Happy New Year!

January 3, 2013

Season’s Greetings, Readers!

Finally have made time to catch up!  Let’s see…

After a successful year without red meat (that was my new year’s resolution last year), I have decided to take the next step and give up meat all-together.  My new year’s resolution this year is to be vegetarian.  I’m excited.  I was looking at my diet over the past month and realized I really don’t eat as much chicken/turkey as I thought and it probably wouldn’t be too difficult to give it up.  Also it makes it more difficult to cheat on my diet–that’s good, right?  The liver’s supposed to have 3 years store of B-12, so I’m not too worried about that–don’t think I’ll keep this up for 3 years, but who knows. 

IM is going swimmingly.  I just finished up the first 4 weeks with my first attending (which was slightly less than “fun”) and am due to start rounding with my new attending when he comes back from vacation on the 9th.  This is definitely the busiest rotation I’ve had so far–there is much to do between being on-call (long call and short call), getting stuff signed off (you know, like that you know how IV’s work and understand echocardiograms), going to classes, going to meetings, doing presentations, reading case files, and ROUNDS, oh my, rounds are a different and threatening beast.  Picture it, you have an undetermined amount of time to go learn everything you possibly can about 2 or 3 patients during which time the doctor can walk in at any time and say, let’s start!  Then he has full authority to ask you anything and everything about your patients and if you don’t know, everyone stares at you and the attending becomes impatient while you have to look things up.  Ya, it’s a little daunting.  I’ve learned so much but I feel like I’ve developed a few gastric ulcers in the process.  Oh–and then too is the fact that most days begin at 4:15 or 5:00 in the morning for me.  So um yeah, that’s why I haven’t been so bloggy lately.  Don’t get me wrong, I LOVE the hustle and bustle…though IM is definitely not for me…but most days just don’t leave me with the energy or the morale to write somewhat objectively.

Had an eye-opening realiziation today.  In working my way up through the ranks in hospitals (first volunteer, then dietary, then secretary, then nursing assistant) there was always this theme of doctors being the be-all and end-all when it came to discussions with patients and their families.  The nurses I worked with were often called into managers offices and chastized for giving too much information to families and strongly advised ALWAYS to default to doctors when patients families had questions with any kind of complexity.  From that end of the totem pole, it was intimidating.  I wondered what kind of life-changing things physicians could possibly have to say to family members that nurses and other personnel would screw up so badly that they were only allowed to utter “You’ll have to ask the doctor about that.”  I hadn’t thought about this in years, but then today when I was looking at the schedule to see what was the topic during our daily afternoon meeting, Inoticed we were supposed to sit-in on the ethics committee.  It turns out this entire meeting was filled with awkward situations where it was defaulted to the physician to make the final call and talk to the family.  My aha moment was when I figured out that THIS was the training for those conversations and, due to the delicate nature of the things being discussed and the ultimate liability of the physician, that’s what the restriction (ask the doctor) was for.  The interesting revelation is that there is no black or white right or wrong–most of this presentation was a discussion of what individuals would have done in each of these situations.  Some would have intubated, some would have started comfort care, some would have waited for a DNI…many different options, but true, ones that do fall on the physicians’ shoulders to decide.  That said, another thing I frequently noticed was that the admitting residents on these cases were frequently uninformed about the patient’s family’s wishes and the motivations for their decisions.  While I understand now why doctors do the majority of the talking with family members, I am a bit disappointed that there’s not more of a collaborative approach to involve the other disciplines.  There is much to be leanred from the nursing staff who spent significantly more time with the family members, and it’s a shame that they’re not more frequently consulted on the family’s attitude, reactions, wishes, questions.  I think it’s a missed opportunity. 



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