I was just thinking about one morning during my intern year. One of our patients had died the night before, and my resident Annie had given consent to have the body transported to the morgue. I don't remember the exact details of what happened, but apparently she didn't have proper consent, which she hadn't realized, and she got bawled out by the coroner. I think the words "you're going to be in big trouble" were thrown around.
Annie and I were alone in the resident room. And as soon as she got off the phone with the coroner, Annie started crying hysterically. She was actually sort of a tough cookie, but I guess it was all too much for her: having her patient die, being awake for 30 straight hours, and now being told she was in big trouble over some confusing issue. I made an awkward attempt to comfort her, mostly just saying I didn't think she'd really be in big trouble, but I was pretty tired and depressed too.
Annie managed to pull herself back together before anyone else came into the room. So nobody but me knew that she had been crying. But even if they had, I'm pretty sure nobody would've done anything about it. We all would've just looked at her awkwardly, and tried to pretend like it wasn't happening.
That's how residency is a lot of the time. You hate your life, you cry, and nobody really seems to care.**
What baffles me is that this is OK somehow. That we were all so miserable, we did nothing to help each other, and everyone basically pretended like it wasn't happening. Despite the fact that the responsibilities heaped upon us were enormous enough that we really should have had our mental health monitored better.
Granted, it's been a long time since the morning that Annie cried in front of me. But I'm pretty sure that things haven't changed much.
**Except in PM&R presidency. There you go to work for a few hours, then head to the beach, and nobody really seems to care. (Just kidding.)
Recently we had a patient who had part of his skull removed following an accident. In the aftermath of this, we called up the neurosurgeon who had performed the operation to make a follow-up appointment. The response of the receptionist at his office:
"Does he really need a follow up?"
"Um, you removed his skull, so yes, I would think so."
We basically had to beg and plead in order to get the neurosurgeon to see this guy. Finally, after a month, he got in for an appointment. We had been eagerly waiting to see what the neurosurgeon thought, because the patient had not been doing that well. Unfortunately, we couldn't find any notes returned to us from his visit. Finally, we found the following scribbled on the back of one of our many notes that we provided him:
First, what the hell does that say? Second, was it really that difficult to use a separate piece of paper? We even provided one that was supposed to be for his recommendations, but instead he chose to scribble it in a completely random place.
Admittedly, I've lost a lot of respect for neurosurgeons thanks to a certain presidential candidate, but I really feel like I would want to have more follow up with a patient if I took off part of his skull. It just seems like the basic minimum of reasonable patient care, right? You see a patient for a major surgery, so you schedule at least one follow-up visit. I mean, it's not brain surgery.
In case anyone was curious, we ended up adopting a cat from an animal shelter. My husband didn't feel allergic at all while he was in the shelter, so we figured it would be OK.
We got a black, five-year-old female cat. Her back story is that three months ago, she approached a person in their driveway for help, and the person took her to a shelter. Apparently, she had been living with a family a year ago, and either they abandoned her or she ran away. In any case, they located the family through her microchip and they said they didn't have money to feed her.
The shelter was a little bit ridiculous about letting us adopt her. We had to fill out pages of paperwork, and even though we gave them a reference, they actually called me at home, asking for a SECOND reference. They even called my work to verify my employment. I mean, I'm glad they make sure that the cats have a good home, but this is a cat that was eating out of garbage cans three months ago. I'm sure it was pretty obvious we could do better than that.
Anyway, the cat is currently in our bathroom, and seems to be very happy. She purrs a lot, and we were all relieved that she used the litter box. Nobody seems to be allergic either, so that's a plus.
It seems like I have a particular skill for choosing the exact wrong line in the supermarket.
A few days ago, I was in the supermarket with my preschooler. We were in a bit of a rush, and the supermarket was surprisingly crowded for the middle of the morning on a weekday. But since we had only eight items, I was able to go to the 10 items or less line, where there was only one woman in front of me, and she was currently paying.
Unfortunately, we only discovered after my daughter had painstakingly loaded all our items onto the conveyor belt that there was an issue with the woman's payment. The woman kept running her debit card and typing in the pin number, and it kept giving her an "insufficient funds" message. I think she actually even called the number on the back of the card while in line. The manager came over, but there wasn't really much that they could do for her. She was buying a pack of cigarettes, which cost $11, and she did have eight dollars in cash, but that left her three dollars short.
It was getting a little bit ridiculous. The woman obviously didn't have the money to pay for her item, but she was basically not willing to move off the line. And to add to the pathetic factor, she was in one of those motorized shopping cart, so obviously she had some medical issues. Considering she was only three dollars short, I really wanted to just offer to pay it for her. If she had been buying a loaf of bread or something like that, I would've happily paid it immediately, regardless of the cost, and counted that as my good deed for the day. But she was buying cigarettes. The most evil product you can buy in a supermarket. I felt like I couldn't in good conscience give money to the tobacco companies, and buy this woman a product that was contributing to her premature death.
However, several minutes later, with this issue still not resolved and my daughter getting antsy, I decided that just this once, I would give three dollars to the evil tobacco companies.
I didn't feel good about the situation. But what could I do? I didn't want to be the jerk yelling at the poor woman to get off the goddamn line if she couldn't pay.
My husband has wanted a cat for literally the entire time we've been together. I'm sure we would have a whole clowder of them (I bet you didn't know that was the name for a group of cats) except that my husband has pretty bad pet allergies. He gets itchy and breaks out in a rash around any pet that sheds hair. I don't have bad allergies, although I definitely have gotten stuffed up when I visited an animal shelter before.
But recently, we decided that we wanted to get a cat. Actually, my husband asked me if we could get a cat, and promised that he would feed it every day and change its litter box.
Anyway, because of his allergies, I thought maybe we should spring for one of those hypoallergenic cats. My husband doesn't want to do that though, partially because of the cost, partially because he would rather rescue an animal, and partially because he'd rather have an adult cat than a kitten. (I agree about the kitten part. The last thing I want is a needy kitten. I've already got at least two needy children.) Also, the closest cat breeder to us won't have kittens until the spring.
However, I'm worried that we're going to get a cat from the shelter and my husband will be so uncomfortable that we'll have no choice but to return it. Which will be really heartbreaking.
I don't know if there's some other option that we are missing. For a person with cat allergies, is the only choice to buy a snooty hypoallergenic cat?
Currently, I don't work with a resident. I know a lot of attendings love working with residents and I do believe in teaching and how important it is. But I just don't want a resident. I've made the decision to work alone for several reasons:
1) I care too damn much
Don't laugh, but it's true. It's so important to me that the resident I work with has a great experience, that I end up spending massive amounts of time teaching them, which is time that I don't really have to spend. And I feel guilty giving them any scutwork. So having a resident always resulted in my being way behind.
2) I like to know my patients
Whenever I have a resident, they end up knowing their patients better than I know them. And that makes me uncomfortable.
3) I don't trust them
This may be something specific to PM&R, but I seriously don't trust the residents. Sometimes I would get a good one that I could trust, but I can't tell you how many times I have asked them to do something and they never did it. Something important.
4) I need my space
If I am feeling stressed out or sick, I can't deal with having a little shadow. I want to murder the little shadow.