You're The Boss

Sunday, 10 pm on the floor.  A nurse reports that her patient is refusing his blood pressure medication for the second night in a row.

Me: Hello, Mr. Logical.  I understand you have a concern about your medication tonight?

Mr. Logical:  Yes, doc.  I'm allergic to it.

Me: Oh, really?  What sort of reaction are you having?

Mr. Logical: I don't like how I feel when I take it.

Me: Hmm.  That's not quite an allergy, but ok.  What do you mean, you don't like how it makes you feel?

Mr. Logical: It slows my heart down.

Me: Yes, that is an expected side effect.

Mr. Logical: Exactly, an allergy!

Me: No, an allergy would be something like a rash or your throat feeling tight.  This medication is supposed to lower both your heart rate and your blood pressure.  That's what the attending wanted for you.

Mr. Logical: But I don't like it!  It's the same damn problem I had with that other medicine, hydralazine.  He tried to get me to take that one too.  But I refused.  I'm allergic.  *smiles triumphantly*

Me: Sir, a lowered heart rate is not an allergy.  I understand that having a lower heart rate might be a strange sensation for you, but I'm looking at your vitals and your heart rate is quite high.  A lowered heart rate in your case would be better for you, not dangerous.  And your blood pressure most definitely could use some lowering, too.  Having a high blood pressure is very dangerous for your body.  Do you want to maybe think about trying this medication?  Otherwise, we can try a different one, like clonidine.

Mr. Logical: No!  I won't take that one either.  They tried to get me to take that before.

Me: So basically, you don't want to take any medications to lower your blood pressure.  You prefer the sensation of high blood pressure and pulse.

Mr. Logical: No, I'll take something.  I'm just allergic.  Make sure they put that on my wrist band.

Me: *sigh*

I-C-London, I-C-France

I'm beginning to have the strangest feeling that my internship is already slipping from my hands.  I always have this sort of feeling around February, the knowledge that winter is nearly done and time is passing right in front of me.  The trees are still bare, but I can see tiny knobbly bits protruding from the tallest twig branches, and I know that in a month or so, real buds will appear and I will be just a few short months from forever ending my internship.

I shouldn't feel sentimental about this at all - after all, internship is That Dreaded Year in the life of all doctors, the year that you are supposed to hate and feel as though you can never get back and so on.  And it is, and I am mentally "done" with the silliness of tylenol orders and 3 am falls and patients demanding dilaudid instead of morphine.  I don't feel like I have to rush to the bedside for every little thing anymore, and I can recall how to write for potassium without looking it up and I can tell whether the nurses really do need my help with an IV line or if they're just being lazy.  But... it's over so soon.  I can't believe it.  The infancy of my career is nearly done.  I feel like I should have taken more pictures.

I've transitioned from my last two weeks on the ICU into the night float, where I'm continuing to cover the ICU and a few other floors.  Despite some very questionable nursing calls, I've had quite an easy week taking care of things, mostly because my nurses are terrific and organized and know what they're doing.  I keep waiting for patients to die (I am covering the critical care unit and the hospice, after all) but for some reason I have been extremely fortunate and sleeping a reasonable amount, which translates into hours at home during the day to relax and do exactly as I wish.  I came into the night float really dreading it, since I was pretty sick of it by the end of two weeks the last time I was on it (and that was with terrific weather in July), but I have been taking my vitamins and bringing my laptop in with me, and I find that a warm room + 4 seasons of Battlestar Galactica on dvd has made for a very pleasant experience.  I am most definitely dreading next week, as the other intern and I will swap floors, leading to lots of late-night troponin blood draws and EKGs and imaginary chest pain calls.  This won't be all that bad, except that I must also go in for an eye appointment and a surgical poster presentation conference post-call next week, all the day before my birthday.  I then have to start two weeks of surgery in-house the day after my birthday, but hey, at least I have it off.

As part of my planning for the coming months, I have finally kicked off a few things that I had in the works for some time.  The first is that I have scheduled myself for Lasik for March, which I am really excited about because I JUST CANNOT DO EYEGLASSES AND CONTACTS ANYMORE.  It really isn't so bad, it's just a massive hassle and when I already feel so unpretty on-call and post-call because I have to wear glasses, it brings my self-image down, and I would love to continue to feel good about myself as I go forward in surgery.  I scheduled it with the same guy my dad went to, and my parents are helping me out with cost, so things should go smoothly and I hopefully will not end up blind and transferring into a specialty where eyes are not required (like psych).  I should be good and recovered by the time I head back to Shmanhattan Hospital for two more months of surgery, which should be a ton of fun since I will be back in the city for the spring.  This time, I will make a greater effort to go out and hit TopShop, because shopping for pretty fun clothes genuinely does make me feel better about myself.

I am also putting things into motion for my spring vacation, and I am trying to juggle a trip to London with a second trip somewhere in the US, maybe Chicago or Texas or something.  I had such an awesome time in Memphis that I really would love to do another southern trip again.  Nothing is set up yet, but I'm just enjoying that I can actually move forward with planning all the fun stuff I had been holding off on for so long, because I am done with my exams and can really take control of things instead of acting like I am a victim of my own specialty.  The best part is that I just discovered Groupon, so once my dates are set, I plan on London spa-ing myself in a bad way while my sister and cousins are working.  We're toying with the idea of at trip within my trip, maybe to Paris or Scotland or Dublin, with the goal of getting smashed and just having an awesome time.  But really, if I come back with a semi-British accent as I typically do, that will be more than enough for me.

Back at the Ranch

Nobody seems to believe me, but I am really really happy to be back at my home base hospital.  After 6 weeks away at two different hospitals, it is thrilling and relieving to be back where everybody knows your name, and people say how they missed you and how nice it is to see you again.  It seems shocking to the other interns, but the nurses really are nicer at our hospital, and you miss that when you go to other hospitals where you have to go into a 20 minute explanation as to why you don't know where the 4x4 gauze is kept in the stockroom before anyone will lift a finger to help you.

It's also really great to be back with all of the other interns in my year.  It's odd to me that I missed them, but it was so nice to be among other people my age who knew me and liked me and joked with me, instead of competing with me for cases or hanging out amongst themselves.  I'm back on the surgery rotation, and this time it's with another surgical intern as well, so I'm enjoying the chance to actually work with my co-interns now that we're all coasting towards an all-surgical 2nd year.  We're all getting our contract renewals for the coming year, and it's so shocking to think how my internship is already more than half over, and I am actually surviving and smiling at the same time.  I'm excited to see who will join us for the next year, and a little nervous at the prospect of actually being in charge of people under me.  I've struggled a little with productively instructing and directing the students that rotate with us, and I've decided to make a better effort to observe the various methods my seniors use to motivate and teach them, so that I can help foster smoother teamwork, and not just scare them into hating surgery.

I only have 2 weeks on this surgical rotation, and all I can think about is how overwhelmed and busy I felt when I was doing surgery in August.  At times, I was in tears from the exhaustion and disappointment in myself.  And now, I keep finding myself with nothing to do, and wondering how I ever thought this same surgical rotation was insane.  I've had a few nights where things got a bit busy, like big cases going into the OR and the senior pager I held exploding with consults, but we managed it.  It might be that I found ways to cope, or that I simply was so busy at the other hospitals that this now seems a snooze in comparison.  Or maybe it's that it's easier to remember that, whatever happens, the call will always end at some point, and I can get things done in time.  In other words, there's less reason to panic than there was before.

This surgery thing, I think it's actually doable.  Hmm.  =)