Saturday, July 16, 2005

down and out, hopefully

Hey everyone. Still alive, still not in labor, though the latter I can say with much less conviction. Sometime over the course of the last week, Cal has decided to "drop," meaning that he has figured that the old cervix is the only exit out of this joint, and he's waiting by the door with his bags packed, occasionally knocking on said door at the cost of some discomfort to yours truly.

At this point, I think it's almost as uncomfortable for the people watching me waddle around crashing into things as it is for me to do the actual waddling and crashing. I have become a human science experiment on gestation. I walk into the break room at work to find people placing bets on when I'm going to go into labor. My OB herself seems convinced that with my current exam and the hours I'm working, I will probably not reach my official due date in two weeks, but is of course unable to give me any more specific of an estimate. I've come to be fine with this fact. Let's get this show on the road. Let's have a baby already.

Meanwhile, work is going well. I'm still an idiot, of course, but starting to be slightly less so every day. On Friday, my attending even left me alone in my room for a twenty minute stretch, and lo, my patient survived. It's like learning to ride your bike when you're little, that moment that your dad first lets go of the back of your seat and off you go. At first, you don't notice that he's gone. Then you notice that you're peddling alone, and you freak out mildly. And then the euphoria sets in, the wind is in your hair, and you feel like The Man. (Luckily, the fourth event of my bike-riding lesson did not occur that day--losing control and crashing into a bush. That would have sucked, and been difficult to explain besides. Where the hell did this bush come from, for instance, and how did it get into the OR?). But seriously, it was nothing but pure rookie exhilaration to be sitting there hunched over the patients head, anesthesia machine to my right and meds at the ready, flop sweating all over the various monitors and beeping things. Oh man, I can't even drive a car, and they let me do this?

The thing that I'm finding I really like about Anesthesia is that there's nothing standing between you and the medicine. It's you and the patient. The patient does something, you respond in real time. Something needs to get done and you do it. There's no delay, no writing order and waiting for them to get picked up, no middleman, chasing down nurses to have them give meds, no neverending rounds. And you know, these are things that I just do not miss.

When I was a Peds resident on call for Oncology, or the NICU, or on the wards, so often I'd just feel like the human equivalent of a USB cable--just a conduit between the attending's mouth and the computer order system. I'd get in early, and then we'd round for eight hours, during which I'd write down everything that the attending was saying. Then I'd park myself in front of the computer for the next two hours, endlessly checking five million lab results and entering orders into the system. After that, I would rush around and poke my patients with sticks, trying to make sure they were all still alive so that I could park myself in front of the computer for another two hours to write a pile of worthless progress notes that no one would ever read. And inevitably, later in the evening, the attending would find me again and give me a whole list of new orders to enter, or change from the first time I entered them earlier in the morning. With the exception of examining the patients, I hardly felt like what I was doing was medical at all. I mean, accountability aside, anyone could enter orders into the computer. Anyone could copy down lab results. Anyone could sit on the phone for hours waiting for pharmacy to confirm that they received my fax. But I never gave the meds myself--I didn't even know what many of them looked like. I never had to run my own IV lines, set up my own equipment, and even rarely would I ever be the one drawing my own bloods or starting my own IVs. I mean, in many ways that's good, to have ancillary staff in a large hospital to help with the little things. But what I ended up feeling was that much of what I ended up doing as a resident (at least during the days) was secretarial, and much less was actually medical.

Anesthesia is different. Now it feels like I'm doing everything. I start the IVs, I run the fluids, I push the meds, I keep the patient breathing. All the vitals are at my fingertips, I tell the patient how fast and how deeply to breathe, how deeply to sleep and when to wake up, how much or how little to move, how fast or slow their hearts should be beating. And while it's great, because really, this is ultimately the field for control freaks, sometimes it's scary to have that much control. For example, I don't love the middle man, but sometimes the middle man is very helpful. I can't even remember how many times on Peds that I got a call from the nurse or the Pharmacy to double-check or correct the dosing on a med order. And many of those times, I was wrong, having made some sort of stupid calculation or reading error. As all of us in medicine know, it just happens sometimes.

Now it's just me and the meds. I calculate and I administer. Don't trust your arithmetic skills? This is not a good field for you. Thank god I have my good Peds math habits still with me, along with a calculator strapped to the back of my ID badge. Because when it comes down to it, whereas I would have really had to work to kill a patient during my Peds residency, I feel like it's a relatively simple task to kill a patient under my care as an Anesthesiology resident, either with sloppiness or bad judgment. And it's that ease of fucking up with majorly bad consequences that scares me. I mean, wouldn't it scare anyone? It should. These are real people I'm taking care of, not Sim Human.

So anyway, the adjustment process goes on. But I'm still having a good time, even though I still feel like a third year med student every single day. I can't wait until this kid is born, so I'll feel completely out of my element both at home and at work. Won't that be fun?

Currently reading: Um, "Harry Potter and the Half-Blood Prince" of course, what the hell are you reading?

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