Tuesday, September 15, 2009

Five More Days

I am tired. Luckily, I have only five more days on this rotation. I am doing the dreaded "terminal call," covering the service overnight Friday and all day Sunday before handing it off to the new interns and senior residents coming in on Monday. This last week theoretically should have been easier, because I have the past five weeks of experience behind me! Instead, it has been really tough so far. I have been taking care of five patients who arrived over the weekend. This isn't a huge number, actually, but they have been quite complicated.

The most straightforward one had a blood transfusion today...so, not that simple, after all! Of the other four patients, one is an alcoholic (which contributed to the problems being treated during this hospitalization), one used to be a drug addict (which led to the organ failure being addressed during hospitalization), one is addicted to food and cigarettes (leading to very, very bad heart and lung disease that will probably kill this patient who is not much older than me), and one is using a variety of illegal drugs, making our treatment decisions about a bloodstream infection extra complicated. All four also have significant mental illness.

This set of patients make me incredibly sad and incredibly frustrated, in about equal measure. Two also have very demanding families who make me want to run the other way. Normally, I really like explaining what is wrong with a patient and what sorts of things we are trying to do to fix it. But these families are completely irrational—not uneducated, which would be OK, but utterly irrational! I can explain until I am blue in the face, and then we go back and start all over again at the beginning, as if we'd never talked before at all. One family member, in total denial, fought tooth and nail against us doing a very necessary procedure yesterday—then today, after the procedure was done and the patient was feeling better, was all upset that we didn't figure out that this "commonsense thing" was necessary sooner, and get it done quicker. Because, after all, the surgeon who did the procedure knew what was wrong! And fixed it really fast! (Um, yes, because we called him and told him the situation and asked him to do exactly that.) Aaargh!

So. That's my work life these days. But in five days, I will get back a bit more of a home life. I will be able to take B to daycare, and pick her up, and spend a couple more hours a day with her. (Perhaps she will then go back to nursing once a night, rather than the two to three times a night that she's built back up to over the last few weeks.) Alex and I may be able to start exercising again. Jasper will get longer walks. And we'll be able to pack up and move into our new house! So, as the much-anticipated New Hampshire fall gets into gear, there is some hope for sanity on the horizon. Please send patient, kind, tolerant vibes my way for the next few days, though. I want desperately to be able to heal my patients—or at least to treat them gently and well during a time of need—but I also have to learn how to leave work behind me at the end of the day.


Anna said...

One of my co-R1s said mental illness is always comorbid with something, usually lots of thing. I hear you--hang in there!

Beth said...

feeling your pain...sending hugs your way!!