Snow Already?

Flurries on the way to work today.

Out of one hospital now, and into the other- I'm covering labor and delivery as well as the pediatric service in Waterville. I'm essentially practicing Maternal Child Health, which was my intention in the first place.

Inpatient medicine really took a lot out of me. The days just blended together and there was hardly ever any down time. I felt like I was working harder to keep my patients from dying unintentionally than improving their conditions- a sentiment echoed by several of my colleagues. The most unbelievable day I have had in my medical career took place when- covering the hospital service alone with my medical student- I was in the ED to evaluate an elderly woman with high blood pressure and dizziness who probably wouldn't need to be admitted. I received a page from the ED, which I was already in. Curious, I took a step out of the room to the middle of the department and asked if someone had paged me. They had- to let me know the patient who was next door to the room I was, who was diagnosed with a pulmonary embolism (a highly lethal blood clot in the lung) and was being transferred South had left AMA after cursing out the nurses. Right after I received this information, I had another stat page- a difficult patient upstairs whom we had expected to leave AMA- was leaving AMA, but had also attacked the nurses, and just before leaving the floor announced to everyone in sight that she was going to kill herself. Instead of allowing her to leave, we then had to retain her with security to evaluate her for absolute suicide risk. I spent a long time working through most of her bizarre rationalizations and demand to read her own chart. After calming her down we were able to formerly discharge her- however the printers were down in the hospital, and I would have to hand write her 5 page list of medications, as well as all of her discharge instructions.

The patient with the PE was never found, the suicidal woman calmed down and went home, and the little old lady with high blood pressure was given the lowest dose anti-hypertensive medication I have ever prescribed and sent back to her home. After all of this I had to do a full history and physical and dictate on a patient on psych who had- a sore throat. And they knew she had a sore throat but didn't know what to do with it. I'm talking about licensed physicians. I signed out, and was extremely relieved to be leaving for vacation.

Vacation was far too short, but I was extremely grateful to spend any time at all home with my godchildren and my family. Sleep is nice too. With a somewhat heavy heart I flew back to New England- back to work.

Maternal Child Health has been relieving. It is a service with long hours- 24 hours on then off, but I get to work with babies- my real passion. It has been nice to work on a discrete team with the nurses, midwives, and obstetricians, and pediatricians, and to get to spend some time in the OR doing sections. The service has been busy but very manageable. There have been some surprises (a precipitous delivery while I was extremely disoriented from having fallen asleep for 5 minutes), but mostly happy experiences. The beauty of being actually, completely off after a call has been extraordinarily refreshing- even if I sleep for most of that day. I've started enjoying work once again (after a very brief hiatus secondary to burn out), and am reading and working every chance I get. I hope it stays fun...

On a side note, someone please buy me an Amazon Kindle. Oprah has worked her magic and now it has bored it's way into my brain. THANKS

Leaves Are Changing

It's Fall in New England, and the year is going by rapidly.

I'm well into my fourth month of my residency in rural family medicine, and I'm amazed by how fast it is all going. I love the work I am doing, the people I'm doing it with, and the place I live. It's a miracle how much things have changed from my very recent life as a frustrated medical student.

I am currently covering the inpatient hospitalist service for our residency, and the hours are long and the cases sometimes frustrating. I can't complain though, as the patient interactions are almost always rewarding, and the work is interesting and diverse. From negotiating with a starved and depressed old man to eat, to sitting with another man while he died- only to watch him rise from the dead and be sent back home, to nursing a neglected baby back to health, to delivering babies and managing obstetric emergencies- just like the family practice clinic- I never know who will be waiting for me at work each day. It has been a bit difficult balancing work schedule, sleep, personal finances, and relationships, all while practicing good medicine- but I think I'm somehow doing it. Housework has basically been triaged to the basement for the next month or so, and I do sometimes open my eyes to find I've already gone to bed and am awakening for my work day without remembering having gone to sleep the day before.

Call has not been nearly as miserable an experience as anticipated, and overall the workload is basically manageable. I do seem to be running up against a wall however when it comes to managing both my outpatient duties and the busy hospitalist service. I get behind on prescription renewals, call backs to patients with lab results, and social service follow-ups, because I'm busy doing discharge summaries or managing sliding scale insulin regimens for inpatients. On other days I'm on top of my clinic, but I lose track of my patient list in the hospital and tasks get neglected.

Last month I covered the Emergency Department here in Augusta, and I enjoyed the luxury of shift-work with no call, the interesting cases coming through the door, as well as the large amount of procedures I was able to perform in such a short period of time each day. Work days beginning at 10 am were nothing to complain about either. I am grateful for the doctors I was able to learn from in the ER- both seasoned Emergency Medicine physicians from Boston, as well as Family docs who have transitioned their practices to full-time ER work. I gained a good deal of confidence in managing codes and emergent situations, that has translated well into managing emergencies on the floor of the wards. Yesterday I ran a successful code with no backup from any attendings, felt comfortable during the entire process, had a good outcome for the patient, and received great feedback in the end on how things had gone. If I hadn't had such good exposure in the ED, or such talented physicians training me throughout my time here, I don't think I could have managed as well.

All in all I'm still loving being a rural family doctor in training. I wouldn't change any of it for anything, except to be closer to the people I love- my friends and my godchildren. But a brief vacation is in the works for the near future, and home is only a call away.

Now for some sleep!