heavy

so mom asked me the other day what this new rotation is like...

"heavy", i said... and it is... that's the best possible word i can think of to describe what its like... its almost surreal- i can't really convey the feeling in words that well- i guess i can just focus on the objective stuff and maybe the 'feeling' will come through?

It's a nutrition rotation- we take consults for patients whose bowels are not functioning or just can't eat on their own-one of the main decisions that needs to be made is HOW to get them fed
- i won't go into that, but if you have any questions we can go from there-

when i get there in the AM- i get all my patient information/labs/medications from the computer lab- takes about an hour to get it all written down, and then i'm off to the floor to go check people out on my own and write progress notes-- we have "rounds" from 10am-3pm or so where my preceptor and/or attending physician go over what i wrote and add their input and write the orders... and we always sit down and eat lunch together as a team in the middle somewhere- and they all eat pretty fast too... but i can hang.

i guess one question you might be asking yourself: "what kinds of patients need this nutritional support?"- i guess in simplest terms- i haven't had one patient who was actually capable of talking to me when i came in to the room to listen to their stomachs and check the rate of their IV meds... with maybe 1 execption, all of our 30+ patients are in the hospital for gun shot wounds, motor vehicle accidents, falls from ladders/buildings, severe burns, a couple farming accidents, and a guy who got hit by a train and lost his legs... as you can imagine- 100% of these patients are located in the trauma ICU, general ICU, or the burn center... i wasn't really sure how i'd handle seeing some of this stuff- but its been surprisingly OK. I figured i'd get a little sick to my stomach seeing some of the burn victims and some of the other serious injuries... but its been ok. The very first day i walked into the trauma ICU, i felt really light headed and a little woozy, but everything was happening so fast i just had to pay attention to what was going on and before i knew it i had almost forgot WHERE i was-

Its also hard not to get overwhelmed with emotion when the families are there at several times during the day for visiting hours-i try not to stop and think about it too much, because when i do i realize how sad many of these stories are and it gets me- but watching some of the surgeons, nurses, and pharmacists who have been doing critical care for several years- you can see that they still care a great deal- but they've come to terms with the fact that they can do more good if they keep their emotions at bay and just do the best job they know how to do- if you're so sympathetic you miss a critical drug interaction, or a critical lab value- you're really doing more harm than good... and that's not natural for me- i've found myself lingering in the room sometime with just me and the patient- maybe one of the ones who can at least make eye contact with me, even if they can't move any of their limbs- the steady sound of the ventilator, the rhythmic beeping of the EKG- and i really just want to hold their hand and smile and share a moment of my time with them- and i have a couple times... but i can't do it for long, or i start to get emotional-


this is really just at the opposite end of the spectrum of what i did last month- in am care everybody is up and living their normal lives- in internal medicine people were really sick and stuck in the hospital for a few days, but they could at least get out of bed and use their restrooms and talk to you about how they were feeling... but this population-- there are several people who may not ever wake up from their comas, may never fight off their infections, may never walk again... its... well... "heavy"