MOMMMMMYY!

So just when you think you're getting a month off of hospital call, the residency surprises you with something called "Mommy Call." It sounds innocent enough. Not only in the name of the call, but its home call---how bad can that be?

bad.

First let me say that when you're on Mommy Call you are also the resident for jeopardy call (see previous post). Secondly, parents will call about anything and everything. At all hours of the night. Demanding things.

My first (really second, cuz the first one I was Jeopardized. again see previous post) Mommy Call consisted of Moms calling about a child jumping on a couch and fell on her face and wondered when she should check to see if her face is "mushy." Another call was from a mom about her child having a rash and wondering what it was. Over the phone.

But my last call of the night (at 5am) was a mom who wanted to discuss illnesses in her 5 children. 5 CHILDREN! So I said start with the oldest and go from there. All in all, the whole call took about 40 minutes to get through it. Just enough time for me to get ready for work. Because even though we take Mommy Call overnight we still gotta work a whole day the next day.

Oh the joys of residency. Even with all this craziness, I love my job and would not change it for anything.

JEOPARDY!

Not the fun American Game TV show that we all have come to love. No, this is an intern nightmare. Its the phone call you wish would never come. Its the request to come in and work someone's call. When you had made dinner plans. Or in my case, a Saturday in which I was to go hiking, then to a movie, and then out for drinks. All down the drain with a simple phone call.
The first idea is the intern you are covering for is really sick. Or has had a disastrous emergency. The second idea is you will be "paid back" by the person who jeopardizes you for one of your calls. So you can schedule a time when you should be on call, in my case a Saturday call, and poof! It goes away without any guilty thoughts. I dreamt about this payback all 30 hours of jeopardy call.

First illness

Ugh. I am home sick today. One of the little tykes decided I needed the viral gastroenteritis. Well I didn't. I haven't called in yet and I am upset that today was the day. I was hoping to make it at least a year. But the idea of puking on a little kid was disturbing, so I am home today. Dang it.

Ahhhhhhhhhh

My new recent pet peeve in the hospital is examining a patients throat. Especially adults. I have my little light turned on. I ask the patient to open their mouth. Then I ask them to stick out their tongue. And then usually their big fat tongue is blocking their pharynx so I have to ask them to say "ahhhhh", which will raise their uvula and pushes down their tongue bringing their pharynx (back of the throat) into clear view. Do you know how many times I have to ask before the patient actually does it? It usually takes three.

This sort of perplexes me because they followed all the other directions prior to that on the first command. They will even roll onto their side with ease for the rectal exam without a hesitation. But there is something about saying "ahhh" that people just do not want to do. So I ask them to say it multiple times. I'm even doing it when I ask it. And generally without a response. Until I explain why I am asking them to say it. Then I finally get an "ah" but not an "ahhhhhh."

With kids they don't understand the "say ahhhh" command. Which is why I have to gag them with the tongue blade. And then they cough onto my open mouth and I get mycoplasma pneumonia. But they are kids, and are cute, so I quickly forgive them.

But I am fed up with resistant adults. So adults beware. I know we all have flashbacks to our pediatricians using a device to see our throat. I'm pulling out the tongue blade. Thats right. Without me asking you to say "ahhhhh" first.

Reassurance

Today marks my final day of OB---a two week stint of up at 415 in the morning, pounding on women's bellies that had just delivered a baby and asking if it still hurt, about 200 pelvic exams, 15 babies delivered by yours truly and three sad cases of babies that did not make it.

It was a whirl wind.

I remember my third year rotation where I heavily considered the field of OB/GYN. Delivering babies was fun and those residents work their tail off. But after these two weeks I realize that I am in the right field, which is one of the most reassuring things I have felt since I started residency.

I may still have the opportunity deliver more babies in the Emergency Department. Which to me is the most exciting idea---you just never know what will walk through those sliding glass doors on the first floor of the hospital. And thanks to the amazing ladies of the OB program I feel more prepared.

going to hell

My last call was particularly difficult. I know I've semi discussed ethics in previous posts but I honestly didn't think it would be such a huge part of my life as a resident. I am quickly learning that this isn't the case.

Around 130am I got a page about a pt on the floor who was not doing well. He was a 90 year old man who has recently been in and out of the hospital for pneumonia. He was actually getting better when that evening he aspirated an entire bottle of ensure. He then started breathing really fast (tachypnea) and required more and more oxygen (hypoxic)and started running a fever. So we transferred him up to the ICU and started to get ready to intubate.

But then we all paused.

He was a full code. He wanted CPR, intubation, cardiac life saving drugs.

And yet we paused. He was 90 years old. The likelihood he will be able to come of the ventilator is small. We tried to explain that to him and he responded with "I dont want to talk about that right now. I dont know what to do." Thats when everything changed.

To go up the chain of command in terms of power of attorney (POA) it usually starts with the patients spouse (but only if they are straight---dont even get me started with that), then their kids, then their parents/family, and then maybe friends? It all gets muddled.

So we called his son because that was the only number we had in the books. He comes into the hospital and we have a 2 hour conversation about to intubate or not to intubate. Meanwhile Mr. H's respiratory rate is slowly declining. After this discussion we realize its his wife who has the medical POA. So then we call her, who says to do everything.

So we set up the intubation again. And I start tearing up. If this man was 20 years or even 50 years old I wouldn't think twice. But with all his other diseases there is a very high chance he will not survive this. I am about to intubate someone who probably will never come of the vent. I am supposed to be doing this to save people. I am exhausted because it is now 4 am. So I start tearing up but try to hide it by pretending I am excited to "do a procedure".

When my pulmonary fellow comes in that morning I start with "I may be going to hell because of this one....."

this is what i've come to....

This when I feel like the singleness is just pouring out of me.....

I recently got a message from one of my pediatric attendings--one who I am fairly close with socially--asking me if I was interested in going on a blind date with a friend of a friend.

That was all it said. So of course my next question is "who is this guy? any more details??"

The response made it all a bit more embarrassing. Apparently another peds attending that I worked with last month "loved" me and wants to set me up with his nephew so he asked around the attendings to find out if I was single.

My attendings are working harder on my social life than I am.

ouch.

The thin line

I am currently on my first medicine ICU or MICU month of residency. And not only that, but it is at the VA where all the patients are already knocking on deaths door, and just waiting for the final say so to move on. Yeah, its pretty intense.

We had our first almost code situation today. And I say almost not because it was a close call---he did pass away---but it was almost called a "code."

He was a 60 something year old man who had perfed his bowel and required extensive surgery to remove the damaged small intestine and then got an infection in his blood which then gave him a really bad infection in his lungs and he started to down spiral around 3pm today. He was actually on the surgery team, we were just the medical help out. His blood pressure dropped and then his oxygen saturation dropped to the 60s (we want most patients above 90) and the highest we ever got it back was the mid 70s even after turning up his ventilator all the way. When his pressures dropped again, we were about to flip on the code button--which announces to all the pagers that someone is in a "code blue" situation and everyone comes running. Thats when someone decided to call his wife and verify his "code status."

We were told we were not to do chest compressions. So we turned off the code blue announcements and continued with increasing his pressures and such. Then there was a discussion what exactly his status was: increase pressures? start drips? chest compressions? withdraw all care? withdraw only some care? give shocks? only do CPR? It has gotten so specific of all the different choices a person has that it got me thinking about the thin line of what each person wants and how it can make such a difference---I needed to know how this whole DNR stuff actually started.

In a basic search on the internet it appears that the history of a person being able to decide what forms of resus they wanted started in 1976 with the case of Karen Ann Quinlan v New Jersey in which a 21 year old woman was found comatose after taking tranquilizers and ETOH. Her family wanted to withdraw life support but the medical team just flat out refused and the case was brought to supreme court where they ruled in favor of the family ruling "Karen's "right of privacy" included a right to refuse medical treatment and that her father, under the circumstances, could assume this right in her stead."

It wasn't until 1991 when the Patient-self Determination Act that mandated hospitals honor a patients desire in their healthcare. And now today's occurrence is so common place across the US.

In the middle of us giving a stronger pressure medication we were told to stop doing what we were doing. What does that mean? Stop the medication? Turn off the vent? The surgeon was running back and forth from where the family remained asking each specific question. Finally an understandable conclusion was given: Stop the pressure medication all together. Then 5 minutes later: turn of the ventilator.

He passed within minutes, hopefully at peace with the decision his wife made for him.

being a (good) teenager....

I recently saw a 16 year old boy who was super awesome. He was a talker. I mean I asked him how school was going, and I think I got a 10 minute response. Straight. Without pauses. Loved it! It sorta reminded me of myself when I realized someone was listening. Now I dont even need people to listen...

Anyway, after kicking mom out to do the genital exam and HEADDSSS exam (Home--are they safe?, ETOH use, Activities besides watching the tube, Drugs,Depression, Suicide, Sex, Smoking) he said, "yeah they asked me if I wanted a female or a male doctor. And I was like, come on! I am 16 year old boy. My hormones are screaming 'Female! Female! Female!' But I'm more mature than that, so I told them either one is fine. Because it is."

Then he immediately followed it with "are we gonna talk about sex now??" I said, "Well that is one of the topics I'd like to cover." When asked if he was having sex his response was "I dont really think of it as having sex. Its called making love for a reason. And I am not in love. So not really making it either."

CLASSIC.

Hmpf

I was extremely excited to be on vacation. And then it suddenly hit me that no one else was going to be on vacation at the same time as me. The amazingness of medical school was we could all go on a trip together. All these new interns I have desperately tried to connect to are still slaving away in the hospital, while I get to roam free. But who wants to roam all by their lonesome? I have recruited my hound on a trip, which he'll have a blast, but he's not much of a conversationalist. But the truth of the matter is my next vacation is in 8 months so I best enjoy this one!!