Confessions of an Intern

Week Eighteen

The second week of inpatient medicine made me feel like I had gone through a time warp. I was transported to my oncology days. I had always wondered why we never had patients on the oncology unit here, as we seemed to have patients everywhere else. That's what I get for wondering. I am now proving myself as a reliable end of life counselor and palliative care champion.

Little did I know what would go down this week. It turned surreal, as my heavy load of patients turned into just a few patients, who were really sick. I had to tell several families that their loved ones were terminally ill. The first family member I spoke with asked me "How can you do this all the time? Doesn't it make you sad?" Instead of my initial conversation about her family member, I told her how I was qualified to discuss the information, and why I felt it was an honor to be able to do so. I had worked for 12 years as a nurse, working in critical care and finishing in oncology. I had experience working with people who were dying and critically ill for a long time. I believe everyone should die with dignity. Part of that dignity includes honoring their wishes. It is extremely hard for families to let loved ones go. Advance directives are your voice if you are unable to communicate your wishes. Even then it is hard sometimes to let go. It is extremely important that you let your family know these wishes at some point, preferably when they are more receptive, as in not at the last minute. This cannot always happen, as we don't know the minute of our death. Anyway, off this soapbox.

I had this conversation with three different families, all of whom took it differently. I got sad, mad, and glad (not in the gleeful way, but the relieved, finally we know way). Different cultures take things a different way, too. Trust is imperative with the African American community. My experience tells me that end of life is somewhat taboo to discuss. There seems to be a reluctance to change to comfort care from the "do-everything" approach. I had to walk the fine line of not assuming this would be the case with one family, to realizing it was the case. This in turn required me to not be pushy, but to only give the facts. My goal is to never assume a prefabricated notion, but to have an open mind and be ready for surprises.

My next "gift" this week was to be informed about 15-30 minutes prior to participating in an interdisciplinary joint commission team meeting. If you are in healthcare, you are probably shivering now, and your insides are cringing, saying "No way! Not me!" Briefly, the JCAHO is the hospital accrediting body who have the authority to shut a hospital down. Not only was I invited to participate, they were discussing my wonderfully unique little patient, and guess who was the lucky one to get to introduce them to the group? Did you say feydoc? Yep. Me.

Needless to say, I was a little concerned at first why this patient was chosen, but in the end, it was random inasmuch as they needed a patient who had several disciplines involved in their care. I won't bore you with the details, but at the end, the surveyor said it was the best "tracer" they had participated in. A tracer follows patient care through several disciplines and watches all the places that communication could fall through, amongst other things. My attending let me know the next morning that I had done well, and people had noticed, that I was getting a good reputation about the hospital. Me? wow. It's only block 5 of my intern year. To paraphrase a good friend, don't put me on the pedestal, I don't want to fall.

Little things have been said to me this week by my attending that have the potential to inflate my ego. Several conversations started with, "I don't want to blow smoke up where it shouldn't be, but..." in regard to how I'm doing. He even asked me what I thought about being Chief Resident. That is a position in the 3rd year. I don't know...I really just want my extra time to go to my family. But who knows? We'll see....