It has been hard finding time to write this last month (January). I started this post at the end of January and just now have time to finish it! I was on an "off service" rotation, Internal Medicine "wards", which is a huge time sink. We were allowed 4 days off over the entire 4 week block, the minimum allowed by the residency rules. The work is not really hard or brutal, it is simple tedious and fatiguing and allowed no personal time other than meals and sleep and that is what this post is really about down the page.
I just finished my first weekend off in about 5 weeks - two whole days all to myself, one right after the other! It was glorious! I went to see "Avatar" (twice) and I have to agree with A.O. Scott of the New York Times. The last time I felt like that leaving a theater was when I was 8 years old and I saw Star Wars on opening day! It was a feeling similar to having a crush on a girl in 7th grade, pure infatuation. Movie magic. I was happy that I finally went after my initial resistance due to the mediocre trailer and my grumpy old man attitude that it was just a bunch of "computer graphics" and nothing special. Some people said the story was simple, but I think that is good. The basic mythological struggles, characters and needs that run deep through us are all simple and that is the point. You recognize these characters and empathize with them right from the start. All the best stories are simple stories, take Casablanca for example! One thing is for sure, you have to see it in 3D though and I don't recommend the IMAX version. It gave me a headache, just see it in a good regular theater that uses that "Real3D" technology.
Aside from movies this weekend (I also had time to watch the BluRay of "Paris, Texas" again, another Sam Shepard classic). I found time for my bike, some exercise with my new barefoot running shoes, a few pages of a book I am reading and I cooked some of my favorite comforts meals. What I barely had time for though was writing, photography and cello. That is what is frustrating me the most, the loss of the activities my heart and soul require more than most. When I get time off I find that I need a certain amount simply to decompress and get the stress and medicine out of my system before my mind can be free from the worries and analysis that medicine forces upon it. The cello, my garden, photography and especially my writing all require empty space & unbounded time. Space without schedule or noise or forced interaction. Space without analysis. I find I can't write at all when it is squeezed between two definite points. Same with my cello. I need to wake up and wander, from moment to moment, perhaps with a cup of tea, perhaps after reading my latest New Yorker. I step onto the porch and smell the air, I look out my back door and watch the birds and squirrels in my yard for a bit. Perhaps I go down to the river and take a walk or to the Farmer's Market to peruse the winter vegetables. It is only after I spend a certain amount of time in this ritual of "unscheduling" myself that some creative urge rises up requiring words or music and I pick up my instrument and pull the bow over a few strings. Long notes and I just listen to it. This empty time is something that has become so scarce in my life that I rarely see this side of myself anymore. I get a glimpse of it every few months if I am lucky and it makes me sad because these important parts of me are lying dormant. I fear they are suffering a sort of atrophy and I wonder if I will ever recover them when this is over.
Well, I made it this far and now I have to run out the door for Orthopedics clinic. Again, the immovable object of residency has halted my unstoppable force. Well, perhaps I will find time to write more in another month or two...
February 8, 2010
January 11, 2010
The Intern's New Year's Resolution
I am not a fan of "New Year's Resolutions" but perhaps that is just because I am contrary much of the time. I quite often like not doing what everyone else is tending to do it seems. I thought I was growing out of this childish trait though, but found that same feeling return when I decided to make some "resolutions" this last weekend. "Everyone makes resolutions and no one keeps them...", I thought. Well, no matter, I found that time has come for some and I am going to make them. What inspired this all??? A nice holiday break. Two weeks where I was away from Sacramento, away from the hospital, away from sick patients and surrounding by my friends and family and with time to simple 'be'.
I returned from two GLORIOUS weeks off on Jan 1st and restarted my life as an intern. I must say I probably had the best 2-week vacation any intern on the planet can ask for. I started it off with a drive from Sacramento to Seattle. I know the photo is a bit blurry (I have since replaced my iPhone 3G with a 3GS!) but as you can see I had 11 hours and 41 minutes of driving time to clear my head from the mashed up placed it was at after my first 6 months of residency. It was a good drive and I only spent $105 in fuel and produced 581 lbs of carbon according to my "EcoTrip" calculator on my GPS. (I wonder what a plane ride would have cost in both $ and lbs?) I chose to drive because I did need the time to clear my head but also wanted to bring enough gear for the Mt Baker cabin weekend I had planned with all my closest friends!
We rented a 4 bedroom ski cabin in Snowline near Mt. Baker and I spent the next 4 days with some of my closest friends and the new additions to the group (Colton & Jillian and one more pre-person still cooking!!). We ate, drank, played games, went sledding, skied and in general just spent time remember who and what is important in life. I returned to Seattle for another few days after that and was able to spend Christmas Eve and Christmas morning with my close friends George & Kristin and their daughter Adela on Sea Breeze farm! After a few more days in Seattle I headed to Utah and saw my mother and then to New Mexico to see my father. I came home tired, but happy, and with new resolve to be more in control of my residency and to try and stop allowing it to thrash me! A new focus on inner health that will in turn radiate outwards I hope is what I hope to be posting about in the near future!
We rented a 4 bedroom ski cabin in Snowline near Mt. Baker and I spent the next 4 days with some of my closest friends and the new additions to the group (Colton & Jillian and one more pre-person still cooking!!). We ate, drank, played games, went sledding, skied and in general just spent time remember who and what is important in life. I returned to Seattle for another few days after that and was able to spend Christmas Eve and Christmas morning with my close friends George & Kristin and their daughter Adela on Sea Breeze farm! After a few more days in Seattle I headed to Utah and saw my mother and then to New Mexico to see my father. I came home tired, but happy, and with new resolve to be more in control of my residency and to try and stop allowing it to thrash me! A new focus on inner health that will in turn radiate outwards I hope is what I hope to be posting about in the near future!
December 12, 2009
Awake
It is 3:47am and I just cleaned my kitchen. I am 4 days into a stretch of sleeplessness which is a new phenomenon for me and a bit confusing. Most of November and early December I was on a Trauma Surgery rotation that was mostly night shifts, 14-15 hour shifts starting at 6pm and although I thought this would be difficult I found that I adjusted pretty quickly to my waking hours being primarily in the dark. Ever since finishing that rotation though I have had restless sleep and now it seems no sleep at all.
For the last several days I seem to fall asleep without trouble, but I then wake 2-3 hours later and stay awake for several hours before falling back to sleep again about an hour before I need to wake. For the last several nights I simply have lain awake in bed tossing and turning, hoping that I will become fatigued but usually finding my thoughts were running circles. Tonight I am trying a different strategy... if I am going to wake up, then I might as well use that time to do something productive. So far tonight I have:
- cleaned my kitchen and stove
- reorganized some shelving for food & spices
- made a cup of ginger-lemon tea, just like I got in China
- updated every aspect of Facebook possible and re-checked all my privacy settings
- reviewed the "Best iPhone Apps of 2009" to make sure I have the coolest ones
- updated my blog (obviously)
- logged my work hours for this month
- updated my procedures log for residency
- completed all pending turns on my various iPhone scrabble games
- reviewed my online calendar and updated my online finances
December 10, 2009
A Good Cause
I don't normally post promotional material as this blog is more or less my own public journal to rant about whatever I wish. A somewhat anonymous way to give a public voice to private thoughts without too much risk. What surprises me is that I often get sent emails from various places asking me to post something about their event or other activity, a simple way to get some free advertising I suspect. I find these requests odd as I don't think that many people read my scribbles but evidently they think enough people do to waste an email on me.
A few days ago I got one of these such emails, but it was a little less flashy and it did not seem quite so "scammy". It was from a group called "The Fresh Air Fund". The name was a bit misleading because it really is not about some environmental global warming action group, it is simply about summer vacations. It seems so anyway. The idea is, from what I can tell from their websites, that they try to raise funding for kids stuck in bad inner city situations to spend a few weeks every summer somewhere healthy, happy and stimulating. A summer vacation. Their latest fund drive is centered around the New York City half-marathon and they asked if I would post something about it. So, here is my post about my summer vacations and what they meant to me. I think this might make a difference to some kids....My parents had their share of struggles and both had hard times with alcohol when I was growing up. They divorced when I was around 9 years old and I spent every year of my life up until 18 moving every 9-12 months, either to live with a different parent or if I was staying with the same, to a new city trying to find something better. I had very few (no) friends as I was always the new kid in town and what friends I made I would have to leave every year with the next move. I eventually got into a tough crowd as a teenager and was headed down a path going nowhere fast. There was one very important set of events early in that period though that made a huge impact on me. My mother was married for several years to a man that lived on an island off the coast of Maine and they flew me out for several summers in a row in the early 1980's. During these summers I was surrounded by the ocean, trees and a host of other kids all spending summers from various backgrounds, good and bad, rich and poor. The "summer kids" often came from wealthy families and although I had a few friends amongst them, my main group were the "island kids" who were the children of the working waterfront families there. Although less monied and less educated, they were totally accepting of me and became some of my closest friends for a short period of my life.
I could spend pages describing the summers I had on Islesboro, but the details are not what matters. What matters is that every year I was pulled out of a life where I was mostly unhappy, unknown and getting myself into trouble and placed in a totally different world - a world of happiness, low stress, friends and beautiful surroundings in a very tight community. People on islands stick together, they know one another, they are truly a "community" in the best sense of the word. For the first time ever I felt I belonged somewhere.What this did for me in my life I only now understand when I look back on it. It gave me tangible proof that life could be different from what I had known up until then. It gave me something to hold onto when I had tough times, something to look forward to and something to dream about recreating again in some way. It gave me a sense that I was valued as a person. Without a dream and the belief that it can be yours I don't know what would keep you getting up every day. I can't imagine what my life would be like if all I had ever known was what it was like being that lonely unknown kid living from city to city with no real prospects or aims in life. Maine helped to give me a sense of family from that community that persist today. It taught me what happiness felt like and what beauty looked like in many ways. Once you have held those in your hands you don't let them go, you work to make them realities again when times are tough. Perhaps that is what these kids need, and perhaps this group can help give them a chance at it. Perhaps someone will read this and it will somehow help in some small way.
December 7, 2009
Why We Listen
Sigur Rós is one of my favorite bands of all time. They create some amazing soundscapes and their music is not meant simply be listened to, it is designed I think to dig down inside you, find something important, and then pull it back out to the surface. I recently viewed the DVD they made in 2007, Heima, meaning "home" or "homeland" (you can watch the trailer HERE). It was evidently made from a series of free, unannounced concerts around Iceland at the end of a long world tour meant as a way of reconnecting with Iceland and giving something back to the country and people that supported them. It is a beautiful DVD, but the reason I am writing this post at all is because of one piece of music I discovered on this DVD that I have not heard on any of their albums.
Rímur is a form of Icelandic chant that began in the 14th century. It has been used to pass down tales for centuries and it dying out. The Icelandic band, Sigur Rós, discovered Steindór Andersen, a fisherman and chairman of the Icelandic Poetry Society, and collaborated with him to transform a few pieces of chant into music. The original CD, Rimur EP, that contained these recordings is no longer in print. There were only 1000 made and sold during this tour. If you can find one for sale it will cost you. I looked around though and found a few YouTube videos. The first (below) is the song that I discovered tonight. The second is linked here. It is from another poem from a documentary on this chant and its transformation. I hope you enjoy them. I would suggest a good sound system or speaker to appreciate it if possible, or better yet, rent the Heima DVD (Netflix has it)!December 1, 2009
Not Sleeping is Unhealthy
This last month I have been on my trauma rotation here in residency. This rotation during your first year is mainly secretarial. Not exactly as dramatic as it looks on TV (although I have not seen it on TV, but I assume it is dramatic). I think the schedule was designed to maximize the ill effects of circadian disrhythmia. I work 5 nights in a row, 6pm-8am, then I am off for a day, then work 2 daytime shifts (6am-6pm), then after a day off I go back to 5 nights. Just enough daylight hours to screw up the routine you finally get into. Not that I would prefer all nights, but this back and forth does suck a bit. The one thing this rotation does give you though is a little personal space which is nice for an introvert like myself.
On the lucky nights when people are not shooting one another, crashing their cars, beating up their neighbors, etc.... I can get some time alone. Being up all night in a hospital is a little surreal. There are few people, most the lights are turned down or off in the halls and nursing stations. The patients (you hope) are sleeping. On the slowest nights your pager goes off randomly to alert you room 88-2's low potassium or their need for extra pain medications, but often you have nice long silent stretches to yourself. I spend most my night getting desk work done. Progress notes on all the patients need to be written for the next day. Physical Therapy notes, consulting services, etc.... all need to be reviewed and incorporated. I spend very little time with patients unless they need me. My role on this rotation is to write all the orders, write notes, put out little pager fires and "administrate". I spend about 10% of the time with patients. It is the second least patient oriented rotations I have had - Anesthesia being the first, but there at least you learn a very valuable skill, intubation. You are technically with a patient but you have knocked them out so you don't really interact with them except for the intubation. I loved it! Here though, I occasionally have to show up to the trauma room where I help with highly skilled aspects of care, such as "rolling" the patient after I "cut the clothes" to expose the patient. Once in a while I take a trip to the CT scanner, but more often than not I just go back upstairs to the Surgical floor and sit in my conference room writing notes.
Sounds dull, but honestly I don't mind it. I like having a rotation where I am not required to be "present" and "giving" all the time to patients. I like the time where I am not forced to interact with other co-workers and family every minute of the day and be "on" so to speak. It is so draining. It takes so much from you to be available and "exothermic" in a way. I may come home tired from the schedule changes but I am not as emotionally tired, which is nice. In the ER I am running from patient to patient non-stop at 75mph all night for 12 hours straight. Here I cruise at 35mph, a much more fuel efficient speed, for long stretches. Where the ER is like drag racing, this is more like cross country touring. It also gives me time to study a little, something I have not had time to do much in residency. Not a lot of course, because when an hour of pager free bliss arrives without any trauma pages to the ER, I am wiute happy to get a nap in the call room. So, another 5 days of this rotations... 5 nights I mean. You know what I mean.... then I am finished. I can say that I have learned to write a lean progress note.
After this I go to Kaiser hospital for my "community" Emergency Medicine rotation. This is sweet for two reasons. One, it is community so less academic politics and pressure and you work with real people living real lives. Because it is community based and money matters they are also efficeint. No wasted time, systems are set up to get things done and you focus on doctor stuff. Also, community folks understand working 12-14 hours shifts in an ER SUCKS, so they work 8's and 9's often with some 10's thrown in. Much more humane and conducive to a human life. The best thing though is that this is my vacation month! The way we do vacation is sweet, we have 1 month's worth of shifts to work over a 2 month period and we do them however we want. So, this month I am working almost every day the first two weeks and taking the last two OFF! Same thing will happen in April when I come back for my last community ED shift. Not bad....
Well, now I am off to my "academic forum" to learn something from the books and attendings. We do this once a week although I make far fewer of these than I should for reasons just like today. I work tonight from 6pm-8am. I should be sleeping right now but I am not. I am will try and sleep for a couple hours this afternoon and then will struggle through my first night and hopefully tomorrow I will get back on track. For the next 5 days, if you can do anything to help me, please wear your seat belts, don't get into car accidents, don't drink excessively and leave the crack-heads down the street alone. That way I can have a nice peaceful night! :-)
On the lucky nights when people are not shooting one another, crashing their cars, beating up their neighbors, etc.... I can get some time alone. Being up all night in a hospital is a little surreal. There are few people, most the lights are turned down or off in the halls and nursing stations. The patients (you hope) are sleeping. On the slowest nights your pager goes off randomly to alert you room 88-2's low potassium or their need for extra pain medications, but often you have nice long silent stretches to yourself. I spend most my night getting desk work done. Progress notes on all the patients need to be written for the next day. Physical Therapy notes, consulting services, etc.... all need to be reviewed and incorporated. I spend very little time with patients unless they need me. My role on this rotation is to write all the orders, write notes, put out little pager fires and "administrate". I spend about 10% of the time with patients. It is the second least patient oriented rotations I have had - Anesthesia being the first, but there at least you learn a very valuable skill, intubation. You are technically with a patient but you have knocked them out so you don't really interact with them except for the intubation. I loved it! Here though, I occasionally have to show up to the trauma room where I help with highly skilled aspects of care, such as "rolling" the patient after I "cut the clothes" to expose the patient. Once in a while I take a trip to the CT scanner, but more often than not I just go back upstairs to the Surgical floor and sit in my conference room writing notes.
Sounds dull, but honestly I don't mind it. I like having a rotation where I am not required to be "present" and "giving" all the time to patients. I like the time where I am not forced to interact with other co-workers and family every minute of the day and be "on" so to speak. It is so draining. It takes so much from you to be available and "exothermic" in a way. I may come home tired from the schedule changes but I am not as emotionally tired, which is nice. In the ER I am running from patient to patient non-stop at 75mph all night for 12 hours straight. Here I cruise at 35mph, a much more fuel efficient speed, for long stretches. Where the ER is like drag racing, this is more like cross country touring. It also gives me time to study a little, something I have not had time to do much in residency. Not a lot of course, because when an hour of pager free bliss arrives without any trauma pages to the ER, I am wiute happy to get a nap in the call room. So, another 5 days of this rotations... 5 nights I mean. You know what I mean.... then I am finished. I can say that I have learned to write a lean progress note.
After this I go to Kaiser hospital for my "community" Emergency Medicine rotation. This is sweet for two reasons. One, it is community so less academic politics and pressure and you work with real people living real lives. Because it is community based and money matters they are also efficeint. No wasted time, systems are set up to get things done and you focus on doctor stuff. Also, community folks understand working 12-14 hours shifts in an ER SUCKS, so they work 8's and 9's often with some 10's thrown in. Much more humane and conducive to a human life. The best thing though is that this is my vacation month! The way we do vacation is sweet, we have 1 month's worth of shifts to work over a 2 month period and we do them however we want. So, this month I am working almost every day the first two weeks and taking the last two OFF! Same thing will happen in April when I come back for my last community ED shift. Not bad....
Well, now I am off to my "academic forum" to learn something from the books and attendings. We do this once a week although I make far fewer of these than I should for reasons just like today. I work tonight from 6pm-8am. I should be sleeping right now but I am not. I am will try and sleep for a couple hours this afternoon and then will struggle through my first night and hopefully tomorrow I will get back on track. For the next 5 days, if you can do anything to help me, please wear your seat belts, don't get into car accidents, don't drink excessively and leave the crack-heads down the street alone. That way I can have a nice peaceful night! :-)
Subscribe to:
Posts (Atom)
