I wake up after the third snooze. I’ve always been a heavy sleeper.
It makes being on call an adventure, as every phone conversation is begun with me still emerging from a deep slumber.
Mercifully, this was a good call night.
I got a few hours of uninterrupted sleep. 1/
It makes being on call an adventure, as every phone conversation is begun with me still emerging from a deep slumber.
Mercifully, this was a good call night.
I got a few hours of uninterrupted sleep. 1/
Brush, floss, shower, shave, change, boom, out-the-door.
As I go, I’m getting my first calls from nurses at the hospital with abnormal lab values.
I used to loathe these calls, but now I appreciate them. Gets my brain in gear.
The first consults are also trickling in. 2/
As I go, I’m getting my first calls from nurses at the hospital with abnormal lab values.
I used to loathe these calls, but now I appreciate them. Gets my brain in gear.
The first consults are also trickling in. 2/
I usually have a fairly good idea of how my morning is going to go by now.
First stop, the hospital.
I listen to music while I drive. Waking up.
Sing along, loudly. The 90’s.
“LIFE IS A HIGHWAY!”
“Hey jealousy!”
And I said, “What about Breakfast at Tiffany’s?”
“1979.” 3/
First stop, the hospital.
I listen to music while I drive. Waking up.
Sing along, loudly. The 90’s.
“LIFE IS A HIGHWAY!”
“Hey jealousy!”
And I said, “What about Breakfast at Tiffany’s?”
“1979.” 3/
Park the car. Stethoscope around my neck. ID badge clipped to shirt.
No white coat. I don’t need the pockets and it’s a grime magnet.
As I enter the hospital I’m already starting to triage the work ahead.
But first, the cafeteria.
Yogurt and granola.
Eat fast. 4/
No white coat. I don’t need the pockets and it’s a grime magnet.
As I enter the hospital I’m already starting to triage the work ahead.
But first, the cafeteria.
Yogurt and granola.
Eat fast. 4/
Next stop, Intensive Care Unit. The day always starts with the sickest patients.
Discuss with the intensivist. Round with the nurses, dietitians, respiratory therapists. Talk with the families.
Each room in the ICU is its own world, with its own realities.
I’ve learned. 5/
Discuss with the intensivist. Round with the nurses, dietitians, respiratory therapists. Talk with the families.
Each room in the ICU is its own world, with its own realities.
I’ve learned. 5/
Some rooms are steeped in sorrow. Some have their own gravity, drawing everything up into that deepest stillness. Some are lighter, bearing witness to everyday miracles.
Sometimes I’m helpful. Often I’m helpless.
I understand that sometimes I’m just there to ... be there. 6/
Sometimes I’m helpful. Often I’m helpless.
I understand that sometimes I’m just there to ... be there. 6/
The work is piling up now. Consults coming in more frequently, plus calls on established patients, clinic patients, dialysis patients, transplant patients.
Multitask.
Some consults are easy. Some are fiendishly difficult, requiring all my knowledge, and lots of time. 7/
Multitask.
Some consults are easy. Some are fiendishly difficult, requiring all my knowledge, and lots of time. 7/
Many of the patients I already know. Many are new to me.
I try and use empathy “shortcuts.” Small personal details that have nothing to do with the patient’s illness.
A pet. A hobby. A dream. A love.
It helps me to connect, and find some context.
Context is everything. 8/
I try and use empathy “shortcuts.” Small personal details that have nothing to do with the patient’s illness.
A pet. A hobby. A dream. A love.
It helps me to connect, and find some context.
Context is everything. 8/
Patients often want me to talk about what’s possible, what’s impossible.
I don’t like dealing in possibility.
I prefer to deal in probability.
Probabilities allow for a better grasp of the issues, and better decision-making, in my experience.
Possibilities often run wild. 9/
I don’t like dealing in possibility.
I prefer to deal in probability.
Probabilities allow for a better grasp of the issues, and better decision-making, in my experience.
Possibilities often run wild. 9/
My day has to be fluid, so I can respond to emergencies. But I also need it to be meticulously structured.
I have a half-day clinic in my office, every day. I have dialysis units to go to, acute rehabs, LTACs.
One sick patient, or an urgent procedure, and it gets tough. 10/
I have a half-day clinic in my office, every day. I have dialysis units to go to, acute rehabs, LTACs.
One sick patient, or an urgent procedure, and it gets tough. 10/
A good day is when I help someone.
A bad day is when I can’t keep my head above water. Or a patient has a bad outcome. Or I mess up. Or all of the above.
Some weeks I soar.
Some weeks I drown every day.
My heart doesn’t break as often as it used to. But it still does. 11/
A bad day is when I can’t keep my head above water. Or a patient has a bad outcome. Or I mess up. Or all of the above.
Some weeks I soar.
Some weeks I drown every day.
My heart doesn’t break as often as it used to. But it still does. 11/
There is a strange but steady undercurrent of resistance throughout my day.
Insurance companies telling me I can’t do this or that, or asking for authorization. Pharmacies wanting to change my orders. Case managers asking why a patient hasn’t been discharged.
I feel it. 12/
Insurance companies telling me I can’t do this or that, or asking for authorization. Pharmacies wanting to change my orders. Case managers asking why a patient hasn’t been discharged.
I feel it. 12/
Middle of the day. Stomach growls angrily. Lunch time.
I grab whatever is convenient, bonus points if it’s healthy, or warm.
I sit by myself. Take a moment to catch my breath. Post a tweet thread (like this one!).
I’m not antisocial.
I just prefer eating alone. 13/
I grab whatever is convenient, bonus points if it’s healthy, or warm.
I sit by myself. Take a moment to catch my breath. Post a tweet thread (like this one!).
I’m not antisocial.
I just prefer eating alone. 13/
Back to the office. Time for my half-day clinic. 6-12 patients, new ones and follow-ups.
I enjoy this. Most of these patients I know fairly well, some for years.
The pace is slower than the hospital. The rhythms are familiar.
Longitudinal care can be deeply fulfilling. 14/
I enjoy this. Most of these patients I know fairly well, some for years.
The pace is slower than the hospital. The rhythms are familiar.
Longitudinal care can be deeply fulfilling. 14/
When is my day over? Technically the on-call coverage takes over at 6PM. Realistically, it’s over when the work is done.
I get home. Shoes off. Change. Exercise.
Try and listen to myself.
Figure out what burdens I’m carrying, and try to let them go.
Be still.
Sleep. 15/
I get home. Shoes off. Change. Exercise.
Try and listen to myself.
Figure out what burdens I’m carrying, and try to let them go.
Be still.
Sleep. 15/
I wake up after the third snooze. I’ve always been a heavy sleeper.
I love what I do. It’s a privilege.
But sometimes I feel like I’m losing pieces of myself along the way.
They say, “Focus on wellness.”
All candles eventually burn out.
The first calls come in.
I answer.
I love what I do. It’s a privilege.
But sometimes I feel like I’m losing pieces of myself along the way.
They say, “Focus on wellness.”
All candles eventually burn out.
The first calls come in.
I answer.
