Well, as most of you know, I’m just starting my medicine internship. It’s been an interesting week so far, and everything does change when you can introduce yourself as “Doctor” so-and-so. You actually feel like you have business being there, unlike the “sorry-do-you-mind-if-bother-you” feeling you get as a medical student.
The weight of responsibility is very different. For example today, a patient had just finished a procedure, and was under instructions to not eat prior to getting the procedure. I had neglected to enter the order to “resume diet,” and therefore the patient could not eat. I eventually got paged to get this problem fixed, but it certainly changes your own sense of significance in the whole hospital process.
I’ve also found it amazing how quickly the patients grow attached to you in the hospital. I have one patient who is very anxious and depressed, and tends to refuse treatment. However, if I show up 5 minutes before the procedure and spend 30 seconds to let her know I agree with the procedure and think that she should go, there’s no problem.
The other night I watched a patient die. It was one from the other team, so I didn’t know her, but it was odd, regardless. She was a cancer patient, with metastasis to her brain. Her condition was incurable, and so she had the order “Do Not Resuscitate.” She was awake, alert, and speaking to people less than 30 minutes before she suddenly got seizures, her pupils became fixed and dilated, and she went into agonal breathing. Her private doctor was right there (he just finished speaking to her), and he told us to let her go.
What followed was rather strange. She still had a pulse, even as she wasn’t breathing anymore. We couldn’t pronounce her dead until her heart stopped, so we stood around waiting for a while. Eventually we slipped away and went back to work, and a resident popped in and out of the room to track her progress. I think a while for her heart to stop.
It was a good thing she was DNR. I’m assuming that she crashed so quickly because one of the metastasis in her brain starting bleeding. Even if we did CPR and somehow saved her, there is little chance we would have been able to save her brain as well.
I’ll try to write more later.