As my Granny once said before my family took a cruise to Alaska, "button up your lip, and buy a new hat." It's Granny's version of if you can't say anything nice, don't say anything at all. I've tried to keep my blog from becoming Negative Nancy's Pity Party @ blogspot.com since I started my job almost 5 months ago, but I'm done buttoning up my lip! (Not done buying new hats, however...)
My sunny, optimistic last blog makes me laugh. Every month at my job has presented new challenges, a steep learning curve, and bipolar-like swings on my job satisfaction scale. First I had to adjust to seeing more patients per day than ever before. This has given me time to reflect on my cushy schedule in residency and in prison (10 patients/day? Ha!) as well as a new skill set -- cutting people off. All too often, patients, with laundry list of ailments in tow, try to derail my 20 minute appointment. I'm improving my ability to interrupt and suggest they schedule a follow-up. I feel bad about this, but it's a reality in my 17.5 patient/day world.
Just when I thought I had a handle on clinic, I started taking inpatient call and doing OB at a community hospital with about 100 beds. My call schedule is quite variable in terms of calls/week. I also do some medicine only calls and some medicine/OB calls. Most of our inpatient service is moms and new babies, with about 1-3 medicine patients at a time (so far anyway...the winter is sure to increase our census, and winter arrived in Denver last night in case you've been watching the news.) While this may sound like a manageable feat, and occasionally it is, OB overrides everything. It's tough to take care of the medicine patients when I'm tied up assisting in multiple C-sections. I am missing my intern to help divide and conquer the work!
One of my biggest gripes is the fact that my clinic expects us to carry on with our clinic schedule post call, no matter if I have a normal "8" hr clinic day (read 10) or 12 hr clinic day (usually 13ish) afterward. I've been struggling to figure out how the other docs maintain this schedule or how they work around it. Sometimes I wonder what planet I'm on altogether. (Do these people really think it's reasonable to work 36 hrs without sleeping?! I'm a basketcase after 24 hrs on.) I have one day a week off, so apparently this is supposed to make up for working nights and weekends. However, my Monday fun day doesn't really soften the blow of a brutal post call Wednesday, unfortunately.
Which basically brings the blog up to speed with the present day. Yesterday I had a 24 hr med/ob call where I delivered 6 babies and was up all night. While I had high hopes of a quick 2 hr 4 am nap, the morning ended in the worst post partum hemorrhage I've ever managed. The patient had a large tear from her delivery, which I repaired, but she continued to have brisk bleeding. I called the obstetrician to come in and help, and we spent an hour or more in the operating room trying to stop persistent vaginal pulsing and oozing. She lost about half of her blood volume. I think she will recover well, but it was terrifying. Then I changed out of my bloody scrubs and put on some clinic clothes. My misery peaked when I had to rescue my Subaru, discovered in the parking lot with the help of automatic key clicker as Scarlet was entombed in 7 inches of ice and snow. Turns out wear clogs wasn't a great choice for the first day of winter. I didn't last through much of my clinic day, but I did hear some neat comments like "you look so tired" and "oh, your hair is different." Indeed the red rimmed eyes and post call frizzy ponytail were, at best, unbecoming.
To avoid the aforementioned NNPP blog, I'll end on a positive note. The only patient on our hospital service right now is my own - a 40 ish yr old guy with moderate developmental delay and low potassium due to a month of diarrhea. One of the nurses must have told him I delivered a baby because when I checked on him later in the night he said with genuine awe, "You delivered a baby? Wow! That's AMAZING! I'm so proud of you! Wow! You do EVERYTHING!" I was touched and will try to keep in mind that my job is full of special, privileged moments, despite its demands.
Hopefully my next blog won't be so delayed!
