Thursday, July 28, 2011

The First Time is the Hardest

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Once again the past two weeks have been a blur of activity, but what is coming into severe focus is that my first month of residency is 1 shift from being over. This month has been a huge learning curve, as I sure the rest of the year will be... but nonetheless, it has a great experience.

Besides being crazy busy, it has been a week of four firsts.

A Patient Lost
I've lost my first patient as a physician. The patient had been really sick for awhile; The family had changed the code status to DNR recently. However, when it actually happened, it happened quickly. Thankfully my attending was already in house and made the call to the family. Either way, it was so strange to watch the vitals fall, knowing we couldn't do anything at that point, knowing that within seconds, this patient, who I've gotten to know over weeks, was about to die.

When the family came in it was hard:. It was hard to see the family I've gotten to know hurting and it was hard to have a patient I've gotten to know pass. I can't say that I didn't have to step away for a moment to collect myself. To be honest, while I do hope that it gets a little easier to lose patients, I hope that I don't lose the emotions attached with it, whether I've know then for a day or a month.

A Patient Stabilized
The second first, I performed a bronchoscopy. Over the past month I gotten a little more comfortable with managing ventilated patients (almost everyone in the unit is on a ventilator), however, there are still times when I make that call to the attending. This was one of those times: The O2 saturation, ABG, and CXR were fine, but peak airway pressures were rising and we were unable to adequately suction the patient. The attending agreed that a bronchoscopy was probably needed and told me to get everything ready and started and that he would be there in 10 minutes. So I walked into the room and started the bronchoscopy, suctioning and removing all the junk in the trachea down to carina. The attending checked out the bronchi and we were done, everything went back to normal. And just like that I realized I somehow managed to do a bronchoscopy; I guess it really can be see one, do one, teach one (although, I think I want to do a few more before trying to teach someone).

A Patient on the Table
The third first: I finally made it to the OR! It took about three weeks, and I had to stay after sign out  and up to my 16 hour limit, but I got to scrub. The case was interesting and went well, and although I was scrubbed I wasn't able to do much (since there was an attending and 2 fellows in the room). But nonetheless, it was a little rewarding to hear the attending add my name as one of the surgeons* to the operative report.

*A note on that, my med student said to me (on one of the rougher days), that no matter what happens, I'm an motherf@#& surgeon. I laughed, and by no means claim that title at this point... I mean, I know I'm a surgery resident, but it's been all of a month. Nonetheless, I came to the realization, that it's probably what my patient's are seeing me as. Weird. I hope that at some point I feel a little more comfortable with that title, but even then, I don't think I'm be claiming to be a surgeon for a very very long time.

A Patient Saved
The fourth first: I experienced my first code as a physician (another title I'm still trying to grow into). Now, I've be "part of codes" as a medical student, but most of them consistent of me standing at the back and just watching it all go down; I think I only was actively involved in 1 during medical school, during which I was doing chest compressions.

This was a completely different situation. First, it was my patient, not one that happened to be on the same floor, or one that my team was cross-covering, it was a patient for which I had already been responsible for taking care. Secondly, I was the one standing there as she as she started to de-compensate, the one who called for stat anesthesia intubation, the one who hit the code blue button, and the one who started chest compressions. Thirdly, I was the only physician in the room... I had the CRNAs there for intubation, I had a lot of nurses with a ton of experience, but it was just me, making the call about what to give the patient. Thankfully, the charge nurse called the attending, who helped to calm the situation and guide the code over the telephone. And thankfully, the patient was resuscitated.

Nonetheless, I was shaken for the rest of the morning.

My attending pulled me aside later and said talked me through everything that happened, confirming the choices I had made and using it as a teaching point for later. It took me awhile to be okay, but I definitely walked away having learned, not only about how to run a code, but having learned how to gain confidence in that situation. Hopefully next time I'll feel a little better about it, and have someone else next to me.

After I left today, I had the chance to talk to a different charge nurse, who really made me feel better about it all. She mentioned, that although I've made some choices in care that they usually don't choose (some of which worked), that my confidence and demeanor was excellent and that she thought I'd do well.

However, if M&M this week were any indication of the year ahead, it's going to be a rough few years.

The Other Side of Residency: Real Life
I've been really blessed to have gotten to know one of my fellow interns over the past few weeks. And at least once per week for the last 4 weeks, we've managed to get dinner post-shift and decompress about everything that's been happening. It's been a great resource to have.

Last night, during one of the downtimes, I also got the chance to catch up with one of my best friend's from medical school. I had been meaning to text her earlier that day, when I received her text. I had a few moments, so I gave her a call. I can honestly say, that the friend's you make in medical school are the people who understand you... they've been with you through the thick of it and you've both made it through the war (that is medical school) *

*I'm pretty sure that friends from residency will be a similar type of experience.

Tonight I had the great pleasure of having dinner with the one and only @Potato_Chip. It was so great to have a few moments to catch up on what's going on with her life over a great meal and ice cream.

Despite all the great, anyone following me on twitter knows life has also thrown a ton of wrenches into my plans recently. My dad was in the hospital about a week and a half ago, but is now doing well and at home. The passenger-side mirror on my car decided to meet a concrete barrier. And then my entire car decided to take a vacation from working (thankfully, I live right near the trolley line, which, although a little unpredictable, has at least gotten me to and from work).

On that note, I should probably crack open the Sabiston or start reading the chapter from ACS for basic science lecture this week.

Hope that life is treating everyone else well.

God bless and godspeed.

1 comment:

  1. Dr. Katie,

    Hope your residency is going well since this post. I just started M2 but I'm leaning toward surgery (pediatric or plastics). Posts like this give me a motivation boost, like I almost got a glimpse into what the future may offer. I did an ER sub-I this summer for 6 weeks and had my own string of "firsts." I loved it, and also got to follow a few patients into the OR.

    Blog on!