Residency 2.9: PICU

It's hard for me for to sit down and write a blog post about my month in the Pediatric Intensive Care Unit for a couple of reasons. I'm so delirious with relief from being done, and with the gorgeous day outside and the nagging of all the things that didn't get done last month, it's hard for me to sit still at all. It's also hard to sum up so many experiences into one blog post. And for now, I almost want to just say, "it's over" and leave it all behind. But that wouldn't be fair to my two readers, so, for you, I will sum up the last month.

For those of you who aren't in health care, I don't know if there are ways to describe what a 26-bed ICU is like. Besides the NICU, which for some reason is very different, my only real experience with an ICU was in medical school at the VA--a 10-bed unit that often wasn't even full, and that was managed by the general teams instead of intensivists (so that tells you how "intensive" it really was). So to be frank, a busy day in our PICU was a rude awakening. I would LOVE for someone to just follow us around for a day and see the craziness. Where nobody bats an eye when rounds are interrupted by having to do chest compressions on a kid whose trach fell out. Or to walk in in the morning and see one of the rooms converted into an OR so that the surgeons can "explore the chest" of one of the post-op heart kids who's having too much bleeding. Yeah, that's totally normal. I could go on and on. Oh the stories!

Somehow in the midst of this environment, I did manage to learn a lot, to grow more confident in my decision-making, and to become (very slightly) more comfortable with really sick kids. I also had the opportunity to be a part of some very difficult end-of-life situations, which, while I wouldn't seek them out and I don't always enjoy, reveal God's hand in so many ways. There are some things that just won't ever make sense unless through the eyes of faith. It was really a good place for me to be during Lent--over-worked, under-rested, totally stressed out, but at the end of the day, my suffering didn't compare to the parent watching their child slip away.

So yeah, it was an intense, intense month. And I'm super glad to be done. And to have a life again, especially with spring being here (Hazzah!). Looking forward to Easter and sunshine and sleeping in and PORTLAND!

Hasta for now!

Down time

I’m on my second overnight shift in the PICU. The fact that I’m having time to blog is encouraging, although I fear that it will come back to haunt me in the next few days. I don’t have a whole lot to share, but posting is one of the only ways I can stay in touch with the outside world, since all my time is spent at work or sleeping (see post from 3/5). The PICU in general is steadily busy, but there is a huge spectrum ranging from blog posting to stay awake to never sitting down and having 34 verbal orders to sign at the end of a shift (which thankfully, I haven’t experienced yet, but like I said, I’m expecting payback for this night).

One thing that is striking about the unit is how differently each of the attendings does things. There are a dozen different ways of solving the same problem, from different meds to different fluid choices to how quickly you make changes. It makes keeping up a little difficult, but it also makes for learning a lot of different options in a short period of time. As long as I can swallow my pride about looking stupid when one attending does things totally different than the last one (and usually they switch just as I’ve gotten used to one way of doing things), then I think I will be fine.

I’m almost halfway there.

What a difference a day makes

So that last post...disregard please. That is NOT indicative of the reality of the PICU. Remember that whole "we don't have any beds" thing? Apparently that is not a deterent. I'm pretty sure Tuesday was more typical of a day in the life. Rounding by myself on the whole surgery service, two post-op admits, including one who wound up on ECMO...Good thing they changed the duty hour rules so that that 10 hours between shifts is more of a strong suggestion.

But...BUT!

I had the day off today. Finally. And I slept in, and I made a delicious breakfast with delicious coffee and went to Mass and worked out and sat in my recliner and read a totally non-intellectually-enriching fluff book with a bowl of popcorn. And some chocolate-covered pretzels. And it was glorious. And I'm (almost) ready to go back tomorrow to do it all again.

Between a 3 and a 7

I'm 4 days into the PICU...Dad says I have to update this so he knows I'm alive. I'm pretty sure if a certain someone wouldn't teach a class on the rare occasion that I have time to call him, he would know for himself.

Surviving so far...I'm on the cardiac surgery service and they keep having to cancel surgeries because we have no beds (thanks to the overflowing medicine service...influenza and RSV are nasty, but I'm grateful that it keeps our service smaller). Learning a bit about efficiency, physiology, interpreting data, good communication, and how to sneak snacks when no one is looking. I'm not going to say anything about the kids mostly behaving at the risk of jinxing something. Two more surgeries tomorrow (and not simple ones) and my co-worker has the day off, so I will be seeing all the kids myself (if there are no more updates, you know it broke me).

So far, we've had visitors every day bearing gifts of Chipotle, chocolate, hugs, and binder clips (for the charts that keep getting thicker). And I haven't cried...yet.

I told Dad that my priorities are as follows:
1) Don't kill any kids
2) Sleep as much as possible
3) Everything else

I guess this falls under everything else, so I must be doing something right on those first two. Off to bed!!!

Residency 2.8: Green Team

Tonight I'm headed out to our celebratory end-of-Green-Team dinner. We're a few days early, and it might not be so much of a celebration as a decompression, but I'm definitely looking forward to it. Green Team is one of our general pediatrics inpatient teams, but it's senior-only, which means just me and another senior and the attending. No interns, no medical students, no pre-rounding. Just seeing patients and making the plans. It's a LOT of work, especially since there were just 2 of us.

It was a real challenge to be the person in charge and making the plan for the day, deciding when someone is ready to go home, or whether another test should be run, and then being the one to explain it all to the patients and parents. For example, how do you decide how much work up to do on a 16 year old that you're pretty sure is new-onset schizophrenia, but you can't rule out a rare autoimmune disease, especially when he won't wake up from his catatonic state enough to answer any questions and has to spend 24/7 in restraints? And how do you explain things to a grandma who believes he has a demon inside him? Yeah, that one was interesting.

I was super grateful that I had an amazing co-senior on with me. We got along famously, worked hard and well together, and had a lot of laughs. Even though I'm ending the month a little burned out, I can't imagine how much worse it could have been.

I go next month to the PICU, which I'm scared for but I know I'll learn a lot. Please pray for me. Also, feel free to send me care packages, love notes, pep talk voice mails, etc. I'll see you on the other side.

Almost a lifesaver

In my first year of medical school, they had this big tent out on the quad where you could swab your cheek and sign up to be part of the National Marrow Donor Program. Being all young and idealistic about my new chosen path of saving lives, I naturally swabbed away. And kind of haven't thought about it since. Today I got an email saying I could be a match. I almost had a heart attack.

So many questions--would I get chosen and get to save a life? When would this happen? Would I be able to get off work? If I was chosen, would I have to do a bone marrow aspirate? (Cause I've seen them done...they do NOT look fun! At least not from the patient's standpoint. From our standpoint, it was pretty cool...until Becca sprayed blood everywhere...long story)

Turns out I was WAY ahead of myself and when I called the registry, I found out I was disqualified for now on a bit of a technicality. And I'm not sure if I feel more disappointment or relief. Probably both. I have the utmost respect for those who choose to be donors, especially for complete strangers. I suppose that when I signed up, I really did hope that I could save a life some day. And if for that, if I have to suffer through someone jabbing a HUGE needle in my hip, then I guess I'll do it...some day.

For now, I'll have to save lives the old fashioned way.

Thanks. Just thanks.

So, inspired by Hilary, I decided to keep a gratitude log for a week. Not just little things like “good breakfast” or “warm car” although those things are nice. But to really focus on something that really makes me grateful. And when this week started, I felt like I was going to need something to keep me positive. Here’s what happened…

2/13—Today at work a lot of things went wrong. I know, not the best way to start a “gratitude log”. Hear me out. We had difficult patient issues, members of our team who were not feeling well, and then to top it all off, the entire paging system in the hospital crashed, making it very difficult to communicate. However, amidst all of this, today we had a couple of my favorite nurses taking care of our kiddos, and it was just super refreshing to see faces that you know, who know you by name and know that you’re working hard, and who do what they can to help you out, and who go above and beyond without being asked. It makes me love my job even more when I feel like part of a team that is firing on all cylinders (or however many cylinders there are when your pager isn’t working).

2/14—While I may have eaten a little too much my weight in Valentine’s Day treats today, I burned off at least half of it laughing. I generally am a neurotically efficiency-crazy person (WHY do rounds take so long!), but I am always happy to pause for stories that make tears stream down my face and my stomach hurt. Like one of my fellow residents shutting herself in her (not walk-in) closet for a mental breakdown, or a child-to-remain-unnamed who used the kitty litter box for her own and still won’t live it down. Or my new favorite video that makes me feel so normal and well-adjusted. Today, I am most definitely grateful for JOY!

2/15—A patient of mine that has been a real struggle this week in many ways was starting to show signs of improvement. Very small signs, and there are still a lot of unanswered questions. More than answered questions by far. But I am grateful for baby steps, for moving towards a goal, for the ability to pray for my patients in addition to offering medicine. It’s not perfect, but it’s something.

2/16—Biscuits and gravy for Halfway Breakfast? Attending brings me a grande latte? Cosentino’s desserts on the counter? Only one admission today? Yup, lots to be thankful for!

2/17—Tonight was Brandi’s bachelorette party. And bridal shower. It was a “showerlette”, which I’m pretty sure is a made-up word. Brandi is my co-senior on Green Team this month, which means she’s spending more time with me than with her fiancé. Yeah, I think it’s true. Brandi is outgoing and expressive and bubbly and confident, and her friends can throw a crazy party! Most fun I’ve had in a LONG time! I’m thankful for Brandi, and for her getting married, and for Italian wine and good friends and better-than-sex cheesecake.

2/18—Was really tired today due to said “showerlette”. But I’m grateful that it was a shorter day than most, that I got done in time to go to Mass, and that I can go to bed early, ‘cause I do love me some sleep!

2/19—I’m super grateful, again and again, that I have a job where more days than not, I wake up excited to go to work. Well, actually I wake up feeling like a truck hit me and I need about 2 more hours of sleep, but once I’ve had my coffee, I’m excited to be at work. I am often reminded of how blessed I am to have work that is fulfilling and challenging, with people that I love, in a supportive environment.

Well, that was fun. The week wasn't as bad as I thought it was going to be. I guess I have a lot to be thankful for. Thanks, Hilary.