I know it seems I have abandon all of you to the abyss that is the Internet. I have been MIA, that is for sure. However, I am attempting to rectify this situation tonight. Let me update you on things these days, as I have a few moments here on call in the hospital.
Nathan Beach of www.nathanbeach.com is back in The United States after his jaunt in Europe. How lovely that he spent his honeymoon with Shelley over there. I received a nice thank-you card from Shelley and also one from Linda Beach. I thought that was swell. I actually still owe Nathan a thank-you card for my graduation present, but I haven't done that yet. Maybe when I am post call on Monday I can get to that. Or maybe I'll sleep all day.
I was in the Surgical ICU last month. It was month 2 of 3 for me in the ICU, so now I feel fairly confident in managing critically ill patients. At least I should be able to identify sick patients in regular hospital beds as I move forward in residency. And for all you lawyers out there, that doesn't mean I'm an expert. It simply means that I'm a first year surgical resident who has spent two months in the ICU and feel much better about managing sick patients than I did three months ago.
I also had to make a lot of difficult decisions this last month regarding end of life issues. I had several older patients who either had metastatic cancer or other life ending illnesses and had to "pull the plug" as it were on a few of them. What this means in more compassionate terms is that these patients were suffering, in pain, and would be dying in the immediate future yet family wanted to continue aggressive care. "Pulling the plug" really means we decide to provide comfort measures (adequate pain medicine and sedation) for the patient and remove life support machines (the ventilator, CPR if the patient's heart stops, drugs that artificially improve the heart's pumping performance, and other various life support). In these situations, the physician must always ask the patient directly how he or she wants to proceed, but often that is impossible because the patient is unconscious or incapacitated. Then the burden of decision-making falls to the family, who is instructed to relay what they think the patient "would have wanted" in this situation. However, often the family member feels guilty about ending a loved one's life, even if the patient would have wanted it that way. In addition, the family member will often interject his or her own feelings instead of what the patient would have wanted which makes things very difficult for everyone. Plus the patient is sometimes suffering, and it's hard for me to watch that happen here in the hospital. Anyway, I had many family meetings last month to provide as much objective information to family members so that informed decisions about end of life care could be made. In the end, I felt good about the decisions that were made as we took suffering away for several terminal patients. At the same time, I cried a few times last month (making sure no one was looking) when faced with the enormous emotional burden of these decisions. I sure picked an interesting job.
This month I'm doing pediatric surgery. It's absolutely incredible! It's really my first month of general surgery as a surgical resident. I received my $850 pair of surgical magnifying glasses (loupes as it were) which are very cool. I look forward to using them not only this month but also Nov and Dec on vascular surgery. The attendings on pedi. surgery are awesome. They are very concerned with technique, which is important for a young surgeon trying to learn the right way to do things. I couldn't be happier that my first true surgical experience is with this group of surgeons. And there goes the trauma pager...
...And I'm back. My call nights are going to be absolute hell. I am covering trauma and pediatric surgery, which means I don't sleep, and I am responsible for 20-50 patients on a given call night. Plus, here in MA we get non-stop trauma. NON-STOP. The problem is that 90% of these cases are non-operative trauma. This means we get the CT scans, X-Rays, lab tests, and all the other stuff only to admit the patient to the hospital and wait for them to heal. There rarely are surgical issues in these patients which makes this less appealing for a surgical resident. It's ok though, I will try and learn as much as possible from the experience. I'm here to learn right? Plus the more positive I am, the better I'll feel...even if I'm perpetually tired.
So that's what's up. I have a new camera which Kayla purchased for my graduation. It's the sweet, sweet Panasonic Lumix FX8 with 3x optical zoom. It's the coolest thing ever. I have several pictures of my dog so far and not much else. I also have a few hospital pictures which I will post with this entry. Look for them soon. I hope all of you are well.
Nathan Beach of www.nathanbeach.com is back in The United States after his jaunt in Europe. How lovely that he spent his honeymoon with Shelley over there. I received a nice thank-you card from Shelley and also one from Linda Beach. I thought that was swell. I actually still owe Nathan a thank-you card for my graduation present, but I haven't done that yet. Maybe when I am post call on Monday I can get to that. Or maybe I'll sleep all day.
I was in the Surgical ICU last month. It was month 2 of 3 for me in the ICU, so now I feel fairly confident in managing critically ill patients. At least I should be able to identify sick patients in regular hospital beds as I move forward in residency. And for all you lawyers out there, that doesn't mean I'm an expert. It simply means that I'm a first year surgical resident who has spent two months in the ICU and feel much better about managing sick patients than I did three months ago.
I also had to make a lot of difficult decisions this last month regarding end of life issues. I had several older patients who either had metastatic cancer or other life ending illnesses and had to "pull the plug" as it were on a few of them. What this means in more compassionate terms is that these patients were suffering, in pain, and would be dying in the immediate future yet family wanted to continue aggressive care. "Pulling the plug" really means we decide to provide comfort measures (adequate pain medicine and sedation) for the patient and remove life support machines (the ventilator, CPR if the patient's heart stops, drugs that artificially improve the heart's pumping performance, and other various life support). In these situations, the physician must always ask the patient directly how he or she wants to proceed, but often that is impossible because the patient is unconscious or incapacitated. Then the burden of decision-making falls to the family, who is instructed to relay what they think the patient "would have wanted" in this situation. However, often the family member feels guilty about ending a loved one's life, even if the patient would have wanted it that way. In addition, the family member will often interject his or her own feelings instead of what the patient would have wanted which makes things very difficult for everyone. Plus the patient is sometimes suffering, and it's hard for me to watch that happen here in the hospital. Anyway, I had many family meetings last month to provide as much objective information to family members so that informed decisions about end of life care could be made. In the end, I felt good about the decisions that were made as we took suffering away for several terminal patients. At the same time, I cried a few times last month (making sure no one was looking) when faced with the enormous emotional burden of these decisions. I sure picked an interesting job.
This month I'm doing pediatric surgery. It's absolutely incredible! It's really my first month of general surgery as a surgical resident. I received my $850 pair of surgical magnifying glasses (loupes as it were) which are very cool. I look forward to using them not only this month but also Nov and Dec on vascular surgery. The attendings on pedi. surgery are awesome. They are very concerned with technique, which is important for a young surgeon trying to learn the right way to do things. I couldn't be happier that my first true surgical experience is with this group of surgeons. And there goes the trauma pager...
...And I'm back. My call nights are going to be absolute hell. I am covering trauma and pediatric surgery, which means I don't sleep, and I am responsible for 20-50 patients on a given call night. Plus, here in MA we get non-stop trauma. NON-STOP. The problem is that 90% of these cases are non-operative trauma. This means we get the CT scans, X-Rays, lab tests, and all the other stuff only to admit the patient to the hospital and wait for them to heal. There rarely are surgical issues in these patients which makes this less appealing for a surgical resident. It's ok though, I will try and learn as much as possible from the experience. I'm here to learn right? Plus the more positive I am, the better I'll feel...even if I'm perpetually tired.
So that's what's up. I have a new camera which Kayla purchased for my graduation. It's the sweet, sweet Panasonic Lumix FX8 with 3x optical zoom. It's the coolest thing ever. I have several pictures of my dog so far and not much else. I also have a few hospital pictures which I will post with this entry. Look for them soon. I hope all of you are well.
1 Comments:
That is insane that my mom wrote you a thank you -- she must have really liked dancin' with you at the rehearsal dinner. I'm mostly curious if the postcard we sent from Prague ever got there -- it was in kind of bad shape by the time it ended up in a mailbox. We forgot to mail it in the Czech Republic (after affixing Czech postage) and then had to layer some German postage over it. That camera model is sweet! Fascinating journal entry otherwise...
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