Tuesday, September 27, 2016

Reality Bites

Well, the shiny gloss of being an attending certainly didn't last long.

I have a new reference point for the expression "being thrown in the deep end of the pool" now. These days I feel like all I'm doing is inhaling water and pathetically thrashing around. 

I can remember rolling my eyes so many times in the past when being dragged through a long-winded seemingly redundant orientation at a new job. I would kiss the feet of someone who would orient me now.

No name tag, no hospital badge to get into the hospital. What are the codes to get into the change room, the back door of the clinic, to photocopy something? What forms do I need to fill out to book a surgery and then where do I put them? Who does the bookings? Do I need to book an anesthetist?

Where are the prescription pads? Where do I send my invoices, my day sheets, my O.R slips? What is my dictation code, do we have an ultrasound tech in the hospital, is there a pharmacy open on Sunday and when do I get paid? What times are the hospitalists on call until, do you routinely collect cord blood, what is an order set, where are the order sets? How do I empanel a patient, send a task, get an old chart?

Just a small sample of the myriad of questions I am trying to sort out while trying to actually care for patients. The cleaning staff are wiping around me an my desk every night. I make so many notes to self during the day; read up on post-kidney transplant surveillance, monitoring polymyositis, review guidelines for Barrett's esophagitis recall, post neonatal resus stabilization...remind myself how to interpret blood gases, put on casts, do fundoscopy, thrombolytics, a lumbar puncture.

But then I get home, nauseated and sweaty. Just so happy to get out of my microbe infested hospital or clinic clothing. I eat and think, "I should read up on those things now, I should work out, I should empty the dishwasher" but instead I find myself crawling into bed. Not caring that my feet probably have dried amniotic fluid on them.

And then a new day comes.

Or it doesn't. Instead the phone rings at 3am and I am driving back to the hospital for another delivery. This time the mom is fine but the baby is not fine. And I spend the next few hours talking to family members who have gone silent with fear and waking up neonatologists who are sleeping hundreds of kilometers away.

Then the night morphs into day and I am the hospitalist for the medical ward and my conversations shift to managing INR results and incontinence and wound vac dressings. A palliative patient, who I haven't met until that day has family there and they want to speak to the doctor about what is happening. My morning becomes afternoon and my lunch becomes the family meeting where I try my hardest to remember all the insightful and beautiful things that Atul Gawande talks about in Being Mortal and I try to remember to do more listening than talking.

So I leave the family meeting and fly into the clinic where on arrival my MOA throws up her hands at all the paperwork I am sending her and tells me it's not working. I duck into the first patient who wants a narcotic refill and disability form filled out and when I press him for details on the background of these requests he tells me...

you doctors are the worst...I was told how terrible the doctors are in this town, they don't care about anyone at all, even if you're dying...the worst...my old doctor cared, he prescribed me valium and dilaudid...he was a good doctor...you're a terrible doctor

And I can't help but feel the exhaustion from the night before crash over me. I can't stop the rising flush in my neck and my quickening pulse.

Where are the disability forms?


Kassy said...

All I can say is, it gets easier....and harder.

Lisa said...

I am so sorry. I hope it gets better. It has to get better, doesn't it?

Fordo said...

I am so glad you're back.... and so sorry you are exhausted. I am absolutely sure it will get better. It just may take awhile. We care about you and want you to succeed.

Fordo said...

I am so glad you're back.... and so sorry you are exhausted. I am absolutely sure it will get better. It just may take awhile. We care about you and want you to succeed.

PGYx said...

Ok, this is all terrible. Some of this can (and really must) be fixed. You need an orientation to those details at any hospital and its frankly egregious that they didn't do this for you. Every new medical job has its surprises but as you know this is not normal. It's in your employer's own financial and medicolegal best interests to ensure that you get this info. Can you make a list and bring it to your medical staffing department for help? Barring that, can you talk to the person who filled your position before you to help answer some of the questions? No physician can be expected to do his or her job without these details.

Albinoblackbear said...

Thank you for all the kind words and support!!!

@PGYx - Yes and no. The other GP-S went on mat leave the week after I started, and she was trying to close her practice and finish up so she was in crazy mode. Everything has been a fly by the seat of my pants kind of orientation and of course I was given the MOA with ZERO experience in surgical/OB stuff so that is an added layer of stress. By trial and error I am slowly getting things figured out but it was REALLY frustrating the first couple of weeks.

Liana said...

Oh, man. I started GP surgeoning after having been in practice for 6 years. So I was just introducing one new variable into the mix, not the cornucopia that you've got going on.

Be good to yourself. Ask for help. Take breaks. I schedule two 15 minute breaks in my clinic day in addition to a 1 hour lunch so I can catch up on charting and not get stuck at the clinic late in the evening.

Zed said...

This sounds like my first day as a doctor, not knowing where anything is or how things worked or what the protocol was.

Ó'Cuinn said...

Thank you for keeping your blog going. It is a good dose of reality for what the life of a MD is like.

skyjockbill said...

Ooof, it's a good thing you're so courageous and have such an indomitable spirit. AND can still write these wonderful posts - magnifique!