Patients, Patience, Stress, and Dress

Sorry for my recent lack-of-blogging. I feel like sometimes all I do is talk about work which, obviously, just about equivalent to life right now. I'm not sure how interesting it is to hear about all the sick people I see every day, so I didn't have much to add last week. But here are some updates.

Patient care is tough. I was over at Kyla and Ben's house last night for a wonderful meal of lasagna (from the farmers' veggies!), and Kyla and I (Ben had to go in to work to the ER) talked for hours about the struggles of residency. It was very nice to be able to vent to someone who has "been there" and knows that it does get better-- she is an incredible role model and has been a great friend to me, too. Anyway, she verbalized something that I had been feeling exactly-- that the challenge is that work now really boils down to this: a balance between thoroughness, bedside manner, and efficiency.

As a resident, you are run around SO MUCH that it is just not possible to be ontop of, or good at, everything. You can't spend all the time you want hearing about all your patients' problems. There is just isn't time. You can't be as thorough as you want to be, but really have to hit the high, pertinent points, which ends up making me feel like I didn't do a complete job. And you surely can't be slow and poky. I think that this has been what has been frustrating me so much about intern year-- I feel like there are so many responsibiltities and things that need to get done that what I'm sacrificing what I thought were my strengths in medicine-- connecting with patients with a good bedside manner and taking very thorough and complete histories. It's sad, but a reality that something has to be sacrificed, that "something's gotta give."

It was obvious this week how thin I was worn when I got angry at patient of mine in the hospital. I had been bending over backwards, calling social work, calling prosthetics with a STAT consult, and talking to the respiratory therapists to help work with us to try to arrange for Mr. B to go home with a CPAP machine for apnea, which had helped him out of hypercapneic respiratory failure (too much C02 retention) that got him admitted to the ICU (once stable, he was transferred up to the floor). Every day I rounded on him, he told me he didn't feel like wearing the mask preceding night, but promised to do it the current night. I believed him. Trying to get him home with CPAP was the only reason he was still in the hospital and that I was still rounding on him, about 4 days later, even though he'd been completely stable to go home the day after his transfer. But he wasn't going to continue to stay well without the help we were offering. And I kind of snapped, saying, "Mr. B, why do you think you should still be in the hospital??? How do you think you're going to get better and stay well without the recommendations we give you? What good are we doing for you here?". He even apologized to me later and told the senior that, "I think the other doctor was mad at me because I didn't wear my mask." He was right. I was mad. I never thought that I could or would be mean to a patient. But I was. It is unfortunate that I wasn't able to be more patient and not let my frustration show.

Ah, patience. I am not a very patient person in general. But I'm finding that my patience, what little there was in the first place, is dwindling further the longer I am in residency. I don't have the patience for patients to grumble about their food, their nurse, why they're NPO for procedures and have to have an IV, among other things, when I have a string of others I have to see in the mornings. I don't have much patience when the nurses or pharmacy pages me. When they talk too slowly and don't give me the important, pertinent pieces of information right away, or if it's a question about something that has already been taken care of, I find myself getting very irritated. This lack of patience carries over into all aspects of life as well. I don't have the patience for grocery shopping and get antsy when I go to the stores without self check-out. I am so fast that I can get in and out within 10-15 minutes now. I find that I don't have much patience for super long phone conversations and find myself trying to end things sooner than I might have originally (sorry! But please still call me! :)). Partly it's because I have a gazillion other things I need to get done. I don't have the patience to be put on hold when I have notes to do and other responsibilities. It is really bad. But I'm getting faster with everything I do in life as, when you don't have time to do very much, you do everything at double-speed.

So onto stress. The baseline is very high during intern year, I'm finding. "You just have to get used to feeling like things are out of control, because that's how it is going to be this whole year," says my current senior resident. It's horrible. Every day, I wonder, "Is this really worth it?" Even if residency is a finite period of time, is it worth it every day to feel scared to go into work to see what faces you and whether you'll be able to handle everything/get your work done without exploding from stress? It is truly a terrible feeling to walk around jittery and anxious that someone is going to page you for an admission, or an order, or a discharge note, or all of the above, at the same time. But don't worry- I haven't cried in two weeks (woo-hoo!!) :)

Some people don't eat when they're stressed. I tend to eat more. Kyla and I were saying that it seems that you might eat to a point two notches above your stress level so, for example, if your stress level was at a 5, you'd eat to a fullness level of 7. So when your stress level is 8 or 9 (as mine feels much of the time), that means....

Yes. So I realize that it's a problem when your clothes don't fit very well. Going from OB to the VA, where our attending is fine with us wearing scrubs, I realize that, in the past 50 days or so, I've worn "normal" clothes maybe 7 days total. Kind of ridiciulous, eh? And, as I've said before, scrubs are very forgiving. And easy to wear. I don' t think that I've ever taken an exorbitant amount of time to get ready in the morning or anything, although now, thinking about having to choose things to wear seems horrific and like a time-sink to me. I know that I can shower, get dressed in scrubs, put on some mascara and earrings, throw some food in a bag, and hit the road in about 15 minutes flat (which was the case on Thursday, when I overslept, woke up around 5:55, and had to leave by 6:15).

I know scrubs aren't the most attractive article of clothing to wear, but really, who am I trying to impress? The vets, some of whom just make inappropriate comments anyway? (A guy I discharged a few days ago went into spontaneous atrial fibrillation [with RVR, or rapid ventricular response] during his hospital stay and when I asked, "Do you feel like your heart is racing or anything?" he responded, "Well, I didn't. But now that you're here, I do. Why don't you come hold my hand and see if that calms things down." Ummm.. I was happy when that one left the hospital). Nope. Not trying to do a whole lot of impressing right now. Yesterday, when I went to Kyla's, I had changed shirts when I got home, but when I went over there, I saw that I was wearing: a purple t-shirt, my teal scrub-bottoms, gray/red/blue socks, and black danksos, with my hair in a sloppy high ponytail with random clips holding up my short pieces of hair. Nice:) Don't think grandma would approve. But I don't see things changing any time soon. Maybe when I'm on vacation.

TWO WEEKS! :) And, in addition to today, I have two more days off before then :)