Report card

My vacation is coming up in a little less than 2 weeks from now, and I'm excited. I've wanted to get away from the hospital setting for a long time, and I think I'm overdue.

Everyday's been pretty stressful, but not the way I thought it would be. I thought the prospect of people getting hurt, people dying, of being the least competent person on the floor would be stress enough to make me dislike my job, and in some ways those prospects have been sources of some unease. Surprisingly, the biggest stressor I've had is the feeling of constantly being evaluated.

It's almost like going to visit the in-laws, except you do it every workday, sometimes on weekends, sometimes for 36 hours at a time. No matter how nice they may be, and no matter how accomodating they are, you never really feel like you can be yourself until you go home.

Also, your in-laws don't give you a report card that will influence your relationship, let alone your career prospects. Although they may give you the cluck of the tongue, the resigned sigh, and the why-am-I-letting-you-date-my-daughter raise of the eyebrow every now and then, you don't need them to write you reference letters so you can get a job later on. If you do, stop dating your preceptor. It's not good for anybody concerned.

It's nice to know somebody's watching me in case I make a mistake but I need a break from my significant other (the hospital)'s parents (the hospital staff). God dammit stop asking me what I'm doing with my life.

I'm leaving for 2 whole weeks, and during that time, the only thing that's going to be evaluated is the room service and my form from the diving board. Booya.

Welcome to the House of God

It is 1220 hrs on July 2 and I just got home 30 min ago.
I have been awake and working since July 1 at 0640 hrs.

This is day 1 (or is it day 2 now?) of my new career as a
resident physician on the general internal medicine service.
I use the term "physician" loosely. July 1st is a bad day to
be on-call. And maybe a worse day to be a patient.

I have peed exactly 4 times during that period. I drank exactly
1 bottle of water, 1 can of diet coke, and 1 cappucino from the
coffee stand in the lobby.  I did not have time to change into
scrubs... until after i got home today. I am eating crackers
to appease the nausea of being up for 30+ hrs.
I am nauseated and hungry at the same time.

Our team comprised of 1 senior resident and 2 juniors.
Each of us juniors carried 3 pagers: our personal pager and
2 other teams' pagers and. As a bonus, 1 lucky intern got
to carry the code blue pager. The team pagers are twice as big
as our own pagers. I need a stronger belt for call.

I wear a long lab coat now. No more of this short-coats-for-clerks
business. But the bottom pockets bunch up when i sit down and
everything spills out of them,
including the 3 pagers clipped on the pockets.

I was assigned 4-5 inpatients to start with.  While on-call,
I picked up 2 more that another resident had admitted during the daytime.
I also admitted 2 new consults in the ER. I covered the wards for a
busy team trying to manage patients whom I knew nothing about.

One of them passed away last night, although I was warned to expect it.
I pronounced a death for the first time. 0215 hrs. I called the family.
I didn't know what she died of.  I learned to introduce myself as "Doctor".

I helped my team to do a therapeutic procedure on an elderly sick man.
It didn't work. I felt his faint radial pulse disapear under my fingers.
Both patients were elderly and very sick.  I learned later that neither
was unexpected.

I did not cry.
Nor did I sleep.

Our attending physician came in at 8am to hear about the patients
that came in during the night.  He told funny stories about things
that happened in his day as an intern.  We rounded with him at 9am.
He was gone by 10am.  We should have been allowed to go home based
on the union guidelines, but we could not leave the patients'
loose strings unattached.  I stayed until 11:30am.

Now I sit here, finally changed into my scrubs, in front of my computer.
Maybe I'll shower then try to sleep.  I have post-call adrenaline
keeping me awake. And hunger, but only for bland foods.

Tomorrow is a new day.... at work.

Signed,
Scutterbug, MD,
PGY-1, House of God Hospital,
pager 4444

The jovial bovine human hybrid pho mascot

A lot of Viet restaurants seem to enjoy using this laughing cow as a logo. It bears a striking resemblance to the cow on those little cheese rounds. It also looks human, which is only distressing if you dwell on it.

I always wondered why these cows were laughing. Do cows find the prospect of having their sides and legs chopped off to be made into soup humourous? Maybe it's not a happy laugh, but an insane kind of cackle, one that a crazy cow would get. A MAD cow. Or maybe it's a picture of a cow about to sneeze. People look all kinds of weird when they're about to sneeze.

Whatever the reason, lately I've been finding myself relating to the cow who laughs. In fact, I look on the cow as something of a role model. That's right. A farm animal you can look up to.

Being on this psych rotation has made me realize how much I put into clerking. Before I came here, where people work civilized hours and and try to maintain some semblance of a functional subset of society, I had to give a lot to the hospital. Sacrificing free time, my nights, my dignity, my youth... Many times I'd felt like maybe I'd given up just a little more than I was getting back.

But there's no real alternative. I'm in too far to back out now. I'm far along enough to think I can see the light at the end of the tunnel. All I have to do now is endure.

That's how this cow must feel. "Jesus they're going after my rump roast. MY RUMP ROAST. For mooing out loud how much more can they take? You can't get blood from a stone you hungry bastards! YOU HUNGRY BASTARRRRRRRRRRRRRRRRDS! Oh wait, cud coming up .... gotta chew..."

And when I feel like I've given all I can, when I've been sucked dry of all the energy I was hoarding to take home, there's nothing I can do but laugh. Laugh laugh laugh. I don't laugh because it's funny. I laugh because there's no other way to deal with it. Ha ha ha! I have no life! Ha ha ha! A cow, being a ruminant, must have done a lot of thinking. I bet she came to the same conclusion. When someone's taking away every last piece of you and there's nothing you can do, might as well laugh.

Ah laughing cow. We're bred from the same stock. Sort of.