actuallyjomd

[actuallyjomd]

Nights 6-10/10

It's been several months since this 10 day stretch of night shifts. And that's because night 8/10 was the worst night of my entire life and the month following that was the saddest month of the entire life.

Night 8/10 was my first night ever in the PICU, first shift at all in the ICU (outside of NICU). I had gone down the night before to shadow and the boy from night 5/10 was struggling to breathe. I sat with his mom as she cried in the next room while the fellow intubated him.

"Will I ever get to talk again?" He said.

We all nodded yes to him. We did our best to reassure.

I walked with his mother to get a latte from Starbucks and she told me all about him. His new gaming computer that he got for Christmas that he wanted to play. His two older siblings with their kids, and how he got along so well with them even though they were step-siblings. His mom really likes pistachio lattes.

Night 8/10, I go immediately to see him. Hopeful.

And I am already traumatized by what I see. He is edematous, covered in purpura, sedated and paralyzed, catheters at his neck and arms. All I can think is that he has to make it. I have to watch him so closely so he can make it.

His labs were drawn almost every hour. His potassium, his blood pH, his lactate levels. Everything was on the edge.

It was 4:43, the nurse noticed his heart rate was dropping. She checked his pupils. Fixed. Dilated. And we started compressions. 45 minutes.

5:36 was his time of death, and I still want to cry as I write this.

His mom wasn't there. I heard her sobbing on the phone.

He never spoke again.

And in the next several weeks, 9 other children died. Including little miracle from night 1/10. I cried for weeks. It was so hard for me to keep going when I felt the incompetence of being in the ICU for the first time, to feel so sad for all the kids and their families, and to just keep pushing. The secondary trauma was real.

To any resident's out there who are feeling it, just wanted to let you know how those days went. I went to therapy, I took a full elective month afterwards, I processed it with the fellow on call. My residency program rose up to meet me as I felt like I was free falling out of this. I hope you all have been able to find these supports where you are at, and if not, that I am happy to process with you. Phone a friend. You aren't going through this alone.

#pgy2 #medblr #medicine #pediatrics #residency #studyblr #medical #medical school #peds #PICU #loss #death #grief #pedsoncology #ICU #timeofdeath #night shift #nights

[actuallyjomd]

Night 5/10

Walked in to one of the patients having a PT prolonged to 23.... WHAT (normal is 13 or less). His liver enzymes have been getting worse since he got admitted but he hadn't gotten any chemo that could have led to such intrinsic failure. He was the before mentioned 6 bolus patient. During the day got plasma x2 and then lasix + albumin + lasix. Halfway through albumin started to have an RR 55 (he's a teenager). So so so much fluid. Poor Kid. Had to send him to the PICU for VOD treatment and fluid balance.

Literally hung around the rest of the night. I was so prepared to correct his liver dysfunction but needs a little more than the floor can give. Another friend I'll see in the ICU.

On a brighter note, went by to see one of the pulm patients, 1 year old with Trisomy 21 and tracheostomy. Little buddy was silent crying in his room. Picked him up and he stopped his little crocodile tears. Had to put him down for reasons and he threw the silliest, cutest little tantrum. Sincerely wish you could go home bud, but will keep you for adorable flopping in your crib because you lonely.

#pediatrics #pediatric heme/onc #peds #medblr #nights #night shift #night 5/10 #medicine #residency #pgy2

[actuallyjomd]

Night 4/10

The usual "We've got a direct admit coming from 30 minutes away" at the beginning of shift.

Shows up 9 hours later.

I know this little kiddo and he's my first admit of 2022. Unique genetics of sickle cell HbSS with beta-thalassemia zero. Back at it again with another virus + fever. It feels fun because I'm pretty interested in Pediatric Hematology, much for the continuity and unique manifestations blood disorders have in the body. All this to say, my boy got his classic - ice water, scheduled antipyretics, and lots a love.

Interesting moment around 0000 when we were toasting with sparking grape juice, noticing my PD (PICU attending) just totally melancholy about how SAD the PICU is right now... bout to start that on night 8...

#pediatrics #peds #pgy2 #residency #night shift #night 4/10 #PICU #pediatric hematology #medicine #medblr #nights #sickle cell #thalassemia

[actuallyjomd]

Night 3/10

Favorite part of the night was when I was going to check in on one of my patients. Walked past a room and the patient, probably 5 years old, was just outside the room playing with the computer station on wheels. Just full on scanning his bracelet, clicking things, sitting on the ground having a good time in the hospital hallway at 11:30pm. Not an adult in sight.

And you know what, I just let him have at it because why the heck not. Have a good time buddy.

Later in the shift was waiting for a new diagnosis (now I know T-cell ALL) with COVID to get a CTA to rule out a PE and the poor ED got 4 traumas all at once. Policy is they can't go to CT without someone with "clean hands" so literally went down myself after 3 hours because we all need spare hands am I right?

Turns out he had a 14cm mediastinal mass and borderline tamponade physiology with rising uric acid, potassium, and phosphorus. Made it to the floor when the labs resulted and OFF to the PICU he went. We've had some mediastinal masses on the floor recently.... BUT would rather not do that again.

#pgy2 #mediastinal mass #pediatric oncology #medicine #nights #night 3/10 #peds #pediatrics #medblr #residency

[actuallyjomd]

Night 2/10

4 admissions right off the bat. 1 COVID positive B-cell ALL, 1 neutropenic fever with aplastic anemia, 1 CF admit with abdominal pain, and transfer from PICU who got 6 boluses for hypotension in 24 hours (!).

I think the best part about this night was that I decided to take a nap around the 4am hour when all my notes were done. Hit snooze on my alarm and my co-residents woke me up at 6:26am before sign out lol. I was having some weird dream that I went on a date with someone who wasn't my husband and my husband was ok with it ??? Anyway needed to be woken up.

#medblr #pediatrics #night shift #night 2/10 #pgy2

[actuallyjomd]

Night Shift 1/10

Slept for 6 hours (?!?)

Was up stalking old patient charts and was reminded of something another resident said:

"Watch out for kids named Neveah or Miracle..."

I feel uncomfortable with that from the get go. Kids names can be weird and there's all kinds of voodoo and superstition around that. But that kind of mentality is something I avoid at all costs. However, I did come across one of those names.

Previously remembered her from my infectious disease rotation. She has an aggressive leukemia which rapidly switches genetics and failed to go into remission after multiple rounds of chemotherapy. I met her when she acquired a rare fungal pneumonia (scedosporium for the curious). She ended up recovering from it and after an experimental therapy went into remission, ultimately qualifying her for bone marrow transplant (BMT).

Fast forward to now. Me in my little call room reading her chart. She's sedated on ECMO after a sepsis work up post transplant. And the most devastating news.

Her leukemia came back despite transplant.

Worst part of all of this is her mother is due to have her next child any minute now.

It just sucks. This little baby gets to enter into their big sister dying right before they arrive. Just full on shittist things about life juxtaposed with birth, joy, excitement, maybe even hope despite the despair of failed BMT. This mom, I remember how protective she was of her daughter when the revolving doors of consultants and MAs, and nurses would tire them out. I can't imagine what it's like to be the oncologist, and I read his note. I know that particular attending and can just picture his stream of consciousness. It's painful to read when you know the lives behind it all.

Which makes the phrase even worse. Like shut the fuck up. I don't care what her name is. Everything about what happened to her should not be chalked up to her name. Just night time rambles...

#pgy2 #night shift #residency #pediatrics #bone marrow transplant #oncology #pediatric oncology #leukemia #medicine #medblr #night 1/10

[actuallyjomd]

My professor, teaching us immunology: I'm not saying the child in your womb is an antigen, but the child in your womb is an antigen.

#pediatrics #house was right #babies are parasites #peds #medblr #medicine #medical school #immunology #obstetrics

[actuallyjomd]

Fellows and Residents who make medical students look good = MERCIFUL SAVIORS GOD BLESS YOU

Attending: *Asks the med student a pimp question*

Student: *Does not know answer and is getting visibly flustered*

Me, sad: *Mouths the answer dramatically when the attending turns around*

Med student: Cardioversion!

Attending: That’s right! Now who told you that?

Med student: Um… Jesus. Jesus came down, saw my suffering, and told me the answer.

#medblr #medical student #lol #I've done this too #from both sides #flustered medical student for life #and flustered resident #JESUS IS ALWAYS THE ANSWER

[actuallyjomd]

hehehehehehe.

they do!!!!

Apparently parachute reflex is a primitive reflex in newborns wherein, if you flip a baby like demonstrated above, and attempt to chuck them at the ground like *whooooosh*... They'll extend all their limbs in anticipation of the fall, and it's a reflex that stays lifelong!

BUT all the time my gremlin brain kept thinking : next time I see a baby (*cough* my next patient in paeds *cough*) I'll attempt to randomly flip them over discreetly and see if it really works? 👀😆😆😆

#pediatrics #medblr #medicine #primitive reflexes #newborns #they're so weird #but so fun to play with #peds #pediatrics resident #the moro reflex will always be my favorite

[actuallyjomd]

Dr. Glaucomflecken coming in hot with the reality check

And you don't want the ophthalmologist to be in the ICU taking care of you...

#medblr #vaccinate #please #hurry #omicron is coming

[actuallyjomd]

I'm right there with you - it's not that we aren't trying hard enough. In fact, I think that we're even talking about this all together is proof that we are trying to do everything within our power to fix the system from the inside, just recognizing that so much is outside of our control. And don't want it to seem that my co-residents are all completely hopeless, but like you said, there are so many things we have to keep up with that it feels hopeless for the responsibility to fall on residents to adjust the system. And I can talk a big talk, but seriously, after a 24 hour shift or on a crazy ICU shift, where you're just trying to stay afloat, I am burnt out. Just want to validate and emphasize how true and hard all of this is and I don't disagree at all!

I think the thing I wish for is that people ahead of us (fellows, attendings) or that even people beside us (like nurses and pharmacists) would take a moment to recognize that also. That being a trainee who changes services constantly, has to attempt to master a wide breadth of knowledge and ever changing research, as well as maintain kindness and compassion, while also eating, sleeping, and keep some semblance of cleanliness is impossible at times. Not that they should have pity or even do something about it. But just to validate it so that way when they hear non-medical people saying stuff about trainees it doesn't encourage the attitude that we are soul-less. And that's where it feels like residents have no one to advocate for them but residents??? But why is it like that??? Or should I even be complaining about this because I have such privilege to be training at a great institution and such opportunity?

AGH

one of those posts is going around again where non medical people talk about how terribly trainees are treated in medical school and residency, but for some reason the final conclusion is never “wow they deserve better treatment”, it’s “wow they must be awful people completely devoid of empathy after going through that”

i get that the people posting these things are primarily concerned by how this affects them (as potential patients), but if they can be sympathetic towards mistreated workers in every other industry, why not residents?

#‘we need better doctors’ #‘there’s no way to be a good doctor through the current system’ #that’s some hopelessness right there and i refuse to accept it #residency #medblr #residency can’t take my empathy #‘there are no other routes to becoming a doctor’ #there’s just something very defeating about

[actuallyjomd]

I think what contributes to this same attitude is “medical providers are burnout, therefore they don’t actually care about you.” It invalidates the compassion and empathy that we have desperately tried to hold onto so we aren’t burnt out.

So so important to move this conversation toward change not hopelessness. But it feels pretentious to ask patients to advocate for their future doctors. Ultimately it comes down to people pushing within the system. I know my co-residents have this same struggle, that we complain about exhaustion but don’t provide alternatives to preventing it or changing it. My goal for this second half of residency is to not allow that attitude to pull us down or to perpetuate an attitude among patients that we are too tired to care.

one of those posts is going around again where non medical people talk about how terribly trainees are treated in medical school and residency, but for some reason the final conclusion is never “wow they deserve better treatment”, it’s “wow they must be awful people completely devoid of empathy after going through that”

i get that the people posting these things are primarily concerned by how this affects them (as potential patients), but if they can be sympathetic towards mistreated workers in every other industry, why not residents?

#remind me who has no empathy? #it just really rubs me the wrong way #medblr #studyblr #medicine #medical school #residency #burn out #i know a lot of people on this website have had bad experiences with doctors #and i hate that i can’t personally weed all of the assholes out of this field #but the people i know are in it for the right reasons

[actuallyjomd]

Most important thing I learned on my path externship

#pathology #medblr #medicine #medical school #medical #studyblr

[actuallyjomd]

Pregnancy and COVID Vaccination

I got fully vaccinated while pregnant. There was no hesitation. But I do know of 3 healthcare workers (a nurse, a pharmacist and a doctor) who were/are pregnant and did not get vaccinated. There was no way to convince them.

I'm fatigued now over the argument from the vaccine hesitant patients I have about how we don't have enough data or we 'rushed' this vaccine and should wait. Wait for what exactly? 30 years to feel safe about a vaccine for a deadly global pandemic? Am I hearing this correctly?

We have large scale trials now in NEJM. The latest, which is free access to all users, included 35 000 pregnant people. With no obvious safety signals. Of course, longer term data is required. But we have numerous documented cases that show that catching actual COVID while pregnant does carry high risks for complications. Thus, it is now a strong recommendation in the guidelines of many highly respected Western country obstetric societies for pregnant patients to get fully vaccinated. These are never lightly added to guidelines. They always go by the evidence. 1/3 of the entire world is now vaccinated with few complications. We're looking at 1 in a million severe complications, which is a common entity to all vaccines which many of the COVID vaccine hesitant have already had in childhood or for the flu each year. Versus the very high risks that catching delta strain COVID actually carries.

Again, where did everyone leave their common sense during this pandemic.

Head of obstetrics at one Australian hospital has now come out with statistics to convince everyone to get vaccinated.

Why vaccinate:

“It does not increase the risk of miscarriage, or abnormalities or pregnancy complications. It prevents severe disease, you coming to manage, you having your baby born early and you put into intensive care.

It is safe. When you look at the side-effects of women in pregnancy who have had vaccinations, they are less likely to get a fever than in the normal pregnant group. The immune protection response actually crosses the placenta to the baby. It provides protection to the baby.

For women who are breastfeeding, the vaccination response – not the vaccination – the vaccination response continues protection into the baby. These are very high risk of needing extreme premature births, due to the degree of infection."

What if you don't and catch COVID:

We know that in pregnancy that coronavirus infection means you’re five times more likely that you’re going to need to come to us... and when you do come to us...[it] is a one in three chance you’re going to need oxygen therapy, is a one in seven chance you’re going to be in intensive care, is a one in two chance you’re going to need emergency delivery of your baby, is a one in two chance of severe infection.

And there’s a one in four chance your baby will need to be born prematurely, twice as likely to have a stillbirth.

This is what we’re seeing from the Delta variant of the coronavirus.

#pandemic #covid #pregnancy #vaccination #medical school #studyblr #resources #medblr #obstetrics

[actuallyjomd]

“I gotta go mom, the doctor is giving me tattoos.”

Temporary tattoos during Halloween weekend on the peds oncology unit

#studyblr #medical school #medicine #medblr #pediatrics #peds #oncology #halloween #tattoos #residency

[actuallyjomd]

It will never not be norovirus

“Out of the diarrhea-causing viral agents, choose ONE that you don’t want to have in your wedding.”

The answer was Norovirus

#medicine #med school #infectology #microbiology #diarrhea #wedding #norovirus #studyblr #medblr

[actuallyjomd]

Proud

because I’ve been ON TIME in my continuity clinic today. AND all my notes are currently done. AND while I’ve been waiting for my next patient I’ve cleaned out my emails and put together a list of recipes I’m gonna cook this weekend.

Last week one of my co-residents had to seem my last patient and I was running 40 minutes behind. Appreciating the lower complexity patients making our clinic seem more realistic. Did send 2 kids for COVID testing whomp whomp. But had normal 11 y/o, 9 y/o visits which I haven’t done in ages because our clinics have been primarily telemedicine for the last year.

#studyblr #medical school #medicine #medblr #pediatrics #peds #clinic #residency #pgy2 #outpatient medicine #medical #day in the life #bored because none of my patients are here