And my torture will come to an end

On August 1, N starts her first job as an attending pediatric anesthesiologist at MY hospital. Now our hospital :) My girl is coming HOME!

Feeling under appreciated

Since I now qualify as the world's worst blogger, I have way too much to say. But here's one for starters: I am feeling very disenchanted with my program. I'm really starting to feel that nobody, in general, gives a shit about how hard we (I) work. I sacrifice for this training. I'm away from N, I put in long hours, and I try to keep a smile on my face. Lots of us do this, some with varying levels of success. But to work so hard and have...nothing in return? I've had a string of attendings lately who just don't care. And I feel like I'm falling victim to a culture of a program that blames the residents for being stupid and doesn't put any responsibility on the attendings to teach us. Over the winter, for example, we got multiple reminders that our attendance was low at special workshops. Evidently, on the special medical training survey we have to take every year, the residents in my program rated education on the part of the attendings very low. We all received a scolding, harsh email from our program director and chief residents telling us that our attendance at these events was poor (I am always there, by the way) and that we have no right to rate the program poorly when we don't go to educational events. Here is what I have to say about that. Most of us go into medicine because we're relatively bright and want to help people. We like the science of medicine and have humanitarian hearts. THAT is why we DID this to begin with. We like to learn. We freaking spent 8 years post high school learning so we could be where we are now. I promise you, this has not changed, espeically since we are now all in the speciality of our choosing. What I can tell you is that when you take a group of awesome people and teach them *just* enough so they aren't dangerous, then treat them like work mules who should be grateful for a 30 minute lunch break once a day and shut up, they're not going to be happy. I can count on one hand the number of attendings I have (there are certainly at least 90 or so of them in the hospital) that will actively teach, answer my questions, or tell me of articles I should read. Most of them don't answer the phone when I call at night, and if they do, I feel like they're not listening. When I work so damn hard, the least you can do is TEACH me. And yes, the extra workshops are nice, but 2 annual workshops do not make up for the fact that educational endeavors are NOT valued. For example, I had to take two post-call days this month to collect data for a research project. Could I have been afforded a day off for such purposes? Uhh. No. Actually not. See what I mean? I practically had to beg people to participate in my study. They were most unsupportive. It was disheartening. I guess what I'm getting at here is that, oh residency program of mine, if you're going to talk the talk you'd better walk the walk. You want to blame us for not knowing things? Don't tell us we need to be "adult learners" and do it ourselves. Don't tell us we're lazy. And for heaven's sake stop blaming us for not being at events when, actually, we are in the operating room, being the work mules you need us to be. Argh.

Deep hypothermic circulatory arrest

The other night on call I had a harrowing...err interesting experience. I was on overnight call and our upper year resident was busy doing a liver transplant. I was snoozing in my bed after being up til nearly 11 in another case.

My pager goes off, thus I report to the workroom to accept my fate. Appendectomy? SICU patient needing a belly washout?

No. Aortic dissection. Type A. (This means that the patient has high blood pressure and riped a hole in the inner lining of their aorta, the main artery coming out of the heart to supply the body with blood, and the blood forms a second passage between the lining and outer layer of the aorta, which in this patient went from the aortic valve all the way down to the abdominal aorta.

I was shocked. This is an open-heart procedure, and an emergency to boot. The patient was flown in by helicopter. And what'sw more, I've NEVER done a heart before. Cardiac anesthesia is a whole unique ballgame. Something reserved for people with significantly more experience than me. Shit.

It was like my stomach dropped through the floor. Instant nausea. I had someone to help me set up the room, but other than that, it was going to be just me with an attending. A nice one, but just me. I was terrified, to be perfectly honest. I felt completely unready...wronged, in a way, to have my first heart happen this way. THankfully one of the second year residents (the one on pediatric call) was there to help me, but I was scared.

For those of you who may not know, this kind of case involves VERY tight control of blood pressure so the dissection doesn't burst. It requres the placement of an arterial line (like an IV in the artery of the wrist), central line and pulmonary artery catheter (HUGE IV in the jugular vein, then thread a catheter all the way down through the heart into the big arteries of the lungs), intubation of course. Then there's cardipulmonary bypass where you put the patient on the heart-lung machine, deep hypothermic circulatory arrest where the patient is cooled down to 18 degrees celsius and you stop all the blood from flowing, while packing the head in ice.

Holy. Cow.

But you know what? I did it! I got all my lines on the first try (with support) and my patient did well. She survived and made it to rehab.

I guess I have mixed feelings about this. I feel like I wasn't ready and I stand by that feeling. I wish I had a chance to do non-emergent hearts before doing this one. I wish it hadn't been in the middle of the night. I wish I could have learned more.

Two things I learned from this. I'm not a baby anymore. They'll ask me to do anything and everything, and I have to do it. Period.

And I can survive. Even though they threw something really really hard at me, I made it and so did my patient. And in the end, I guess that's what matters most.

Stay tuned for more work stories. I have some up my sleeve and I need to be a better blogger :P

Really neglectful blogger

It's funny how life gets in the way of documenting my life...my oh my how things do change.

I survived the surgical ICU and two more months of the OR...regular and ambulatory surgery. There have been ups and downs, I think I'm getting better at my job, and time marches on. Call schedules are never favorable, people are always being unfair, and I'm always tired. I think that sentence sums up medical residency pretty well.

On the personal side of things, I had a wonderful Thanksgiving with N and her family in Pittsburgh! I got 4 days off from work, thanks to one of my generous colleagues who traded calls with me, and I had an amazing time. The consistency of being together for nearly a week made life feel normal again. Until I came back to New Haven.

Things are up in the air these days. N had an amazing two months in cardiac pediatric anesthesia and is likely going to pursue additional training, which inevitably means more time apart. We miss each other so much that we're both riddled with chest pangs and moments of coming nearly to tears for no apparent reason. Living apart is just...so hard when residency is involved. Unpredictable and demanding schedules prevent us from making plans, and when we can make plans, they end up ruined often times.

I know that it's "just a year" turning into "it's just one and a half or two years," and I know that in the long run, this may not make a lot of difference, but the truth is, we're miserable. It's so damn hard to look ahead at months more of this. So hard to be away from the person I love so much all the time. I feel like life happens in fits and starts, or when we're apart, like the other night with N went with her brother and his wife and child to a flower show. They sent me a photo...and I cried. I just wanted to be there so much. I hate having to hear about her life on the phone, on my cell which gets bad reception in my apartment. My heart breaks every day.

But we're professionals, and we're developing careers, and this is how it has to be, I guess. I feel trapped. There's no good way to make things work nicely at this point, so we have to settle for the best we can do. I've been in a place before where all I could hope for was my future, but then I met N and I knew what it was to be happy *right now.* Now it's really hard to be back in that place, wondering when things will just feel normal again.

Maybe N should try to go to Boston for fellowship, even though it will be one year and not 6 months? Maybe I should try to find another residency where we can be closer? Maybe we should both just quit, skip the country, and hide in Trinidad weaving baskets?

I just don't know.

For the record, I'm not a moron

I had my first official day of SICU as a resident today. The way the rotation works is as follows:

Three residents. One on call, one pre-call, one post call from the night before.

Postcall resident has been there all night and sees all the patients in the morning, writes their notes before rounds, if possible. Presents patients at morning report. Presents patients on rounds, stays til rounds are over and notes are written, goes home.

On call resident listens real good on rounds and makes the to-do list. Then does the to-do list after everyone else leaves.

Pre-call resident enters all the patient orders on rounds. Then goes over the to-do list and leaves.

I was pre-call resident today, and on-call resident treated me like shit all day. I swear, she thinks I can't do anything and have no brain. It's highly annoying. You know those martyr people who insist upon doing everything themselves and fishing for sympathy, even when there are many capable hands to share the work? Yeah, it was like that. Shoot me in the face.

If she's the same way tomorrow, she gets a piece of my mind. Cause today just felt like a massive, useless waste of time to me.

Sigh.

Is it over yet?

I had a great weekend with N. Trip to the local beach, great meals together, lots of down time.

Then I took her to the airport and she left.

And now I'm miserable. Is it June yet.

That's really all I have to say.

Balance

In order to be healthy, you're supposed to have balance in your life, right? Sleep enough but don't oversleep. Eat enough, not too much, and only the right things. Have hobbies, but work before play. Exercise. Work hard and be good at your job but don't make it your whole life. Dedicate time and energy to your relationship, but have friends you spend time with also.

I know how to do all of these things, somehow. But my present situation makes that balance so hard to find. We'll start with the fact that work doesn't end when I go home. I have to study, review my schedule, plan for tomorrow, and discuss my cases with an attending on the phone every night. I try to coordinate studying with one of my classmates so I can get that friend time in there and also make progress on learning for work.

I eat well, most of the time, but since I have so little time, it's not ideal...either too heavy or too light...it never leaves me feeling content like when I cooked for N and myself in Philly. So I never really feel properly fueled.

I exercise...found a great place to to kickboxing nearby, but I can't do it every day...both because of exhaustion from work, soreness from prior workouts, and needing to split my time between studies and working late/call. And when I have a headache? Forget it. Not happening. Headaches come with less sleep and longer hours at work.

Sleep...I try to get to bed early, even as much as 8 pm some nights, but that all depends on my ability to fit all that other stuff in before that time. Often I don't get to bed until after 10, with all I have to accomplish, and of course, what I REALLY want to do: talk to N. Her schedule is worse than mine, and we find maybe an hour, or significantly less, to talk each day. This is a huge departure from being together in most of our spare time for the 2 years before we moved apart. So even when I can, precariously, keep all my other plates spinning, this one seems like it's the hardest to keep in the air. Lacking the balance I crave makes me stressed and crave that stability even more...

Today was exhausting. I did 3 cases at work, all of which were over my head. Even though I was assigned with a senior resident for those cases, it was still a lot of work last night and I was on my toes all day. That and my attending asked me a lot of questions about things that I should probably have known, somehow, but didn't. I'm feeling knocked down a bit, and have a headache, and all I want is a decent dinner and to curl up with N on the couch, talk about our days, and then watch something dumb on TV until we fall asleep and start the whole thing over again. Sigh.

I'm scrambling, but I'm okay for now. In a way, I'm distracted from missing N by my busy job, but really, that's just a disruption of my balance. Sigh. What to do? Is all year going to be like this?