I have one week left in the ICU and my feelings are mixed about it. I love the fellow (someone who has finished residency and is doing further training) I am working with- she is a great role model, she thrives on teaching, and she is fun to joke around with. My attending is an intern's dream. He is nice, patient, and trusting just enough to let me safely learn and gain experience. The patients are incredibly sick and so I am forced to learn a lot...quickly.
Daily I am thrust into situations where I am the leader- running a code, holding family meetings, discussing end-of-life issues...that aren't as prevalent on other services. On the other hand, being on call is ridiculous. I'm sure it will be just as busy on most other rotations, but hopefully more giving tylenol and anti-nausea medicines and less of the actively dying issues. It's a lot for an intern to handle. It's a good thing that there are tons of people there to help. It is amazing to see how many patients actually get better. I see miracles happen every day.
Things aren't going to be easier next month since I'm doing transplant surgery for the third largest transplant program in the country. It should be full of unique challenges and learning opportunities.
I couldn't be happier about how residency has started. I am at the absolute best program for me, surrounded by friends as colleagues, working with attending physicians who are teaching and encouraging me, with a phenomenal relationship network keeping me sane.
I am so thankful that God knows what we need and what is best for us long before we are able to see the big picture. How great is our God!
Sunday, July 27, 2008
Tires
I went to the Brickyard race today with a friend. I thought it would be really fun to stare at mullets and watch cars zoom by. Instead I only saw one mullet (everyone had hats on) and cars were moving slowly thanks to all the yellow flags resulting from the tire problem. What in the world was wrong with the tires??? I thought the race would never end. I actually texted a friend to find out how many laps the race would drag on for. I fell asleep through a few cautions-although I will blame that mostly on having been on call Friday night and arriving at the hospital at 4:30 am today.
Anyways, I am usually up for trying things once and I am glad I went. I still don't understand the Nascar phenomenon. You can hardly see the cars when they are racing, you sit in the heat for hours, and the traffic is insane afterwards.
I was sitting across from Jimmie Johnson's and the other top driver's pits so it was fun to watch their many many pit stops. The strategy the Johnson crew had at the end seems to be what won the race for them.
The best part was watching (and listening) to the crowd go nuts with every yellow flag that was waved.
I'm glad I went. I love trying new things. You should experience it for yourself at least once. It's a different world...
Anyways, I am usually up for trying things once and I am glad I went. I still don't understand the Nascar phenomenon. You can hardly see the cars when they are racing, you sit in the heat for hours, and the traffic is insane afterwards.
I was sitting across from Jimmie Johnson's and the other top driver's pits so it was fun to watch their many many pit stops. The strategy the Johnson crew had at the end seems to be what won the race for them.
The best part was watching (and listening) to the crowd go nuts with every yellow flag that was waved.
I'm glad I went. I love trying new things. You should experience it for yourself at least once. It's a different world...
Wednesday, July 16, 2008
Quote of the Day
Someday I want to be this confident in my surgical skills:
Lance Armstrong asked Dr. Shapiro ( a neurosurgeon at IU) why he should trust him to do the surgery to remove the brain metastases from his testicular cancer.
Dr. Shapiro said, "Because I'm much better at neurosurgery than you are at biking."
I love it. It probably sounds arrogant, but if you met Dr. Shapiro and realized how down to earth he is it is just fantastic proof of his skill. He is humble yet strong.
It reminds me of an experience at Camp Adventure many years ago when Mark Beeson encouraged us to not shrink back and play at the camper's level in sports or whatever we were doing. We weren't to crush them or slam a ball in their face, but playing and living with excellence is inspiring and that is the example they needed to see. The world needs to see that Christ-followers are capable of performing at the highest levels in every arena.
Lance Armstrong asked Dr. Shapiro ( a neurosurgeon at IU) why he should trust him to do the surgery to remove the brain metastases from his testicular cancer.
Dr. Shapiro said, "Because I'm much better at neurosurgery than you are at biking."
I love it. It probably sounds arrogant, but if you met Dr. Shapiro and realized how down to earth he is it is just fantastic proof of his skill. He is humble yet strong.
It reminds me of an experience at Camp Adventure many years ago when Mark Beeson encouraged us to not shrink back and play at the camper's level in sports or whatever we were doing. We weren't to crush them or slam a ball in their face, but playing and living with excellence is inspiring and that is the example they needed to see. The world needs to see that Christ-followers are capable of performing at the highest levels in every arena.
Sunday, July 13, 2008
Rite of Passage
My 30 hour shift on call was insane. It was the stuff out of movies, or at least it felt that way. It was one of those days that I knew would happen eventually just not my second time on call. It was me and one other intern taking call on 112 ICU beds and another hundred or so in the progressive care unit. Plus we have to respond to every code blue in the hospital of over 900 beds.
It all started out fine for a few hours while I saw my usual patients. And then one died and I pronounced someone dead for the first time. It was horrible with the family standing around watching me look for signs of life and saying, "Time of death...". How do you tell someone that their loved one is gone? I'm going to be working on that one for a while. I told them that I was sorry for their loss. I filled out the death certificate and all the paperwork and continued to answer my pager (aka "cowbell" as Tara affectionately refers to it) and see new patients in the ICUs.
I had one patient actively having a heart attack and crashing while another new one was needing to be intubated and others were not doing well. So I ran around and took care of things. I was getting pretty backed up but insisted on eating dinner. While I was quickly eating a code blue was called on one of my patients. So I was the white blur sprinting out of the cafeteria nearly vomiting up my tasty dinner. It was clear the patient wouldn't survive, but I was told to try and keep him alive for a couple of hours while lots of relatives rushed in to say goodbye. So it was me, a large and hysterical family, and several nurses and respiratory therapists around the patient's bedside for a couple of hours. The family was very emotional and I tried to work with them to understand what was happening while trying to keep the patient alive. It was exhausting and went on for a couple of hours. During those hours I was getting paged like crazy with new patients to admit, other patients not doing well that I needed to see urgently.... When all the family was there I worked with the family to withdraw all support and I watched the patient slowly die. I watched a wife say goodbye to her husband, children say goodbye to their dad, siblings say their last words. I gave lots of hugs. I pronounced him, filled out the paperwork, and then had to hustle to another patient who wasn't doing well.
I talked with the next patient about his desires if his condition should worsen. It didn't seem necessary to me, but the staff I talked to suggested getting some clarification. It was tough but later proved to be important. If only medical school trained us to talk about difficult subjects with patients and families. Another hysterical family needed to meet with me to discuss their loved ones condition. I met with them and tried to discourage them from making any big decisions in the middle of the night especially since I knew nothing about the patient. I was more of a counselor than anything. I continued to move around for hours seeing critically ill patients. My pager was beeping nonstop with complicated problems.
I put a chest tube in a patient who had a large pneumothorax (air pushing against her lung causing it to collapse). I had been told that it is one of the most rewarding thing that surgeons do and I agree now. She immediately improved significantly. The crazy thing is that a relative of the patient had been at my house the day before. It is a small world.
While I was trying to work on writing notes in the morning the patient I had discussed end-of-life concerns with started coding. I became the white blur sprinting across the hospital again. There were a few doctors there but since I was the primary physician for the patient I was thrust to the head of bed. I intubated him, ran the code, and once again tried to keep him alive while his family came in. I spent hours working with the patient to keep him going, talk with the family about the situation, give hugs, answer questions.... So I kept the patient alive and tried to work with the family to decide when to withdraw support. It was super intense and went on for hours.
I worked with cardiologists, the patients family, and the chaplain to try and decide what was in the patient's best interests. I ended up having to go home before support was withdrawn but I visited them before I left to make sure everyone was on the same page.
So in one 30 hour shift I walked through the imminent death of a loved one with three different families. I had never done that once before. I learned that it is wise to bring a member of security with you to tell a family bad news. I have never pronounced someone dead, talked about withdrawing support with family members, run a code. I met with countless other families to help them understand the prognosis for their loved ones. It was one of those nights that I know makes me a better doctor- both intellectually and compassionately. It won't ever be easy to tell someone that their loved one is not going to survive, but hopefully I can become more eloquent and helpful.
There were many times during the night when I wondered what I had gotten myself into. For 29 of the 30 hours I was moving nonstop seeing patients and putting out fires. It is amazing how mentally alert you can be when you need to! I hope every night on call isn't so eventful, but I feel more confident that I can handle whatever comes my way.
It all started out fine for a few hours while I saw my usual patients. And then one died and I pronounced someone dead for the first time. It was horrible with the family standing around watching me look for signs of life and saying, "Time of death...". How do you tell someone that their loved one is gone? I'm going to be working on that one for a while. I told them that I was sorry for their loss. I filled out the death certificate and all the paperwork and continued to answer my pager (aka "cowbell" as Tara affectionately refers to it) and see new patients in the ICUs.
I had one patient actively having a heart attack and crashing while another new one was needing to be intubated and others were not doing well. So I ran around and took care of things. I was getting pretty backed up but insisted on eating dinner. While I was quickly eating a code blue was called on one of my patients. So I was the white blur sprinting out of the cafeteria nearly vomiting up my tasty dinner. It was clear the patient wouldn't survive, but I was told to try and keep him alive for a couple of hours while lots of relatives rushed in to say goodbye. So it was me, a large and hysterical family, and several nurses and respiratory therapists around the patient's bedside for a couple of hours. The family was very emotional and I tried to work with them to understand what was happening while trying to keep the patient alive. It was exhausting and went on for a couple of hours. During those hours I was getting paged like crazy with new patients to admit, other patients not doing well that I needed to see urgently.... When all the family was there I worked with the family to withdraw all support and I watched the patient slowly die. I watched a wife say goodbye to her husband, children say goodbye to their dad, siblings say their last words. I gave lots of hugs. I pronounced him, filled out the paperwork, and then had to hustle to another patient who wasn't doing well.
I talked with the next patient about his desires if his condition should worsen. It didn't seem necessary to me, but the staff I talked to suggested getting some clarification. It was tough but later proved to be important. If only medical school trained us to talk about difficult subjects with patients and families. Another hysterical family needed to meet with me to discuss their loved ones condition. I met with them and tried to discourage them from making any big decisions in the middle of the night especially since I knew nothing about the patient. I was more of a counselor than anything. I continued to move around for hours seeing critically ill patients. My pager was beeping nonstop with complicated problems.
I put a chest tube in a patient who had a large pneumothorax (air pushing against her lung causing it to collapse). I had been told that it is one of the most rewarding thing that surgeons do and I agree now. She immediately improved significantly. The crazy thing is that a relative of the patient had been at my house the day before. It is a small world.
While I was trying to work on writing notes in the morning the patient I had discussed end-of-life concerns with started coding. I became the white blur sprinting across the hospital again. There were a few doctors there but since I was the primary physician for the patient I was thrust to the head of bed. I intubated him, ran the code, and once again tried to keep him alive while his family came in. I spent hours working with the patient to keep him going, talk with the family about the situation, give hugs, answer questions.... So I kept the patient alive and tried to work with the family to decide when to withdraw support. It was super intense and went on for hours.
I worked with cardiologists, the patients family, and the chaplain to try and decide what was in the patient's best interests. I ended up having to go home before support was withdrawn but I visited them before I left to make sure everyone was on the same page.
So in one 30 hour shift I walked through the imminent death of a loved one with three different families. I had never done that once before. I learned that it is wise to bring a member of security with you to tell a family bad news. I have never pronounced someone dead, talked about withdrawing support with family members, run a code. I met with countless other families to help them understand the prognosis for their loved ones. It was one of those nights that I know makes me a better doctor- both intellectually and compassionately. It won't ever be easy to tell someone that their loved one is not going to survive, but hopefully I can become more eloquent and helpful.
There were many times during the night when I wondered what I had gotten myself into. For 29 of the 30 hours I was moving nonstop seeing patients and putting out fires. It is amazing how mentally alert you can be when you need to! I hope every night on call isn't so eventful, but I feel more confident that I can handle whatever comes my way.
Friday, July 11, 2008
On Call
Please excuse the picture- I was very tired when Tara took this last weekend! Maybe that is how I always look since sleep is becoming a rare commodity.I just got back from a fun night out on the water by my house with some friends- enjoying good food and great company.
Tomorrow is my second day on call. It will be a long 30 hour shift. I'm doing trauma/critical care medicine (at a level one trauma center) and it is a weekend in the summertime so it will be very busy. I hope I don't see any of you there.
So far I am loving it! My body is certainly adjusting to sleep deprivation but I have never been more certain that I am doing exactly what I am supposed to be doing where I am doing it. God is faithful and good! And now I am off to sleep.
Monday, July 7, 2008
HIPAA
I can't say much thanks to HIPAA, but I'm taking care of a loved one of a familyI love and respect immensely. I never would have imagined that would happen so quickly. It's pretty humbling and a little scary!
Tomorrow is my first night on call. I'm not sure who needs more prayer- me or the patients.
Bring it!
Tomorrow is my first night on call. I'm not sure who needs more prayer- me or the patients.
Bring it!
Tuesday, July 1, 2008
Beginner's Luck???
My first day as a real doctor went so much better than I could have imagined. It was wild to introduce myself as "Dr. Qualey" for the first time. Every time I wrote an order in a chart it felt weird not asking a doctor to cosign the order. Nurses actually sought me out to ask questions and update me on our patients. Families asked to speak with me to talk about their loved one's situation.
Within 60 minutes of being in the ICU I had to go emergently intubate a patient. In addition to never having met the patient I had to quickly talk with the family, get their consent for the procedure (which I've never done), and intubate a patient (which I haven't done in 2 years) who just happened to have a broken neck. It was crazy! As we were trying to get the patient sedated I felt my legs shaking a little as everyone was watching me. The amazing/miraculous thing is that I was able to intubate her on the first try with lots of people in the room staring at me. I have never intubated someone on the first try, let alone someone who is crashing and who has a broken neck. My attending was very pleased!
Then throughout the day I had to put in a few central lines (catheters into large veins). My attending was clearly dreading what he thought would be painfully long procedures, but all 3 times I hit the vein on the first try. It was ridiculous. The first time he told me I seemed like a natural. The second time he told me that it was going to be a great month together because I am obviously a natural with "the touch". I laughed and told him that I hoped he was right, but it was probably just beginner's luck. He said, "No seriously, you have the touch. It's obvious."
Are you kidding me?!? On my first day of residency I expected to be pummeled verbally by surgeons, not have one tell me that I am a natural. I am under no delusion that I will always have this kind of success nor will I get warm fuzzies from my attendings often, but I sure needed it today. I'm still very inexperienced, but at least I know I have hope! Thanks so much for all of your prayers and encouragement! God is so good!
Within 60 minutes of being in the ICU I had to go emergently intubate a patient. In addition to never having met the patient I had to quickly talk with the family, get their consent for the procedure (which I've never done), and intubate a patient (which I haven't done in 2 years) who just happened to have a broken neck. It was crazy! As we were trying to get the patient sedated I felt my legs shaking a little as everyone was watching me. The amazing/miraculous thing is that I was able to intubate her on the first try with lots of people in the room staring at me. I have never intubated someone on the first try, let alone someone who is crashing and who has a broken neck. My attending was very pleased!
Then throughout the day I had to put in a few central lines (catheters into large veins). My attending was clearly dreading what he thought would be painfully long procedures, but all 3 times I hit the vein on the first try. It was ridiculous. The first time he told me I seemed like a natural. The second time he told me that it was going to be a great month together because I am obviously a natural with "the touch". I laughed and told him that I hoped he was right, but it was probably just beginner's luck. He said, "No seriously, you have the touch. It's obvious."
Are you kidding me?!? On my first day of residency I expected to be pummeled verbally by surgeons, not have one tell me that I am a natural. I am under no delusion that I will always have this kind of success nor will I get warm fuzzies from my attendings often, but I sure needed it today. I'm still very inexperienced, but at least I know I have hope! Thanks so much for all of your prayers and encouragement! God is so good!
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