Confessions of an Intern

Week Forty-three

Week 43.

Those weeks where I don't have a lot to say I should remember are a blessing. That means while I may have been learning and becoming a better doctor, I had not experienced anything that profoundly rocked me to the deepest parts of my soul.

This week has once again been exhausting. I am five days into twelve in a row, twelve to fourteen hour days at work, and still not enough time in the day to get all my work done. That is the easy part. I made the mistake a couple days ago to tell the medical student I was working with I was bored. As I said it, I consciously thought 'Should I say 'bored' out loud?' I am superstitious to a certain point. We don't say 'quiet' or 'bored' or 'slow', because you will immediately be so busy you won't know what happened to you. So I said it, because I was tired of running a nursing home service.

No lie, I ended up with more admissions that afternoon than average, and some interesting cases, too. I had told said medical student I did not feel I was being used to my full potential and wanted to stretch my brain a bit. Open mouth, insert foot.

That afternoon, I admitted a young woman with stroke like symptoms. Too young. It didn't add up. I brought up multiple sclerosis to the Neurologist, and he poo-pooed my idea, actually thinking it was in her mind. MRI brain report comes back with "multiple periventricular white matter densities consistent with multiple sclerosis". Score one for the intern. I was happy my hunch was right. Then my giddyness fell away to sadness. This poor young woman had a life long diagnosis, one that is usually progressive and devastating.

Next morning I found out why her platelet count was not resulted with the rest of her lab. It was 1.6 million. Normal is 150,000-350,000 or so. I started doing research and started ordering tests to differentiate her condition. It might be reactive, in response to her MS. As each lab I had ordered came back normal, my heart fell more. There were no signs of inflammation in her bloodwork. She has a blood cancer. The specialists swooped in like the heroes, but this lowly family medicine intern diagnosed them first. I am the one, who at the end of her day of testing, went in and sat by her and asked if she needed anything. She is nervous and slightly in denial. Turns out, she had a small work up for the elevated platelets two years ago, but didn't follow up, because she was scared of a needle. She lied to me earlier in the day when I had asked if she had ever been told her platelets were high. She did not want it to be true.

When I told her primary care doc, a dear friend of mine, he broke down. He had no idea how sick she was, but had a gut feeling something was wrong. Next time you wonder how the doctor that told you or a loved one bad news stays so cold and collected, think again. We have to stay stoic and calm. We cannot afford to break down and be weak in these critical moments. Don't get me wrong, some docs are asses, but most of us break down with each other, maybe go have a drink alone, maybe two. Sometimes we cry alone in a corner. There will be a time when we cry with you, but that is when we have done all we can. Sometimes it is happy tears, sometimes those of heartbreak.

I feel as if the weight of the world is pressing on me right now. It is palpable.

Other victories for this intern:

*Vindication on and EKG. I went to see a new admission who I was told was being admitted for bradycardia and altered mental status. I was told she was in second degree heart block. I look at the tele monitor and I see complete heart block (the atria and ventricles are beating independently of each other, with a very slow ventricular rate, making very little blood flow). I called cardiology and their nurse came up and waffled on the rhythm. I said it really doesn't matter what we call it now, her heart rate is 30. She needed an emergency pace maker. Three of the cards nurses studied the EKG. Later I see the toughest cardiologist we work with agreed with me. Score 2 for the intern.

*Patient with a leg rash. Everyone freaks out and thinks it's an infection. I look at said rash, and notice it's purpural (look it up :D). Patient has a history of hepatitis C. Rash was recently diagnosed as vasculitis and people just weren't putting the two together. Again, I called it. Who needs a stinking rheumatologist? JK, I do, and often. But hey. Not this time.

*Mystery patient a co-worker can't figure out. Again, I come to the rescue. You just have to know what words to search on the internet and most of the work is done for you. I guess that means I have to know what I'm thinking. Myositis isn't the first thing that comes to most people's minds.

These are just little things (big things) that reaffirm I am doing what I'm supposed to be. I need these victories to help me through the tough things. I'm going to share something I saw on facebook. It really sums up some of the things we go through everyday. It is not my original work, credit given at the end.

Somebody asked: "You're a Doctor? How much do

you make?"

I replied: "HOW MUCH DO I MAKE?" ...

I can make holding your hand seem like the most

important thing in the world when you're scared...

I can make your child breathe when they stop...

I can help your father survive a heart attack...

I can make myself get up at 4AM to make sure

your mother has the medicine she needs to

live...and I will work straight through until 4am                                                                                        to keep her alive and start the day all over again!

I work all day to save the lives of strangers...

I will drop everything and run a code blue for

hours trying to keep you alive!!!

I make my family wait for dinner until

I know your family member is taken care of...

I make myself skip lunch so that

I can make sure that everything I did for your wife today was

correct...

I work weekends and holidays and all through the

night because people don't just get sick Monday

though Saturday and during normal working

hours.

Today, I might save your life.

How much do I make?

All I know is, I make a difference.

Share it doctor !!!

Medentzz - We Care,Not Just Cure (C)