Tuesday, January 01, 2019

Plenty of Time

Back at work again after the change of units, it dawned on me that if I followed my boss’s instructions, I was never going to get to visit any patient on the oncology unit. My orders are to do initial visits in the ICUs on the three days of the week that I work, while Merlin does the same the three days of the week he works that I don’t. In the first week, I never succeeded in making it to the third, less intensive ICU, let alone to the oncology unit. (There is a nurse in the least-intensive ICU who was there when I was doing CPE who made it clear she hated me; she’s still there, which adds to my less enthusiastic feeling about that unit.) I started to write my boss an email asking for her help in prioritizing, but then I deleted it: I can figure this out.

I decided to quietly give myself new orders. Accordingly, I decided to spend the first day I work each week in the oncology unit. Then I can spend the next day doing initial visits in the ICUs, and on the last day, maybe by afternoon I will have done all of the ICU initial visits and can get back to the oncology unit for a bit. That should leave things in the ICUs in good shape for Merlin.

Many patients in the ICU are unconscious and intubated and unavailable for conversation. Some are awake but in horrible pain. Of the talking that I do there, probably half is with family members rather than patients. I am continuing to practice my Spanish. I talked to a Spanish-speaking patient who was able to go home from the ICU soon after our visit. His nurse said it happens so rarely that a person goes home from the ICU that she had to remind herself of the procedures. It’s not that patients don’t leave the ICU; most do, but they go to another unit in the hospital or to a skilled nursing facility or to a rehab rather than home.

I was exhausted after work. I am taking the bus to work, and, to save time, I’m taking a cab home after every shift: $60 a week. Over the past year, a week that contained two paying shifts seemed burdensome. One shift a week was perfect, and when there was a stretch of two weeks with no shifts, that was even better. Now I have signed up for three a week—why did I do this to myself? I’m going to stick with it (unless the new boss lays me off) for at least a year, because the project I’m doing for school partly depends on the experiences I’ll have at work.

Last year was kind of easy: one day at County Hospital per week, and one or two days at my paying job, maximum. The year before, doing CPE, was hard. So maybe the thing now is a hard year alternating with an easier year. It may also be that this seems particularly hard right now because it’s new and there are various little learning curves all happening at once, and perhaps also because I keep saying to myself, “I’m exhausted! There is no way I’m going to get enough sleep. Why did I do this to myself? I’m going to end up burned out and miserable.” Maybe those aren’t the best affirmations.

There is plenty of time.

I am getting enough sleep.

I can do this.

It also helps to think of those who work 90 hours a week at two or three different minimum wage jobs, who can’t even take a day off to go to the doctor because they have families to support and can’t forego even a few hours’ pay. My situation is luxurious by comparison and complaining is unseemly. Also, I chose this. I can unchoose it at any time.

It was mentioned at palliative care rounds that the mother of a seriously ill patient had been mentioning that she (the mother) might commit suicide. I shared that with the patient’s nurse and she looked so shocked that I wondered if I had done the wrong thing, so I texted one of the palliative care doctors to see if this is OK to do and she said it is, that it helps for other care team members to know what to keep an eye out for.

In the rounds meeting, one of the doctors said of a patient, “His lifestyle doesn’t match his goals,” which I thought was a delicate way of putting it.

Mid-December, I spent one morning being shadowed by a medical resident. She had a calm, friendly presence, and I could see that the patients liked her right away. Afterward, I sent her an email recommending that she read Being Mortal, by Atul Gawande.

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