Sunday, October 16, 2016

ER Month and Internalizing, some knitting

This is a long post about the challenges of ER month. Knitting content is near the bottom! ~Z

October is ER rotation month, and brings with it many challenges. I am by nature not the most quick-thinking of people, and coupled with ten hour shifts with no guaranteed mealtimes makes for some interesting experiences. There have been many a day when I've looked up at the clock and realized I hadn't eaten anything in 10-12 hours except a few chocolate almonds and a handful of pumpkin seeds. Makes for a great weight loss plan, but I shudder at what I might have missed in patient care, except that my attendings are sharp and thoughtful and eagle-eyed when it comes to making sure I don't miss anything.

That being said, the second challenge of ER month is the guilt, doubt, and internalizing. ER is such a fast paced place that we are always juggling several patients, hurriedly writing down all the details as soon as possible because no one knows when the next emergent case of septic shock, stroke, or cardiac arrest might come through the door. Patients often feel like it is taking a long time for providers to see them, but that is because there are so few providers for so many patients, and the less urgent cases sometimes get pushed aside to deal with real emergencies. I feel guilty sometimes that my patients are left to wait in a thin gown while I try to write orders and document history and check on lab results for another patient at the same time before I get a chance to go check up on them. I feel guilty sometimes that I don't know as much as I should, and that I take much longer than any of the other residents (okay, so they are 3rd year residents, and I'm a first year, but still, I am the weakest link this month.), and that sometimes I forget to put in orders until after I've seen the next patient. I feel guilty that I'm not doing as much for my patients as I could, such as the lady this morning I did OMT on, but only had time to decrease her pain from 8/10 to 3/10, whereas if I was more efficient I could have decreased her pain to 0/10 and let her go on her vacation completely pain free. I have doubts about whether or not I am doing the right thing, whether or not I am harming my patients with my inept attempts to be a physician. And then there is the internalizing. I saw a patient today who was a low to mid level health care provider, and had a substance abuse problem and a mood disorder. She walked into our community hospital ER, and wanted to get some help to become sober. I was so surprised and happy that she found the strength to seek help, except for the fact that our ER did not have the resources to provide inpatient detox counseling. We called the social worker, got her the phone numbers and resources that we could, but I highly doubt that she will actually follow up. I counseled her the best that I could, but there was very little that I could do in terms of medications and or physical care. And at the end of the shift, I could still remember the defeated and doubtful look on her face as she walked out of the ED with her designated driver. I felt so bad for her life situation, as it would be too easy to imagine myself in her circumstance, life in wreck and ruins, embarrassed to seek help and fearing discovery and recognition by coworkers and other providers. Internalizing patient problems is something that I've learned to manage for the most part, leaving everything at the office or hospital, but sometimes fear and doubt still creep into my private home life, as I lie awake thinking if there was something else I should have done, that I could have done, to help that patient seek help, or find her inpatient care. I know it is silly and there is nothing else that I can do right now, but some days, it is difficult to let go.

The third challenge is the fear of patient repercussion. I am lucky that I am just starting out, and that my attending physicians are there to help and guide me. However, it is still so nerve-wracking to make all of the small decisions that lead to a final diagnosis: do these lungs actually sound crackly? Does the patient's heart rate mean that they are nervous, in pain, infectious, or have a heart condition that requires further evaluation? Should I order lab tests on this patient who has been here for the same problem ten times in the last 3 months, and all of the lab tests have been negative? What if this patient, whom I send home because I tell him there is nothing wrong, goes home and gets worse, and now the patient and his family want to sue me? What if the patient who I ordered labs on had something come back and I missed it? I try my best to make sure I see everything, but it is sometimes hard to be able to get everything done and do it fast. I think I am happy to stick to Family Medicine in this case. ER will help train me to think fast and act fast and know what is an emergency, and I will be able to go back to figuring out the whole story on Family Medicine.

The fourth challenge is the schedule. I have worked 70 some hours in the past 7 days. There are a few days in which I am barely home long enough to sleep and eat before returning to the hospital for my next shift. There are some days I don't know how I would function without constant coffee to keep me alert. It doesn't help that we are shorthanded this month, due to a fellow resident's family emergency. While I wish all the best to the resident, it also makes for some interesting times when there are 2 attendings and me. I do a lot of running. (Who says I don't exercise, Ma? I exercise all day long.)

ED month is busy, so I pretty much only do a bit of bedtime knitting, the occasional long stoplight knitting, and didactics knitting. I love didactics. It is the only time in my week when I can knit at work. All of my fellow residents know that I knit, and I have demonstrated to my attendings that I can knit and lecture my fellow residents on medical subjects, as well as knit and pay attention to the lectures at the same time, so they have not yet given me any trouble. Some days, I get a little more knit than others, but all in all, it is great for productivity and helps keep me awake. It is also Socktober, which is hard because I want to knit socks, but also want to work on my sweater. It is getting chilly here in Ohio, so I really want to finish my sweater so that I can wear it!

First, though, some yarny acquisition goodness. I won a prize in Socktober! The generous ladies of the Carolina Fiber Girls podcast are hosting Socktober, a month-long knit-a-long where all we knit are socks, and I was selected as a prize winner for posting in the forum. It came super quickly, and the colors were just up my alley! I can't wait to knit with it! And it make this past weekend's shifts so much more tolerable.

 2. Socktober Socks #1: I worked on some socks while I was at the health fair, hosting a table on hypertension, and they were the hit of the fair! I had so many pregnant women coming up to me, asking me how to knit. It was fun to have that as an attraction so that I could capture their attention and lecture on pertinent subjects.

3 Lolo House Special#2: I knew October was going to be ER month, and I ordered the Bar Maids box very early on because I thought I would need some cheering up, and I was right. It made my week to have the goodies show up unannounced. It was a great surprise!

 4. Socktober socks #2: Well, okay, I think the above socks were actually the second pair, but I worked on these socks while I was at didactics last week, and now they are done! The yarn was so great to work with, and I can't wait to get more Copper Corgi yarn!
Sorry for the long rant, but I needed to get some steam out. On most days, I am so happy and feel so lucky that I have the privilege to help people with my knowledge and skill. Having 6 shifts in 7 days makes that hard to remember sometimes. But with great support, wonderful friends and family, and the knitting community, I muddle through pretty well. Thank goodness for knitting!

Hope everyone is having a great fall! I'm so jealous of everyone at Rhinebeck right now!

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