he ate the whole thing.

mark in detroit

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i'm almost done with my 2nd week of internal medicine. which i LOATHE. it's terrbile. the first problem is that half our patients are old. we're talking how-on-earth-have-you-lived-this-long old. they can't hear and they don't bathe regularly. the other half have a list of medical problems longer than life itself. they're crabby and non-compliant. and some of them don't bathe regularly either.

the second problem is that the doctor i'm with is slow. i don't mean short-bus slow. just flat out slow. he speaks so slowly and deliberately that i think occasionally, i doze off between words. it's bad.

the third problem, which really doesn't bother me until i think about how much i'm paying for this month of my education, is that i don't see any of the office patients on my own. i only get to see patients on my own if they are in the hospital (of which we've had three the past two weeks...) and otherwise i just follow him around all day. horrible!

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the other day we had a patient named earl. earl had the hairiest ears i'd ever seen. i couldn't stop staring.

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i spent the majority of this afternoon contemplating whether or not it was acceptable to meet a guy in the laundromat. on one hand, he's at the laundromat, which means he probably doesn't live with his parents (because he's at the laundromat) and he probably doesn't have a serious girlfriend (who'd do his laundry for him... or at least with him). but on the other hand, it's the laundromat. and there are some pretty different sorts of people at the laundromat. what's your opinion? (just for the record, he was really cute, and clean as far as i could tell.)

hating.

i really hate when your toe nails are polished very nicely with your best friends polish that is a hundred miles away and then the big one on the right begins to peel.

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i also really hate when dead-beat alcholics finally show up for a court date, only to find out their nearly-worthless lawyer chose to skip out and everything gets pushed back another month.

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i also really hate when everyone has exciting things going on in life and you don't. like getting engaged and having babies kind of exciting. which is way more exciting than becoming a doctor. because let me tell you... this is not all that exciting. as a matter of fact, this month really stinks. it's all old people and slow old doctors that don't let me do anything on my own. and when i say slow. i mean SLOW.

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i also really hate when you feel like you have a million things to do, but you aren't really sure what they all are, but it just feels like there are millions of things swarming above your head that you have to get done and if you don't get them done the world might implode.

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and one more thing... i also really hate when you feel like you are STILL spending every waking minute studying but nothing, NOTHING! sticks. it all just slips out like your ear canals are coated with tanning oil and letting everything slide out as fast as you can shovel it in. may be a valid reason NOT to study by the pool...

i'll get back to you on that one.

processing.

29 year old white female brought to the ER by ambulance at 2:30am 7/2/06 after her husband heard her gasp for breath and then pass out while sleeping. He immediately calls 911.

when they rolled her through the doors from the ambulance bay doors, i had a sinking feeling. she was already intubated and the paramedics were still doing chest compressions. the monitors showing asystole - no electrical activity in her heart.

the rest of her clothes are removed and the fury of activity ensued. she was petite, and upon removing her pants, it was impossible not to notice the swelling of her abdomen. a catheter was immediately placed into her bladder and a urine pregnancy test was run. meds are being pushed; more IVs are started; her hands and feet are blue and her face is dusky; the respiratory therapist is manning her airway and breathing for her; a paramedic continues to beat for her heart.

the urine pregnancy test is negative. how can that be?

word arrives that her family is here and i'm sent out to get some history. what meds is she taking? does she have any medical problems?

a nurse beat me to it and comes back with the info. she's 3 months post-pardum. she takes some meds for depression, but they don't know the name of it. she also has a 6 year old daughter and her 3 month old daughter has a serious heart condition for which she has already undergone one open heart surgery.

the cycles of cpr continue as the doctor and i go out to speak with the family. he explains that the only explainations for her condition is a blood clot in her lungs or that she had overdosed on some medications trying to hurt herself. but she hadn't been trying to hurt herself. she had been sleeping. we were waiting for some medicine from the pharmacy that would help break up the clot.

her husband and parents came back to the room with us.

the doctor takes over chest compressions as the family adjusts to the picture before them. she regains a pulse, but it's slow and weak. more drugs are pushed. she's in v-tach and needs to be shocked. everyone backs up. her mom clutches me and i hold onto her. the jolt makes her body jump, and noone in the room breathes, as if our holding our breath would will hers to somehow return.

a medic takes over chest compressions for a few minutes. cpr continues. the doctor points at me and tells me to take over chest compressions. i do. but it's hard. i get tired after only a couple of minutes and am relieved by the medic. the activity continues.

her husband begins rubbing her feet, and i imagine that she's probably begged for him to rub her feet. i wonder if he did. her mom holds her hand and begs for God to help her baby. she knows it's out of our hands.

the clot busting medicine has been in for about 18 minutes. if nothing has changed by 20 minutes, the doctor says we have exhausted our options. but she miraculously regains a pulse just in time. more meds are pushed and she is rushed to CT for a scan. she maintains her pulse throughout the scan, but when she gets back, it begins to weaken again, and then it fades completely.

it's about 4:30am now. cpr is continuing. i've long since lost hope that there could be a good outcome. my heart is breaking for her husband; her mom and dad; her babies.

i'm sent to see other patients who have been waiting almost three hours at this point. it's hard to feel sympathy for them. their "emergencies" are so minor that i want to scream at them. at some point, while i am with a little old lady who fell out of bed, the doctor calls it. i can hear the crying of the mom in the hallway. my heart hurts. i'm sewing a laceration on a drunk guys hand from where he hit a mirror and i hear the little baby crying in the waiting room. a sob catches in my throat. i am selfishly glad that i didn't see the older daughter.

there are likely no good answers. and there are definitely no words to ease their pain. i just hope they recognize that we did the best we could. and i hope they know that our hearts are breaking for them.

and i silently wonder what i've gotten myself into.