on selling the living will: "if you did this at a lawyer, it'd cost like 400 bucks. and here we'll do it for free!"
"We go to the doc for 85years. And they say, 'you have high blood pressure, take this pill', or 'you have diabetes, lose weight'. But when things get hard, we go 'you just sort things out and we'll just wait here'...it's okay to offer a recommendation if you understand the patient's goal." -- physician on advising a patient when it comes to end-of-life care
since we're about to be let loose onto the wards, we've been having a couple lectures to help remind us about a couple things we may have forgotten (read: how to present patients in a way that won't have residents salivating over who gets to ream us first on our inadequacies, the entire physical exam) and teach us a couple things we've never [really] learned, but somehow will manage to grasp and retain after a 50-min crash course (read: ABGs, EKGs, PFTs, LFTs, CMPs, phlebotomy, scrubbing in, fluids and electrolytes, everything ohmigod please keep me in the classroom before I accidentally do something I'm not qualified to do. like touch a patient). seriously, I have to pause for a moment to recall that maleus belongs in the middle ear, malleolus makes up the ankle bits I always manage to bump into the bed frame when I get up to pee at night, and to squash the instinct to say tibula (incidentally, my selective is in ortho how hiLARious is that?).
I used to LOVE being responsible. I LIVED for it. being the one who got things done, who people depended upon, who played critical roles in A through Z (type A, occupational hazard). not going to lie, sometimes I think about the responsibility and then panic and then think about how I could be plying tips with my boobs.
we also have lectures on other things, lest we forget that there are far more things to worry about being incompetent in, beyond the funds of knowledge [I don't have] and the practical techniques [I haven't learned on anything made of real fleshy bits]. for example: talking to patients. had a lecturer speak to us on advanced directives and DNAR. because these are precisely the types of things that terrify me about being given the privilege of now interacting with patients as part of their care team (auuuugh please don't expect me to know/do/not break anything), I was listening and taking notes in rapt attention. and mild terror.
here are some pearls.
how NOT to ask about code status:
If your heart stops, do you
want us to restart it? (pfft yeah, because we can actually do that)
want us to perform cardiopulmonary resuscitation? (jargon; yeah I want that, give me two of those)
want us to put you on a breathing machine and do chest compressions? (woah there, let's not start with the mechanics)
want us to put a big tube down your throat and do chest compressions and break all your ribs? (a little aggressive)
do you want us to do everything? (boy, talk about a euphemism here)
do you want help? (is this a rhetorical question?)
on talking about end-of-life care, or what the patient should be telling his/her loved ones:
"I want you to be able to communicate for me if I am too sick to speak for myself and not 'second guess' yourself."
"when I am in a vulnerable state, I don't want to worry that you will listen to others opinions about 'what is best for me'."
SUM: one way to skin this cat
"If you should die in spite of all of our efforts, how do you want things to be when you die? Do you want us to use heroic measures to attempt to bring you back?"
alternatively, the CATastrophe (harhar see what we did there?) question: "If there was a catastrophe and your heartbeat and breathing stopped, would you want us to sound the alarms and try to restart everything or let things be and allow you to die naturally?" (this is good, because then it doesn't sound like you are withholding something from them)
