Sunday, August 23, 2009

A Bump in Karma. Rebounding.

Friday's call was not pleasant. 14 admission, 11 of those were between 1030 am and 7pm. I had to call in a back-up resident to help bail me out. Not that I should have had to do that.. I should have had an intern assigned to me, and then wouldn't have had to call for help. Also, if there were any sense of team work amongst the senior residents this month, it would have gone a bit more smoothly. But alas...
 
At midnight I finally felt caught up. All of the admission notes were done. I'd rechecked a few of the sick kids who had been admitted hours earlier. And I started the tedious process of starting the discharge notes for the admission that had come to by team. This use to be the expectation, that you'd stay up on call to get these things done, which would help facilitate the discharge, as quite a few of the kids who were admitted would be going home on Saturday, a few more I suspect will go home today. I found out, however, that this isn't really what happens anymore. The ethos of residents seems to have taken a bit of a dive...
 
We finished signing out to the team who would be on call on Saturday, and then I headed to the post-office. I had a notice for a package, and was glad to know that the computer battery I was expecting-shipped from Colorado by my computer guru (aka Dad), had arrived. The old battery would only last for about 30 minutes before dying. And so I took my slip to the counter and waited for the package.
 
Maybe it was the fact that I'd been up for 27 consecutive hours, had survived a painful call, felt like I'd provided good care to my patients and their families, and the realization that I have only one more f*cking week of this lame schedule, but as the post-man walked to the counter with my packages, and I realized that my "stolen" packages that I had mail from South Africa almost 5 months ago were miraculously before me, I felt an almost giddy euphoria. Maybe it was fatigue.
 
The past 8 weeks have been rough. Really rough. I had to move away from a place which I loved, leaving behind one of the greatest group of friends I've ever had. Randall died, and with his death ended mystery of knowing what the final outcome between us would be. And with his death ended the plans that I had made for the next year post-residency, that being to return to somewhere in Sub-Saharan Africa for a year of work. And on top of that, my residency program did an unprecedented move (to fill a hole in their schedule), and took away the intern on my team-so that I get the joy of doing the work of two people. There's also been a karma deficit which has affected some of my close friends. It's been a shitty 8 weeks, where the literal goal has been to get by on a day-by-day basis, and to not think about what the next day would hold.
 
I felt victorious post-call. I'd made it through a long night. My kids were doing well. The nurses let me know how glad they were that I'd been on call. Well, aside from the fact that I have a huge black cloud. And when I saw those packages, for some reason, the suffering of the past 8 weeks just seemed to melt away. As if the universe was aware that there'd been a huge Karma Deficit, and that this was a way to prove that things were going to be ok. And I raced home to open the packages. Months ago, when filing out police claims for theft, I couldn't remember the specifics of what was in those packages...
 
Taking out my Tibetan Prayer Wheel, and spinning the prayer wheel brought be right back to a chilly evening in Pokhara, when my friend Dilip and I were talking to the Tibetan Refugee women from whom I would eventually buy the prayer wheel. I open my Ethiopian Lonely Planet and looked at the pages on which I'd made notes about cool streets, and where I'd made note of hidden cafes.  I laughed that I'd mailed back a book which I doubt I'll ever read again. I'd come to accept that I'd never see these things again...
 
I slept a few hours post-call, and then went to join some friends in NoHo for lunch. And then I headed to Boston to have dinner with a couple (H&R), one of whom is on my "panel of advisors" about my post-residency plans. I've had to debate where I'm headed, and what I plan to do. And in the past 2 weeks I'd spoke to a few of my advisors about things, and the possible evolution in my plans, and the algorithms which I've diagramed out. There is not a Plan A, with a back up of Plan B, etc. But rather there are Plans A, B, C, and D. All of which are fine, but none of which excite me to the level that they should. The plan that excited me the most, is no longer in the cards. Anyway, H&R and I had a great evening, gourmet burgers, good margaritas, and plenty of discussion about options.
 
And as I drove home on the Mass Pike, with a U2 CD blaring, things seemed to have finally started to pick up, as if I'm rebounding from all that has happened in the past 8 weeks.
 
Finally.
 
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Thursday, August 20, 2009

Flashback

Tomorrow is my first overnight peds call of the year. It's quite remarkable to think back 4 years ago to my first peds call as an intern. I never thought I'd hit the comfort level that I have finally reached...

I'm actually looking forward to the call...

Sunday, August 16, 2009

Thanks Rob...

Aquarius Horoscope for week of August 13, 2009
(from freewillastrology.com)

In the days ahead, you may not realize what you're looking for until you find it. I advise you, therefore, to put into action the following five-point plan. 1) Suppress any know-it-all tendencies you might have. 2) Revive your childhood talent for being voraciously curious about everything. 3) Ask more questions than you've ever asked before. 4) Figure out how to be receptive without being passive, and how you can be humble without muffling your self-confidence. 5) Consider the possibility that you have a lot to learn about what's best for you.

My Horoscope from the infamous Rob Brezsny.

1-yeah sure, that sounds fine in principle
2-I don't have the energy for curiosity
3-There's already an overflowing list
4-think I have this one down
5-No shit, really?

I laid under the stars at Tanglewood tonight (www.tanglewood.org) thinking that I hadn't written in a while, that I should make a note of what's been going on since I got back to the US.

But it's just not stuff I really care to write about right now, so in a burst of insomnia, went back to my old friend Rob for some amusing answers to why the universe has been all outta whack... Think I'll check back week for a better response.

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Tuesday, August 04, 2009

Square Peg

In a round hole.
 
I snuck into noon conference to get lunch yesterday (with no intention of listening to the talk-did I mention the lunch is free) and saw David. David who is now a real doctor. Making real money. Taking care of patient as a real doctor, not having to discuss his every plan with an attending. I couldn't help but have some slight envy when I saw him. Ok, I'm lying it wasn't slight. It was pretty good envy.
 
I have a small talk which I am suppose to give tomorrow, and a small talk to give on Friday.
I'm on call tomorrow.
I no longer have an intern assigned to me.
I'm making money, but squat compared to that attending salary David is getting.
I'm tired of having to precept my management plans with attending doctors.
 
But I guess this is a small price to pay for having been able to be away last year. If I could go back in time, I'd do it all again--in a heartbeat.
 
Everyday I see people whom I haven't seen since I got back. And they all ask the same question. "Are you glad to be back?" 
 
Am.
I.
Glad.
To.
Be.
Back??
 
It's a loaded question.
 
Recently the answer is no. Yesterday I was helping the intern do a spinal tap, and we needed more numbing medication (like the stuff the dentist gives). But in order to get more lidocaine, I had to take off my sterile crap, go out of the room to a computer, and put in an order which would allow the electronic-computer-controlled-medication dispensing machine release a vial of it.. all so that the charge would be passed on to the patient. They whole process took 5 minutes. Which was 5 minutes of more discomfort for the patient (and the intern who was already sweating).. and for what cost?? To save the hospital a few bucks.
 
Recently the answer is yes. On the rare time that we'd want to use lidocaine in SA, it would likely be impossible to find some. There was a secret stash in the ICU, which was used for more intensive things, like central IVs, but we wouldn't waste lidocaine for small things, like spinal taps.
 
It's hit and miss. And I feel like the square peg, fitting into a round hole. I can fit into the holes, but it's not an ideal fit... That's just one example. There are many, on a daily basis.. but as it is, I need to go finish these talks that I have to give this week..
 
I can't wait to be done. I just want to be a doctor.
Where-I'm not sure.
Doing what-I'm not sure.
 
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