EM, Finances, and Relationship with God

We are on four-week blocks, doing a different rotation each block. This block is my Emergency Medicine rotation. Despite being a rather laid-back rotation and having some interesting cases come through the ER, I have had a tough time on this block. Actually, I think it's because it's so laid back that it's tough (remind me of this next month when I'm whinging about having too much to do). Since the ER documentation system is different from what the rest of the hospital uses and we residents aren't set up to use it, I don't have to/can't record anything on any of the patients. This also means that I basically have no official responsibilities while on this rotation, a situation that lends itself to feelings of uselessness. A good system has been to watch the board for new patients, then act like I have responsibilities to care for them. I do a history and physical, then report to the attending ER physician what I've found, what I think is wrong, and what I would like to do for the patient. We can then discuss what may be going on and I can get critiqued and learn from the case. This makes it feel like I'm actually doing something meaningful and definitely engages my mind more than just floating about doing half-hearted H&Ps and homing in on just the cool stuff.

Speaking of cool stuff, I have sewn up a machete cut and stapled up scalps split open by a 2x4 and a door edge. We have also had a patient actively seizing; a snake bite victim; myriad belly and chest pains; a mostly-resolved stroke; a possible medication ingestion; and a psychotic patient who taught me that psychotic people can have the full range of fears, anxiety, and childish immaturity that non-psychotic people have.

I am more or less following Dave Ramsey's Total Money Makeover plan for getting out of debt, and I am seeing some exciting progress on my highest-interest loan. It is really heartening to feel like I am getting a handle on my finances and I am really thankful that God has blessed me with this income. Some of my fellow residents have the mentality that they're doctors, so they can start spending like doctors, and it's an odd feeling to be in the same boat as them, yet living much more frugally. I'm living in an apartment that's not just cheap in regard to its cost, I'm driving a car that's pretty well lost its curb appeal but that I take pride in maintaining, and I'm not buying stuff left and right. Now and then I'll want to buy a new car or a bright, shiny toy, but for the most part I'm getting a good deal of satisfaction from living responsibly and paying off what I owe.

It has been made apparent that my relationship with God has been distant lately. I want to be a great husband, father, and physician, but above all of these, I want to be a devoted man of God. I keep relearning the fact that my relationship with God is an ongoing process of getting to know him better and not a one-time action after which you can just coast. I guess you could say I've thrown it back in gear and have stopped coasting. Back to the part about being a great husband, if I'm not interested in growing closer to God and try to start a spark of godliness just so I can be with a woman who is devotedly following God, that spells trouble. But if, already having the flame of desiring to grow in my walk with God, I find a woman who fans ablaze that flame, great! "How did you go from your walk with God to finding a godly woman," you ask? Well, it's a long story. In any case, the next paragraph is related.

The other day, while browsing a Christian dating site, I felt so weary of wanting and waiting to get married and worrying over how much to invest in a relationship each time an opportunity comes along and whether it's going to lead anywhere. I prayed that the next time I got involved with a woman would be the relationship that leads to marriage. Later on, I found the profile of a woman who, as far as I can tell, is devoted to living for God and growing closer to him. On her profile, she mentioned that since she isn't subscribed to the site's email service, one would basically have to Facebook stalk her to get in touch. Having become adept at this, Despite not having done this before, I was able to find her rather easily and sent her a friend request and an email. She accepted my friend request, but said in her reply email that her intent had been to reject this friend request from some random person, but accidentally hit the wrong button. Had she hit the right button, she wouldn't have seen my message. I believe her accidentally connecting with me on Facebook was a work of God, but my hope is not in assuming that we will get married, but rather in knowing that regardless of what pans out in my relationship with her, God is working "all things for the good of those who love him, who are called according to his purpose." This is an unexpected bit of peace in a situation in which I typically would be champing at the bit to forge ahead in this relationship. "Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus." (Philippians 4:7&8) Praise God.

Scott

On Call

Call continues to be the most stress-inducing part of my job. I was just on call last night from 6-6, which actually translated to me being at the hospital from 5:30pm-7:00am. I'm on call again tomorrow night from 6pm to midnight, then again on Friday from 6pm to midnight. Definite growth experience for me. What really causes the anxiety leading up to and during call is the possibility of having admissions and codes to take care of, on top of handling any issues arising with the patients already in the hospital on our service. When those above my pay grade decide that a patient should be admitted to the hospital to the residency service, it's my responsibility to go see the patient, get their history, do an examination, come up with a list of what's likely going on with them, and a course of actions to take to get more clarification on their situation and/or treat them. I then run all this by the senior resident who's on call with me to make sure it sounds halfway decent, then report everything to the attending physician who's on call at the time. In a given night, you could get no calls about current patients and no admits, or you could get called every 5 minutes with complicated questions and have to do a dozen admissions. It's just the luck of the draw. Amidst all this, if anyone in the hospital decides to go into cardiac or respiratory arrest, you have to drop everything and run to take care of them. This will probably take at least an hour by the time you've run the actual code, then dealt with the necessary calls and documentation afterward. Time management becomes critical.

This all is so hard for me because I like to take the time to figure a problem out and totally wrap my mind around it before taking care of it. If I have a bunch of disorganized tasks that involve concepts I don't fully understand with additional tasks getting thrown at me, it is very difficult for me to function. With time constraints, there is no way I can fully wrap my mind around everything and complete all my tasks perfectly. As a perfectionist, this is a hard pill to swallow. Also, the more times I'm on call, the more things I realize I need to be doing during a shift, so it feels like the more experience I get, the farther I get from adequacy. This is quite disheartening, since everyone knows you're supposed to get better at something the more times you do it.

I'm working on thinking through my call duties in manageable chunks. I know how to round on patients. I know how to take a history. I know how to do a physical exam. I'm trying to think of the call night as a series of individual tasks I know how to do as opposed to a nebulous, monolithic impossibility. There are things I still don't know how to do, and I'm trying to have the perspective that I can learn and get better at each of these individual things, instead of seeing them all as a unified, insurmountable obstacle.

Tomorrow brings a new rotation for me. I'll be doing Emergency Medicine, so I'll be in the ER, seeing patients and working with the ER attending (full-fledged) physicians to get treatment initiated and either get the patients back home if they aren't too severe, or passing the patient's care on to another physician who will admit and care for the patient in the hospital. Word has it I'll be able to do a good amount of procedures while in the ER. This includes doing stitches, starting central lines, pelvic exams, chest tubes, etc. That part should be fun. Since we have clinic as an ongoing part of our training, I will actually spend tomorrow morning in clinic (typical primary care doctor's office) seeing my patients there. And, yes, call continues regardless of which rotation I'm on.

Fourth of July!

This is why I get misty-eyed whenever I hear the Star Spangled Banner (I did take a bit of license):

It's the war of 1812. Still a baby, the United States of America has just suffered devastating and demoralizing losses to England, their former ruler. Looking to cripple and finally crush the young US, England has now set its sights on the important seaport of Baltimore, whose harbor is protected by Fort McHenry. From his vantage point on a ship several miles distant, Francis Scott Key watched with bated breath as the British ships’ 25-hour bombardment of McHenry raged on. Imagine standing where he stood, watching for an entire day as THE military power focused its wrath on a vital link in your beloved country’s armor. As sunset approaches, you can just see the flag waving atop the walls of the fort. You can’t sleep, worried about the fate of your country and your own fate as a supporter of that rebellious collection of colonies. Each explosion, though heart-wrenching as it could herald the end of your nation, also causes your spirit to soar as the brief light shows the flag still flying high above the fort. Passing out with exhaustion in the pre-dawn hours, you are soon awakened by a commotion among the crew. You turn to them and ask, “In this early-morning light, can you still see what we were watching with such pride as the evening light faded? We watched as its broad stripes and bright stars flew strong above the fort’s walls throughout the vicious battle. The bombs and rockets only encouraged us more as their light showed our flag to still be there. So, tell me: does that star-spangled banner still wave over the land of the free and the home of the brave?”

 

The answer is, “Yes! It does!”

 

While this is an emotional song for me and I do consider myself patriotic, I don’t put my hope in this country, nor in the redemption of our nation’s widespread immorality, nor in the rise of some other nation that could stay focused on God better. I would love for the US to return to the God-centered principles on which it was founded, but my hope is not in that. My hope is instead placed on the fact that God is still in charge and has a plan that he is bringing to fruition in his own timing.

 

In personal news, I am settling in to my new life situation without too much trouble. I am meeting people and getting connected, which is so encouraging for me. As a natural loner, it is easy for me to isolate and get lonely and depressed. While there is still a component of that, it is less than in the past and I am able to deal with the loneliness in a much more healthy manner. I am much less anxious and have a much more positive outlook on the coming year than I expected. Again, that’s not to say everything is perfect, but I’m handling bumps in the road better than I could in the past.

 

Scott

Beginning FM Residency

I haven't posted since I was trucking. Since then, I quit trucking, attended an intensive therapy program, renewed my relationship with God, became a Home Depot associate, and moved to Georgia to start a Family Medicine residency. That's right! I've resumed medical training. Wow, a lot happens in a year.

Things I learned while trucking:
-Trucking is not the career for me
-The US is a stinkin' huge place full of great things to see and do
-I like knowing in advance when and where I'm going to sleep for the night (or day) and whether I will be able to do so legally
-More generally, I like having a home I can actually live in, instead of being on the road all the time
-A better sense of how to read the road while driving, especially when semi trucks are involved

Things I learned in the therapy program:
-I tend to stuff my emotions and the majority of my personality down deep lest anyone get a glimpse of them and judge me for them
-Emotions have a huge sway on how I see the world and the decisions I make unless I unpack them and sort through them
-God made me and redeemed me from sinfulness, and the disapproval of other people doesn't degrade my worth as a person

Things I learned working at Home Depot:
-While working in the parking lot, I rediscovered that manual labor is not my cup of tea
-Some people seem entitled to abuse people who are paid to help them
-Many unpleasant interactions between people can be traced back to poorly-communicated, pre-formed assumptions
-Many home-improvement skills

The latest development is being accepted to a Family Medicine residency in Georgia. I just moved into an apartment earlier this week and am getting settled in as well as possible while waiting for my belongings to arrive. The moving company misunderstood my request to move my container to Georgia and instead left it sitting in a facility in Colorado. It arrives at the end of next week, so I'll have the weekend to unpack and fully settle in before starting on Monday the 30th.

Tomorrow, I'm attending church in the morning and hosting a BBQ for the other first-year residents at my program in the afternoon. I think I have found the church I want to commit to for the duration of my time here, which is a big blessing. I was worried about finding a good Christian community. I'm looking forward to kicking off the year by getting to know the other residents because one issue I've had in the past is staying isolated, so getting to know the people I'll be working with in a more informal setting will be good.

I'm shooting for blogging weekly, with longer newsletter-style posts each month. We'll see whether my schedule and motivation level allow for that.

Scott

My aunt and uncle gave me this loveseat to help complete (actually, start) my furniture ensemble. It was made by another uncle.