Wednesday, August 14

55 words

I fell down a little narrative medicine hole today, and in so doing, I found a writing mechanism called the 55-word story.  There is an excellent discussion of this mechanism in this JAMA article from 2017.  Writing is a tool for processing, reflection, entertainment, teaching, and so much more.  But sometimes you just don't have any bloody time.  Enter this tiny sliver of writing!  It's almost a game - 55 words exactly, no more, no less, but in any format you'd like - and completing one is terribly satisfying.

I am going to start doing this, and I hope it will be a regular event.  Here is today's story.

Friday, August 9


My boss leaned back and put her hands on her hips.  "Well, you know what?  I think we kicked ass today.  Well done."

I didn't lift my eyes from the transfer paperwork I was filling out at top speed.  "Do you think so?  I just feel like I got my ass handed to me all day."

She was unfazed.  I saw her shrug out of the corner of my eye.  "No, I think we did a good job.  It was tough today but we took care of patients."

I grunted.  "I guess."


Her words came back to me several hours later, when I was driving home berating myself.  It's something I do often.  Over the years my commute has naturally become an opportunity for me to take stock of the day.  I like to take stock of things, sum them up.  This is especially true of work, where I don't have the time or space to emotionally process during the shift.  I do a kind of final evaluation, sorting my experiences and trying to put them away before I get home. 

The trouble is, I'm never satisfied with my own performance.

Is it a win that I stabilized a transplant patient enough to make it to her critically important transplant meeting tomorrow?  Or is it a sign that I can't manage patients efficiently, since it meant she was with me for nine hours?  Does it mean something that she and her husband thanked me when I checked in with them one last time before I left, two hours after the end of my shift?  Or should I focus on the mother of the child with an earache who had to wait two hours to be seen while her son cried in pain?  She told me off pretty soundly when I finally got in the room.  I couldn't tell her that I had been prepping and transferring a patient with intracranial bleeding and coordinating care for my first ever case of acute angle closure glaucoma, and I didn't mention that we were short a doctor that day.  My instinct isn't to defend myself in those situations.  I just apologized.

I saw so many sick patients today.  Bowel obstructions, cancer complications, my transplant patient.  Two patients with heart rates sprinting away, their owners pale and panting for breath.  I reassured a post-stroke patient that their recovery was just beginning.  I kept someone out of a nursing home by helping to arrange for assistive devices at home.  I made two little kids laugh during their exams!  My boss is right.  She did a good job today and so did I, damn it.  So why don't I feel like I did?

Maybe it's because we were so busy.  My charts aren't finished.  Wait times were long.  That kid with the earache?  He wasn't the only one who had to wait a long time, and people were annoyed about it.  When my night colleague came on, there were patients who had been waiting for hours already queued up for her.  She was nice about it, but I know that's a lousy situation to walk into.

Or maybe there's no external reason.  I know one of my strongest traits is perfectionism; it's a double-edged blade that medicine has sharpened and hardened over time.  I don't know what today would have had to look like for me to feel like I did well.  I just know that I always feel like I'm not disciplined enough, not knowledgeable enough, not efficient enough, not fast enough.  Not kind enough.  Not consistent enough.  Not enough.

I still don't feel like I'm enough.

Friday, July 12

The Importance Of The Physical

My charge nurse stepped out of a room and waved to get my attention.  "We need a doctor in here, please," she said in a level voice.  In non-ED-charge-nurse speak, this roughly translates to, "GET IN HERE RIGHT FREAKING NOW THIS PERSON IS DYING."  I dropped everything and headed in.

Saturday, June 29

Boundaries, or, Sometimes I'm An Idiot

"Hey, so..." I exhaled.  "This second job is getting on my nerves.  Wait, I don't think I told you.  I got a second job a few weeks ago."

There was a pause on the line, then my best friend said, "What?!  Why?!"

Let me tell you why.

Sunday, April 21

Listen. Listen. Listen. Listen.

I am not doing this anymore.

It was Tuesday, I was in the occupational therapy clinic for just the third time, and I hated it already.  The first visit consisted of testing my weak, uncoordinated hands; picture me failing to pick up tiny metal pins and put them in tiny holes, and then bursting into tears.  The second visit was full of painful exercises that left my hands limp.  Today I was doing silly putty exercises under supervision and it was making my arm cramp.

I threw the putty down on the table.

Monday, January 28

Disability: Having A Sound Bite

Gasps greeted me as I walked into the exam room.  "Oh my- what happened to you?!"

Caught entirely off guard, I struggled for a response, but blanked.  There was an awkward pause in the room.  The problem was...

Thursday, January 17

(Sporadic) Money Update: 2018, or, Imagine Me Rolling My Eyes

I am so sick of paying down debt.  So let's talk about it!

My husband and I are in the middle of this debt-paying thing.  At this point we have completed several of the most important steps:

- figured out how much debt we actually have, which is horrifying but necessary
- refinanced all of our loans for a lower interest rate (which will save us approximately $40,000 over the life of the loan)
- sucked it up and started paying ridiculous amounts of money on our loans

That means that we are in the "paying ridiculous amounts of money" stage.

Monday, January 7

Uncertainty, or, 2019: Midnight Tracks

I love planners; I'm a bit obsessed with them, really.  I've always had one.  I think by nature I'm a plan-maker, someone who takes the long view.  Years of practice and training have taken my penchant for journalling and turned me into a list-maker as well.  At this point, if I don't have a formal planner, I eventually clutter up my life with piles of to-do lists and thought fragments.  This year, when it became fatiguing to write, I tried to abandon my paper planner for digital alternatives that I can talk into, but it's not the same.  So a 2019 paper one it is.  Usually I get something with monthly and weekly pages, and room for notes - pretty standard.  My planner choice* is different this time, though.  For the first time, I want a goal-setting planner, I think for several reasons.

Tuesday, January 1

Uncertainty, or, 2018: A Retrospective

What a year.

Did anyone else have a really eventful 2018?  I certainly did.  The time passed so quickly that I'm tempted to say not much happened, but that is completely wrong.  Enough happened this year - and enough is happening next year - that I've decided to do something I've never done before and try to look back on the year as a whole.

Wednesday, December 12

Reflections on Primary Care

Just because I haven't written about burnout in a while doesn't mean I don't still care about it.

Over the past year or so, I've become an avid, sympathetic reader of a blog called Reflections of a Millennial Doctor.  The author, M, vividly details her struggle with burnout and giving up on primary care.  She fought so hard this past year, wrestling with whether or not to stay in her current practice or throw in the towel and try her hand at something else.  She recently admitted that she will be leaving her practice soon for a job as a hospitalist.  I can relate - not to the hospitalist part! I hate hospital medicine.  But her tale of getting bled dry by her clinic job resonated with me deeply.  Honestly, I don't know how her primary care dreams survived her training.  Mine didn't.

I remember being a medical student and writing an essay about the importance of trajectory change for my family medicine residency application.

Friday, October 19

Sometimes they live

A patient walked out on me the other day.

It doesn't happen every day, but it happens often enough.  I usually never find out why.  Sometimes it's to go pick up children or meet another time-sensitive obligation.  Sometimes it's to go smoke a cigarette or get a dose of drugs.  I think sometimes they get scared and feel as though running from the department can help them escape their diagnosis.  Whatever the reason, I learned early on that I have to be able to let those people go.  The other side of the patient autonomy coin is this: they're responsible for getting the care they need and it's not my job to force or coerce them.

Except when it is.

Wednesday, September 26

Sometimes they die

Honestly?  I hate traumas.

I can't stop thinking about one I got a while back.  Auto vs. motorcycle.  A nice young man had been driving at dusk - not texting or anything as far as we know - and turned left in front of a motorcyclist who wasn't wearing any gear.  He never even saw the motorcycle coming.  The driver in the car was fine.  The guy riding the motorcycle - another young guy, I never quite learned his age - became our patient.  I was the backup doctor in the room but it still felt like he belonged to me.

Traumas don't go the way you would envision from watching a show.