F Heme/Onc...FONC !!!

Ahhh.... I'm trying hard to find the humor in the AWFUL, AWFUL experience that is Heme/Onc. I'm violating the 10hr rule all the time (supposed to have a 10hr break between shifts at the hospital...allegedly). The nurses pager-bomb us about EVERYTHING ("Just wanted to let you know the patient's temperature is in the high 98 degree to low 99 degree range! It's not actually a fever yet, but it could BECOME one- I just wanted to make sure you were aware!"), so I can't get any of my notes done until late. And I know it's random because we alternate admissions between interns, but I keep getting all the most sick, least stable patients. In the last 2 weeks, I've had 3 transfers to the ICU, 2 near transfers, and 3 deaths on service. Came in today to hear that yet another one of my patients (aplastic anemia and hemorrhaging) got transferred to the MICU overnight. In retrospect, it probably was not an appropriate transfer for Outside Hospital to admit her directly to our Heme-Onc service from their ICU. Anyway.

I usually get to the hospital around 6:15am; I'm there until 8 or 9pm. 10pm sometimes. By the time I get home, eat dinner, bathe... it's 11pm or midnight. I go to sleep, and wake up at 5am to do it all over again. This in itself would be depressing enough; add to it that the entire day we're working nonstop, trying to juggle all our patients (the service has been at or near capped most of the past 2.5wks), who are all seriously ill cancer patients. Seriously ill = time intensive care. Cancer patients = every story is a sad story. There are no happy stories. The closest thing to a happy moment with a patient today: agreed with 27yr old new mother with leukemia that she looked "very punk rock" with her newly shaved head. She had given herself a buzz cut last night since her hair was falling out in disturbing chunks due to the chemo.

Or how about another of my patients, formerly healthy construction worker, now with acute leukemia, usually so cheerful and positive but today... just starting to feel the effect of his chemo. He asks daily about his prognosis (the heme/onc fellow's predictions aren't going to change, they're all based on genetics and his bone marrow biopsy...which we review every single day)- today after he asked his usual questions, he just stared off into space and looked so sad. He looked like he was facing his own mortality for the first time as a real and imminent possibility. Like he was watching his own soul wander away from his body and leave him there, helpless. Then his wife came over and caressed his forehead and told him not to worry, they were going to fight this one day at a time, and she smiled and winked at me, and then she thanked me for "everything" and gave her husband a prompting look, and he turned to smile weakly and thank me also, and wish me a good day. I felt so worthless as I walked away. Thank me for what? The PRN antacid I ordered? I'm not doing anything for you. The fellow wrote the orders for the chemo. I'm just watching your electrolytes and making sure your red blood cells and platelets don't get too low. And as shitty as you feel now, I know you're probably going to feel worse over the next week. And this couple is SO SO SWEET. It breaks my little intern heart.

So essentially this is an oppressive, depressing rotation that consumes all my time. This leaves no time left over for...DISCHARGE SUMMARIES. I got another deficiency notice (see prior post about S/C summaries) in my inbox informing me that I'm behind in my discharge summaries, as well as death summaries (a discharge summary for a patient who dies in hospital... a celestial discharge). I ignored the damn notice because I don't have time to do my laundry on a regular basis, let alone respond to stupid notices reminding me I have work to catch up on.

And then it happened.

CONTACT.

I got PAGED by someone from the medical records department. First thing she does is laugh and make fun of the message on my pager (where I say my name and identify what service I'm on); because I "sound sooo tired! Hahaha!" [strike ONE] She informs me that I am late on two particular discharge and death summaries. I say I know, I am very busy on the inpatient Heme-Onc service, but I will get to them. She tells me that I will do them, and do them TODAY. [strike TWO] I remind her again that I am very busy with sick cancer patients, but that I am aware and will write the summaries as soon as possible, I'll try to tonight after work. She tells me that not only will I write them both TODAY, she also tells me which one I should write FIRST. [strike THREE. Patience is out.] Pause. I ask WHY. She says because they are late. I KNOW. Why does she need them done today? She says.... because they are holding up billing. "Oh I SEE. Well I'll get to them eventually!" and hang up. I stayed (extra fucking) late and did one that night. The other, I still have to do tonight. Then I'll only be 5 or 6 behind.

I hate this service. Last week, after grabbing a hurried lunch in the hospital cafeteria, I told one of the other interns that I refused to go back to work. I curled up into a ball on the floor of the lobby just outside the cafeteria, held up a fist, and said the only way I was going back to work is if she dragged me. Annnd she did, all the way across the lobby over towards the elevators. Apparently the coefficient of friction for white coats is similar to steel bearings because the ride was actually quite fun and the highlight of my day. That's right, I said getting dragged across the floor of the lobby was the highlight of my day. Do you feel better about your life yet? You should!!!