Ramblings on my day off

“Pluots pluots . . . Super dulce” a mexican accented voice

Man, I love having weekdays off

I’m sitting in Cafe Spritzers in Alameda after a breakfast of samosas and pluots (cross between apricots and plums and damn good and juicy) that I got from the Webster St Farmer’s market. Tomorrow is my last day of emergency med at highland hospital. I think I’ve done well there and the training has definitely been a trial by fire but certainly made me a stronger better trained physician. Its certainly not going to be an easy road ahead. Part of me really longs for the idyllic worlds of places like CPMC and DHMC where the patient’s send you wine, thank you for your help and tell you how great a doc you are. But there is something about medicine that I’ve realized, maybe it shouldn’t be easy. Thinking about doing emergency medicine seems like a really really long hill to climb. Its no wonder so many Highland residents finish residency and then do 6 shifts a month, they are simply burned out and need time to recoup, reflect. Sure you learn how to save lives but at what cost? My thinking now has turned from do I like/love emergency medicine enough to can I even make it through this residency? Yet the skills are quite amazing. I talked for about an hour with an old Chinese gentleman during a medical code yesterday AS HE WAS DYING in front of me. He was having a severe heart attack. We had to shock him 4 times and gave him thrombolysis (clot breaking medication) to save his life. Twice I had to start CPR because we couldn’t find a pulse. Both to distract him from the pain and to assess his mental status, I talked with him about the Beijing olympics, about his family, his grandchildren and what he had for dinner that day every minute reassuring him that everything was going to be okay. Ultimately we were able to transfer him to a hospital in Oakland with a catheterization lab where the cardiologists can mechanically image and make sure the blood is flowing to this man’s heart and on the way I heard he began to reperfuse his myocardium. We saved his life. A few hand slaps and sighs of relief later with the residents, my shift ended and I was satisfied that we did the right thing for this man by giving him risky but life saving medication. But as I left the hospital that day, I felt something was missing. Where was that buzz of excitement that I had from saving my kickboxer patient with the rhabdomyolysis? Or the sense of purpose that I felt after giving my Chinese patient bad news about his lung cancer? I was so tired I just wanted to go home . . . to finish this month and relax . . . I know by my the evaluations and compliments I’ve received from patient’s and supervisors that I can play the role well . . . be polite, listen to the patient . . . but is this the kind of doctor I want for myself?

Emergency Med reflections

Been a busy couple of weeks. Professionally, its the middle of the hump right now and emergency medicine has definitely been a roller coaster, if nothing else. Part of me likes the excitement, there are definitely lots more procedures and you really do feel like your doing real medicine. Real world patients, you really do get to learn how to save lives, a little bit of ICU, a little bit of OBGyn, a little bit of peds, a little bit of anesthesia and a little surgery as well as a whole boatload of medicine problems. I do think I miss the safety and security of a structured and slower paced environment like an internal medicine at CPMC. During my shift I always feel like I’m frenetically running around and treading water just to stay afloat. But as Jane said, I will definitely give it till the end of my rotation and having a little patience before really weighing in on it. On the other hand, I do really like it when I am complimented and my confidence level goes up a bit.But man am I tired after doing these shifts.

Right now I think Emergency Medicine would be ideal from a career point of view, higher pay, less hours in the hospital, very interesting and exciting which would allow me to do VC or be an entrepreneur while still supporting myself.

On the other hand, I just like hospital medicine more: a little slower paced but not outpatient, more time and opportunity to think through differentials and read up on diseases. And I kind of like the academic environment and the people are more to my liking, more thinkers than doers. And you have time to think in a less hectic setting where there are still acute things. And you still have the opportunity to do outpatient later on in life. I will definitely say that being in the clinic is definitely a lot more chill than having to go to the hospital every day. It just makes me feel a little inadequate though to think that you really won’t be very proficient with procedures compared to ED with internal medicine. And the pay is almost half that of EM which is unfortunate and I really don’t think the culture is quite there of moonlighting etc.

Maybe all this rumination eventually comes down to that last line.