Death and Birth

It's been about a week and and a half, and my return to Shmeens has started a bit smoother than I expected.  Considering how tense and nasty everyone was acting the last time I was there, I clamped down and tried extra hard to be sweet to everyone I spoke to.  I encountered a nurse or two who I had gotten into throwdowns with, and thankfully they didn't remember me, so I was able to start over with them and act extra grateful (even if all they were doing was a basic task).  I would have tried to do this anyway, since I was scheduled to spend a lot of time at Shmeens, but I had a separate reason for doing so.

Without revealing too many details, it is looking a bit likely that my home base hospital may close.  Sadly, this is the story not just for our facility but for many many others in the metropolitan area.  It seems to be a clusterfuck of a situation, for lack of a better word, because all of the hospitals' debt is being called out at the same time that corruption in the governing hospital systems is being called out, at the same time that the state is unable to provide funding despite acknowledging a need for hospitals in underserved areas like ours.  There has been a lot of rallying on the part of the community and doctors and nurses to save our facility from a terrible fate, but I fear that it's just too late for what seems to be a done deal.

The kind of pall this sort of event throws on everyone, it's hard to describe.  When we first heard news (which wasn't even news), the nurses went into a super-chicken mode in which they basically screeched and clucked the news to anyone and everyone who would hear, even if there wasn't anything definitive to report.  There is so much sadness that everyone feels for the community residents, many of whom cannot seek medical help elsewhere because of economics and geography.  The attendings have all gallantly tried to roll up their sleeves to help, but of course must think of their families and so are quietly exploring jobs elsewhere.  Everyone agrees that it's a tragedy of Greek proportions.

This, of course, puts the residents in an uncomfortable position.  Because of the nature of residency programs and spots nationwide, when a program shuts down, residents don't lose their positions - they are typically redistributed to other programs (who happily take on the $150,000 value + resident labor) and the spot is later lost after the resident graduates.  In other words, while the hospital closing creates drama as far as where we will all go, we are not in the same boat as everyone else in terms of job security, and it's hard to look everyone in the eye when they're struggling and we aren't.  This is especially true of the surgical program, because our director is working hard to preserve the program itself as a living structure - to do this, we are trying to shift our home base to Shmeens.

We are very fortunate because we already were spending so much time at Shmeens, running their service and staffing their OR, that the program disseminating would be a massive blow to them.  Additionally, Shmeens once had a residency many years ago and lost it, and there has always been an interest to re-acquire one if possible.  All of our attendings there have been exceptionally supportive of the plan to relocate permanently, and seem excited to have us.  The chairman in particular has shown a lot of enthusiasm to further develop our program and utilize affiliations to create new outside rotations that we can add to our roster and boost our academic strength.  And fortunately, we already share one attending with the home base, to help ease the transition.

I'm not really sure of how I feel about it.  Or rather, I know how I feel, but then I'm overwhelmed by guilt about it.  Our program will have an easier transition by far than the other residencies at the home base, and they are still fighting to stay open.  One in particular will likely be split into two programs, a travesty because that program is quite coveted in the area because of the specialty it trains for.  On my part, I almost wish closure would happen as soon as possible so that we could all move on with Shmeens, but the reality of that would mean expediting the loss of nearly a thousand jobs in a relatively poor area.  Being at Shmeens where it feels safe, I'm taken away from the tragedy and heartbreak.  I don't want to go back.

The January Blues

Ahh, winter.  There's nothing like it.  I love this time of year, it's when the air is crispy and you become more appreciative of sunshine (and feel the effects of neglecting your vitamin D / calcium supplements).  I love winter very much, it's when the whole world can feel transformed in a few hours to a white wonderland, into which you wander with oversized hats and crocheted scarves.  But, every year, I start getting very depressed around January, most likely due to a combination of lack of exercise, vegetables, sunshine and generalized explosion of personal problems.  I always get blue around this time of year, and I never figure it out until I'm well deep into it.  This year, I heard snatches of Billie Holiday on the radio singing "Gloomy Sunday" and I finally figured it out.  I have the blues.

It's a magical time of year for other people, too.  The roads are slushy, the sidewalks are icy, the wind is knife-like.  Not surprisingly, so are the people in the hospital.  I first noticed it with the nurses back at Shmanhattan - every time I smiled back at a nurse or wished them a nice day, I only got stares or dismissive expressions.  I thought, at the time, that it was because it was a fancy Shmanhattan hospital, and people are just ruder when something is nicer.  But then, I remembered that I live in Queens, where drivers routinely stop at red lights and then careen right on through anyways.  So that couldn't be it.

It was the end of the day, and the surgery team decided to get together and do table rounds in the resident lounge, to review the day's events and update the patient census.  I had been holding the on-call pager since I had the least number of patients, but instead became the busiest person because I received non-stop calls on the most ridiculous things.  When I presented the day's events for my patients, I was met with underhanded comments which indirectly mocked my hard work to get done what I could.  I kept my mouth shut, and observed that multiple similar comments were being made around the room, with everyone giving off a sour face and nobody appreciating anybody else's efforts.  In the middle of these tense rounds, a nurse decided to page me multiple times regarding a patient needing a medication.  I spoke with her and clarified that this was a patient who was already discharged and merely awaiting a ride home, and that she was in no acute distress, just needing a renewal of a medication for pain.  I tried to tell her as politely as I could that we were rounding, and that I would send someone up to write the order renewal as soon as possible, but her only response was "Well, my patient is in pain, and that's all that matters".  I received the same page from the same nurse twice more, still while rounds were occurring (and conveniently increasing the anger of my seniors), who finally sent me upstairs to sort out the matter.

I found the nurse and tried to pull her aside from the nurses station to discuss the issue privately, and remind her that residents cannot leave rounds just to address one patient's needs unless it is an emergency.  She instead responded by avoiding my eye contact, and repeating her same lines over and over, without listening to me at all.  I said that we should discuss the issue as a group, and for the first time ever, I got into an actual tiff with a nurse requiring a nurse supervisor's intervention.  The supervisor was extremely professional, listened to both of us and tried to assuage the nurse's concerns.  I explained as best as I could that we were responsible for many patients, and a proper uninterrupted sign-out round is essential to maintaining safety and continuity of care.  Instead, she avoiding my eye contact again, looking away at the ceiling, much like a 7 year old.  I finally had to conclude the session by reminding her that the extra order was now written, and walked away without any peaceful resolution effort on her behalf at all.

I felt terrible.  Normally nurses love me, because I try really hard to be as polite as I can and show appreciation for their patient advocacy.  I went home feeling upset and wondering if I could have handled things differently, but seeing that the nursing supervisor agreed that I had escalated the issue in an appropriate way, I couldn't find any different avenue.  I started to wonder if there was something in the water the following morning, when our team met to review surgery content material.  I didn't even know what the tension was about, but suddenly I looked up from my patient list of to-do's to see two residents making tense loaded comments to each other.  I left the room to assist another intern with a blood draw just as shouting commenced in front of a room of students and residents from other programs.  It was embarrassing.  I just couldn't figure it out.  Even if people have legitimate reason for disagreement, to argue in front of people you set an example for in a hospital is just crazy.  That tension extended to the remainder of the day, to the point where I could feel items not being mentioned in sign-out just to avoid further conversation.

I think everyone needs to take their vitamin D.

Welcome to Shmeens

I was going to start this post by saying how awesome it was being home post-call for the snowstorm, but as it turns out, it won't get started until I'm already asleep.  Not that this should matter at all, but I'm all holed up in my jammies with my Belgian cocoa dusted truffles and glass of milk and bucket of korean wings and kimchi (awesome combination, I know) and dammit, I want me some snow.  I continually have great things to say about my house and neighborhood, and the latest in that list is that I live one block from an old subway rail line, which in this area runs above ground and transports freight only twice a day.  So I have a ready-made garage under which to park my car, and my neighbors and I will all be able to pull out in the morning without having to additionally dig out the car.  Hooray!!  No damaging the car paint with my shovel this time =P

I woke up yesterday morning to a sweet text from my chief resident, wishing me luck on the upcoming Shmeens rotation.  I feel that I have a lot to prove these two weeks, as I am the only intern from my program being sent here, and I want to make a good impression.  Fortunately, all of the other interns I rotate with seem both capable and nice, and I even ran into a med school friend's boyfriend, who I had forgotten was doing his traditional rotating internship year at Shmeens before starting anesthesia next year.  I really expected the service to be rough and rigid, like a bigger boot camp than my home base hospital, but instead it turned out to be oddly casual.  There were no lunchtime or evening rounds, since the OR was so busy that it simply wasn't practical.  There was minimal pimping, and I didn't get yelled at for the many simple mistakes I made (most of which came from being so disoriented in the hospital, since I had never been there before).  I kept asking the interns when the other shoe was going to drop, and getting blank stares in reaction.

The hospital reminds me a lot of my home base, in that it is neither wealthy nor prestigious, but it is bigger and attracts a reasonable number of patients.   I couldn't believe that in one day, they had two appendectomies, one strangulated hernia (into which a third appendicitis seemed to have perforated and caused abscess formation), one EVAR for AAA repair, two sub-total thyroidectomies, and a million other routine cases.  I'm really looking forward to my non-call days, when I hope I can scrub on a few of the smaller cases and get some more experience.  In that sense, I'm becoming more and more sad that I'm not spending more time at Shmeens, and I'm getting really excited to come back as a second year resident.

So, for now, it's ominous clouds and Gilmore Girls re-runs for me.  Laugh, but know that I have everything I need in my little hole.