24 hours at a time or less, but then its on the weekend. And it kills any hope of having the kind of good time I would like to have.

Now don't get me wrong, I am not trying to complain. I can handle the work. I have worked over 80 hrs a week before, so this is no biggie. And its FUN work, its challenging work, and its what I have been training to do for years! I can honestly say that I love it. And I am blessed to be able to do it. That said, it IS an adjustment, and one that I am finding harder to make than I thought it would be.

I also got a vacation. Thanks to a scheduling flub up I got vacation THIS August, when I thought I was going to get vacation NEXT August. I took full advantage, and went to WI to see my grandparents. It was a blast, great weather, and Bond Lake was great! Overall though, the best part is seeing my Grandparents. Time with them is priceless.

All in all there has been too much to cover in one post. Hopefully I am somewhat caught up with my blogging here, so that I can go ahead and stay current from here on out. More to come!


Tiger Striped Doc