My worst night on call
Yes, one day I'll get back to the writing posts. The light and breezy posts that make folks giggle.
But not today. I need to process this night. Couldn't tell my parents because they are already horrified and I'm only telling them about 20% of what I'm dealing with. I told hubs, but he's already doing a lot to support me and doesn't need to be my counselor as well. Didn't make sense for a Twitter thread or Facebook post. (Knowing FB, the deniers will come out and try to explain why none of this is real.)
Trust me. It's real. And it's terrible.
Within the past week, I had the worst hospital call night ever. That's saying something, considering I have written posts about delivering stillborn babies at 3am. But this recent night was as bad if not worse but in a different way.
There’s something about airports that gets me in the writing mood. It’s probably because any time I’m in the airport, by default it means that I’m not on call/working at the Day Job. (Okay, that’s kind of a fib. I totally just logged off the EMR where I was putting out a few fires right before this plane boards. Anyway.)
There’s a saying in medicine: “You want care that is Good, Fast, and Cheap? Just know that you can’t have all three – you have to pick two.” Yes, there might be some public health folks who disagree, but just go with me on this one, because in broad brushstrokes, it’s true.
You know what else is true? I can’t have Medicine, Manuscripts, and Mayhem all at the same time. I have to pick two to focus on at any given time. As writers, we’re always picking two out of the three things. Or sometimes we’re choosing two out of four or more aspects of our lives for our focs! We’re making that seesaw balance, back and forth, all the time.
We’ve heard so much about burnout. There are articles in my medical journals about physician burnout, Posts about burnout for writers, and articles about physical burnout in my trail running magazines. In each of these documents, the guidance is clear: take time for yourself. That’s cool.
But what happens when you don’t have the time to take?
What happens when everything fries at once?
So, quick update for those of you who don’t know me yet. I’m a family doc who does deliveries (FP/Ob) near The End Of The Earth. It’s rural, and no we don’t have specialists. FP’s do most stuff. In my clinic, I’m it for Ob – we don’t have another FP/Ob on site for my group, so I workity-work as long as I think I can go, then get a locums doctor to come in and cover for a few weeks while I try to recharge. Only this time, nothing is recharging. I pushed beyond what was prudent over the past three months and it caught up to me in a nasty hurry.
This is going to be a long post, but it needs to be written. It has to do with a developing leader being told to speak up – but not speak up >too< much. It has to do with a seasoned physician being presented with a terrible choice: remain true to herself or become someone else’s definition of success.
And it has to do with trusting that one’s core values and self are really … perfectly reasonable and adequate, after all.
First of all, folks, let me set up this situation.
#1) Recruiting physicians to a rural area is the hardest recruit in all of medicine. When we see a quality applicant, everyone knows that this applicant is looking at several other locations, all equally in need of good help. Other locations do not have the constraints that my group does; we cannot throw a boatload of money at a candidate because of the way the larger organization is structured (our constraints involve maintaining Medicare designation, nonprofit status, etc.) What that means is this organization, unlike others who are also recruiting as hard as they can, is required to offer industry standard rates for things like salaries. We have to be careful with extra incentives like financial bonuses or created directorships to help the employment package. That’s cool, though. In the end, we doctors who want to be here for the right reasons. Just understand that candidates are not beating down any doors -- anywhere, given supply/demand in the market these days. And especially not FP/Ob (family docs who do obstetrics). They’re like the Sasquatch or the last of the white rhinos.
New Year's Goals
Man, I hate to call them “resolutions” because the word sounds so formal, so big, and so insurmountable. But for the first time in a long time, I feel the need to make a list about the upcoming year, if only to bring focus to the next 365 days. Also, it’s scary to write these things down for all to see – but it’s important to keep doing stuff that scares me. So here goes…
#1) Get better at saying “no” to more call/more duties/more meetings and not feel any guilt when saying “no”.
#2) Complete a 4-year longitudinal leadership course to create future non-clinical opportunities.
#3) Cease being afraid/too modest to describe my experience, background, and strengths.
#4) Focus on patient care, and try to ignore all other BS. If it’s not about patient care, I’m not spending time/energy on it.
#5) Seek out leadership opportunities.
#6) Champion development of a resident training program at my hospital.
Recently, I responded to a series of colleague’s tweets regarding the way an intern was treated. https://twitter.com/CadenceDO/status/823300940895842311 The intern was part of a team that cared for a young adult in the ICU, and they had to withdraw life support. (I know nothing of the situation, but withdrawing life support generally occurs when brain activity is not present.) So, one of the most gut-wrenching events to experience not only for the family members, of course, but also for the medical personnel caring for the patient.
The tweet story went on to explain that once care had finished, the intern asked to step away for a few moments in private and collect himself. (Or herself. Interesting side question: would this story play differently if the intern were male or female?) The intern was then given a negative evaluation comment by the attending physician because the intern displayed emotions.
Because there are times when when I get drained and need to recover, this story generated a ton of thoughts and concerns.
#1) Are there instructors out there teaching our medical students/residents to “not feel”? Let me be clear: if medical professionals lose their humanity, then health care is no better than being treated by a robot. Quite frankly, I don’t want to be treated by people who have zero emotional response if I live or die. And also, I don’t want to BE a treating physician who has no emotional response to my patients’ situations.
#2) Let’s talk burnout. There is a direct correlation with suppressing emotional distress/stress and the development of burnout. There are papers upon papers written on this subject. People have developed freakin’ CURRICULUM about how to “talk through” these stressful times with peers, family, or counselors. Training a doctor to suppress the very thing that makes them human? Cruel. Destructive.
This blog post highlights a unique anthology slated for release in 2017 and spearheaded by Victoria Griffin. It involves stories regarding brain injuries/concussions. The anthology, “Flooded”, will contain selected works from authors who have experienced or observed brain injuries, or who have written about them in a way that makes the experience tangible to a reader.
As a physician, I see the devastating effects of brain injuries in my patients. From teenagers who are no longer allowed to play sports and who now have cognitive challenges, to adults whose brain injury has literally changed their personality, to veterans who have suffered TBI’s (traumatic brain injuries) and struggle to explain why they are disabled when they bear no visible scars – brain injuries can be complex to manage, long-lasting, and the effects can change from day to day.
One of the most profound concussion cases I witnessed was in medical school when an internal medicine physician in a rural practice had what anyone would think was a simple concussion. Dr. Smith (name changed) was pulling into his driveway, had his seatbelt off, and another vehicle hit the back of his car. He had a brief loss of consciousness and a headache.
Three months later, Dr. Smith still couldn’t function at anywhere close to previous work capacity. His short- and long-term memory suffered. He couldn’t recall patients he had cared for over the past 20 years!
Excuses for not getting a mammogram
Ok, people. This month is Breast Cancer Awareness Month. Otherwise known and "Save the Ta Ta's" month.
It's not simply about wearing pink, although that's cool and everything, no question. Pink rocks.
A few quick facts:
Breast cancer is the #1 cancer in women.
It KILLS over 40,000 women per year.
1 in 8 women will be affected by breast cancer.
And yes, fellas. Guys can get breast cancer, too.
What about a new study that questions the value of mammography? Look, here's what we know, and here's what the preponderance of research tells us: Mammograms save lives. Period. There's new data suggesting that we might be picking breast cancer up super early in the stage just prior to invasive breast cancer, and maybe this is "over-estimating" the cancer?
If it's there, why not fix it early? Who wants to take the chance and wait? Seriously.
A Circle of Life day
(Trigger warning: miscarriage/stillbirth)
So yesterday was day number…whatever…of this last call block. I’m off call today, going to a writing conference (ECWC). But before I could leave for ECWC, there was work to be done, and yesterday pushed the emotional and physical limits of my patients and me.
Doesn’t help that I have a whopper of a cold. Yeah, no one wants to acknowledge it, but doctors get sick. Especially when I see every coughing, booger-oozing toddler in a twenty-mile radius for the past two weeks. And those same sick toddlers like to sneeze directly on me, or grab at my face with those grabby, snotty, glistening, crusty little hands. So that’s the background. Not at 100% to begin with on this last day of the call week.
Yesterday. Phone rings at 6:30am. It’s the ER. 20 week patient has delivered a fetus literally 2 minutes ago in the ER, and the patient is bleeding badly. My head spins. Is it my patient? If so, which one? ER doc doesn’t give a name. Just asks me to get there quickly. I go from REM sleep to fully awake in 5 seconds and provide a few orders before pulling on clothes and hurrying to the hospital. En route, I’m thinking through hemorrhage protocols and meds, and also planning for the non-clinical things that need to be done to help the patient through such a devastating event.
This week is a call block, which means yours truly is on call for 7 days in a row for Ob deliveries, if my colleagues need someone to do a C-section, and at times for all admissions to the hospital (adult or peds) and q15 minute calls from the nursing home. Call is always feast or famine. It could be boring. It could suck rocks. I work in a small, rural hospital, so FP’s do pretty much everything here.
If you live in a big city, then this job may seem like the unholy love child of Marcus Welby, M.D., Dr. Quinn Medicine Woman, and Dr. Joel Fleischman (Northern Exposure). And you’d be correct. The net result when I’m on my call stint? Poor sleep, putting out fires in the office and all hours of day and night, and difficulty doing anything but sit around and wait for the next call to light up the phone.
Author, daydreamer, and practitioner of trying very hard to duct tape folks together and help when I can.
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