Surgery Senor

Midway through second year, my mental health has never been worse. I go to a school that is relatively supportive, with classmates who are, on the whole, genuinely kind people. I haven’t even made it to the wards yet, but I still feel beaten down. I’m tired. I’m sick of being constantly examined and nitpicked, of unclear expectations, of what sometimes feels like superhuman demands, of being told to do more “self care” when I don’t have time to take care of myself.

My advisor is kind and well meaning. She says things will get better third year when I’m not stuck in the classroom all the time, but she also reminds me that things are only going to get harder when I get to residency. She says this in the context of wanting me to get my mental health issues taken care of now, which is totally valid, but it’s also devastating to hear that this is not as bad as it gets. 

No one feels bad for medical students or doctors, not really. The conversation is mostly about how we get paid too much, or how our lack of sleep puts patients at risk, or how something got missed because we just didn’t empathize enough with or listen to our patient. Sometimes it feels like no one cares if our quality of life sucks as long as it’s not affecting patient care. “We knew what we were getting into”, and we get paid too much for anyone to feel sorry for us. 

That’s fine, I get it. We’re in the business of caring for people. We really are, in so many ways, privileged beyond belief. I got into medicine because I genuinely, truly wanted to help people. I wanted to be the “good doctor” that can empathize, that can really listen to and hear their patients. I wanted to give of myself every day. I wanted to be part of the solution, to fix “the system”. I wanted the ability to eliminate some of the pain and suffering in the world because I had watched my family suffer greatly due to the imperfection and limitations of medicine. 

Now I just feel tired, and broken, and sad all of the time. I feel deep regret for all of the life I’ve missed out on in the pursuit of medicine. All the sacrifices I made just to get here don’t feel worth it. 

Then you just do what you can to survive. 

There’s nothing right about crippling debts and a system that not only traps you economically but robs you of a meaningful life outside this career.  You become a slave to this machine.  And we’re taught (no one directly says this, but we tacitly systemically accept this) that to not go with the flow of things as it is, we’re somehow weak. 

I don’t recommend this career. 

partly it’s that there’s almost too much interest in it, people spend 3 years on average just to get into one. That’s 3 years of your young life and you haven’t even started medicine. 

I especially don’t recommend it to anyone with anxiety or depression or mental health issues. Not that I think they’re incapable, to the contrary we need more people who understand what it’s like to suffer from a medical or psychiatric condition. It’s just that the system will never offer any reprieve, and if anything destroy what resilience they have. it’s not just that it happens in medical, it gets worse in residency. Medical school is only the beginning.  Things are always at an extreme in this line of work, and things get both better and so much worse as you go up in training. there is perfect job or balance, not in medicine. 

And despite everyone asking about it a lot during med school, there is no work life balance. Maybe in family medicine or GP. But it’s a huge misconception otherwise. it’s just do what you can when you can, and you will barely have time to see family. I live my husband and there will be periods where we don’t physically see each other for a week because our schedules don’t match. it’s not even a question of they’re sleeping so we can’t interact. They’re not home at all when I’m home. And vice versa. 

There are great parts to this career, it goes without saying. But far more people are aware of its attractions than its realities or are so idealistic they don’t want to see the downsides of which there are many. 

“No matter the specifics, the officially-endorsed solution to unwellness is always: “Do more.” But do more is literally the last advice anyone should be giving residents. Adding commitments to a resident’s calendar will never be the answer.”

The second installation of the “Resident Wellness is a Lie” series by residency program director Jennifer R. Bernstein, published on in-House, the online peer-reviewed publication for residents & fellows.

Source. A collection of Meddit resources and advice on what bread-and-butter topics interns would most benefit from brushing up on/memorizing prior to the beginning of their internship. 1) Fluids. How and when to use them, dosage, timing and other pearls.

Review of fluids (not how to use them per se) by Dr. Strong /u/ericstrong

Maintenance Intravenous Fluids in Acutely Ill Patients - NEJM.

Pretty thorough review of fluid management on openanesthesia.org

2) Nausea. When to treat, how to treat and at what dose.

3) Standard pn orders: pain killers, sleep aids and antiemetics aka how to reduce nighttime calls from nurses by 25%

4) “Reflex” antibiotic choice for routine inpatient infections.

http://www.bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx /u/ChristianM and /u/ive_been_up_allnight

5) Initial work-up and treatment of dyspnea. (more realistic to approach by symptoms as, unfortunately, you first have to diagnose whats wrong. E.g. heart failure, pulmonary edema, embolism, COPD, pneumonia).

6) Initial work-up and treatment of oliguria/anuria.

7) A sensible initial approach to suspected ileus.

8) Blood. When, how, why to replace.

9) Pain. Optimal management without inducing narcosis.

Managing cancer pain: Frequently asked questions: CCJM

10) Potassium. When, why and how to shift or replace.

A review on both potassium and sodium disorders by Dr. Strong /u/ericstrong (Not reposted in 12) hyponatremia but applies there as well) https://www.youtube.com/playlist?list=PLYojB5NEEakXVIAapcSEleP4doUdHVtld

11) Hyponatremia. Most common electrolyte disturbance, commonly mismanaged.

12) Resuscitation aka commit the ACLS algorithms to memory.

Current ACLS guidelines. https://www.acls.net/aclsalg.htm

Would love a video series, interactive cases etc.

13) Basic EKG interpretation.

Whole EKG video courses

A whole free youtube EKG video review course by meddit’s own u/ericstrong

An alternative EKG course that takes you through all the basics. This however has no free version and costs 96$ a year. The quality is amazing. Here are 6 basic sample videos on youtube. The paid course is available on http://www.ecgteacher.com/

I have to admit I haven’t used this course personally but his free youtube videos are on-point and he seems like a good teacher. Also behind paywall. Free youtube samples are here. The full course can be found here https://www.ecgacademy.com.

EKG video cases

Amazing case-of-the-week emergency medicine EKG videos on youtube by Dr. Amal Mattu

– If you like Dr. Mattu’s cases (and you most certainly will) he is still posting every single week on his new site https://ecgweekly.com. It costs 4 starbucks coffees a year and is going to save someones life.

Practice EKGs with answers

Watching videos isn’t enough, you still have to grind out EKGs to keep your game strong. Visit http://ecgmadesimple.com and http://ecg.bidmc.harvard.edu/maven/mavenmain.asp for this.

EKG blogs

I recommend signing up for some kind of RSS feed (e.g. https://feedly.com/) and subscribing to the following EKG blogs:

http://hqmeded-ecg.blogspot.is (Dr. Smiths ECG blog)

http://www.ems12lead.com

http://ecg-interpretation.blogspot.is

http://jhcedecg.blogspot.is

EKG resource libraries

Life in the fastlane has a nice resource to look up a specific EKG finding, criteria or concept.

http://www.practicalclinicalskills.com/ekg.aspx /u/collidge

14) Know when to order ABGs and how to interpret them.

Almost too detailed video lecture series on ABGs and how to interpret them by Dr. Eric Strong (/u/ericstrong)

Practice makes perfect. ABG interpretation generator. https://abg.ninja/abg

Bonus 15) Basic CXR interpretation

CXR video lecture course

Again, Dr. Eric Strong has an excellent video course for free on youtube

Step-by-step guides to basic CXR interpretation

The Radiology Assistant: Chest X-ray - Basic interpretation

Radiology Masterclass step-by-step basic CXR

University of Virginia’s step-by-step basic CXR

All inclusive resources

The art and science of thoracic imaging All inclusive resource for all things thoracic! Jokes aside amazing resource.

UPenns CXR learning website

Loyola Universities excellent CXR Atlas Most outdated look but amazing content.

Checklist approach to CXR

Bonus 16) Overnight o-shit-what’s-that Head CT interpretation

Midnight radiology: Emergency CT of the head

As healthcare professionals, we have the unique privilege of meeting many people throughout our careers, often at extremely vulnerable times in their lives. Some of these times are vulnerable in happiness, but more often they are vulnerable in pain, suffering, and grief.

Loss is something that every human experiences at some point in their lives. It is as ubiquitous as it is inescapable. Every day, there is a person in the world who loses a loved one.

Over the weekend, we lost one of our chronic PICU patients, mere days before her first birthday. This sweet, lovely baby girl was always a joy to visit on my days in the PICU, and even when she spent some time on our chronic complex ward I would swing by to see her before I headed home.

When you lose a patient, you are allowed to feel the grief. You are allowed to mourn. There will always be this cloying feeling of not enough that sticks to the back of your throat, but the loss that you feel is testament that your memory of them is enough. The weight in your gut is the imprint they left on your soul and it is not a symbol of failure but rather a reminder that you knew them, you cared, and that was enough.