Happy Halloween!
3 years ago
Friday, October 30, 2009
Say hey
I've got this song on repeat, because I just can't listen to this song and NOT smile. It makes me want to get up and move, and do good deeds and other wonderful things. "Seems like everywhere I go, the more I see the less I know, but I know one thing - I love you, I love you, I love you."
Hope you're all having a happy weekend - full of smiles, full of dancing, full of life.
Wednesday, October 28, 2009
The other side of the door
Today was my first day of primary care, and I found out that a couple classmates and I are working in the same group practice. After specifically asking my attending what she wanted me to do, I started to figure out the rhythm and flow of things. I was to get the patient from the waiting room and get vitals. Then, depending on what my attending had pre-decided with me, I'd either do a quick checkup by myself, or wait for her and do it together.
It was going well.
So I went out to the waiting room to bring the 2 o'clock appointment back, and then I saw him. The college grad from my neuro rotation. I had totally forgotten that I had set up his appointments for him, and he was to see his primary care physician today at 2:15pm.
I didn't know at the time, but his primary care physician is in the same practice as my attending.
"Mrs. O'Grady?" I called out, hoping that he was so engrossed in the magazine he was flipping through that he wouldn't look up, wouldn't see me, and I could pretend he didn't exist.
An old woman looked up. "Is it my turn, dear?"
"Yes, ma'am," I replied, cringing at bringing more attention to myself.
He did look up. And he did see me. "Michelle!" he said loudly, inquisitively.
"Oh hi there, Mr. Clark," I mumbled.
"Aren't you supposed to be on neuro?" he asked.
"Uh, no, I finished that rotation last week," I replied, willing my elderly patient to get her things together quicker, and to walker her way over to the door faster.
"Oh, so you're here now! Awesome! So I'll see you later?" he asked.
"Oh, I'm um, not working with your doctor, but I hope you have a good visit," I mumbled back, finally going over to help my little old lady with her things, and rushing her through the entrance door into the safety of my doctor's exam rooms.
I took an especially long history with Ms. O'Grady, but thankfully his physician's office is located in a completely different area from where I was. I never did see him after that.
But I guess I spoke too soon last time.
Seriously? What are the odds?!
It was going well.
So I went out to the waiting room to bring the 2 o'clock appointment back, and then I saw him. The college grad from my neuro rotation. I had totally forgotten that I had set up his appointments for him, and he was to see his primary care physician today at 2:15pm.
I didn't know at the time, but his primary care physician is in the same practice as my attending.
"Mrs. O'Grady?" I called out, hoping that he was so engrossed in the magazine he was flipping through that he wouldn't look up, wouldn't see me, and I could pretend he didn't exist.
An old woman looked up. "Is it my turn, dear?"
"Yes, ma'am," I replied, cringing at bringing more attention to myself.
He did look up. And he did see me. "Michelle!" he said loudly, inquisitively.
"Oh hi there, Mr. Clark," I mumbled.
"Aren't you supposed to be on neuro?" he asked.
"Uh, no, I finished that rotation last week," I replied, willing my elderly patient to get her things together quicker, and to walker her way over to the door faster.
"Oh, so you're here now! Awesome! So I'll see you later?" he asked.
"Oh, I'm um, not working with your doctor, but I hope you have a good visit," I mumbled back, finally going over to help my little old lady with her things, and rushing her through the entrance door into the safety of my doctor's exam rooms.
I took an especially long history with Ms. O'Grady, but thankfully his physician's office is located in a completely different area from where I was. I never did see him after that.
But I guess I spoke too soon last time.
Seriously? What are the odds?!
Monday, October 26, 2009
Bad romance
[Day 1 of hospitalization]
It was a busy day on the stroke service. Our entire team was getting slammed, admitting people with migraines, TIAs, and stroke-like symptoms. I already had three new patients that morning. And then the ED paged us again. A young 21-year-old guy who had just graduated from college was downstairs with the Worst Headache Of His Life.
Worst headache of your life = subarachnoid hemorrhage = not a good thing.
"You think you can handle this one, Michelle?" my senior resident asked me.
"Oh, I've already handled it," I sassed back. Because when I'm stressed out, I say inappropriate things to people of authority.
"What?"
"Nothing," I mumbled, as I ran down to the ED to meet the patient. And after getting a CT scan of his brain and a lumbar puncture, we ruled out hemorrhage, and started the work up for dissection.
He ended up having a pretty severe vertebral dissection. So we started him on some anticoagulation, but because Coumadin takes some time to reach therapeutic levels, he'd have to stay on our service for a couple of days.
[Day 2 of hospitalization]
I saw him the next morning for no more than five minutes, as I was just checking to make sure he was still alive and not having any more complications. I didn't have any extra time to spend on him, since I had patients with lateral medullary strokes and actual findings on physical exam that I'd have to report during my oral presentations. He was just getting anticoagulated. He was a low-priority patient to me.
I went home later that night, and upon checking my email, saw that my patient had found me on Facebook and sent me a friend request. I ignored it, but changed my privacy settings.
[Day 3 and 4 of hospitalization]
I had class on Friday, so I wasn't in the hospital. And Saturday was my designated day off.
[Day 5 of hospitalization]
I got to the hospital pretty early that day. I had to preround on my patients and my teammate's since it was his turn for a day off. I decided to check on my college grad first, since he probably had no complications and would be leaving as soon as his INR was therapeutic.
We delved back into health-related conversation. No pain overnight, no headaches, no tingling, numbness, or weakness. I checked the computer. His INR was 2.1 - just therapeutic. He'd be going home that day, as soon as I prepped his discharge papers, I told him. He was excited - he had tickets for some concert that night.
The next day, we were back to our normal weekly rhythm. I was typing up discharge instructions for another patient when I got a page from my senior resident - "come to ED, now."
I ran.
Apparently our college grad was back. Thinking he had probably gone out drinking or done some massive headbanging at his concert, my senior resident and I were convinced he had done something to exacerbate his dissection. He had told the ER docs that he was having a headache, 10/10 on the pain scale.
Yet, when we pulled the curtain aside, he was lying there in his bed, in no acute distress. In fact, he greeted me with a cheery, "Hi Michelle!" when he saw me. As we probed further, we found out that he hadn't filled his prescriptions for his anticoagulation.
We left the room to check his labs.
"Damn irresponsible college teenagers!" my senior resident muttered, as he clicked around on the computer to see what our patient's INR currently was. But before I could jokingly remind my resident that college grads aren't necessarily teenagers anymore, we saw the number. His INR was 1.5.
He was subtherapeutic, and would have to be rehospitalized. "Dang it," I echoed.
"Hey, was it just me, or did he seem too excited to be back in the hospital?" my resident asked me.
"Huh? Uh, I dunno. Well, yeah, now that you've mentioned it, I guess so. I'd be pretty bummed out if I had to spend the night here," I replied.
My resident cocked an eyebrow at me. And then he wrote in an order along with bed assignment, male nursing preferred. I didn't even know that was possible.
His INR was back to therapeutic levels the next day, so we were ready to discharge him again. We personally filled his prescriptions and set up appointments for him. There would be no excuses for him to come back to the hospital.
Later that day, while I was finishing up some progress notes, I got a Facebook message. From my favorite patient. It was lengthy. And to be honest, it started off quite sweet, thanking me for taking care of him and explaining things in layman's terms. Then, he started telling me about how he was new to the area and wanted to get to know me better, when he wasn't stuck in a hospital bed. Perhaps I would agree to dinner and a movie?
I shrieked. And my fellow M3 teammate sitting next to me immediately looked over, read it, and started cracking up. "Well, now we know why he came back to the hospital." "Shut up." "Are you going to answer it?" "Hell, no." "You should! Be like, dude, I saw you naked. You'd think I'd say yes?" "Oooh, that's so mean." "But funny!"
I didn't answer it. He had been discharged, and I'd never see him again.
Or so I thought.
Two days later, while I was hiding in a conference room studying, I got a page from my resident - "Get ye to the library and stay there until I tell you it's safe to come back to the floor."
I was confused, but like a good medical student, I followed my orders and went to the library.
An hour or so later, my resident called me. Apparently, my favorite patient had been back to the floor voluntarily. He was asking the unit secretary to page me and my resident overheard.
That's when my resident paged me with his 911 warning.
And that was my last day on neurology. And hopefully, the last time I'd ever have to hear about this patient. Because I honestly think I'd be okay never seeing or hearing about him again.
It was a busy day on the stroke service. Our entire team was getting slammed, admitting people with migraines, TIAs, and stroke-like symptoms. I already had three new patients that morning. And then the ED paged us again. A young 21-year-old guy who had just graduated from college was downstairs with the Worst Headache Of His Life.
Worst headache of your life = subarachnoid hemorrhage = not a good thing.
"You think you can handle this one, Michelle?" my senior resident asked me.
"Oh, I've already handled it," I sassed back. Because when I'm stressed out, I say inappropriate things to people of authority.
"What?"
"Nothing," I mumbled, as I ran down to the ED to meet the patient. And after getting a CT scan of his brain and a lumbar puncture, we ruled out hemorrhage, and started the work up for dissection.
He ended up having a pretty severe vertebral dissection. So we started him on some anticoagulation, but because Coumadin takes some time to reach therapeutic levels, he'd have to stay on our service for a couple of days.
[Day 2 of hospitalization]
I saw him the next morning for no more than five minutes, as I was just checking to make sure he was still alive and not having any more complications. I didn't have any extra time to spend on him, since I had patients with lateral medullary strokes and actual findings on physical exam that I'd have to report during my oral presentations. He was just getting anticoagulated. He was a low-priority patient to me.
I went home later that night, and upon checking my email, saw that my patient had found me on Facebook and sent me a friend request. I ignored it, but changed my privacy settings.
[Day 3 and 4 of hospitalization]
I had class on Friday, so I wasn't in the hospital. And Saturday was my designated day off.
[Day 5 of hospitalization]
I got to the hospital pretty early that day. I had to preround on my patients and my teammate's since it was his turn for a day off. I decided to check on my college grad first, since he probably had no complications and would be leaving as soon as his INR was therapeutic.
ME
Hey, good morning! I haven't seen you in a while! How've you been?
COLLEGE GRAD PATIENT
Well, I'd be better if you had friended me on facebook. Where have you been the past couple of days? Are you avoiding me?
ME
Uh, oh, um - I had class on Friday and yesterday was my day off. And uh, I'm not on facebook much, so uh, yeah.
COLLEGE GRAD PATIENT
I'm just teasing. It's okay if you don't want to be my friend.
ME
[nervous laughter]
Uh, let's talk about any overnight events. Anything happen?
Hey, good morning! I haven't seen you in a while! How've you been?
COLLEGE GRAD PATIENT
Well, I'd be better if you had friended me on facebook. Where have you been the past couple of days? Are you avoiding me?
ME
Uh, oh, um - I had class on Friday and yesterday was my day off. And uh, I'm not on facebook much, so uh, yeah.
COLLEGE GRAD PATIENT
I'm just teasing. It's okay if you don't want to be my friend.
ME
[nervous laughter]
Uh, let's talk about any overnight events. Anything happen?
We delved back into health-related conversation. No pain overnight, no headaches, no tingling, numbness, or weakness. I checked the computer. His INR was 2.1 - just therapeutic. He'd be going home that day, as soon as I prepped his discharge papers, I told him. He was excited - he had tickets for some concert that night.
The next day, we were back to our normal weekly rhythm. I was typing up discharge instructions for another patient when I got a page from my senior resident - "come to ED, now."
I ran.
Apparently our college grad was back. Thinking he had probably gone out drinking or done some massive headbanging at his concert, my senior resident and I were convinced he had done something to exacerbate his dissection. He had told the ER docs that he was having a headache, 10/10 on the pain scale.
Yet, when we pulled the curtain aside, he was lying there in his bed, in no acute distress. In fact, he greeted me with a cheery, "Hi Michelle!" when he saw me. As we probed further, we found out that he hadn't filled his prescriptions for his anticoagulation.
We left the room to check his labs.
"Damn irresponsible college teenagers!" my senior resident muttered, as he clicked around on the computer to see what our patient's INR currently was. But before I could jokingly remind my resident that college grads aren't necessarily teenagers anymore, we saw the number. His INR was 1.5.
He was subtherapeutic, and would have to be rehospitalized. "Dang it," I echoed.
"Hey, was it just me, or did he seem too excited to be back in the hospital?" my resident asked me.
"Huh? Uh, I dunno. Well, yeah, now that you've mentioned it, I guess so. I'd be pretty bummed out if I had to spend the night here," I replied.
My resident cocked an eyebrow at me. And then he wrote in an order along with bed assignment, male nursing preferred. I didn't even know that was possible.
His INR was back to therapeutic levels the next day, so we were ready to discharge him again. We personally filled his prescriptions and set up appointments for him. There would be no excuses for him to come back to the hospital.
Later that day, while I was finishing up some progress notes, I got a Facebook message. From my favorite patient. It was lengthy. And to be honest, it started off quite sweet, thanking me for taking care of him and explaining things in layman's terms. Then, he started telling me about how he was new to the area and wanted to get to know me better, when he wasn't stuck in a hospital bed. Perhaps I would agree to dinner and a movie?
I shrieked. And my fellow M3 teammate sitting next to me immediately looked over, read it, and started cracking up. "Well, now we know why he came back to the hospital." "Shut up." "Are you going to answer it?" "Hell, no." "You should! Be like, dude, I saw you naked. You'd think I'd say yes?" "Oooh, that's so mean." "But funny!"
I didn't answer it. He had been discharged, and I'd never see him again.
Or so I thought.
Two days later, while I was hiding in a conference room studying, I got a page from my resident - "Get ye to the library and stay there until I tell you it's safe to come back to the floor."
I was confused, but like a good medical student, I followed my orders and went to the library.
An hour or so later, my resident called me. Apparently, my favorite patient had been back to the floor voluntarily. He was asking the unit secretary to page me and my resident overheard.
RESIDENT
Hey buddy, why are you back? And why are you looking for Michelle?
PATIENT
Oh, I uh, think I left something here in my room, and I didn't want to bother you about it.
RESIDENT
Let me just send something really quickly on the computer, and then I can take you to your room and see if you forgot anything, okay?
Hey buddy, why are you back? And why are you looking for Michelle?
PATIENT
Oh, I uh, think I left something here in my room, and I didn't want to bother you about it.
RESIDENT
Let me just send something really quickly on the computer, and then I can take you to your room and see if you forgot anything, okay?
That's when my resident paged me with his 911 warning.
And that was my last day on neurology. And hopefully, the last time I'd ever have to hear about this patient. Because I honestly think I'd be okay never seeing or hearing about him again.
Tuesday, October 20, 2009
Hey good-lookin'
The characters:
A feisty 97 year old patient
My short and balding, but gracefully aging, neurology attending
A feisty 97 year old patient
My short and balding, but gracefully aging, neurology attending
ATTENDING
When was the last time you saw your doctor?
FEISTY PATIENT
Pshaw! I don't need a doctor. I've only seen a doctor TWICE in all these years. And I didn't even need the checkup!
ATTENDING
Well, I think you need an internist now for sure. I'll make sure we set you up with someone. Do you prefer a man or a woman?
FEISTY PATIENT
A man, of course! Can you make him young and good-looking??
ATTENDING
Hm. You want a young, good-looking internist. Well, I'm sorry ma'am - I'm a neurologist, so we'll have to find you someone else.
When was the last time you saw your doctor?
FEISTY PATIENT
Pshaw! I don't need a doctor. I've only seen a doctor TWICE in all these years. And I didn't even need the checkup!
ATTENDING
Well, I think you need an internist now for sure. I'll make sure we set you up with someone. Do you prefer a man or a woman?
FEISTY PATIENT
A man, of course! Can you make him young and good-looking??
ATTENDING
Hm. You want a young, good-looking internist. Well, I'm sorry ma'am - I'm a neurologist, so we'll have to find you someone else.
Friday, October 09, 2009
Say my name
NEURO ATTENDING
[droning on and on about something]
...blah blah blah, and so then we use clozapine frequently for that reason.
ME
But dude! Clozapine has so many terrible side effects...that agranulocytosis would not be worth it in my opinion.
NEURO ATTENDING
[staring at me]
ME
Um...or not?
NEURO ATTENDING
Did you just call me 'dude'??
ME
Of course not, my good kind sir.
[droning on and on about something]
...blah blah blah, and so then we use clozapine frequently for that reason.
ME
But dude! Clozapine has so many terrible side effects...that agranulocytosis would not be worth it in my opinion.
NEURO ATTENDING
[staring at me]
ME
Um...or not?
NEURO ATTENDING
Did you just call me 'dude'??
ME
Of course not, my good kind sir.
Thursday, October 08, 2009
In 1984 (who could ask for more)
Joshua Bell plays Bruch, Cafe des Architectes, triple chocolate mousse, raspberry cheesecake, green tea cream trifle, cupcake cakes shaped like fluffy puppies, really just way too much cake, sushi galore at Meiji, lots of birthday surprises and unsurprises, 8 lbs of crab legs (no joke!), neuro call, Cranium meets Taboo board game mash up, Godiva chocolates, the best friends in the world, and a really fantastic boyfriend.
Thanks much to everyone for helping me celebrate my quarter-century milestone.
Thanks much to everyone for helping me celebrate my quarter-century milestone.
Sunday, October 04, 2009
Dear agony
I must have some mild form of Asperger's.
Seriously. There's no other way to explain how I can be so frightfully awkward sometimes.
So a couple of weeks ago, I met my friend Amy at a high-end grocery store. I had just gotten home from a long night on call, so my hair was a mess, my face was oily, and there was a peanut butter stain on my pants. She wanted to take advantage of a 15% off sale, and I just wanted to get some dinner. And since Amy is non-judgmental, I figured she wouldn't mind seeing me in all my dirty glory.
She didn't. But I really ought to know by now that when I look my absolute worst, I am bound to run into someone. (See here, here, and here.)
So as Amy and I were perusing the pastries and desserts, I saw someone familiar. Realizing who it was, I shrieked, grabbed Amy's hand and pulled her down to the ground with me to hide behind a large display of condiments. It was my first boyfriend. I haven't seen him in years and then on a day when I look terrible, I randomly run into him in a grocery store? What are the odds? Seriously, fate has a wicked sense of humor.
Amy yelped as I pulled her arm down. "Who are we hiding from?" she whispered. "An ex-boyfriend," I replied. She peered around the corner and upon seeing who it was, asked, "but wasn't that like five years ago??"
No, it's actually been seven years. One full dog year. What is wrong with me?
In the midst of our whispering, someone came up behind us.
"Michelle?"
It was him. He had heard someone cry out, and being a responsible doctor and all, had come over to investigate.
"Oh hi! We were just, uh, checking out these cool Frontera Grill salsas. Look at the crazy variety!"
Amy was cracking up, and after making up some obviously fake excuse about her cupcake being ready, she darted away.
We made small talk. Very awkward small talk.
"So, I hear you've moved into that new condo building along the river. It looks so nice!"
"Yeah, sadly, the monthly mortgage bill is not so nice."
"Haha. So how's your intern year going? Oh! My intern from last week is in your program!"
"Oh yeah? Who?"
My mind blanked. I had just spent a whole 80-hour work week with him, and I could not for the life of me come up with a name.
"Ummm, it starts with a J. Uhhh, oh JAMES! James! His name is James. Yes, James."
I said James four times. Count them. I don't know why, but I couldn't stop the word vomit.
"Oh, there are a few James. Does he have a last name?"
He was jokingly mocking me, but the thing is, again, my mind blanked. Seriously, I had worked closely with this guy. I had introduced him so many times to my patients. What was wrong with me?
"Oh last name! Yeah, he has one of those. [Nervous laughter.] Uh, it rhymes with moose. Tousse. James Tousse. That's my intern."
"Hm, I don't think I've met him yet."
"He's tall, incredibly smart, and All-American...he kinda looks like an Abercrombie guy."
He started saying something, but in the midst of my embarrassment over not knowing my own intern's name, I only heard the last bit: "....man, competition!"
It was my turn to say something, as he looked at me. So I blurted out, "oh he's not! He's married!"
There was an awkward pause. Did I really just say that? Holy cow, I did. WHY? Why did I just say that? I still have no idea what prompted my subconscious to associate competition with marriage. I floundered for words. "Oh you meant for chief resident! Dude, no, you're going to be great. Uh, I'm going to go find my friend and see how her cupcake came out...but good luck with everything and uh...I'll see you around!"
I high-tailed it out of there as soon as possible, my face as red as it would be after a couple of drinks.
What is wrong with me?! Seriously! It's been seven years!
Sigh. I must have Asperger's.
Seriously. There's no other way to explain how I can be so frightfully awkward sometimes.
So a couple of weeks ago, I met my friend Amy at a high-end grocery store. I had just gotten home from a long night on call, so my hair was a mess, my face was oily, and there was a peanut butter stain on my pants. She wanted to take advantage of a 15% off sale, and I just wanted to get some dinner. And since Amy is non-judgmental, I figured she wouldn't mind seeing me in all my dirty glory.
She didn't. But I really ought to know by now that when I look my absolute worst, I am bound to run into someone. (See here, here, and here.)
So as Amy and I were perusing the pastries and desserts, I saw someone familiar. Realizing who it was, I shrieked, grabbed Amy's hand and pulled her down to the ground with me to hide behind a large display of condiments. It was my first boyfriend. I haven't seen him in years and then on a day when I look terrible, I randomly run into him in a grocery store? What are the odds? Seriously, fate has a wicked sense of humor.
Amy yelped as I pulled her arm down. "Who are we hiding from?" she whispered. "An ex-boyfriend," I replied. She peered around the corner and upon seeing who it was, asked, "but wasn't that like five years ago??"
No, it's actually been seven years. One full dog year. What is wrong with me?
In the midst of our whispering, someone came up behind us.
"Michelle?"
It was him. He had heard someone cry out, and being a responsible doctor and all, had come over to investigate.
"Oh hi! We were just, uh, checking out these cool Frontera Grill salsas. Look at the crazy variety!"
Amy was cracking up, and after making up some obviously fake excuse about her cupcake being ready, she darted away.
We made small talk. Very awkward small talk.
"So, I hear you've moved into that new condo building along the river. It looks so nice!"
"Yeah, sadly, the monthly mortgage bill is not so nice."
"Haha. So how's your intern year going? Oh! My intern from last week is in your program!"
"Oh yeah? Who?"
My mind blanked. I had just spent a whole 80-hour work week with him, and I could not for the life of me come up with a name.
"Ummm, it starts with a J. Uhhh, oh JAMES! James! His name is James. Yes, James."
I said James four times. Count them. I don't know why, but I couldn't stop the word vomit.
"Oh, there are a few James. Does he have a last name?"
He was jokingly mocking me, but the thing is, again, my mind blanked. Seriously, I had worked closely with this guy. I had introduced him so many times to my patients. What was wrong with me?
"Oh last name! Yeah, he has one of those. [Nervous laughter.] Uh, it rhymes with moose. Tousse. James Tousse. That's my intern."
"Hm, I don't think I've met him yet."
"He's tall, incredibly smart, and All-American...he kinda looks like an Abercrombie guy."
He started saying something, but in the midst of my embarrassment over not knowing my own intern's name, I only heard the last bit: "....man, competition!"
It was my turn to say something, as he looked at me. So I blurted out, "oh he's not! He's married!"
There was an awkward pause. Did I really just say that? Holy cow, I did. WHY? Why did I just say that? I still have no idea what prompted my subconscious to associate competition with marriage. I floundered for words. "Oh you meant for chief resident! Dude, no, you're going to be great. Uh, I'm going to go find my friend and see how her cupcake came out...but good luck with everything and uh...I'll see you around!"
I high-tailed it out of there as soon as possible, my face as red as it would be after a couple of drinks.
What is wrong with me?! Seriously! It's been seven years!
Sigh. I must have Asperger's.
Saturday, October 03, 2009
Digital monkey
After a week or so on the wards, my resident sat down and taught us how to get the Code Status from patients. It’s required that every patient be asked their code status, of course, and it was always a bit awkward that I would spend 40 minutes getting to know the patient, and then after I left, my intern or resident would see the patient for two minutes and quite informally ask them about DNR/DNI. Needless to say, the patients were always somewhat taken aback. “The medical student didn’t say anything! Am I going to die?! Are you expecting me to need to be intubated?” So my resident decided that it would be best if we learned how to get the code status, so that it could just be a part of our spiel. We practiced with each other and had a pretty standard speech set and ready to go when I would need it.
All I knew about my patient was that she was an 82 year old female who had an atrial fibrillation episode with a rapid ventricular rate. She was Russian, she told me in broken English after I walked in and introduced myself. No problem. I picked up the phone, dialed in the Russian language line, and we started having our conversation. The history went really well, even with the awkward pauses as we each waited for the interpreter to translate. In the middle of our conversation, I got a page from my resident - “Don’t forget to get the code status!!” After the initial butterflies and a couple of deep breaths, I reassured myself that I could do it. I'd practiced with my resident, with standardized patients - how hard could it be on a real live person?
So I pulled out the pre-written speech that my resident had given me, and I started my code status spiel. “Lastly, this is a question we ask all of our patients who are admitted into the hospital. Now, we think you’re going to be fine, but in case of an emergency – specifically, if your heart stopped or you had such difficulty breathing that you’d need a breathing tube or ventilator, what would you want us to do?”
She was smiling as the translator translated. And then as more of it got translated, confusion and shock took over. “You’re my physician! I came to the hospital to be taken care of by you!”
I reassured her that we would of course take care of her. I explained to her what we normally do during a code status, adding at the end, “so I’m just asking if you had wishes or beliefs contrary to this.”
She spoke rapidly in Russian with the translator.
The translator then broke from her translator role and told me that in Russian culture, it is taboo to talk about possible life-threatening situations, as my patient thought that it was essentially inviting in the devil. My patient didn’t want to make this decision, since she felt it was the doctors’ responsibility to determine whether to do everything or let her go.
I apologized, and ended the encounter as gracefully as I could.
When I went back to the team room and relayed the whole story to my resident. He nodded understandingly, told me to review her chart and said, “and if there’s nothing, just put her down as Full Code.”
She had never been to our hospital before, so there were no records for her. So, like a lemming, I did as I was told, and put her down as full code.
Two weeks later, I had a class on difficult discussions, and the issue of obtaining DNR/DNI status was brought up. We were told to never use specifics - don't ask about their heart stopping or breathing cessation, and NEVER ask if they want the care team to do everything. And of course, never assume anything. And NEVER go in alone.
I had done everything wrong.
Luckily for me, nothing happened. Her hospital stay was uneventful and she went home the next afternoon. But I can't help worrying about the Full Code status that is now in her chart. Because, chances are that she will return to the hospital with yet another heart issue, and another med student will interview her and she will again refuse to make a DNR/DNI decision, and some resident will tell that med student to review the charts. And there it will be - FULL CODE.
All I knew about my patient was that she was an 82 year old female who had an atrial fibrillation episode with a rapid ventricular rate. She was Russian, she told me in broken English after I walked in and introduced myself. No problem. I picked up the phone, dialed in the Russian language line, and we started having our conversation. The history went really well, even with the awkward pauses as we each waited for the interpreter to translate. In the middle of our conversation, I got a page from my resident - “Don’t forget to get the code status!!” After the initial butterflies and a couple of deep breaths, I reassured myself that I could do it. I'd practiced with my resident, with standardized patients - how hard could it be on a real live person?
So I pulled out the pre-written speech that my resident had given me, and I started my code status spiel. “Lastly, this is a question we ask all of our patients who are admitted into the hospital. Now, we think you’re going to be fine, but in case of an emergency – specifically, if your heart stopped or you had such difficulty breathing that you’d need a breathing tube or ventilator, what would you want us to do?”
She was smiling as the translator translated. And then as more of it got translated, confusion and shock took over. “You’re my physician! I came to the hospital to be taken care of by you!”
I reassured her that we would of course take care of her. I explained to her what we normally do during a code status, adding at the end, “so I’m just asking if you had wishes or beliefs contrary to this.”
She spoke rapidly in Russian with the translator.
The translator then broke from her translator role and told me that in Russian culture, it is taboo to talk about possible life-threatening situations, as my patient thought that it was essentially inviting in the devil. My patient didn’t want to make this decision, since she felt it was the doctors’ responsibility to determine whether to do everything or let her go.
I apologized, and ended the encounter as gracefully as I could.
When I went back to the team room and relayed the whole story to my resident. He nodded understandingly, told me to review her chart and said, “and if there’s nothing, just put her down as Full Code.”
She had never been to our hospital before, so there were no records for her. So, like a lemming, I did as I was told, and put her down as full code.
Two weeks later, I had a class on difficult discussions, and the issue of obtaining DNR/DNI status was brought up. We were told to never use specifics - don't ask about their heart stopping or breathing cessation, and NEVER ask if they want the care team to do everything. And of course, never assume anything. And NEVER go in alone.
I had done everything wrong.
Luckily for me, nothing happened. Her hospital stay was uneventful and she went home the next afternoon. But I can't help worrying about the Full Code status that is now in her chart. Because, chances are that she will return to the hospital with yet another heart issue, and another med student will interview her and she will again refuse to make a DNR/DNI decision, and some resident will tell that med student to review the charts. And there it will be - FULL CODE.
