Today’s inane image of the day:
You still work that many days?
I’ve been asked whether my schedule is more “humane” or “manageable” now that I’m an attending. The answer is a resounding “yes!”… but, I still have blocks of long weeks. The work never stops being challenging for one reason or another. There are certainly still weeks when I am scheduled to work 70 hours. Yet even with this assignment, the work still feels so much better than when I was in training. Long weeks as a trainee felt exhausting because there was always something new to learn. Long weeks as a first-year attending also felt exhausting for the same reason. Now that I’m a few years out, I feel more at ease, confident in my clinical skills, and able to appreciate how incredible the work I get to do is.
Notes on staying “well” [sane] during a long-stretch
A couple weeks ago I worked an 8-day stretch in the ICU [one of those days was an extra shift because I’m saving up to enjoy an upcoming vacation]. The last time I was on this particular assignment, I had a lot of “wins.” When working in an ICU setting for many days in a row, you follow the course of a patient’s clinical course and sometimes, contribute to a positive outcome. I say sometimes because the reality is that while there are certainly interventions we can do to help an individual and even save them from certain death, there are also situations that are completely out of our control. I went into this long week with a positive outlook and disposition.
The last time I had a block like this, I was resolute about maintaining a regimented schedule. The older I get, the more I realize how much good sleep, consistent exercise, and a healthier diet impact my well-being. The better I feel when I’m on a long stretch, the easier it becomes to invest my entire self in the care of my patients. When I feel like I’m present, I also feel like communication is better. Everything seems to harmonize.
This time, I decided to fill my week with evening commitments. Some of them were work-related. Some were things I expected to overall fill up my cup. And inevitably, there were a couple of later evenings in the ICU to ensure that things that needed to get done got done. Going into the week, I felt a sense of dread looking at all the filled spaces on my calendar, but I thought it was manageable.
Turns out I need to be more discriminate with my time during these long weeks. Although it didn’t feel horrible while I was in the midst of it, my tank was running on empty at the end of it. Note to self: don’t do that again.
Thoughts from the week
Some of the reflections are from prior experiences and scenarios to maintain patient privacy. Some of these events may be fictional or a conglomeration of multiple patients.
Day 1
There is something so gratifying to be able to provide direct patient care. This first day was my “extra” shift where I am in the role of intern/resident/fellow/attending. I made a promise to myself to always maintain skills across a spectrum so that I am versatile and able to be useful in a variety of roles. The shift was a reminder of how tedious the electronic medical record is, how healthcare disparities dictate so much of our outcomes, and just how precious it is to be able to sit and connect with patients.
Day 2
This is the official start to my week covering two units as the attending. My usual approach is to pre-write all of my patient notes. Documentation is one area of medicine that most dread, mostly because of the required components included for billing purposes but may serve minimal purpose for patient care. Luckily, I get to write the high-level notes so they serve as a tool for me to get to know the patient and as a reminder for the areas I want to follow-up on each day.
My first day on the service was also a holiday, so I carried the airway pager [in my hospital, anesthesiologists place breathing tubes in patients that need them]. Often, nights, weekends, and holidays are when the airway pager is busy. On this particular day, it was busy.
Day 3
The ICU is always full of surprises. One of the most humbling aspects of medicine is just how little we really know. We think that we are on the right trajectory only to be surprised by a sudden bend in the road. The most dangerous healthcare professionals are the ones that are certain of everything.
Day 4
I am tired. The previous night, I stayed late to facilitate a procedure I felt was important for a patient to undergo. Getting home close to 8p and not having time to decompress meant that this day felt heavy. I have an evening meeting I am running and need to prepare for.
Day 5
The evening meeting I led was at least fulfilling. It felt useful and was a reminder of why I volunteer my time with that particular organization. Although it bothers me that the culture of medicine thrives off of the generosity of its healthcare workers volunteering their time, sometimes the investment is worth it. Or maybe this is what I tell myself to continue to invest the time and energy into these commitments.
Day 6
Why did I think that it was a good idea to go on a date during a week in the ICU?!
[Maybe someday I’ll share more of my dating adventures on the blog; in the interim, if you know me in real life, feel free to live vicariously through my dating stories.]
Day 7
It is a weekend and I wake up extra early to coordinate a bagel delivery. In spite of my best laid plans, the delivery is delayed and I’m a bit flustered starting the morning. Ultimately, this is out of my control, but I’m getting toward the end of the week and my mind is tired.
I am carrying the airway pager again. I’ve now been an attending for over 3 years, yet this particular week has been one of my more challenging ones with the airway pager. I feel that I’ve handled each of the challenging situations well. I felt secure in my decision-making and even received feedback that we appeared to be calm, cool, and collected but what we project to others is often not an accurate representation of what we feel on the inside.
Day 8
The previous night I forced myself to make an appearance at a social event. I felt awkward and a bit out of place at first, but ultimately I was really glad I went. There is something so nice about getting to know your colleagues outside of the confines of the hospital.
It is my last day on the service. I feel drained but I what I can to still try to ensure that my patients are getting the best possible care. Luckily, a colleague is covering one of the other floors that I normally would.
Day off
I get one day off before going back to the OR. I decide to sleep in; no alarm is set and I end up sleeping more than 10 hours straight. When I wake up, I feel groggy and like a bus has hit me. I write out my “to do” list and feel zero motivation to work on it. At some point, I start watching television and feel guilty. Why don’t I have the energy to do anything?